A recent conversation with Dr. Eric Donnenfeld revealed we are all united in three things at least: death and taxes, for which he offered no input across a one-hour conversation, and diminished sight after a certain age, roughly 45 years old, for which he offered a world of information and cutting-edge help.
Donnenfeld is president of the 10,000-member American Society of Cataract and Refractive Surgeons; professor of ophthalmology at New York University; founding partner of Ophthalmic Consultants of Connecticut in Fairfield and medical director for TLC Laser Eye Centers, also in Fairfield. In 1989, while practicing in midtown Manhattan, he was among the first five surgeons globally to treat eye problems with light amplification by stimulated emission of radiation, the laser.
In the last three years, Donnenfeld has begun using lasers to operate on cataracts. As with his plunge into lasers 25 years ago, he was among the first in the world to remove cataracts with lasers. He now performs 500 such procedures per year. “It removes the variables,” he said. “Everything is digitized. Everything is more precise. Everything is more exact. Therefore, we can use less energy.”
The eyes broadly are divided into three parts ”” surface, lens and retina ”” and all are clouding, being infiltrated, clogging, stiffening or degenerating as part of the aging process. “One-hundred percent are affected to one degree or another,” Donnenfeld said.
Few have perfect vision beyond 50. Presbyopia ”” a loss of lens elasticity ”” gets us, every one. New surgical treatments possess treatment potential for presbyopia, which is a combination of the microscopic muscles that manage the lens weakening and the lens stiffening at the same time. “This will be a major area of growth across the next decade,” Donnenfeld said.
The ocular surface ”” which has no blood supply ”” loses moisture; aging eyelids and tear glands bear the blame. New in the arena of help for dry eye is a heated contact lens. It is coupled with gentle massage to clear the lubricating ducts on the underside of the eyelid. Donnenfeld called it “a very effective and exciting way of treating this disease.”
Drying also worsens when lacrimal (or lachrymal) glands become “infiltrated across time,” Donnenfeld said. Two types of medicine are proving effective: steroids for quick reduction of lacrimal inflammation and anti-rejection drugs of the sort pioneered for heart transplants for the long-term.
The eyelid itself ”” the thinnest skin on the body ”” is itself prone to sun-induced skin cancer, hence holistic treatment No. 2: Simple UV-eliminating sunglasses are the eyes”™ best friend. Donnenfeld also recommends his patients take a quality Omega-3 fish oil ”” those that feature triglycerides, which promote absorption.
“I favor the holistic approach,” he said. “We reserve medicines for when common sense does not work.”
Below the ocular surface, the lens becomes less elastic with age and may cloud over. Treating the cloudiness ”” cataracts ”” outpaces even the common hernia in numbers of surgeries per year, 3.5 million.
The cells at the back of the eye on the retina increasingly with age avail themselves of too much blood, wet macular degeneration, or succumb to loss of photo receptors, the dry version. Macular degeneration, once untreatable, has now witnessed advances, amazingly via injections that in the last five years have shown results with the wet, more problematic, version. “It”™s revolutionized treatment,” Donnenfeld said.
Pale-eyed people tend to get macular degeneration more than those with dark eyes, a function of UV light penetrating lighter irises more easily than it penetrates dark ones. But darker irises, with their upped pigment levels, are more prone to glaucoma. As for glaucoma pressures and their treatment with medical marijuana, he said, “There are much better medicines than marijuana. They do relieve pressure, but from the perspective of someone other than myself, not as enjoyably.”
After 50, Donnenfeld said the incidence of eye disease increases dramatically. And there is no replacing early detection. Donnenfield recommends an eye exam. “Early recognition and prevention are always superior to treatment once a problem has become significant,” he said
“In 25 years of laser treatments we”™ve seen tremendous improvements,” he said. From the original goal to simply improve a patient”™s sight, the science progressed to achieving vision sufficient to drive. Now, the goal is to leave the patient with better sight after an operation than he or she had wearing glasses before the operation.
“I”™ve done 12 major league ballplayers,” Donnenfeld said. “And after the operation, they tell me they can see the seams on a curveball.”