Keeping An Eye On Eyes

By Dr. Jeffrey J. Wong
Interviewed by Melissa Moniz
Wednesday - June 09, 2010
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Dr. Jeffrey J. Wong
Ophthalmologist, co-owner of Honolulu Eye Clinic

Where did you receive your schooling and training? I went to Punahou and then to Brown University. From there I went to medical school at the University of Hawaii and later New York University for ophthalmology residency. Finally, I did an extra year of fellowship training in cornea and refractive surgery at Tufts Medical Center.

How long have you been practicing? Two years. We took over Dr. Gary Edwards’ practice at Queen’s Medical Center after he retired in July of 2008.

What is your area of specialty? Cornea, cataract and refractive surgery.Can you talk more about the common disorders/diseases that you see and treat? In our older patients, the most common condition I diagnose is cataracts. Cataract surgery is actually the most commonly performed surgery in the United States, and one of the safest and most successful. This will become even more prevalent as the baby boomer generation ages. As far as cornea, I see a lot of eye infections, allergic eye disease, pterygia and dry eyes. I also see conditions requiring corneal transplantation such as keratoconus and Fuchs’dystrophy, as well as corneal infections.

Do these diseases/disorders present symptoms?Cataracts generally cause cloudy or blurry vision. Sometimes a patient will have trouble with glare, for example, from an oncoming headlight when driving at night. Cataracts tend to be slow growing, although it can be rapid in certain people. Corneal disorders such as keratoconus typically cause a slow distortion of vision. However, corneal infections or ulcers cause redness, pain, light sensitivity and a decrease in vision.

Many of the diseases and disorders affect the older population. You mentioned keratoconus. Are there any other disorders or diseases that the younger population should watch out for? I’d say one of the most common problems I see in younger patients is corneal ulcers, which are usually caused by improper care of contact lenses. Contact lenses are a wonderful invention, but people tend to abuse them, wearing them for longer than recommended or sleeping in them, which can increase the risk of corneal infection by 10 times. I also see a lot of eye injuries from trauma. I’ve had patients who have been hit in the eye with their surf-boards, bungee cords, by metal when hammering, and even by plant sap when making leis. All of these injuries can be quite serious, so wearing proper eye protection is critical.

Dr. Wong checks patient Richard Hanson’s eyes

What is diabetic eye disease and is this a common problem? Unfortunately diabetic eye disease is extremely common. It is the leading cause of new cases of blindness in adults aged 20-74. Hawaii has a large population of diabetics and many of them are not getting annual eye exams.

Diabetes causes blood vessels to become weak and leak fluid in all parts of the body. The difference between the eyes and the rest of the body is that an ophthalmologist can dilate the pupils and can actually see the blood vessels in the retina. In early stages, diabetes causes small spots of bleeding in the retina. In more advanced stages, the blood vessels are so impaired that the retina doesn’t get the oxygen it needs, and fragile, abnormal blood vessels grow in response. These new blood vessels break easily and bleed. If blood sugars are uncontrolled, these blood vessels can lead to retinal detachment and blindness.

The better control an individual has over their blood sugars, the less likely that they will develop diabetic eye disease. By examining the eyes, I can assess the level of control, which is why it’s so important that diabetic individuals get their eyes screened at least once a year. People can have advanced diabetic eye disease and yet be completely asymptomatic. Sometimes I am the first person to diagnose a patient with diabetes when they come in for a routine eye exam for glasses. Screening is very effective, because if you can treat it early on, you can often avoid blindness.

Can you discuss treatment of diabetic eye disease? If there is swelling in the retina or new blood vessels growing, then laser therapy is the treatment of choice. It can clear up the swelling and prevent the abnormal blood vessels from growing. Sometimes there can be large amounts of blood in the eye from diabetes in the gel of the eye, or vitreous. In these cases, a retina specialist must remove the vitreous to clear the blood. But, as I said before, the best treatment for diabetic eye disease is prevention. The better control a patient has over their diabetes, by keeping the blood sugars in the range recommended by their doctor, the less likely they are to develop eye complications.

Can you talk about the new advances in cataract surgery, specifically the new artificial lens implant? This is one of the most exciting advances in ophthalmology. When cataract surgery is performed, the cloudy lens, or cataract, is removed and an artificial lens is inserted into its place. For a long time, there was only one type of artificial lens available. With this lens, patients could see OK in the distance after cataract surgery, but still needed reading glasses or bifocals for up close. However, in the last few years, there have been several different types of artificial lenses developed, which allow people to see clearly for distance vision like driving, intermediate vision such as computer work, and up close like reading. Now, it is possible to not need glasses at all after cataract surgery. These new multifocal lenses, as they’re called, offer a wonderful option for patients now who are having cataract surgery.

Are there any new technology or medications on the horizon that will help you better treat your patients? The new multifocal artificial lens implants still have much room for improvement, and I expect them to just keep getting better and better. As for the cataract surgery itself, there are newer machines that will allow me to make even tinier incisions to perform surgery. There also is a new type of laser, the femtosecond laser, which is being studied and will more precisely carry out parts of the cataract surgery. This laser will hopefully make surgery even safer and more efficient. Another new advance being developed is for patients who had LASIK surgery. LASIK has been around for almost 20 years now, so we’re getting to the point that individuals who had LASIK to get rid of their distance glasses now need reading glasses as they approach their 40s. It’s an exciting time to be an ophthalmologist.

There are these new products called corneal inlays, which are tiny disks inserted under the LASIK flap. With these, people who had LASIK can be less dependent upon reading glasses. Of course, all of these advances I’ve mentioned are still in the investigational stages, but they are right on the horizon. and to help usher in this era of new technology. It’s part of what I love about my field.


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