Corneal Transplantation: Transitioning to PDEK (Pre-Descemet’s Endothelial Keratoplasty)

By |May 28th, 2017|Corneal Transplants|0 Comments

Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK – Dr. Mark Terry), Descemet’s Membrane Endothelial Keratoplasty (DSEK – Drs. Garrett Melles and Frank Price), DSAEK (“A” for Automated – Dr. Mark Gorovoy), Descemet’s Membrane Endothelial Keratoplasty (DMEK – Drs. Garrett Melles and Frank Price) and now, Pre-descemet’s Endothelial Keratoplasty (PDEK – Dr. Amar Agarwal).

The goal with PDEK is to offer a procedure that takes the advantages of DSAEK (younger donor tissue, fewer re-operations, shorter surgical learning curve, intraoperative surgical predictability, robust tissue suitable for manipulation) […]


Are you anxious about cataract surgery?

By |March 5th, 2017|Astigmatism, Blog, Cataracts, Duke Eye Center, Myopia, Refractive Surgery|0 Comments

Cataract surgery, understandably causes anxiety to anyone needing or considering this procedure.  Patients hear “there is nothing to it” but every patient knows that there are potential problems.  If there were not potential problems, they would not need to undergo and sign an “informed consent.”  My patient offers a HIPAA-compliant and Social Media-compliant in-depth analysis of her care at Duke Eye Center in Durham, NC.  In her case, we addressed her pre-existing retinal surgery, high degree of myopia and astigmatism, and her anxiety.  This involved the Femtosecond LenSx LASER, Verion precision, ORA intraoperative wavefront aberommetry confirmation, and a premium toric […]


The Cataract Patient That Also Has “Dry Eye”

By |March 2nd, 2017|Blog, Corneal Transplants, Dry Eye, Duke Eye Center|0 Comments

A striking percentage of patients needing eye surgery, particularly cataract surgery have the signs and symptoms of preexisting “dry eye” consisting of tear film instability, rapid tear breakup time, ocular surface disease – all resulting from inspissated secretions clogging meibomian glands leading to blockage and dysfunction.  The single most effective treatment in my practice involves a pre-treatment preparation of the glandular openings followed by a painless, 12-minute treatment delivering vectored thermal pulsation.  A treatment that I did earlier today is best represented by the attached video of a patient who underwent successful treatment a year ago and now is back […]


Chronic Dry Eye Syndrome – A Patient’s Perspective and Testimonial

By |February 22nd, 2017|Blog, Caring For Your Eyes, Dry Eye, Other Eye Conditions, Uncategorized|0 Comments

10 years ago, if you complained of redness, dryness, irritation, and a feeling of “tired” eyes, I would have likely told you that you are not making enough tears.  It is only recently that we have realized that these symptoms are a result, NOT from tear quantity, NOT from tear production, but rather, a result of poor tear quality – leading to tear film instability and inflammation, a result from an inadequate and improper contribution from the oil/lipid-producing meibomian glands.  Fortunately there is a painless, safe, effective, FDA-approved, 12-minute treatment that is remarkably beneficial in treating this problem that is […]


Muro 128: What is it and how did it get that name?

By |February 18th, 2017|Blog, Corneal Transplants, Other Eye Conditions|0 Comments

I want to credit the insight given to me from Dr. Doug Rett, OD, FAAO:

“In 1958 Muro Pharmacal Labs was founded and it manufactured ophthalmic drugs. It was named Muro for the Italian word for “wall,” which I think is fitting given the barrier that the cornea plays in penetration of ocular drugs. With tight junctions, pH sensitivity and the hydrophobic nature of the epithelium and hydrophilic nature of the stroma, it’s difficult for modern-day drug companies to pass medication through the cornea, let alone in the 1950s. In 1968 Muro was sold to George Behrakis, a pharmacist from Lowell, […]


Corneal “Hydrops” – What is it and how did it get that name?

By |February 16th, 2017|Blog, Corneal Transplants, Keratoconus|0 Comments

Corneal hydrops involving a rupture or break in Descemet’s membrane is a relatively uncommon event occurring in patients with advanced keratoconus or other or corneal ectasia  – possibly caused by aggressive eye rubbing – is characterized by stromal edema due to leakage of aqueous humor through a tear in Descemet’s membrane.  It was the Greek physician Hippocrates (ca. 460 BC–370 BC) who is often credited with developing the theory of the four humors—blood, yellow bile, black bile, and phlegm—and the influence of these “fluids” on the body and its emotions.  Swelling associated with disease became known as oidêma (swelling) and […]


Needle Driver Designed to Make Eye Surgery More Precise and Efficient

By |February 16th, 2017|Cataracts, Corneal Transplants, Duke Eye Center, Uncategorized|0 Comments

While much of our surgery in Ophthalmology has moved away from needing sutures, there are still procedures that require very delicate suturing, including corneal transplant procedures, deep anterior lamellar keratoplasty, traumatic injuries, sutured intraocular lens implants, and other procedures.  I am grateful to Doug Mastel and the great folks at John Weiss & Son International for their help in bringing into production the Carlson-Troutman needle holder that serves as an extremely precise needle driver while simultaneously serving as a tying forcep – allowing the passage of a needle and also tying the suture without exchanging instrumentation – improving efficiency, precision, […]


Why a lens is called a lens?

By |February 16th, 2017|Blog, Cataracts|0 Comments

What is a lens?  A lens is a transmissive optical device that focuses or disperses a light beam by means of refraction. A simple lens consists of a single piece of transparent material, while a compound lens consists of several simple lenses (elements), usually arranged along a common axis.

Lenses are made from materials such as glass or plastic and ground and polished or molded to a desired shape. A lens can focus light to form an image unlike a prism, which refracts light without focusing. Devices that similarly focus or disperse radiation oth
er than visible light are also called lenses, […]


Panuveitis Treated with Cataract Surgery, Intraocular Lens Insertion, Synechialysis, Retisert Steroid Implant, and Glaucoma Filtration Tube

By |August 12th, 2016|Blog, Cataracts, Duke Eye Center, Glaucoma, Retina, Uncategorized|0 Comments


Panuveitis can be one of the most challenging problems in Ophthalmic Surgery as this type of severe and pervasive inflammation can affect multiple aspects of the eye resulting in loss of vision.  This particular patient needs the Retisert steroid implant for the treatment of severe inflammatory complications.  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC works closely with Glenn Jaffe, MD and Pratap Challa MD to treat this patient with removal of scar tissue (synechialysis and removal of pupillary membrane), cataract removal, intraocular lens […]


Tearscience Achieves 20,000+ Dry Eye Treatments Using LipiFlow

By |June 30th, 2013|Blog, Dry Eye, Duke Eye Center, LASIK, Refractive Surgery|0 Comments

The LipiView diagnostic instrumentation and LipiFlow Thermal Pulsation Units by TearScience bring an enormous advance for our patients suffering from one of the most common conditions seen in virtually every optometric and ophthalmic practice – including the Duke Eye Center in Durham, NC.  This condition is dry eye and the most common cause resulting in dry eye is tear film instability rather than tear production.  If you asked me 15 years ago about dryness of the ocular surface, I would relate the problem to aging, hormonal changes, and inadequate tear production.  We have witnessed a dramatic shift in our understanding […]