Eye Surgery & Lasers
We perform complete and thorough routine and medical eye examinations for people of all ages using a variety of advanced instruments and techniques which make it possible to diagnose conditions both inside and outside the eye.
Dr. Cassel is a board certified ophthalmologist. He has been trained in eye surgery including cataract, lens implant, and laser surgery, as well as the treatment of glaucoma, corneal, and retinal disorders and many other eye problems. Dr. Cassel performed cataract surgery for over 40 years, and although he no longer doing this surgery, he is available to give second opinions on cataract surgery, as well as the diagnosis and treatment of other medical and surgical eye problems. The excellent staff and the surgical and laser facilities and equipment at Greater Baltimore Medical Center, the Johns Hopkins Hospital, and the University of Maryland support him in providing total and state of the art eye care to his patients.
EYE SURGERY
Cataract Surgery
Modern phacoemulsification cataract surgery is still a very successful operation with few complications for patients where cataracts are the cause of significant vision impairment. This modern surgical technique has made it possible to remove cataracts at earlier stages of development based on the level of visual problems they are causing, not on their degree of maturity.As an ophthalmologist, Dr. Cassel has been trained in using surgery and lasers for eye conditions. After many years of performing cataract surgery, he is now focused on the evaluation and treatment of glaucoma, corneal and retinal disorders, and many other eye problems. He is available for second opinions regarding the need for cataract surgery and will be happy to refer you to a trusted colleague for the operation.
Do cataracts need to be "ripe" before they can be removed?
This was true many years ago but is not any more. Modern microsurgical techniques have made it possible for us to remove cataracts (a haziness which develops over time in the eye's lens) at any stage. Surgery, however, should only be performed when cataracts are causing you significant problems with your eyesight, such as trouble with your distance vision, difficulty seeing to drive (particularly at night), reading problems, glare, ghost images or double vision in one eye, or a halo around lights. We perform many cataract operations each year. These are never performed just because they are "ripe" but are based on how the cataract is effecting your visual needs.Glaucoma Surgery
Trabeculectomy (filtering surgery) is the type of operation most often used to reduce pressure in eyes with glaucoma. Trabeculectomy is usually done when medication and laser treatment for glaucoma have failed to reduce the pressure in the eyes enough to prevent damage to a person's eyesight. Filtering surgery (lowering the eye pressure) has a high success rate, and many patients are able to stop or reduce their glaucoma eye drops afterwards. Of course, as with any surgical procedure, there are risks including the possibility of bleeding and infection. In rare cases, complications can lead to blindness. Drs. Ratner and Cassel consider the benefits of filtering surgery in all their glaucoma patients who have not responded to conventional drops or laser surgery for glaucoma.
LASERS
Glaucoma, Cataracts, & Retina
Dr. Cassel is specially trained in the use of lasers for glaucoma, retinal disease, and for opacified posterior capsular scarring after cataract surgery. Although many people still believe that cataract surgery is performed using lasers, please be assured that this is a misconception. For more information about cataract surgery, we refer you to THE EYE BOOK written by Dr. Cassel and published by The Johns Hopkins Press. This source is now in it second edition and distributed worldwide to help people undertsand bout their eyes and eye care.
TREATMENTS OF EYE PROBLEMS
Punctal Plugs for Dry Eyes
Blocking the drainage of tears from the eye by placing plugs in the puncta (the tear duct opening in the eyelid) has become a very popular and effective means of treating dry eye patients when conventional tear drops and ointments do not provide a significant amount of relief. Many new varieties of punctal plugs have become available this year. Dry eye patients should ask us at their next visit if this treatment is appropriate for them. You can also call our office and speak with Dr. Flemke for more information about the use of punctal plugs in dry eyes.I have tried eye drops for my dry eyes but they only work for a short time and are inconvenient to use. Is there anything else I can try?
Yes. We have had a lot of success treating people with dry eyes by closing off the tear duct either with punctal plugs or thermal cautery. Punctal closure acts like putting a stopper in the drain of a sink. This keeps whatever tears you have from flowing out of the eye, increasing the moisture in your eye similar to the way the stopper prevents water from draining out of a sink. These procedures, with or without tear supplements, can be a big help for people with dry eyes where artificial bottled tear drops alone are not helping. Ask us about punctal closure if you want more information.
EYE MEDICATION HIGHLIGHTS
Vigamox belongs to the family of medicines called antibiotics. Vigamox ophthalmic solution (eye drops), a new generation of antibiotics, is now available to treat infections of the eye, such as bacterial conjunctivitis. Sincee it eliminates a very broad spectrum of bacteria and is unpreserved so it's easy on the eye, Vigamox also provides excellent antibacterial coverage for our patients at the time of their eye surgery.Xalatan, Travatan and Lumigan are among a class of glaucoma drugs called prostaglandins. Your body produces prostaglandins naturally for many things. In the eye, one particular prostaglandin has been shown to help the fluid flow out by opening alternative drainage canals, thus keeping the eye pressure from becoming elevated. These medications work similarly to this natural prostaglandin and are believed to increase the fluid outflow through this secondary drainage system. NATURE'S TEARS is an all-natural moisturizing mist spray for the eyes. Studies of NATURE'S TEARS and dry eye patients showed, on average, that the mist spray doubled the moisture volume of the eyes' tear film without disrupting the tear film's delicate structure. Contact lens wearers were the most enthusiastic. The mist creates a microenvironment of pure, all-natural, unpolluted pH correct humidity around the face. NATURE'S TEARS spray is available in our office without the need for a prescription.
The U.S. Food and Drug Administration approved Restasis as the first and only therapeutic treatment for patients with dry eyes. A trial of Restasis is recommended when conventional tear drops, ointments, mist, and other treatments have not significantly benefited a patient and if tear production is suppressed due to ocular inflammation. Restasis became available in the U.S. market in April 2003. Its primary ingredient is cyclosporine A, an immunosuppressive agent used in organ transplantation. The anti-inflammatory effect of topical cyclosporine A improves overall tear function and/or production and restores mucin production by tear glands of the eye.