We talk to eye surgeon Arthur Benjamin about old but timeless themes, and then touch upon a new one. 

Let’s suppose that you get tested for cataracts and you find out you have glaucoma. What do you do?

Modern ophthalmology has a new solution for this with the iStent, a trabecular microshunt. Let’s first talk about the basics – the main feature of glaucoma is an increase in intraocular pressure, because the outflow of fluid has been inhibited. We can repair this by either improving outflow or reducing the production of fluid. Most medicines do the latter, but the eyes need this fluid, as well.

The soft tissues of the eye must maintain a certain pressure, so the eye can be compared to an inflated tire. The ciliary body acts as a pump, moving the aqueous humor to the posterior chamber, where it flows through the eye and nourishes it, before finally exiting into the bloodstream via the trabecular meshwork.

So the liquid can’t be too much or too little?

Yes, and that’s why the best option for treating glaucoma is one that provides continual irrigation, but maintains the proper pressure. Now there’s a new method, a device called the iStent, which is a titanium microshunt that resembles an underwater pipe, allowing the anterior chamber to drain.

So this microscopic implant helps to reduce the pressure. Does the patient feel like they have something in their eye? Is it generally safe?

They don’t feel anything, and its safety depends on a steady hand. The introduction of a micro-shunt adds 1-2 minutes to cataract surgery, but without the usual post-op complications from low intraocular pressure. Not just any doctor can do this; it requires special training. The part of the eye where the shunt is implanted isn’t visible, so it’s necessary to use special lenses and mirrors. That’s the main problem. With surgical skill, however, it is both safe and effective.

Are there many surgeons in Los Angeles that are able to do it?

In my opinion, there are a few good people. Many doctors resist innovation because it’s outside of their comfort zone. For example, maybe you’ve been doing cataracts for 30 years and don’t want the extra hassle. There are also those that have tried and didn’t get the best results, so why should they continue? And finally, not everyone loves to learn new things.

Are there many people that need this shunt?

At Benjamin Eye Institute, practically every other patient has glaucoma, and the patient’s intraocular pressure will be normal for about 7 years.

ИЗ ИНТЕРВЬЮ С АРТУРОМ БЕНДЖАМИНОМ

– При глаукоме повышается внутриглазное давление, поскольку не работают оттоки для внутриглазной жидкости. Главный из этих оттоков называется трабекулярной сетью и напоминает сито. Если отток жидкости через это сито затрудняется или блокируется, то внутриглазное давление повышается, поражая чувствительные нервные волокна глаза. Существует два варианта починки. Первый – это улучшить отток каким-то образом. Второй – понизить продукцию жидкости. Большинство лекарств основано на том, что они уменьшают продукцию. Но эта жидкость на самом деле очень нужна глазу.

– Получается, лекарство избавляет глаз от нужной жидкости? А в чем ее функция?

– Глаз должен сохранять свою прочность, благодаря которой его мягкие ткани находятся под определенным давлением. Принято сравнивать глаз с накачанной шиной или воздушным шаром. Ресничное тело внутри глаза играет роль насоса, т.е. перекачивает водянистую влагу из сосудов в глаз, орошая внутренности глаза, питая его живые ткани, после чего жидкость оттекает в кровеносное русло через трабекулярную сеть.

– Значит, этой жидкости должно быть в меру, как и всего остального в жизни, но как ее обеспечить?

– Лучший вариант лечения – сделать так, чтобы жидкость продолжала выделяться и обеспечивать «ирригацию», но и каким-то образом оттуда уходила. И это действительно очень сложно, потому что постоянно идет борьба – то слишком высокое давления, то слишком низкое. На правильно поставленный вопрос рано или поздно находится ответ. В результате и появился этот новый метод, приспособление iStent 

микрошунт, сделанный из титана и представляющий собой подобие подводной трубки, которая соединяет дренажи с передней камерой глаза.

– А если у человека катаракта и глаукома одновременно, ему будут делать две операции вместо одной?

– Нет, в этом случае все делается в ходе обычной процедуры по ликвидации катаракты, что добавляет к операции 1-2 минуты  и проходит без всяких послеоперационных осложнений, обычно связанных со слишком низким давлением. Микрошунт можно назвать созданием внутреннего клапана, в отличие от наружного, когда делают такую варварскую глаукомную операции, создавая большой лоскут, что чревато трудно регулируемым давлением.

Безопасность любой технологии зависит не только от конкретной детали, но и от рук исполнителя. В опытных руках внедрение микрошунта не только безопасно, но и крайне полезно.

– А в какую область глаза его помещают? Он же, насколько понимаю, так и остается там?

– Микрошунт располагается в дренажном углу между радужкой и роговицей, так что его не видно, не слышно, на качество зрения он не влияет и пациентом никак не ощущается – никакого «бревна в глазу», поскольку это чуть ли не самый микроскопический «девайс», существующий в современной медицине.

– Каким пациентам с катарактой рекомендуют эту добавку?

– Тем, у кого есть предрасположеность к повышенному давлению или глаукома у них уже обнаружена и они принимают 1-2 капли. Ты вначале убираешь катаракту, внедряешь хрусталик, а на следующем этапе делаешь эндоскопическую циклофотокоагуляция. Что это такое? Это когда лазером немножко, на 10-15%, понижают влагу, и только после этого ставится микрошунт. Эти три процедуры  – избавление от катаракты, циклофотокоагуляция и iStent – понижают давление так, что пациенты вместо двух или трех лекарств принимают лишь одно, а ряде случаев вообще ни одного.

– А это совсем новое изобретение?

– Изобрели довольно давно, но где-то года два, как в обиходе. Внедрить эту штуку довольно сложно, не все умеют это делать. Для этого нужно пройти специальный тренинг, получить сертификат, т.е. доказать, что у тебя это хорошо получается.

– Почему не все офтальмологи это умеют?

– Многие, и при желании их можно понять, сопротивляются новшествам, потому что каждый боится выйти из зоны комфорта. Т.е. он делает катаракту 30 лет и ему уже не очень хочется что-то там менять, он опасается лишних проблем. Есть и такие, у кого и так-то едва что-то получается, так зачем им еще и это.

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Glaucoma, Eye floaters and Symfony - Benjamin Eye Institute

ИЗ ИНТЕРВЬЮ С АРТУРОМ БЕНДЖАМИНОМ 

IStent is an FDA-approved implantable device that reduces the intraocular pressure, slowing down the loss of vision from glaucoma. IStent can be performed in conjunction with the cataract surgery and it is very safe and effective. 

Обсуждаем методы починки глаз при глаукоме. Как выяснилось, есть два звена, куда направляется терапия: первое - это улучшить отток ( iStent – микрошунт, сделанный из титана и представляющий собой подобие подводной трубки, своего рода дренаж), второй – понизить продукцию жидкости, достигается глазными каплями.



Glaucoma, Eye floaters and Symfony

Staff was very personable and accommodated my needs.  Dr Benjamin was very professional and great bedside manner.  I would highly recommend the office to friend and family

An awesome experience as is the norm for our visits to Dr Benjamin. We have trusted him and his office with our multiple surgeries and care for many years, and plan to continue forward. Thank you Dr Benjamin, and your staff.

Great front desk and tech staff. The doctor was super nice and I’m so pleased I found this eye institute! Everyone was great and happy to finally have taken care of an appointment I had been putting off for a while. Great check-in process also for first time patients.

⭐️ My review of LASIK after one year ⭐️I told Dr. Benjamin I would do this a while ago, but I kind of feel like it says a lot I have kept this on my checklist for a year. I feel like a year is a good amount of time to review a procedure like this and give my honest thoughts and recommendation.So, let me tell you about my journey to getting LASIK and how I ended up in the amazing care of Dr. Benjamin. After going to an optometrist for years and him advising against LASIK because of my genetically dry eyes, I finally got a second opinion from an ophthalmologist (Dr. Benjamin). I didn’t know the difference between an optometrist vs. opthalmologist, but once I learned it kind of made sense why my optometrist didn’t want me getting LASIK lol. Because he couldn’t sell me on contact lenses or glasses for the foreseeable future if I got my vision corrected :) I mean, who knows, but I am glad I got a second opinion.I figured being in Los Angeles with some of the best doctors in the world… if anyone is going to touch my big, blue eyeballs, might as well get it done while I’m here. I found this business due to the reviews and they seemed to really know what they were doing and how to talk to clients.Upon meeting Dr. Benjamin he told me that I wasn’t a candidate for LASIK with my dry eyes, but he could put me through treatments for dry eyes and reevaluate after; and that these treatments had a good success rate for most.So, I started doing two treatments every other week for about 2.5 months - IPL laser treatment and Lipiflow. Lipiflow, especially, was a weird painless experience but highly recommend anyone with dry eyes to ask about it regardless of LASIK. I could tell my eyes felt way less dry a couple days after each treatment. There are videos on YouTube that talk about this treatment… Who knew this stuff existed. I’m not gonna lie, it’s an investment to do all these treatments on top of LASIK, but my eyes rarely feel dry anymore so if you’re going to get it done - do it right.Finally, I was approved for LASIK. I ended up waiting until the end of year to make sure I saved up the funds to do it and had some time to heal. I also took advantage of an end of year deal they were offering. $1000 off was a pretty nice forcing function to get me to finally do it after prepping my eyes with the treatments. The procedure itself I couldn’t feel anything even though I was awake the entire time (medicated). Even the scary part when bubbles form on your eyes Dr. Benjamin let me know about in advance so when it happened I just went with the flow. I think the worst part was the recovery the few days after and coming home drugged up lol. I remember day 1 thinking omg what did I do to my eyes. My eyes just hurt and felt weird, but omg I could see 20/15 immediately. And then, day by day it gradually got better. It took a few weeks for my eyes to heal, but after 1 month you couldn’t even tell I had surgery. One eye was a bit more bloodshot than the other.I can see 20/15. It’s been life changing for the past year not having to worry about contacts or glasses. I just got married and was able to walk down the aisle with clear vision. I only wish I had the means to have done this earlier in life. If you’re considering it - do it! And definitely consider Dr. Benjamin to do it right.Lastly, to continue treating my dry eyes, Dr. Benjamin gave me an extra LipiFlow treatment, and also recommended I try punctal plugs (painless plugs inserted into your lids that help your tears last longer). He placed the plugs in my eyes under 5 mins. Wild.I heard from people during the LASIK process they have been nervous to get the procedure so I wrote this to help and because I think highly of this business for changing my life. And, some of the dry eye treatments I would’ve never known about had it not been for them. Again, I wish I would have had been able to do this years ago. It is so, so worth it!Thank you, Dr. Benjamin (and staff!)

Concerned about a reoccurring virus, I text Dr Benjamin’s office first thing in the morning seeking immediate advice and an appointment. In quick time I received both sage advice and a same day appointment. Dr B takes a personal interest in his patients well being and has diligent, competent and attentive staff to support the care and support needed. Can’t speak highly enough.

Been going to Dr B for nearly a decade after trying many other eye doctors in LA.  Beyond solving my chronic dry eye and being the most knowledgeable, he is an all-around great guy and spends time educating. The staff is wonderful as well.

The ophthalmologist that performed my surgery, Dr. Benjamin, was extremely skilled and knowledgeable. He took the time to thoroughly explain the procedure and answer all of my questions. I felt confident in his abilities and knew that I was in good hands.

Dr Benjamin and his team are extremely professional. I had Lasik surgery performed by him and his team and everything to date has gone exactly as described to me. Front office is very friendly and scheduling appointments is easy.

The office staff were kind and considerate. The technician that assisted me explained everything she was doing. The Doctor was very nice and explained everything. He was definitely knowledgeable about my condition.

Dr Benjamin has been the “go to” eye specialist for 3 generations of my family, starting with my father and now grown children. Simply put, he’s an exceptionally capable, trustworthy, and cutting edge doctor with a courteous and professional staff.Without any reservations, I recommend him to anyone seeking an exceptional eye doctor.

The surgeons at Benjamin Eye Institute are true experts in their field - they were able to explain the procedure in detail and answer all of my questions and concerns. The surgery itself was quick and painless, and the recovery was much faster than I had anticipated.

I just completed my first visit and can say that this office deserves every high ranking it gets. The staff are efficient, friendly but highly professional.  The office is modern and sparkling clean. The examination was smooth and thorough. The doctor saw me on time.  He listened closely to the background of my problem, and he clearly communicated his treatment plan and the rationale for it. I absolutely trust him and highly recommend him.

Dr. Benjamin is always personable and thoughtful and very much an expert.  He has been my eye doctor for many years.  Now that I am older I am very grateful that he is still my ophthalmologist. Everyone in the office is very helpful. I, of course, highly recommend Dr. Benjamin.

One of the things that sets the Benjamin Eye Institute apart from other ophthalmology practices is their team of experienced and highly trained surgeons. The surgeons at the Benjamin Eye Institute have performed thousands of cataract and LASIK surgeries, and have a wealth of experience in these procedures. They are committed to providing the best possible care for their patients and strive to achieve excellent outcomes.

No exaggeration, this was the best visit with any doctor I've ever had. The facility is very nice, the staff is exceptionally thorough, professional, and efficient and Dr Arthur had by far the best bed side manner I've ever encountered. I 100% recommend him and his team

My experience at Benjamin Eye Institute was exceptional.  I’m not sure if I’ve ever encountered such an efficient and professional staff in a doctor’s office.  The front desk was communicative and everyone up to the doctor was beyond detailed in their care.  I would recommend this place to anyone who has eye problems because they have the most advanced equipment and Dr. Benjamin is caring, thorough and knowledgeable.

Dr Benjamin and his staff are excellent! 3/5 members of my family are patients from senior to adult to teen. Great care and professionalism. Highly recommend!

Immediately after  cataract surgery, I can see my husband’s face accross the room for the first time in 40 years! No more glasses since childhood, both distance and close up. If you are thinking, should you spend the big bucks to see everything both near and far?  I can tell you it’s so worth it! Thank you Dr. Benjamin and all the wonderful people in your office! I appreciate your efficiency, attentiveness, professionalism and welcoming space! Please feel free to use me as a reference any time!

I can’t ever express my deep gratitude for Dr . Benjamin and his entire extraordinary team at the Benjamin Eye Institute.I was nervous as eyes are so sensitive,  but his incredibly kind receptionists and nurses make you feel at ease and diminish all fears right away . He offers impeccable medical knowledge and state of the art technology to heal . My son and I have both experienced his phenomenal treatment and have had all our eye issues resolved . I am so thankful and can’t recommend him and the Benjamin Eye Institute highly enough 🙏

Dr.Benjamin is the best of the best.Very personable, knowledgeable and kind.I had a stye and in a bad shape.He  took me right in.His staff polite , kind and very professional.Highly recommended.

My 18-year-old son has been under Dr. Benjamin's care, and we were truly impressed by the level of service we received at Benjamin Eye Institute. From the moment we stepped into the clinic, the staff was incredibly helpful and accommodating.Dr. Benjamin conducted a comprehensive eye exam for my son, and his expertise and professionalism were evident throughout the entire process. He took the time to explain everything clearly, making sure my son understood his eye health and any potential concerns. His patience and attentiveness were truly appreciated.We highly recommend Dr. Benjamin to anyone seeking exceptional eye care. He and his team exceeded our expectations, and we are grateful for the outstanding service we received. Thank you, Dr. Benjamin!

Dr Benjamin and Alba were great. He is very professional, kind and with clear explanations. I had an eyelid quick surgery and I’m just missing the glasses prescription, I left the office and forgot to ask for it. But he and his team were amazing!

I was referred to Dr. Benjamin from both my eye doctor and a very close friend of mine who also had her LASIK performed there. My experience was exceptional. Every single person that you meet in the office is a joy to work with. Whether it was the constant and clear communication, or the fact that they were always listening to feedback and answering my questions and concerns, they went out of their way to make me feel comfortable trusting my vision to them. They were very kind and never once pressured me into anything (including when I had to push my surgery back after I broke my leg).I would recommend this place to anyone who has eye problems because they have the most advanced equipment and Dr. Benjamin is caring, thorough and knowledgeable.

Top notch service and staff! By far the best experience I’ve had at a doctors office in 20 years. I wish every office was as well trained, friendly, and professional as Benjamin Eye Institute. Seriously if you have eye problems you won’t find a better doctor.

More than everything I value professional people. Dr. Arthur Benjamin is one of them. He is taking care of me and my husband for pretty long time. All I can say we are very thankful to the doctor and people who work as a team to make us healthy and happy !

LASIK Eye Surgery- The short is go see Dr. Benjamin!I visited Dr. Benjamin Eye Institute after deciding I wanted to learn more about Lasik eye surgery and what the process would look like. I stare at computer screens for very long periods of time so I was nervous to make this life change but ready to ditch my glasses for good! The entire team from day 1 of my consultation made me feel very comfortable. The office is clean the staff are extremely welcoming, friendly and all took the time to answer any questions I had about the procedure - which was very quick and painless the day of. They also have awesome social content for educational purposes and just to make you laugh!I am about a month post procedure and it has been life changing and a freedom restored. Your eyes are important so make sure you consult with the best.Thank you Dr. Benjamin and team!!!

Dr. Benjamin is an exceptional doctor and eye surgeon. He is innovative, and anticipates a patient’s needs. Above all Dr. Benjamin is kind and caring. My results are outstanding. I can thank him for changing my life. Thank you.

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