August 20, 2014

See Hear

“I had really bad eyesight, and this is just amazing. I can see every blade of grass.”Most of us can’t imagine not being able to hear our favorite song, listen to the voice of a loved one, see the beauty of a Southwest Florida sunset or watch a dolphin play.

Yet just a generation ago, those fates were unfortunately common. Eyesight can dim and hearing fade with age, but that doesn’t have to hinder the richness and quality of life so well-earned at maturity. Physicians and specialists in Southwest Florida use cutting-edge technologies in eye and ear care to help ensure the dreaded doesn’t happen.


The new bladeless laser approach


Cataracts are the leading cause of blindness in the world, according to the National Institutes of Health. This clouding of the lens behind the eye occurs naturally as we age and the majority of people over 65 will eventually develop them. About 22 million people in the United States have cataracts, and surgery is the only way to treat them. So with more than two million people having it each year, cataract removal is the most widely performed surgical procedure in the U.S.

The latest buzz is cataract surgery using a bladeless laser. Dr. Jonathan Frantz of Fort Myers is the first eye physician in Southwest Florida to get one, called the LenSX. The laser was approved by the FDA in November. There are other manufacturers with devices either recently approved or awaiting approval this year.

The equipment isn’t cheap. Frantz spent $500,000 to equip his practice in May. But that’s proving a popular decision, as more than 60 patients went through the procedure in the first three weeks.


Barbara Shanahan, 58, of Cape Coral had both eyes done by Frantz, a day apart, in early June. “Oh my God, I can’t describe how much the difference is,” she says. “I had really bad eyesight, and this is just amazing. I can see every blade of grass.” The procedure was quick, she says. “No pain, no nothing. It’s like I’ve been in the dark way too long. I’m ready to have a party. A sight party.”


Laser cataract surgery creates a customized cut in a patient’s cornea, to the exact length and depth needed, so the physician can access and remove the cataract. Previously, the incision was done by hand.


“There is no way I can make an incision as precisely as a laser,” Frantz said. A recent study showed that the laser was up to 10 times more precise than manual incisions, he says.


The laser also allows for the correction of astigmatism at the same time as the cataract surgery, which can greatly decrease or eliminate the need to wear glasses.


“This is kind of a transformation here,” Frantz says. The 3-D computer imagery combined with the bladeless laser’s direction, accuracy, precision and safety is unmatched, he says.


Advances with injections and drugs


While cataracts are the most common sight-robbing condition, there are plenty of others, including macular degeneration, diabetic retinopathy and glaucoma.


The Bascom Palmer Eye Institute, part of the University of Miami’s Miller School of Medicine, is on the forefront of finding new ways to treat these and other diseases and disorders of the eye. The institute, which has a location in Naples, has been ranked No. 1 in ophthalmology in the U.S. News & World Report’s annual Best Hospitals edition for eight years in a row.


Dr. Stephen Schwartz of the Naples institute is an expert in treating age-related macular degeneration (AMD), diabetic retinopathy, blockage of the main retinal vein and detached retinas.


There is no simple explanation for what causes AMD, Schwartz says.“It really looks like a combination of genetic predispositions and various environmental factors.” Risk factors include high blood pressure and smoking.


The macula is located in the center of the retina at the back of the eye and is responsible for central, or reading vision. The types of degeneration are labeled “wet” and “dry.” Wet means the blood vessels swell and leak, and more abnormal vessels grow, causing scarring on the macula, vision distortion and decline. It is less common, more severe, and the onset can be sudden.


Dry macular degeneration affects 80 percent of those with the disease, and involves the slow deterioration of the macula and normal tissues.


There are no specific treatments to stop dry AMD at this time. A major study has shown that vitamin combinations can slow the progress, Schwartz says, a specific formula of beta carotine, vitamin C, vitamin E, zinc and copper.


The advances have been in treatment of wet AMD, which include injections to stop blood vessel growth and improve eyesight. The blood vessels proliferate because of a naturally occurring protein in the body, called VEGF, that runs amok. Now patients receive eye injections of Lucentis or the cancer drug Avastin, which have been shown to interfere with, inhibit and compete with VEGF, Schwartz says. The Naples institute does up to 1,200 injections per year.


The FDA drug label says that the medication should be injected once a month for two years. However, each patient is different, Schwartz says. Some are fine with just one injection in six months; others need more than one a month.

There are some major side effects possible with all these drugs, related to the actual injection, Schwartz says. There is a one in 2,000 chance of infection, which could be “catastrophic” and lead to loss of vision or loss of the eye, he says.

The anti-VEGF drugs are also helpful in treating blockage of the retinal vein and diabetic macular edema, a swelling in a part of the retina due to diabetes, which can cause vision loss.


Another new drug called Iluvien, yet to be approved by the FDA, looks promising, Schwartz says. The drug would be injected into the eye as a tiny implant that would release corticosteroids for three years.


“I DON’T EVEN REALIZE THEY ARE IN MY EAR. MY HEARING IS JUST PLAIN NATURAL AGAIN.”Music to the ears


Everyone knows the frustration of having to shout at or repeat things to a relative or friend who just can’t hear and refuses to believe it, or refuses to wear a hearing aid.


Only 15 percent of those with hearing loss do something about it, says Dr. Jay Roberts, assistant medical director and chief of surgery for Physicians Regional Medical Group.
Roberts is an otolaryngologist —more widely known as an ear, nose, and throat specialist or ENT.

Maybe those not doing something would change their minds if they knew about the advances in the sophistication of hearing testing, the development of hearing aids that are digital and all but invisible, and some that allow for live wireless streaming of TV and phone conversations. But there is another reason to address hearing loss.


A study released in February 2011 showed a link between hearing loss and the risk of developing dementia, Roberts says. Dr. Frank Lin, lead researcher from the Johns Hopkins School of Medicine, showed that for each 10-decibel loss in hearing over time, the risk of dementia rose 20 percent.


If you think about the fact that people who lose their hearing aren’t hearing as much as they used to, the brain then is not being sent those messages, so the brain is doing less work,” Roberts says. “After a while, if you’re giving less information to the brain, it slowly goes on retirement and the word discrimination drops.”

People have to get hearing aids before word discrimination drops below 85 percent, he says.

There are two types of hearing loss: conductive and nerve, Roberts says. Most of those with nerve hearing loss are candidates for hearing aids. More than 90 percent of hearing problems can be dealt with using hearing aids, he says.

The other group is conductive hearing losses, which affect the outer ear, ear canal, ear drum and middle ear, Roberts says. Conductive problems, from ear wax buildup to fluid in the middle ear to a hole in the ear drum, must be fixed by some kind of procedure. Conductive hearing loss is generally reversible.

That’s something an ENT can take care of.

For those with nerve hearing loss, the choices among hearing aids is overwhelming, says audiologist Timothy Roupas of the Center for Hearing in Naples. But each patient has to be assessed according to lifestyle and what they want to achieve with the hearing aid, he says. The amount and duration of the hearing loss also come into play, as well as the person’s ability and ear anatomy.

Hearing aids that fit over the back of the ear are now small and lightweight. Others go inside the ear and some are so small that they can’t be seen. Roupas shows one that was one-quarter to one-half inch long, with a pinpoint of a battery. The programming of the hearing aids is done by computer.

A hearing aid can be customized by taking a silicone impression of the ear canal, Roupas says. The clarity, noise reduction and speed of sound processing has advanced, along with the wireless capability that just came out a few months ago, Roupas says. “That is monumental.”

Stan Lipp, 75, of Naples, is thrilled with his two invisible, in-the-ear-canal hearing aids provided by Roupas. “I don’t even realize they are in my ear,” says Lipp, an avid cyclist who rode 76 miles on a recent Saturday and wears a Bluetooth headset. “My hearing is just plain natural again.”

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