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The Eyes Have It!
A Modern Girl's Guide to Better Vision . . . From Contacts to CRT

by Carol Cooper

When I first discovered them back in the mid-1980s, the eye doctors at 30 East 60th Street in Manhattan were already famous throughout the entertainment world for being able to fit even the most fearful or difficult patient with a comfortable contact lens. This reputation was so well earned that for years happy clients simply referred to them as "The Contact Lens Practice". Today, Doctors Barry Farkas, Jordan Kassalow, Susan Resnick and Associates, are perhaps best known by their surnames alone, especially now that their expertise has expanded even beyond contacts and into areas like pre-and post-op care for the kind of laser surgery which renders contact lenses obsolete.

Although Farkas, Kassalow, and Resnick can count celebrities like Kimora Lee Simmons and Ashford and Simpson among their clients, they offer the same level of skilled and customized care to ordinary folk like you and me. I'd tried wearing contacts several times from other optometrists before finding the perfect fit courtesy of Dr. Theodore Kassalow. Although the senior Kassalow has turned over his pioneering partnership in the firm to his son, Jordan, he still comes in several days a week to look after long-term patients like me, and was gracious enough to talk to BE about the newest and most important aspects of modern eye care, based on over 30 years of helping people look good and see even better.

Q: What are the three most common mistakes people make when they begin wearing contact lenses?

Dr. T.W. Kassalow: One, they overwear them . . . meaning wear them faster than they should, not following the schedule. Two: changing solutions and cleaners from brand to brand -- because it's possible to have an adverse reaction if you keep switching. And three: just not cleaning lenses properly at all.

Q: Which of these three are most dangerous to the eye itself?

Dr. Kassalow: Probably, I would say, not cleaning at all. You can end up with deposits on the lenses that scratch the cornea, or you can end up with a bacterial buildup, which can cause an infection. Q: What are the three most common reasons a person can be "hard to fit" for contact lenses?

Dr. Kassalow: There are certain eye conditions that make a person not disposed to wearing contacts at all. An extremely high astigmatic correction is one. And there are just some people who are extremely sensitive and really can't get the lens on. They fight it, they shove their hands in their eyes, and just brutalize themselves. They're just not good candidates.

Q: Why might one person need a more "water loving" lens, while another might need a more "oxygen permeable" lens?

Dr. Kassalow: Again, each person's ocular physiology is different. And there are certain things we can measure, but other things we cannot. I mean we can get an idea if an eye is a "dry eye" or not . . . what the quality of the normal secretions of the eye are. Sometimes if you don't have enough lipids, (fat molecules), or too much of them in the eye fluid, it can have an effect. Any of the eye chemistries that are out of whack can effect the whole situation.

Q: Describe the many bad effects cigarette smoke can have on a contact lens wearer, and why over exposure to dust and smoke might make one grow intolerant of previously comfortable lenses.

Dr. Kassalow: Well, particularly in soft lenses -- and now probably 80% of wearers wear soft lenses -- you're wearing an absorbent material. So we can't absorb noxious fumes safely. And the eye -- the mucous membrane and the cornea itself is quite sensitive. It's not unusual to see somebody who works in a smoky environment, like a patient I once had who was a piano player in a bar, come in with red eyes complaining about his lenses. One day I visited him at work and it was like Dante's Inferno in there, completely smoke-filled. Basically you're poisoning yourself in there.

Q: Yeah, it's amazing. Many doctors don't bother to tell you this . . . they'd rather just fit you and send you on your way. They don't tell people they should quit smoking if they are going to wear lenses, or that being in any smoking environment is really bad for the health and comfort of the lens-wearing eye.

Dr. Kassalow: Also, when people have nicotine on their hands from smoking they have to clean their hands very well before touching their lenses, because the nicotine can transfer to their lenses.

Q: How do allergies affect contact lens wearers?

Dr. Kassalow: Allergies can range from mild (which is generally not a problem) to severe. And when allergies are severe, a lot of times you'll get a build-up on the inner-upper lid, "bumps" if you will, which form secretions which can coat the lenses. And just the elevated bumps themselves can be very uncomfortable for lens wearers. You can be allergic to pollen, pet dander, dust, to the lens itself, or even in some rare cases to the lens solutions. But no matter the cause, the end result can be lowered wearing time or losing the ability to wear lenses at all.

Q: Are there still any conditions for which hard lenses are better than soft?

Dr. Kassalow: Definitely. "Cortacornus" is a condition of the cornea in which the corneas are sort of bullet-shaped and neither soft lenses nor glasses will correct the vision much at all. But the firm contact lens in effect becomes a new cornea and the vision is restored to a great degree. Also, the most efficient bifocal contact lenses are still the firm, gas-permeable types.

Q: What do you think about the new bifocal and astigmatic soft lenses? Are they getting better?

Dr. Kassalow: Absolutely. We have many more products to choose from. And sometimes we'll mix and match, use one product in one eye and another in the other. The secret to making this work is first, experience, and second, having a wide range or "depth" of product allowing you to utilize that variety to get the best results.

Q: Glasses are becoming somewhat fashionable again. Do you find any number of older or younger people coming to you now who are choosing glasses over contacts or even permanent laser vision correction?

Dr. Kassalow: As far as glasses are concerned, yes, more so than before, but still people prefer not to wear anything on their face if they can. With the laser situation we started doing the pre- and post-operative care of people choosing the surgery, and that has gotten very big over the past couple of years. But, this past year it seems to have dwindled a bit, because the people who really wanted it in great numbers have had it done already.

But, the procedure's a very good one -- and the way you know it's a good one is if your doctors have their immediate family do it. In my case, my son's wife just had it done, and my son had it done two years ago. The two most important things there are first picking the right surgeon, and then picking the right case. A lot of the people who've had problems with it are people who should never have been operated on. But if you have a surgeon who is conservative, and weeds out those people who shouldn't have it, it really is a very good procedure.

Q: I hear that it really only fixes nearsightedness and not so much farsightedness and presbyopia.

Dr. Kassalow: It can correct farsightedness, but to a much lower degree. And presbyopia, which means a need for reading glasses which is usually age-related, it just has no effect on that at all. In other words, you can correct your eyes to 20/20 by laser surgery and still need reading glasses once you hit that "magic age" just as if you'd been born with perfect vision.

Q: What about the colored contact lenses? Are those still fashionable, are people still coming in for those?

Dr. Kassalow: The answer is yes -- we don't do it very much at all -- but we do do it. The important thing there is if you do it, do it properly. There was a whole big deal in the press recently about color contacts being sold over the counter! This is definitely something you do not want to do. But colored contact lenses can be very effective, and they can be fun.

Q: As a market, I think it would be an area of growth because teens and young adults just love being able to change their eye color whenever they want.

Dr. Kassalow: Show people and actors too. The first one I ever did was George Segal about 30 years ago. He had to portray an Arab in an acting role and we had to make his blue eyes brown. And Nick Ashford of Ashford and Simpson has about five different pairs in different colors. Again, it's a fun thing.

Q: What is the recovery time on laser surgery for a severely nearsighted person?

Dr. Kassalow: They'll be seeing fine the next day after the laser. Sometimes, you'll get some kind of a haze or glare at night for a month or two, but it's fairly minor. And, rarely do you have to miss more than a day's work.

Q: So, the adjustment times are comparable then? Especially with soft lenses?

Dr. Kassalow: Even with a patient who hasn't had contacts before will still take almost a week to work up to full-time wear.

Q: How often should people see their eye doctor for maximum eye health?

Dr. Kassalow: As a contact lens patient or just generally? With a lens wearer we like to see our patients twice a year, but once a year at least. The test for glaucoma should be done yearly, and the dilation of the pupil should be done every two years. If you're not a contact lens patient, usually every two years is fine.

Q: Any new preventative treatments around for glaucoma, cataracts, or macular degeneration?

Dr. Kassalow: There's been enough research to show that macular degeneration will not reverse from taking certain vitamins, but they do find it seems to obviate the need for further surgery in some cases. It's one of those things that's kind of wishy washy, but there's enough evidence in the journals to indicate that if there's any family history or chance of that occurring, the advantages of taking the vitamins preventively outweigh any disadvantages.

Q: And cataracts? Any new ways to avoid those?

Dr. Kassalow: Not really, same old stuff. You want to avoid large degrees of exposure to the sun without sunglasses, and get good sunglasses that actually block the ultraviolet light. For general walking around it's not a problem unless you live in a climate like Florida or Arizona where you are outdoors in the sun a lot.

Q: Is laser surgery more indicated for eyes which need minimal or major correction as a cost vs. benefit assessment?

Dr. Kassalow: More for higher degrees. Sometimes if somebody is only mildly nearsighted they're almost better off not doing it because when they get to be 40 or 50 they can function without any glasses at all for reading. And they could put off needing reading glasses for another 5, 8 or 10 years.

One thing you didn't ask me about is CRT -- Corneal Refractive Therapy. That's the use of a specially designed lens to be worn at night while you're sleeping. It exerts pressure on the cornea somewhat akin to what happens with braces on your teeth, so that the next day you don't have to wear anything at all. That way, for people who are too chicken to have laser surgery and don't want to wear lenses you can sleep with all the time, here they have an alternate procedure that's come along very strongly. With prescriptions up to about a minus 3 -- meaning not very high ones, but certain low to moderate ones -- it can be very effective. You sleep with them, you don't even know it's there, then you take them out in the morning and you see fine all day. Sometimes even for two days at a time without reapplication.

Q: So is the effect cumulative? If you started doing it early, might you eventually reach a point where the eye was permanently corrected?

Dr. Kassalow: No. The primary advantage of this technique is that it bounces back. It's short lived, but effective.

Q: And it's much less invasive than the surgery would be?

Dr. Kassalow: Exactly right.

Published in: Black Elegance, Spring 2003

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