Guest Blog: LASIK & Dry Eye

Guest blog by Dr. Hannah Yecheskel of All Eyes On Rockville. Read Dr. Rubinfeld's guest blog about LASIK and vampires (seriously!) on the All Eyes On Rockville blog

Since the beginning of LASIK, subsequent dry eye has been a major post-operative concern. Well guess what. It is no longer……

At the May 2016 annual American Society for Cataract and Refractive Surgery, the medical association of surgeons specializing in cataract and vision correction surgeries, provided updates of several high-profile research studies, including the FDA sponsored PROWL study and Modern LASIK Outcomes: A Review,” conducted by ASCRS president Kerry D. Solomon, M.D., showing consistently high ratings for safety, outcomes and patient satisfaction.


These studies overwhelmingly support LASIK as a safe and effective option for vision correction for those who qualify. Amazingly, these studies show the procedure is more likely to help symptoms of dry eye, glare, starbursts, ghosting and halos than it is to cause them.

The FDA PROWL study was conducted as a prospective, post-market, observational study designed to develop and evaluate a patient reported outcome questionnaire for use post-LASIK. Approximately 574 subjects were enrolled and asked to fill out an online questionnaire before LASIK and 3-months after LASIK.

The “Modern LASIK Outcomes: A Review” updated the work from the LASIK World Literature Review: Quality of Life and Patient Satisfaction published in 2009 by analyzing the impact of advanced treatment profiles in LASIK. In the current work, nearly 4500 clinical study papers on the topic of LASIK were evaluated for relevancy and authority. The final data set included 97 high-quality studies that combined, represented 67,893 procedures.

“Although each take a different investigative approach, these studies provide some of the best data and insights into LASIK, particularly from the patient’s perspective,” said Daniel S. Durrie, M.D. and one of the clinical investigators for the FDA PROWL study. “One of the key findings, from both studies, is with modern equipment, modern techniques and well-selected patients, good surgeons can deliver terrific results with a high degree of safety. LASIK is a great procedure.”

More About Dr. Hannah Yecheskel, Doctor of Optometry

Dr. Hannah Yecheskel

Dr. Hannah Yecheskel

Learn more about Dr. Hannah Yecheskel and her premier practice specializing in advanced eye care & boutique eyewear. Named BEST EYE DOCTOR 2016 by Washington City Paper's Readers Poll, and one of the TOP OPTOMETRISTS in Rockville on Yelp, Dr. Yecheskel and her staff are currently accepting new patients. Dr. Yecheskel sees a lot of patients in the Washington, DC area afflicted with dry eyes. Her practice is based on the principle that each patient deserves the best care and attention to detail. That is why Chilli Amar from 97.1WASHFM Morning Show with Loo and Chilli chose to be her patient. Learn more about Dr. Hannah Yecheskel and her practice, All Eyes On Rockville on her website. And, read a guest blog by Dr. Roy Rubinfeld on the All Eyes On Rockville website.

More About Comprehensive Eye Care:

Did you know that as your eyes begin to mature, a regular exam with your Ophthamologist or Optometrist is very important? Many believe that eye health reflects overall body health. Eye diseases and disorders such as GlaucomaCataracts and Macular Degeneration can all be detected during a routine eye exam with your eye doctor. Early detection and preventative care are very important in optimizing your visual and overall health.

You can schedule an appointment with Dr. Hannah Yecheskel in her Rockville, Maryland offices by calling (301) 984-EYES.


How Long Have People Been Wearing Glasses?

Ever wonder just how long people have been wearing glasses? It turns out that the earliest form of glasses were worn by monks and scholars in the Middle Ages. While the inventor is not known, their origins have been traced back to Italy between 1268 and 1289. It's unclear if the monks and scholars were customers of Warby Parker.


If you want to learn more about the interesting history of glasses, The American Academy of Ophthalmology has a handy timeline on their website, which you can check out here.

Laser Vision Correction and the U.S. Military

Capt. "Mulan" - Dr. Rubinfeld's patient

Capt. "Mulan" - Dr. Rubinfeld's patient

We at Re:Vision - Roy Rubinfeld enjoyed reading this piece about the problems involved with wearing glasses while aboard an F-15 fighter jet and how laser vision correction changed one military member's life. While glasses and contacts are often the first choice for people of all walks of life, they are not always the best or even the safest choice. To me this whole article really speaks to the idea of independence and the potential for improved visual freedom.


Read the article at this link.

A New Textbook About CXL Hits the Stands

Dr. Rubinfeld is honored to have worked on a textbook about Corneal Collagen Cross Linking (CXL), a treatment for a corneal eye disease called keratoncous along with other internationally recognized keratoconus experts including:

Professor Mazen Sinjab and a host of internationally recognized keratoconus experts including Michael Mrochen, Brad Randleman, Farhad Hafezi, Samer Hamada, Renato Ambrósio Jr, Anastasios John Kanellopoulos, Aylin Kılıç, George Asimellis, Jon Talamo, Kathryn Masselam Hatch, Roy Rubinfeld, Yaron Rabinowitz, Hani Sakla, Wassim Altroudi, Doyle Stulting, Ed Manche, Paolo Vinciguerra & team, Fernando Faria Correia, David Tabibian, David Myung, Joseph Frucht-Pery, Denise Wajnsztajn, Rebecca McQuaid, Eberhard Spoerl, the Caparossi team and others.


If you have keratoconus and would like to set up an appointment with Dr. Rubinfeld, please contact his offices at 301 908-8091.

Summer is Coming. Don't Make Bode Miller's Mistake.

Bode Miller

Bode Miller

This article in USA Today perfectly sums up why laser vision correction can be so critical for athletes. In the piece, skier, Bode Miller, five-time Olympic medalist, admits that not having LASIK was a huge mistake that affected his performance in a race that was meant to signal his comeback. "For me, said Miller, "my vision is critical. When the light's perfect, I can ski with any of the best guys in the world. When it goes out, my particular style suffers more than the guys who are more stable and don't do as much in the middle of the turn."


While your aim might not be the Olympics, if professional athelets, jet fighter pilots and many others in demanding careers have found their performances enhanced, than you can rest assured that laser vison correction can make your life a lot easier in the long run.

To read the whole article on Bode's regretful decision, click here.

Corneal Pharmacokinetics and White Wine

Dr. Rubinfeld lecturing in Salerno, Italy

Dr. Rubinfeld lecturing in Salerno, Italy

Dr. Rubinfeld and Professor Ostraloco in Salerno, Italy

Dr. Rubinfeld and Professor Ostraloco in Salerno, Italy

Growing up, some of my fondest memories were weekends spent working on cars with my father. Learning how to fix things and find better ways of doing things became a lifelong theme. ‘Fixing” bad vision is more rewarding and nourishing than I can express. As a child I wanted to become an inventor but wound up going to medical school where creativity took a far back seat to rote learning.


I thought that was pretty much that, until I invented and patented a device to cure a corneal condition I saw often in my practice years ago. After donating the royalties from that invention to eye care charities, again, I thought that was that… Until I became the first eye surgeon in Washington to become involved with laser vision correction and worked on developing new techniques. But now, I’m obsessed with developing the safest, most comfortable, least invasive way of improving and saving vision.

Last month in Salerno, Italy, in a building that was 18th century on the outside and futuristic within, I collaborated with Professor Carmine Ostraloco. Professor Ostraloco is likely the world’s leading expert in what’s called corneal pharmacokinetics. This just means how vitmamins and other substances get into the cornea to help patients. As I, along with my excellent team, have been pioneering and further improving a technique to treat keratoconus without some of the risks of older techniques, we are particularly interested in Professor Ostraloco’s opinion of our work. We were delighted when he called this “the best work he had seen in this area.” After he and I went out for some local seafood and delicious white wine, we were fast friends. We compared notes and talked about working together on additional projects as well as his eventually coming to the United States to give a lecture. A great trip indeed!


Putting Your Eyes Where Your Mouth Is - Do LASIK Surgeons Get LASIK?

Dr. Rubinfeld after his laser vision correction procedure in 1995.

Dr. Rubinfeld after his laser vision correction procedure in 1995.

Ever met an eye doctor and wondered why they are wearing glasses? Why doesn’t he/she get LASIK? People often ask us why they meet eye doctors who wear glasses. If LASIK is such a good idea for others, why aren’t all eye doctors lining up for the procedure? A recent study shows us that, while you may meet the occasional doctor wearing glasses, that the overwhelming majority are actually having their eyes corrected through LASIK. The study, which can be found here, indicates that eye doctors who specialize in performing laser vision correction are actually four times more likely to have their own vision corrected than the general public.


Another study looked at physician satisfaction after they had laser vision correction themselves. These doctors reported high levels of satisfaction and better quality of life. In fact, 85% reported an actual increase in the quality of their vision as compared with when they wore glasses or contact lenses. Also, 39% reported that their ability to perform medical procedures accurately had improved.

So next time you see an eye doctor wearing glasses, it may just be that his specific condition cannot be overcome with LASIK, or perhaps he just feels more comfortable in glasses. Remember, eye doctors are people too.

Vision Enhancements and Sports

Jennifer Capriati's autographed photo she gave to Dr. Rubinfeld after surgery.

Jennifer Capriati's autographed photo she gave to Dr. Rubinfeld after surgery.

Drug testing scandals in so many professional sports remain in the news. More and more, students are taking amphetamine-like drugs to enhance their test performance and grades. These bring to mind the question of what is an unfair competitive advantage or, not to mince words, cheating?


This caused us to wonder if the most advanced vision correction options could be cheating? Many leading professional sports figures who have had vision correction have in fact claimed it enhanced their performance. I have personally performed vision correction on several well-known sports figures. One of them, Jennifer Capriati, credited her improved vision as among the reasons she won three international Grand Slam tennis championships. Imagine, as Jennifer told us, that with every blink, contact lenses can move and your vision fluctuate. With serves over 100 miles per hour, that matters.

We also have had the honor of correcting the vision of many in the military who told us they could not possibly have performed their missions or stayed alive (especially at night) without their vision correction. In careful studies, state of the art custom LASIK has been demonstrated to actually improve night vision and reduce glare compared with how patients saw before with their glasses or contact lenses. So we have to ask the question – with solid evidence pointing toward enhanced performances due to laser correction – is it cheating?

Does LASIK Scare You?

Given a choice, most people would prefer not to have to wear contact lenses to drive, play sports, or see across the room. Twenty years after the FDA approved the excimer laser, still only about 8% of people eligible to correct their vision have done so. Why? Because, for many people, the idea of LASIK is very scary. Never mind that some studies have demonstrated that the risk of contact lenses are higher than having laser vision correction by an expert surgeon. It is deep in our DNA to not want anybody doing anything to the only set of eyes we are born with.


I’ll occasionally be sharing some stories from my 25 years of practice. The one below is quite funny but it does demonstrate just how nervous people can sometimes become, even when there is nothing at all to worry about. In short, it’s normal to be nervous about any medical procedure, but LASIK is truly one of the safest, effective, quickest, life-changing procedures you can have.

Once, a patient who was seeing better than 20/20 in both eyes the day after LASIK called my answering service late at night, unable to sleep, terrified that something was wrong with his left eye because of what I had said earlier that day. The next morning, confused about what he could possibly be nervous about, I listened carefully to the message. The voice on the other end told me that he was very worried because after I looked at his right eye I had said "perfect," but upon examining his left I, I had only said that it, “looked very good.” I called this patient right away to let him know that his fears were unfounded and from that moment forward was even more aware of just how nervous patients could be and how important my word choices were when speaking with them.