EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW CATARACT 18 December 2014 Cataract editor's corner of the world by Vanessa Caceres EyeWorld Contributing Writer which helps to reduce skin discolor- ation, age spots, and fine lines. The procedure can be easily performed during lunchtime, Dr. Kherani said. Although these procedures can be a nice complement to eyelid surgery, they do require some advanced training and the rental of related equipment, Dr. Cockerham said. Other nonsurgical options that ophthalmologists can offer are dermal fillers that provide volume and injections of botulinum toxin A. "Dermal fillers should be used with caution around the eyes as they can embolize and cause visual loss; if injected too superficially they can result in puffiness, bumps, and even a bluish coloration due to the Tyndall effect," Dr. Cockerham said. "Training is required to use these products appropriately." Surgical options Blepharoplasties are a common eye-related surgical procedure requested by patients. "Ophthal- mologists are trained to do upper lid blepharoplasties in residency," Dr. Cockerham said. "The other cosmetic procedures for the brow, lower eyelids, and midface require advanced training." Additionally, a blepharoplasty alone may not be sufficient, Dr. Shriver said. "If you just trim the lid skin, you still have the weight of the brow," she said. This may prompt surgeons and patients to discuss other work. In Dr. Kherani's practice, pa- tients can combine blepharoplasty with a chemical peel or a laser skin resurfacing to rejuvenate the whole face. Facelifts, neck lifts, and brow lifts are other options for some pa- tients, said Wendy W. Lee, MD, MS, associate professor of ophthalmolo- gy and dermatology, Bascom Palmer Eye Institute, Miami. Eyeing less common procedures Oculoplastic surgeons say there are other cosmetic options for patients —both ones emerging in the U.S. and ones that are only available abroad for now. "Microneedling is now Food and Drug Administration-approved and is an effective tool that stimu- lates collagen," Dr. Cockerham said. Cosmetic nonsurgical and surgical options can enhance image, self-esteem C ataract surgeons help patients to see better, but they can also play a role in helping patients to see themselves better. Comprehensive ophthalmologists can be a trusted source for patients Giving patients a boost to learn how to take the best care of their eyes and face, said Erin Shriver, MD, assistant professor of ophthalmology and visual sciences, University of Iowa Carver College of Medicine, Iowa City. Here are some cosmetic non- surgical and surgical options that ophthalmologists can offer patients to help improve their facial appear- ance. These options are suggested by ophthalmologists who specialize in oculoplastics. Nonsurgical options Skin care products are an easy nonsurgical option to offer patients, said Femida Kherani, MD, FRCSC, Heights Laser Centre, Vancouver, and clinical instructor, University of British Columbia. Dr. Kherani often discusses skin care with patients who come to her for a blepharoplasty. Finding a product with a prov- en, trusted reputation is important, but you will also want to see the re- sults—and your staff members could be part of the vetting process. "Hav- ing aesthetic nonsurgical treatments or products available is a benefit you can offer your staff," said Dr. Shriver, who has been able to offer her staff product samples as well as chemical peels and fillers. "If your staff has tried a particular product or treat- ment, they will feel more comfort- able counseling patients about it." One important aspect of skin care to recommend is sunblock for the eyelids and face, said Kimberly Cockerham, MD, FACS, Zeiter Eye Medical Group, Stockton, Calif. "Colorescience [Carlsbad, Calif.] makes a zinc and titanium powder that can be reapplied every 2 hours to provide maximum protection. The brushes come in SPF 30 and 50 and retail for $40," she said. "There is also one prepared for the eyelids that retails for $25 and is very help- ful for postoperative eyelid surgery to prevent redness of the incision or hyperpigmentation." Products that enhance eyelashes are another option. Dr. Cockerham finds that Latisse (bimatoprost oph- thalmic solution, Allergan, Irvine, Calif.) is effective but can be irritat- ing to many patients. She also said the applicator brush is abrasive and wicks away the product. "I instruct my patients to purchase an eyeliner brush and use that instead to apply the product," she said. Ophthalmologists may also want to stock reputable mascaras in their optical shop, said Dr. Shriver, who is a fan of the brand blinc (Boca Raton, Fla.). Laser skin resurfacing is another popular option that removes skin layers for a more youthful appear- ance. Another nonsurgical option is intense light pulse therapy (IPL), I performed uncomplicated cataract surgery on a healthy 77-year-old woman. Her cataract was quite mature so I was anticipating hearing the usual comments about her amazing new vision on the day after surgery. Instead, I walked into the exam room to find her sitting with her arms folded across her chest and an angry scowl on her face. I quickly glanced at the chart and was relieved to see that her uncorrected vision was 20/20. I then cautiously asked how she was doing. She said that she was satisfied with her vision but wanted to know why she had seem- ingly aged a decade overnight. I let out a chuckle, thinking that she was joking. Soon enough, I realized that she was not joking. She stated that her friends had always told her that she had beautiful skin, and she was adamant that she did not look this old before her cataract surgery. I attempted, in vain, to explain that her appearance had not changed but rather her vision had improved. She did not accept my explanation and never returned for a follow-up examination. In training, we learn about managing complications of cataract surgery. No one had prepared me for this type of compli- cation. As cataract surgery becomes more and more refractive in nature, patients are also more cognizant of aesthetics. Refrac- tive surgery exists because of the demand for uncorrected vision. But we should also be aware that after surgery, many of these patients will start to focus on the other signs of aging in their faces and around the eyes. Bonnie An Henderson, MD, cataract editor Patient 1 month post blepharoplasty and Latisse. Blepharoplasty is one cosmetic option that ophthalmologists can offer their patients. Source: Wendy Lee, MD