In The News
An Act of Love
PERTH AMBOY - Married on December 7, 1941 - Pearl Harbor Day - and sharing over 65 years of life together, Tillie and Israel pass have four children and six grandchildren.
The couple has just shared another life-experience: cataract surgery performed by Dr. Jaime Santamaria II, MD, FACS.
Cataract surgery - performed by ophthalmologists throughout the world, with varying degrees of success - has come a long way since the days of hospitalization, sandbags immobilizing the patient, and large incision operations.
Its most recent advances are taking a long time to trickle-down to the neighborhood surgeon. Those who do not perform much surgery find keeping up with these advances difficult, falling back on the ways of the past which, although effective up to a point, lag behind those with greater numbers of patients and experience.
In this day of small incision surgery, there still are surgeons performing "extra-capsular", an operation in which the eye is opened with a large incision requiring numerous sutures and weeks of healing, resulting in astigmatism and a relatively uncomfortable post-operative period.
By choosing Santamaria Eye Center, whose main office is on Market Street, Tillie and Israel Pass were assured of receiving the most advanced cataract surgery, "topical clear cornea", which involves making a very small incision (3mm or less) that is self-healing, and does not require a suture. The incision is made in the cornea's outer-edge, where there are no blood vessels - truly "bloodless surgery". The operation is performed without injections around the eye to numb it, instead being numbed just with drops, and there is no need to stop blood-thinners, including aspirin.
The performance of such advanced surgical techniques requires very significant expertise by a doctor with a great deal of experience and a large surgical volume like Santamaria, who has performed over 15,000 cataract operations. He has been performing refractive surgery since 1985, is a corneal specialist, and has been performing LASIK for correction of myopia, astigmatism and hyperopia as well as more complex procedures including corneal transplants. Santamaria invented the Phaco-Gard blade (patented), which facilitated suture-less cataract surgery.
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New Options in Specialty Services
By Jeffrey Cohen
Medicine has become increasingly specialized, with care for particular conditions, symptoms or diseases being covered more by physicians and staff trained specifically for those purposes.
In New Jersey, it is possible to find specialized health care for virtually any condition, as patients find a higher level of expertise and experience with their ailments. Increased patient confidence and a more integrated approach to the treatment involved can be the well-appreciated results.
There, Michael Flemming, administrative supervisor of nursing, says the goal is to create a more comfortable atmosphere for the patients who are being treated in the units.
"These are secure units, so (patients) can ambulate freely, if theyâ€™re able," Flemming reports. "We have a specially trained staff and special activities for dementia patients." Among these is the Evening Stars program, which consists of smaller groups of patients participating in activities designed to help calm them and increase their sense of well-being. "We may have a few people come in to play soothing music or storytelling," Flemming says.
"We care for our people with a lot of compassion. We try to give individual residents the same caretaker as often as possible, so it's a familiar face." With about 100 patients currently in the two dementia units, Runnells has eight certified nursing assistants (CNAs), six nurses and two unit managers on staff.
For patients with vision problems, the Santamaria Eye Center, with locations in Perth Amboy and Edison, is providing innovative solutions to common problems. Dealing chiefly with what he says is "the front of the eye," Jaime Santamaria II, founder of the center, performs LASIK surgery as well as procedures for cataracts and glaucoma, among other conditions.
LASIK is no longer performed with a blade at Santamaria. "I do it entirely with the laser," Santamaria says. "It creates absolutely perfect flaps. The other great innovating of LASIK is custom-view, which corrects any added aberrations in the optical system." For anybody over the age of 45, we tend to stay away from LASIK (because it doesn't correct vision for both distance and reading), and we use multifocal interocular lenses." These lenses, recommended for cataract patients who don't have conditions like macular degeneration or a problem with corneas, can correct vision for both near and far viewing.
"We can correct astigmatism at the time of the cataract surgery," Santamaria says. "Usually within a couple of weeks, the patient's vision is very sharp, but with some patients, it's the next day." Ira M. Klemons, director of the Center for Sleep Apnea in South Amboy, says that sleep disorders like apnea, which starts as snoring and evolves into difficulty breathing while asleep, have new therapies that eliminate some of the problems previous treatments often included.
Apnea patients "gasp and have great difficulty catching their breath" while asleep, Klemons says. "In its worst case, it can be treated with surgery, but that's not something most people would like to do."
Instead, Klemons can offer advice on lowering the risk of apnea ("the first thing we say is to lose some weight"), and therapies like CPAP, in which the patient sleeps on his or her back wearing a mask connected to an air compressor that forces air into the throat. But Klemons says there usually are better solutions.
"(CPAP) is not very pleasant for many people," he explains. "You can't roll over, it makes noise, and you have to clean it regularly, or you can get infections." As an alternative, Kle-mons offers Oral Appliance Therapy (OAT), in which the patient wears an appliance similar to a dental night guard. The device brings the jaw forward, and helps the patient breathe. "It's called mandibular advancement therapy," he says.
"And with a new device we have called a tharyngometer, we can know in advance if the oral appliance will be effective. We can tell you before you start." Anil K. Sharma, founding partner of the Spine and Pain Management Centers headquartered in Little Silver, says pain management has taken great leaps forward in recent years.
"Pain is now recognized as a vital sign in hospitals," he says. "(Staff) have to monitor pain when you're in the hospital, which is something they didn't have to do before. There is a new awareness on the part of patients and physicians to treat pain."
Until recently, patients would try not to complain about pain, feeling it made them look weak, Sharma says. But the trend is changing. There are also better ways to diagnose where the pain is coming from, and better medications that are taken only once a day.
He adds that an exploratory needle, guided by X-ray, helps find the right place to administer anesthetic injections.
"Fewer and fewer people need surgery for pain," Sharma says.
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Union County Voice
Eye Care Guide
The Santamaria Eye Center was opened more than 27 years ago by Dr. Jaime Santamaria. Today, with two locations, two board certified ophthalmologists and two therapeutic optometrists on staff, the center offers a full range of eye care services, from vision testing, to contact fitting, to corrective surgeries.
Dr. Santamaria received his B.S. from Cooper Union School of Engineering and Science and in 1973 his M.D. from the College of Physicians and Surgeons at Columbia University in New York. He is also a member of the Wills Eye Surgical Network and was named one of New Jersey Monthlyâ€™s â€œTop Doctorsâ€ in 2001. Having executed over 15,000 cataract operations, Dr. Santamaria is currently performing the most cutting edge cataract surgeries that enable patients to see without bifocals, utilizing intraocular lenses. He also performs the most current â€œbladelessâ€ Lasik surgery.
Dr. Kenneth Darvin, Director of Retina Services and Attending Physician at Robert Wood Johnson Medical Center, joined the practice over ten years ago. A specialist in the treatment of diabetic retinopathy, Dr. Darvin has personally performed over 4,000 laser procedures. He also provides a new treatment, just approved by the FDA, to help prevent further loss of vision in patients suffering from wet macular degeneration. Dr. Darvin received his M.D. from the State University of New York at Downstate.
Also on staff at the Santamaria Eye Center are Laila Colicchio, O.D. and Michelle Avergon, O.D. Both are highly experienced in contact lens fittings and offer the latest technology in lenses, including silicone lenses. Dr. Colicchio also has significant experience in helping patients suffering from dry eyes to find relief utilizing a variety of techniques.
Operating out of two newly renovated facilities, one in Perth Amboy and one in Edison, the staff at Santamaria Eye Center offers the very latest in diagnostic and treatment options and their motto is â€œexcellent vision comes from excellenceâ€.
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Sunday Star Ledger
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At Santamaria Eye Center, Dreams Really Do Come True
"I just knew she would want us to do it together," Robert Forster said with a nostalgic twinge in his voice. A week earlier, just before Robert's mother, Irene, passed away, she told her two sons that she wanted them to visit Dr. Santamaria, her eye surgeon, so he could do for them what he had done for her. In tribute to her, the brothers decided to realize their big-time dream: to see the world clearly through their own eyes, without contacts or glasses. Jaime Santamaria II, M.D., F.A.C.S., founder and director of Santamaria Eye Center made it happen.
Everything just fell into place for Robert and John. Dr. Santamaria immediately made room in his schedule to see them for LASIK evaluationsâ€”the brothers were good candidates. Dr. Santamaria explained the LASIK process to them. As is customary with Dr. Santamaria's extensive pre- and post-operative care, Robert and John returned to Santamaria Eye Center on Friday for one last check-up. On Monday morning, had wanted it.
"Robert and John were ecstatic," remembers Dr. Santamaria. "They had a check-up on Tuesday morning and John flew back to Jacksonville on Wednesday. They both were very happy with their results."
A Rich History of Community Care
For over twenty years, Santamaria Eye Center has provided Central New Jersey with compassionate, knowledgeable care and thorough patient follow-upâ€”Robert and John Forster are primary examples. Patients depend on Santamaria Eye Center for the most advanced techniques in eye care, including corneal and cataract surgery. In fact, Dr. Santamaria was one of the first doctors in New Jersey to use the AMOâ„¢ Arrayâ„¢ multifocal, intraocular lens during cataract surgery. The foldable lens reduces dependence on glasses not only for distance, but also for reading.
Dr. Santamaria also licensed his own patented invention, the Phaco-Gardâ„¢ Knife, which facilitated the performance of sutureless cataract surgery. Since 1985, Dr. Santamaria has been performing refractive surgery and now is actively performing LASIK not only on nearsighted and astigmatic patients, but on farsighted patients, as well. He is also the author of several scientific papers on the safety of refractive surgery and LASIK.
In addition to being certified by the American Board of Ophthalmology, Dr. Santamaria is a Fellow of the American College of Surgeons and a Fellow of the American Academy of Ophthalmology. Dr. Santamaria serves Columbia University in New York as an Assistant Clinical Professor of Ophthalmology.
Santamaria Eye Center is a leader in eye care for Central New Jersey. To make Santamaria Eye Center your partner in healthy vision, visit the office at 100 Menlo Park Drive, Suite 408, Edison, New Jersey 08837. Call 732.826.5159.
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Eye-Opening Experienceâ€”Cataract Surgery Corrects Severe Farsightedness
For an eye surgeon, Dr. Jaime Santamaria recently did what was once unthinkable. He removed a perfectly healthy lens from the eye of a 52-year-old Perth Amboy woman.
Two weeks later he did it againâ€”in the woman's other eye.
The procedure itself is not so astounding. Except for the superpowerful replacement lenses Santamaria implanted into the eyes of Diana Blum, it was basic, garden variety cataract surgery.
But it was anything but routine for Blum, who has suffered for most of her life from disabling farsightedness. The farsightedness was so extremeâ€”hyperopic, it's calledâ€”it blurred everything regardless of whether it was near or distant.
Blum's visionâ€”particularly her peripheral visionâ€”only worsened after suffering a stroke and undergoing brain surgery about six years of age. To compensate, she wore glasses as thick as Coke bottles that obscured her big green eyes. Her condition made her completely dependent on her husband, Gary, she said.
Apart from the cosmetic issues, the thickness of her eyeglass lenses worked best at the focal center and virtually blocked any opportunity for seeing on the sides. And the severity of her farsightedness made wearing contact lenses difficult and uncomfortable.
"What this doctor is doinâ€”he's very close to the Lord, this man," Blum said.
Like many people who undergo cataract surgery, Blum was able to throw away her glasses after surgery. But it was more than just a cosmetic achievement. Arriving home after the first surgery on her left eye, she discovered she had "the loudest pink kitchen I've ever seen."
Now she can put on more than just a little eye make-up, read recipes, and perhaps give her constant companion, Gary, a much needed break from chores such as reading the newspaper out loud.
"It sounds so simple, but it isn't," Blum said. "I was satisfied with life the way it was, but now I see things different."
Blum takes credit for the radical idea of having cataract surgery to improve her vision. The severity of her farsightedness rendered her ineligible for the standard procedure, laser in-situ keratomielusis, or LASIK surgery. She wondered why, if older people were getting cataract surgery and throwing away their glasses, she couldn't do the same. But when she asked eye doctors about it, they sent her away telling her to come back in a few years when they might be better prepared to do that sort of thing, she said.
Finally her stomach specialist referred her to Santamaria, who headquarters his eye center in Perth Amboy and also serves as an Assistant Clinical Professor of Ophthalmology at Columbia University.
Santamaria needed a week to think about it, Blum recalled.
"He's a very religious man, and he's used to working with decayed cataracts," she said. "It was very hard for him to make the choice. I begged him."
Removing a healthy lens is in a sense as radical as pulling a healthy tooth, Santamaria agreed. "However, if that helps the overall bite, maybe a dentist would do it," he said.
In LASIK surgery a flap is made in the cornea, the central cornea is reshaped by a laser and then the flap is reclosed. Even though cataract surgery is almost routinely performed with wonderful success, LASIK is considered less invasive.
"It's not something I've done, and most don't at this point," said Dr. Stephen Gordon, Chief of Ophthalmology at St. Peter's University Hospital, New Brunswick. "You are operating on an essentially healthy eye to get a refractive result, which is not unusual today on healthy eyes. But the difference (is) that, (with cataract surgery) You are going through the wall of the eye entirely whereas with LASIK, you do not; and when you do that, you introduce a set of risks not inherent in the less invasive procedure."
Though small, the risks of cataract surgery include infection and retinal detachment, Gordon added.
Technically, Blum did not really have cataract surgery because cataract surgery denotes a clouding of the lens that typically occurs with age. The decayed lens is then replaced with a clear synthetic lens.
Instead Santamaria calls Blum's procedure a "Clear leans extraction with intraocular lens placement." But like the cataract surgeries he has performed by the thousands, he removed her natural lens and replaced it with a synthetic lens in less than 15 minutes without general anesthesia or sutures. He used eye drops to numb the area, made a tiny 3-millimeter incision in the outer cornea, removed the lens and replaced it with an intraocular lens that fit her prescription.
The only difference was that Blum needed a super-duper variety of intraocular lensâ€”in essence two intraocular lenses formulated with a specially designed computer program.
When confronted with a choice, eye doctors should always choose the less invasive procedure, said Gordon, who also has a private practice in Highland Park and East Brunswick. But when there is no alternativeâ€”as there was not for Blum â€” then a clear lens extraction could be more than just cosmetic, it could be "a godsend," he said.
"It's a matter of having a patient come in who needs it and making the commitment to operate on a normal eye, which is kind of like a bar we have not been trying to go over very much," Gordon said. "We are trained in the field to leave normal eyes alone because there is risk in everything."
Santamaria performed the first clear lens extraction on Blum's left eye in early October at the Surgical Center of Central Jersey in North Brunswick, a surgical network facility of Wills Eye Hospital in Philadelphia. Two weeks later he had her return for the right eye.
Prior to the second operation, Blum demonstrated the before and after effects. Closing her good, left eye, she could only see the image of people standing in front of her, not the details, she said. When Santamaria stood about six feet away and held up some fingers she had to struggle to see how many.
But when she opened her left eye, "It's like I have a magnifying glass in front of me," she said.
When she returned for the second operation, the nurses didn't recognize her without her thick glasses. Nevertheless, Blum was still carrying them because, she admitted, it's hard to break a lifelong habit.
Considered an elective, lasik surgery is not generally covered by health insurance, so one can only assume clear lens extractions are not covered either. The federal Medicare program for the elderly and disabledâ€”Blum's primary insurerâ€”does not even have a billing code for the new procedure though it routinely pays for cataract surgery for the elderly.
Medicare refused to cover Blum's procedure. In total, Blum paid $5,400, which is comparable in price to LASIK surgery.
"I would have given him anything," Blum said. "It's worth every penny."
Santamaria said it took only one look at the resultsâ€”and the look on Blum's face after the 15 minute surgeryâ€”to convince him that the time is ripe for clear lens extractions. Using a new multifocal lens now available to cataract patients, he said he will begin offering the procedure as an alternative to LASIK for people over 45 years who need bifocals. He also will offer it to people of all ages who, like Blum, are ineligible for the more standard procedure.
"She's the first of many who can be helped by this," he said.
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Creating Corneal Flap Is Safer with Blade Sheath
JACKSONVILLE, FLâ€”Getting the sharp tip of a microsurgical knife safely through a scleral or corneal tunnel has always been a problem in sutureless cataract surgery procedures. Several specially designed diamond, spoonblade, and crescent knives have been developed for creating the initial incisions, but knives that were designed in the early days of phacoemulsification are still used for the most critical step in the creation of a corneal flap.
Now, with the development of the Phaco-Gardâ„¢, the surgeon can advance the blade to the desired location in the scleral tunnel prior to entry in the anterior chamber without the danger of its catching on the sides of the tunnel.
This is a disposable microsurgical knife fitted with a clear plastic sheath that covers the tip of the instrument during insertion into the incision. It was developed by Alexander M. Eaton, MD, a specialist in the treatment of diseases of the retina, macula, and vitreous, at Eye Centers of Florida, Fort Myers; and Jaime Santamaria II, MD of Santamaria Eye Institute, Perth Amboy, NJ. It is available from Xomed-Treace in a range of sizes.
The Phaco-Gardâ„¢ is designed to avoid a number of difficulties the surgeon can encounter such as entering the anterior chamber too posteriorly, resulting in the need for sutures; iris prolapse; postoperative bleeding from the wound margin; increased corneal distortion; decreased visualization during surgery; or even damage to the iris and uveal tissue.
Dr. Eaton explained that once the device is in the correct position in the anterior chamber, the knife is simply advanced into the eye. The sheath remains in the tunnel and continues to protect it.
He noted that use of the Phaco-Gard knife enhances the surgeon's control during the final and most critical step in creating a sutureless incision. Entry into the anterior chamber is in the correct place, and the incision is more reproducible, he adds. In addition to making the initial incision easier, the design of the knife makes it easy to re-insert the blade into the original incision to enlarge the wound. The chance of creating a second opening is greatly reduced when expanding the incision to insert larger lenses.
For further information on this device, contact Xomed-Treace, 6743 Southpoint Drive North, Jacksonville, FL 32216; 800.874.5759 or 904.296.9600; fax 904.296.1004. OT
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New York Times Health
in Cataract Surgery Bring Far Quicker Recovery
WASHINGTON, Feb.8â€”Leon Kaczmarek went home just hours after having a cataract removed one Friday last month. A soft bandage covered the eye where an artificial lens had no stitches and needed no painkillers. By Sunday he was outside his New Jersey house chipping ice off the front walk.
A few years ago, the operation to remove the cataract, a clouding in the eye's natural lens, would have left Mr. Kaczmarek puttering carefully around his house for three weeks, wary of jarring his stitches, unable to return to work until his eye healed. But recent advances in surgical techniques are shortening the recovery period to mere days.
"I've started to see things I've never seen before," Mr. Kaczmarek, 64, a retired display developer for Woolworth Corporation, "colors, and looking into the distance and seeing sharpness."
Like most cataract sufferers, he had been crippled by blurry double vision and distorted depth perception. It forced him to use thick reading glasses. His wife had to do all the driving.
New technology, including the use of ultrasound to break up the cataract and remove it in fragments, artificial lenses that fold for insertion and new methods of entering the eye, means that doctors can make incisions that are so small they seal themselves, assuming they are properly shaped, meaning that no stitches are required.
The American Academy of Ophthalmology says cataract removal is the most commonly performed surgery in the nation. Cataracts usually strike the elderly, with such predictability that ophthalmologists believe they are an inevitable part of aging. So far, researchers have not pinpointed any way to prevent the condition, although they know it can also be caused by diseases like diabetes.
In 1991, Medicare spent $3.4 billion on more than one million cataract operations. The new surgical techniques not only offer patients a shortened recovery period, but also may cut casts for the health care system over all.
"The biggest part of cost is the facility cost," said Dr. Monica L. Monica, a consultant to the American Academy of Ophthalmologists. Many ophthalmologists say surgery time can be halved if stitches are not required. And the use of topical anesthesia allows patients to bypass the recovery room.
"Small-incision surgery saves on operating room and recovery room costs, maybe by as much as $500 to $600, depending on the facility fee," Dr. Monica explained, "so it is cost effective."
In New Jersey, where Dr. Jaime Santamaria routinely performs stitchless surgery, he charges $2,500, and Medicare pays $1,200 of that cost.
So far only about 30 percent of doctors nationwide use the tricky stitchless techniques. The surgery Dr. Santamaria performs requires cutting a precise tunnel in the eye. He said many surgeons found it difficult to avoid nicking the tunnel sides, which defeats its self-sealing potential. He has invented a sheath that covers the knife as it travels down the tunnel and is retracted when it reaches the damaged lens, to help avoid nicks.
Using ultrasound can be difficult as well. Surgeons must handle a rapidly vibrating tool without knocking other parts of the eye or losing fragments of the cataract. The chances of complications, including infection and detachment of the retina, are small, according to the American Academy of Ophthalmologists. The academy says 90 percent of cataract patients get their good vision back.
Before the middle of this century, crude stitches were used in cataract surgery, and patients had to spend two weeks in the hospital, lying in a dark room for days, sandbags against each ear, forbidden to lift the head or move while the eye healed. When eye stitches were refined in the 1950's, cataract surgery became an out-patient procedure, and sutures, bandages and painkillers made it possible to recover at home.
The stitches were necessary because doctors removed cataracts in one piece, meaning that the cut, usually about 10 millimeters, was too large to heal without stitches. But in the 1980's, many surgeons began using ultrasound waves to break up the cataract, which is then removed in pieces.
Ultrasound "allows us to bounce sound waves around to crack up the lens and take it out through a small port," explained Dr. Monica, who is also a New Orleans cataract surgeon. But while ultrasound lets doctors make a six-millimeter incision, small-incision surgery did not become stitchless surgery until the invention in the late 1980's of folding and rolling artificial lenses, which could be unfurled after being inserted.
Together, ultrasound and folding lenses permit Dr. Monica and others to perform the operation with a three-millimeter incision.
"You go through the cornea for the incision so as not to disturb the blood vessels in the white of the eye," she said, "so there is no bleeding, redness or blackening of the eye. No sutures are put in the eye to bridle and hold the eye in place. Patients return to full activity within 24 to 30 hours."
Another method favored by Dr. Santamaria involves cutting a tunnel three millimeters across from the white surface of the eye at an angle toward the cornea. In both types of surgery, stitches are unnecessary because the eye is a fluid-filled sphere. Internal pressure seals the incision.
Because the technique can be tricky, experts suggest choosing an opthalmological surgeon who has done the procedure many times before. "Unfortunately," Dr. Santamaria cautioned, "a patient may be on the doctor's learning curve."
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News Tribune, Woodbridge, NJ
Medical Centers Cut Into Hospitals
WOODBRIDGEâ€”In the past, hospitals served as everyone's base of operations. But that surgical supremacy is now being challenged by a number of independent outfits, which are starting to make major incisions in a once-exclusive field.
"Hospitals are often very confusing, very scary, and very impersonal," said Ellen Samuel, administrator of The Medical Care Center at Woodbridge, on Route 9. The center is one of a new breed of "same-day surgery" outposts that do anything from gynecological work to plastic surgery, to abortions.
The center doesn't handle emergency surgery, nor does it do appendectomies and other long-term projects that might involve overnight visitors. Indeed, they've been able to keep their costs down by eliminating the hotel aspect of hospital operations, with the sleeping accommodations, food service staff, and so on. This is strictly outpatient care.
Also, needless to say, the surgical work here stops short of brains and hearts.
As for courage, however, many patients visiting the relaxed setting have discovered they have more than they thought. And best of all, the wizards at the center can whisk you back to Kansas on the same day you arrived.
"Here we tell our patients what's going to happen, who's going to do whatever it is, how long is will take, what the procedure is in detail, and how they will feel afterward," said Samuel, a Westfield resident.
"We don't give a patient a gown with no back so their bare behind is sticking out, and ask them to follow a red line down a corridor, a yellow line down another corridor, and then come back when they're finished filling out some forms."
The center started out in 1982, strictly for gynecological care, but like any center it's been spreading outward from the middle. Now it has twenty staff physicians in its orbit.
"1985 is a wonderful year for health, because there are so many changes in the health industry," said Samuel, "changes in terms of technology, and also in terms of knowledge. Consumers are asked to know more and take more responsibility."
To aid patients in their thirst for knowledge, the center has prepared a number of potent draughts from the Pierian Spring. For one thing, the staff is always careful to give clients a post-operative debriefing, to make sure they can nurse themselves back to health. They even provide a light after-surgery snack.
Another offbeat option of the center is a Zeiss microscopic camera, which literally turns the surgical chamber into an operation theater. Friends and relatives sitting in the lounge can watch the entire surgical procedure on closed circuit television, if they have a stomach for it.
Dr. Jaime Santamaria, the staff eye surgeon, has no problem fixing cataracts on camera. In fact, he takes great pride in doing his operations prime time.
"These are beautiful procedures, and if they're beautiful, they should be open to all," said the Perth Amboy-based surgeon, who's also an instructor of ophthalmology at Columbia Presbyterian Medical Center in New York.
"It goes with the policy of making the surgery more open to the patient. I don't believe in the secrecy of the operation roomâ€”'don't come in, this is only for trained professional.' I want to make every operation not only safe, not only successful, be memorable."
According to Samuel, some hospitals have a paternalistic approach to medicine. "The doctors treat you like a child, and decide what's in your best interest. The physician makes all the decisions."
"Here you're always treated with dignity. We believe that the patient is entitled to as much information as we can possibly gave them, and then the patient is entitled to decide what course of treatment is in his best interest. Which frequently leads you to question more, but also leaves more responsibility on your shoulders. We're patient advocates here. I think the consumers are demanding it, and rightfully so."
The seeds of same-day surgery originally germinated in the Midwest several decades ago, according to Samuel. It's only recently that they've begun to sprout in northern soil. "These places are more common out West. It mightâ€”this is hypotheticalâ€”have to do with the fact that there are less hospitals and more space. And the goal is to keep healthy people who are in need of surgery out of the hospital."
The center is also in the vanguard of new and improved surgical techniques. Recently, Santamaria became the first surgeon in Middlesex County to perform radial keratotmy, a procedure that can correct moderate nearsigtedness.
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News Tribune, Woodbridge, NJ
Eyes Potential of Laser Device
PERTH AMBOYâ€”Cataract surgery is being revolutionized by a laser device that uses some of the same focus and search techniques incorporated in modern fighter aircraft for the tracking of targets and for missile guidance systems.
The instrument credited with bringing ophthalmology into the space age is the Nd-YAGâ€”short for Neodymium-Yttrium-Aluminum- Garnetâ€”laser. And if the name and concept smack of Stars Wars phantasmagoria, there's good reason.
Amazingly, the YAG directs a point of light harmlessly, and painlessly, a local physician assures, through the cornea. It concentrates its burning and cutting abilities behind the eye.
"It's the hottest device in ophthalmology," said Dr. Jaime Santamaria II, an eye surgeon who has installed the first YAG in use in Middlesex County at his office at 104 Market Street.
With several surgical applications for the YAG now under investigation, including the control of glaucoma and removal of dislocated lens implants, Santamaria feels the instrument has almost unlimited potential.
It should be noted, however, that no laser is currently being used to remove cataracts. That procedure must still be done surgically.
Rather, the YAG is "an assistant to the whole cataract removal process," said the eye surgeon, a graduate of Columbia University.
It is employed to correct a physiological problem that results in about fifty percent of cases involving a fairly new method of cataract extraction called extracapsular surgery.
As Santamaria explained, the eye contains an anterior, or frontal lens, where cataracts form, and a posterior capsule, the back part of the lens, which contains the retina.
The old method for removing cataract opacity of the lens causing poor visionâ€”was called intracapsular surgery. It necessitated extraction of both the anterior lens and the posterior capsule.
Surgical dislocation of this capsule can, however, result in such complications as retinal detachment and cystoid macular edemâ€”swelling on the retina producing decreased vision.
Extracapsular surgery is seen as a distinct improvement over the intracapsular method in that the posterior capsule is left in place. Therefore, the incidence of complications is reduced.
Still, in about half of all cases where a portion of the capsule is left behind, cataractous material can grow back and cloud vision somewhat. This may happen within one year of the primary surgery.
Formerly, a delicate surgical procedure called a "discission" was required to dislodge this material. It generally worked, said Santamaria, but was prone to hemorrhage, infection or other complications.
The YAG has modernized the process. Santamaria explained that the laser removes the buildup by concentrating a small "plasma explosion" in a spot that the physician feels would allow the best result.
Precision is vital. "It has to be so accurately focused that another laser is used to focus this one," Santamaria said of the surgical device.
The doctor lines up the spot by focusing two red dots in a scanner. When the spot is in focus, a foot pedal is pressed and the surgical laser produces a minuscule burst for a fraction on a second.
The procedure takes from five to ten minutes with the patient sitting awake and conscious. No anesthesia is required because the light passes through nerve fibers in the cornea to focus behind it, where there are no nerve endings.
Santamaria added there is no exposure to radiation and no harmful effects have been noticed as the result of laser use. "Generally, it's a one treatment procedure," he said," even though at times further opening of the capsule is needed."
The Columbia Presbyterian Medical Center, where Santamaria is a member of the surgical staff, is renowned for its advanced applications of laser technology in ophthalmic medicine. The YAG, however, was invented in France by Dr. Danielle Aaron-Rosa in 1978.
From its earliest inception, the device created a stir. Santamaria said many eye surgeons convinced of the validity of extracapsular surgery performed it knowing the operation might result in opacification of the posterior lens and that a subsequent operation might be needed.
"In spite of that they thought it was a better procedure" than the intracpsular method, he said. "When this (the YAG) came out, it was the most beautiful concept because it solved a very big problem."
Santamaria, who underwent training to master the device, has treated several patients since the $65,000 YAG was installed in his office last winter. For now, the only FDA-approved use of the device is as a follow-up to extracapsular surgery.
Other microsurgical applications are being explored. One, called an anterior capsulotomy, involves using the YAG laser to loosen the front part of the lens, which can then be removed easily during surgery.
The advantage of this technique is that it avoids possible difficulties sometimes associated with surgical removal of the capsule.
Dr. Jaime Santamaria of Perth Amboy is the first eye surgeon n the area to use a revolutionary laser device in the treatment of those who encounter clouding of vision following cataract surgery. Nicknamed YAG, the device is used now in conjunction with standard cataract surgery. Other uses for the $65,000 machine are being investigated.
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