OPHTHALMOLOGY ON THE VERGE OF A REVOLUTION

“Ophthalmology – small but phenomenal changes, on the verge of a revolution”.

Arthur Benjamin recently returned from the annual conference of the American Academy of Ophthalmology in Chicago in a great mood. He’s usually in a great mood, regardless, but this time was different.

This new technology. In order to fully appreciate it, let’s recall the steps of our evolution. What has vision correction consisted of? If a patient sees poorly, a doctor has several methods for focusing the image on the retina. Monks came up with the easiest method about 400 years ago – glasses. Contact lenses appeared a few hundred years later. Germans, during WWII, invented a version that was rigid, uncomfortable, and messy. The technology didn’t stop there, though, and new materials were invented. They became more comfortable.

More oxygen was able to reach the cornea. But these rigid lenses were expensive and easy to lose. When baby boomers reached the “age of the contact lens”, progress had stopped. Somewhere in the 1970s, though, soft lenses were developed, and then disposable. Laser correction appeared after and then intraocular contact lenses, which were more comfortable. When it came to cataracts, they were able to replace the cloudy lens with an artificial one. Then came laser surgery. At this point, the evolution of the lens began. Toric (for astigmatism), multifocal, and multifocal with extended depth of focus, so the patient can see near and far.

What does this current revolution consist of?

When a patient comes in and says, “Give me a better lens,” it’s clear what to do. Ophthalmology is on top of it. But what about the hundreds of millions that had operations 5-10 years ago, before these advanced lenses appeared? For example, a patient who’s had a monofocal put in comes to the office and says, “You know, doctor, it’s really my mistake – I agreed to a simple, spherical, monofocal lens, and the doctor that put it in has since retired. I can see things at a distance, but that’s it”. Or maybe it’s vice versa. Someone previously had a multifocal put in and they say, “I can see both near and far, but have really strong halos at night. Only 2% of people are supposed to get them, but why am I in that 2%?” What can be done for these people?

OPHTALMOLOGY ON THE VERGE OF A REVOLUTION. Arthur Benjamin returned from the conference of the American Academy of Ophthalmology in Chicago in a great mood

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OPHTALMOLOGY ON THE VERGE OF A REVOLUTION - Benjamin Eye Institute

ОФТАЛЬМОЛОГИЯ НА ГРАНИ РЕВОЛЮЦИИ

Arthur Benjamin recently returned from the annual conference of the American Academy of Ophthalmology in Chicago, inspired by a REVOLUTION in ophthalmology. To appreciate the path and steps of evolution is necessary to go back to history. From the “age of hard  contact lens” to these advanced lenses.

Недавно вернувшийся с ежегодной Конференции Американской Академии Офтальмологии Артур Бенджамин былкак-то по-особому приподнят. 

– Не расскажете в двух словах, что вас там в Чикаго так приятно удивило?

 – Новая технология поразила даже меня. Кратко напомню шаги эволюции. В чем заключается коррекция зрения? Пациент плохо видит, у доктора – несколько методов фокусирования изображения на сетчатке. Самый простой придумали монахи 400 лет назад: очки. Через несколько сотен лет после этого возникли контактные линзы. Они были жесткие, неудобные и грязные; есть версия, что их изобрели немцы во время второй мировой войны. Технология не стояла на месте, были придуманы новые материалы, линзы стали удобнее, больше пропускали кислорода к роговице. Но жесткие линзы были все еще дороги, и их легко потерять. Когда бэби-бумеры достиглит «возраста контактных линз», за прогрессом дело не стало. Где-то в конце 1970-х были созданы мягкие линзы, потом и одноразовые, после чего появилась лазерная коррекция зрения, вытачивание контактной линзы на роговице, потом возникли внутриглазные контактные линзы, тоже удобные. Дошло и до катаракты, начали менять мутный хрусталик на искусственный. Позже операцию начали делать лазером. Пошла эволюция хрусталиков, появились торические от астигматизма, мультифокальные, и наконец последняя модификация – мультифокальные с продленной глубиной фокуса, когда пациент может видеть вдали и вблизи. 

– А в чем революция сейчас?

– Когда приходит новый пациент и говорит: «Поставьте мне лучшую линзу», – то понятно, что делать. Но что делать с сотней миллионов человек, которым сделали операцию 5-10 и более лет назад? Т.е. до того, как возникли такие передовые хрусталики. К примеру, им поставили монофокальный, они приходят и говорят: «Вы знаете, это была моя ошибка – согласиться на простую монофокальную сферическую линзу, которую мне поставил врач, уже ушедший на пенсию. Вдаль-то я вижу, но это все, что я вижу». Или наоборот, кому-то поставили мультифокальный хрусталик: «Я вижу и вдаль, и вблизи, но у меня сил уже никаких от этих ореолов по ночам. Я знал, что у 2% они есть, но почему я попал в эти 2%?» Что делать с такими людьми? 

– Раньше у хирурга было два варианта. Или предложить пациенту привыкнуть, или заменить хрусталик. Но замена искусственного хрусталика – операция намного более сложная и рискованная, чем сделать «девственную» катаракту. Особенно, если прошло больше 6 месяцев. Есть еще риск, что новый хрусталик также окажется не идеальным. Абсолютная точность хрусталика никогда не гарантирована. Другой вариант – лазерная коррекция зрения, операция на роговице. Но нужно иметь в виду, что пациенты эти –немолодые, и роговицы у них тоже немолодые… Как же быть? Тут не бывает простых решений. Все решения требуют или много денег, или рискованных операций, или того и другого, но без гарантий. 

– И вот мы подобрались к самому главному?

– И вот впервые за 25 лет… Примерно столько прошло с тех пор, как я изумленно смотрел на операцию LASIK – еще на той огромной древней установке размером с три комнаты. Однако сам факт, что ты можешь сделать операцию на роговице и поменять ее рефрактивную силу, ее диоптрический рецепт – это поразило всех, и полностью изменило лечение. Это была не эволюция, а революция. С тех пор езжу на конференции каждый год, и каждый год вижу какие-то эволюционные вещи, все становится более элегантным и красивым, но чтобы дух захватывало – такого не было, пока я не увидел презентацию, о которой и пойдет речь. Оказывается, приспособив ту технологию, которая у нас уже есть, т.е. фемтосекундный лазер, можно сделать так называемый Refractive Index Shaping.

– Перевод не поможет, лучше объясните, что это.

– Допустим, у вас внутри глаза установлен хрусталик и стоит как нужно: нет никакого отторжения, помутнения, он правильной формы, но единственное, что мешает – рефрактивно он не подходит. Или в общей системе глаза есть минус, или плюс, или астигматизм, или хрусталик монофокальный, а пациенту хочется мультифокальности, или наоборот. А что если взять и как-то повлиять лазером на тот хрусталик, который уже стоит? Так вот оказывается , это можно сделать!

– Ты кладешь пациента под машину, которая выглядит примерно так же, как и обычный LASIK, и… меняешь рефрактивный индекс, т.е. делаешь тот же самый LASIK, но не на роговице, а на самом искусственном хрусталике, который уже сидит в глазу. Приходит пациент со «старым хрусталиком» и говорит: «У меня астигматизм». Роговицу трогать нельзя: у него сухость глаз. Тогда ты вытачиваешь ему этот астигматизм прямо на имеющемся у него хрусталике. Причем занимает все это секунды. Или так. Пациент говорит: «Когда мне ставили хрусталик, мультифокальных еще не было. Сможете помочь?» Сможем. И ты превращаешь его монофокальный хрусталик в торический мультифокальный. А другому, который жалуется на мультифокальный из-за того, что не может водить машину вечером, ты превращаешь его мультифокальный в монофокальный. «Ой, но так я слишком плохо вижу вблизи!» Еще одна манипуляция – и он видит вдали, вблизи и в ночное время. Я описываю очень условно, но факт тот, что такую операцию можно делать шесть раз.

– А как врач добирается этим лазером именно до хрусталика?

– Примерно так же, как он добирается до сетчатки: пациент лежит, хрусталик на своем обычном месте, и этот лазер фокусируется на хрусталике и меняет его рефрактивный индекс. Хрусталик, должен вас успокоить, довольно толстый и нужны лишь минимальные изменения.Изменения минимальные, но с точки зрения офтальмологии – феноменальные. 

– Такие изменения и называют революционными. И что дальше?

– Дальше – еще лучше. Требования пациентов к результатам операции растут с каждым днем. Уже можно встретить такого пациента, который сидит после операции со зрением 20/20 и вопрошает: неужели лучше нельзя? 

– Ну этот пациент, наверное, с психическими отклонениями.

– Может быть и 20/15. Врачи, особенно хирурги-офтальмологи высшего пилотажа, тратят огромные усилия и средства на диагностические машины и специальные программы с тем, чтобы оттачивать результат и делать его все острее. Но они все равно сталкиваются с проблемами. Многое зависит от того, как прошла операция, как заживает глаз… все это вносит долю неопределенности. Последние 5, если не 10 лет многие офтальмологи предвкушали возможности так называемой «Калхун-линзы». Calhoun – это человек, который изобрел новый хрусталик. Точнее, он придумал новый материал, из которого делается линза, что позволяет ее ставить без окончательного закрепления. И если в процессе «утряски» в течение нескольких недель у пациента меняется рецепт в сторону плюса или минуса, то ты можешь специальным лазером повлиять через полимеризацию на хрусталик, изменить немножко его силу и потом уже его окончательно зафиксировать.

– Что если врач поставил пациенту «Калхун-линзу», а через три недели зрение его стало 0.75?

– Пациента снова кладут под машину и убирают эти 0.75. И это уже – последний штрих. Звучит хорошо? Но! Хрусталики эти очень дороги, поскольку дорог материал. К тому же офтальмолог должен покупать всю систему, а не только хрусталики: оборудование для измерений и все-все-все остальное. И многие уже вложили в эту новинку много денег, на саму систему были потрачены сотни миллионов, все это прошло FDA, все уже готово к выпуску, как вдруг… прилетает черный лебедь (абсолютно неожиданные новшество – В.К.) в лице поистине потрясающей новации, о которой я рассказал. «Вдруг откуда-то летит маленький комарик, и в руке его горит маленький фонарик».

К тому же под воздействием ультрафиолетовых лучей этот хрусталик Калхуна затвердевает. Т.е. когда тебе пробно его поставили, ты не можешь на улицу выходить, разве что в специальной шляпе и очках. 

– Получается, что вся эта Калхун-махина, как я понял, пошла прахом. 

– В новой технологии все проще. К тому же ты можешь помочь пациентам не только сегодняшним, но и вчерашним, и позавчерашним, и даже тем, кому сделали операцию 25 лет назад.

– Мы говорили про вчера и позавчера, теперь назревает вопрос: когда это все будет? 

– Эта новинка сильно изменит офтальмологию, огромные плюсы ее очевидны, но когда происходит такая огромная трансформация, трудно предугадать и какие-то минусы. Там есть еще вещи, которые нужно доказать, апробировать, доработать, провести через FDA. Но нет сомнений, что эта технология появится в скором будущем. И в 

, который всегда идет вровень с эпохой, – абсолютно точно.

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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