Advanced Lenses

By Dr. Pooja Khator
Pooja Khator, MD, a glaucoma specialist and cataract surgeon, is certified by the American Board of Ophthalmology. She joined Coastal Eye Institute in 2006. 

Cataracts, or clouding of the lens of the eyes, are common as we age. Fortunately, cataract surgery is quite effective and, in fact, one of the most common surgeries performed in the United States. lenses

When ophthalmologists perform cataract surgery, they remove the eye’s old lens and replace it with an intraocular lens (IOL). Originally, a standard intraocular lens, which can certainly help patients see better but cannot correct astigmatism or presbyopia (the ability to see close up), was the only option for such a replacement. Advances in lens technology, however, have expanded our arsenal, and we now have lens options to help improve astigmatism and reading vision after surgery.

Advanced options in lenses

Astigmatism is a common vision condition that happens when a person’s cornea is not symmetrical. A normal cornea is round like a baseball. With astigmatism, the cornea curves more like a football.  With the toric intraocular lens, regular astigmatism can be corrected, allowing for crisp distance vision without glasses.

Another premium lens option is the multifocal intraocular lens. By separating the light entering the eye into zones for distance and for near vision, it can allow correction for driving and for reading at the same time. Many multifocal lenses come in several reading powers, allowing surgeons the ability to tailor the lens to fit specific visual needs. Not all patients are good candidates for this type of lens, however, and a full eye examination to exclude the presence of glaucoma or macular degeneration is necessary.

The latest arrival to eye surgery is the Technis Symfony lens. The Symfony allows correction for distance and intermediate vision. These days, much of our world is in the intermediate range of vision. If you are over the age of 40, chances are you have experienced loss of intermediate vision, making you wish you had longer arms to read your phone screen, the labels of cans on a shelf, or a recipe in a cookbook. The Symfony lens is potentially an excellent choice for those who do a lot of computer work or spend a lot of time reading on smaller devices, such as an iPad. Furthermore, the Symfony lens comes in options that correct astigmatism at the same time, as well as being a good choice for patients with mild glaucoma and macular degeneration who may not be good candidates for a multifocal lens.

How do I choose?

Your ophthalmologist can conduct certain tests to make sure you are a good candidate for a premium intraocular lens and help educate you about the benefits of these lenses following cataract surgery. These lenses take some time to get used to, so it is important to understand exactly how they work and their limitations. Although a premium intraocular lens can reduce your dependence on eyeglasses, it does not completely eliminate the need for glasses in all situations.

Coastal Eye Institute has served this community since 1964, focusing solely on comprehensive eye care and providing everything from routine check-ups to diagnosis, correction and management of complex medical eye conditions. Coastal Eye Institute has four offices to serve you. For an appointment visit CoastalEye.com or call 941.748.1818.

Shoulder Injuries in Golf

by Dr. Steven Page

Steven Page, MD is an Orthopedic Surgeon with a specialty in Sports Medicine at Sarasota Orthopedic Associates. He is Fellowship Trained and Board Certified. Dr. Page serves as a Team Physician for the Mustang football team at Lakewood Ranch High School.

Shoulder injuries are common in golfers. Stresses on the shoulder are different from other sports because each shoulder is in opposition when swinging the club. The forward shoulder stretches across the body with the trailing shoulder raised and rotated. This leads to different complications in each shoulder.

In addition, the rotator cuff muscles are placed under stress, as they are a major force in providing power and control of the swing. The leading, non-dominant shoulder is most commonly injured. It is placed into an extreme position during the backswing, causing impingement or pinching of the rotator cuff. This condition causes inflammation and rotator cuff tears. The placement may also put stress on the shoulder joint and cause tears of the labrum (a stabilizing structure in the shoulder).

Pain may be felt in the shoulder or upper arm at various phases of the golf swing or following play, often when the arms are overhead or at night. Injuries to the shoulder may be sustained from a poor golf swing, a mis-hit, or from overuse. Golfers can develop tendinitis and tears in the rotator cuff from a combination of poor mechanics and the repetitive motion of the golf swing.

Prevention

While many golf injuries occur due to a combination of overuse and poor technique, a lack of conditioning and flexibility also contribute to injuries and pain.  Following these tips could greatly reduce the chance of injury:

• Rest between playing to prevent overuse injury.

• When in discomfort, decrease the amount of time you play.

• Shorten your backswing and turn more through the hips & waist.

• Refine your swing to decrease force on the shoulder joint (pro lessons will help).

• Exercise when not on the course to improve flexibility.

• Warm up with brief cardio and stretching.

In the event of injury, the following at-home

treatments may be effective at relieving pain:

• Shoulder pain should be treated initially with rest or decreased playing time.

• It’s best to completely avoid playing until pain is resolved.

• Nonsteroidal anti-inflammatory drugs may be helpful short-term.

• Icing over 24-48 hours may support relief.

• Range of motion exercises can improve flexibility.

• If pain persists beyond 7-10 days, consult your physician.

A sports medicine physician can examine the shoulder and obtain x-rays or an MRI to determine the cause of injury. Most injuries are treated with rest, anti-inflammatories, and/or physical therapy. Bursitis and tendinitis may be treated with a cortisone injection.  For pain that persists despite treatment, surgery is an option to consider. Recent advances in arthroscopic surgery allow repair of most injuries through minimally invasive techniques, enabling quick return to your game and minimizing downtime.

The commitment of Sarasota Orthopedic Associates is to get our patients back on their feet, back to work, back in the game, and back to life. For an appointment, go to our website at www.SOA.md or call 941-951-2663.

Atrial Fibrillation

by Dr. Kenneth D. Henson

Kenneth D. Henson, MD, FACC  is certified by the American Board of Internal Medicine in Cardiovascular Disease (2013) as well as Internal Medicine (2014). He began medical practice in Sarasota in 1995 and is a former Chief of Cardiology at Sarasota Memorial Hospital. 

Atrial fibrillation is one of the most common heart problems that cardiologists see in daily practice. Increasing age, high blood pressure, coronary artery disease, valve problems and an overactive thyroid may increase the risk of atrial fibrillation.

Atrial fibrillation is an irregular rhythm that starts in the upper chamber of the heart, known as the atrium. In a normal heart, the atrium collects blood returning to the heart and then pumps it through a valve to the lower chamber, known as the ventricle, which then pumps the blood back out to the body. When the heart is in a normal rhythm, the upper and lower chambers are synchronized and blood flows briskly. In a normal heart the rhythm is perfectly regular, like a clock or metronome. With atrial fibrillation, the atrium no longer beats regularly; instead, it quivers (fibrillates). The ventricle does not get its regular signal to contract and therefore beats in an irregular or chaotic pattern. Most importantly, atrial fibrillation causes the blood to stagnate in the atrium. This stagnation can lead to clot formation and increase the risk of stroke. Strokes from atrial fibrillation are often fatal.

There are many options for treating atrial fibrillation, but the most important initial treatment is anticoagulation with blood thinners. Cardiologists use a simple formula known as a CHADS2 score to estimate the risk of stroke. With a score of zero, aspirin is adequate. Higher scores may require more potent blood thinners. For many years, Coumadin was the only oral blood thinner available. While Coumadin is effective, it has drawbacks, including the need for frequent blood draws and multiple interactions with drugs and foods. On a positive note, Coumadin is rapidly reversible in the event of bleeding. Newer blood thinners like Apixaban and Rivaroxaban do not require frequent blood monitoring. Both are effective at preventing clots and reducing stroke risk, but they are not rapidly reversible. Dabigatran, a similar drug, is now reversible. In selected patients, a device known as a Watchman may be implanted using a minimally invasive technique to prevent clots and reduce the need for blood thinners.

Many patients with atrial fibrillation are asymptomatic. In these individuals, protection with blood thinners and simple medications to slow the heart rate may be the only treatment needed. Symptomatic patients may benefit from restoration of a normal rhythm, which may involve rhythm-regulating medications. Antiarrhythmic medications may require a hospital stay for safe initiation. In some cases, an electrical shock, known as a cardioversion, may be used to return the heart to a normal rhythm.

For patients who cannot tolerate medication or who return to atrial fibrillation despite medical treatment, a minimally invasive, non-surgical procedure known as ablation or pulmonary vein isolation may help restore rhythm. The procedure uses either a radiofrequency or cryogenic probe to “burn” or ablate the area in the heart that causes atrial fibrillation. When successful, ablation is a cure and eliminates the need for ongoing medical treatment in many patients.

Atrial fibrillation is a complex problem with many treatment options. Choosing the right treatment for an individual patient requires a thorough knowledge of their medical history, diagnostic studies, lifestyle and personal preferences.

Culp-Henson Private Cardiology and Internal Medicine is located at 1250 South Tamiami Trail, Suite 201 in Sarasota. For an appointment, visit culphenson.com or call 941.929.1039.