• Ilya Rozenbaum, MD visited a prominent glaucoma surgeon in Rio de Janeiro, Brazil for one week where he observed clinical activities and exchanged ideas about glaucoma research and treatment.
• Phuong Le, OD celebrated his wedding in California this March. Please join us in congratulating Dr. Le and his wife.
• MEA is proud to be a part of World Glaucoma Day designed to raise awareness of glaucoma as a leading cause of preventable blindness worldwide. With two fellowship-trained glaucoma specialists, MEA is on the cutting edge of glaucoma care and is committed to preventing blindness from glaucoma.
• Cynthia Matossian, MD was honored to have her study on the comparison of various glaucoma medications published by Allergan Pharmaceutical.
• MEA is proud to be involved in a clinical trial with Ista pharmaceutical. MEA is one of few sites selected in the USA.
• Our optometrists, Drs. Melissa Richard, Jennine Lutz, and Phuong Le, are certified to fit SynergEyes contact lenses. These specialty lenses are designed for patients with keratoconus or patients who have had prior refractive surgery. Synergize contact lenses provide the optical quality of a gas permeable lens with the comfort of a soft contact lens. A multifocal version exists for those who need distance and near correction in one lens.
• Melissa Richard, OD presented a lecture on treatment options for contact lens discomfort at the Health and Wellness Center in Warrington, PA.

A PERSONAL MESSAGE FROM DR. MATOSSIAN
Spring is here and I am very happy about that. This February, I attended the American College of Eye Surgeons’ meeting where the latest techniques of cataract surgery and premium implants were discussed. In April, I attended the American College of Cataract and Refractive Surgery meeting in San Francisco. I was invited to give a presentation to a group of ophthalmologists on the subject of premium implants in Bergen County, NJ a few months ago. Many of you know Aliceann, who has been with MEA since 1987. Her husband passed away recently after months of illness. Please join us in conveying our sympathies to her. My husband and I visited our daughter, Nora, who just completed her junior year at Davidson College in NC. She is majoring in Psychology with a concentration in math. She wants to go into business. She turns 21 this summer!

Inside MEA's Fall/Winter 2008 Newsletter

Matossian Eye Associates Welcomes Dr. Ilya Rozenbaum
Ilya Rozenbaum, M.D. is a summa cum laude graduate of the University of Maryland at College Park and New York University School of Medicine, where he was elected to the medical honor society Alpha Omega Alpha. He received his ophthalmology training at the New York Eye and Ear Infirmary in Manhattan. Dr. Rozenbaum, his wife, and 3-year-old daughter just moved to Jenkintown, PA. He is available to see patients in both our Ewing and Doylestown offices. He specializes in the medical and surgical treatment of glaucoma and cataract surgery. Please join us in welcoming him to MEA.

Ilya Rozenbaum, M.D. had the following published recently:
Rozenbaum I, Ritch R. Eye on the Web:
The Faces Behind the Eponyms. Arch Ophthalmol.
2008;126(6):846.

Rozenbaum I, Ritch R. Eye on the Web:
Four Eyed Fish. Arch Ophthalmol.
2008;126(5):733.

(At the time of writing, the following are “In Press”:)
Rozenbaum I, Ritch R. Eye on the Web:
Video Gonioscopy Atlas. Arch Ophthalmol. In Press.
Radcliffe N, Liebmann J, Rozenbaum I, Sbeity Z, Sandler SF, Tello C, Ritch R.
Anatomic Relationships Between Disc Hemorrhage and Parapapillary Atrophy.
American Journal of Ophthalmology, In Press.

Smoking & Your Eyes
The harmful effects of smoking on the body have been known for many years. Some of these effects can be learned by simply reading the warnings on the package. Not only does smoking increase the risk of lung related diseases, certain cancers, heart disease and fetal injury, recent studies have demonstrated that it can also increase the risk of dry eyes, cataracts and even blindness.

In one study, heavy smokers (at least 1 pack/day) experienced a higher rate of dry eye symptoms (foreign-body sensation, burning, stinging) than non-smokers. This appears to be related to damage to the oily layer of the tear film. In another study, heavy smoking appeared to increase the risk of cataract formation 3 times that of non-smokers. Finally, the study that showed an even more alarming association of the effects of smoking on the eye is the risk of blindness. In this study of 222 twins, smokers had a 1.9 times increased risk of macular degeneration which can lead to blindness.

If all previous side effects of smoking were not reason enough to quit, then perhaps the awareness of ocular complications may be a strong argument to stop.

Diabetes & Dry Eyes
Diabetes, if not treated properly, can lead to various health problems including complications with the eyes. In the United States, it is one of the leading causes of irreversible blindness in patients under age 65. Many do not realize that diabetes is also associated with cataracts, glaucoma, and according to recent studies, dry eyes.

Dry eye syndrome has many causes such as aging, medications, menopause, the environment, certain disease processes and prolonged visual tasks. In the case for diabetes, decreased corneal sensation is the cause for dry eyes. This decreased sensation interferes with the neural feedback loop from the cornea to the lacrimal gland (main gland of the eye that produces tears) causing decreased tear production. According to some of the studies, the incidence of dry eyes is greater if patients have underlying poor blood sugar control, peripheral neuropathy and advanced diabetic retinopathy.

Diabetic patients already know that they should have an annual dilated eye exam. Now that there is evidence showing a correlation between diabetes and dry eyes, it is that much more important for diabetics to keep their regularly scheduled eye exams. Treatment options for Dry Eyes can help with the annoying gritty sandy sensation caused by this condition.

The Effect of UV Radiation on the Eye
Today the harmful effects of ultraviolet (UV) rays on our skin are well known but few are aware of the damage they cause to the eyes. UV radiation can be divided into two components: UVA which has lower energy but penetrates deeper into the eye and UVB which has higher energy and is more damaging. More than 99% of UV is absorbed by the cornea (clear dome over the front part of the eye) with some of the rest reaching the retina.

UV radiation can play a role in the development of various ocular disorders including cataracts, pterygia/pingueculas (growth of tissue on the white portion of the eye that can extend on to the cornea), cancer of the skin around the eye, photokeratitis (sunburn of the cornea) and possibly macular degeneration.

Most people would not go out into the sun without putting sunscreen on their skin and the same protective precautions should be applied to the eyes. Recommendations to minimize UV exposure to the eyes include: a brimmed hat or cap and UVA & UVB absorbing sunglasses or other eyewear. These recommendations are for everyone including children.

Matossian Eye Associates Participating Insurance Plans as of Sept 2008

• Aetna
• AmeriHealth – All Products
  • Amerihealth Administrators
  • Keystone Health Plans
  • Independence Administrators
  • Independence Blue Cross
  • Personal Choice
  • Blair Mills Administrators
• American Postal
• Beech Street PPO
• Horizon Blue Cross Blue Shield NJ
  All Products
  • Managed Care (HMO)
  • Indemnity
  • PPO
  • Medicare Blue
• Cigna
• Devon Health Plans PPO
• First Health PPO (formerly The Affordable)
• First MCO
• GHI
• Great West
• Guardian
• Health Net
  • PPO
• Health Assurance
• Highmark
• Humana
• Insurance Administrators of America (IAA)
• Magnet/Magnacare PPO
• Mail Handlers
• Medicare
• Medicare Railroad
• New Jersey Manufacturers
• One Health Plan
• Oxford
• Private Health Care Systems PPO (PHCS)
• QualCare
• Time Insurance Company
• Tricare
• US Family Health Plan (USFHP)
• United Health Care
• Golden Rule
• Well Choice (formerly Empire Blue Cross)

• The staff of MEA

  The staff of MEA enjoyed a beautiful evening at a Trenton Thunder baseball game in July. Pictured above is Dr. Matossian with mascots Boomer and Strike. MEA is the official team ophthalmologist for the Trenton Thunder.

  MEA was selected as one of few sites in the US to be involved in a Phase II clinical trial for a new product from Ista Pharmaceutical for Dry eyes.
• Cynthia Matossian, MD gave a presentation on Xibrom, a non-steroidal anti-inflammatory medication used in cataract surgery, in NYC, to a group of ophthalmologists in June 08.
• MEA is honored to be selected as one of few sites in the US to be involved with an Allergan Combigan glaucoma trial which is currently underway.
• Cynthia Matossian, MD was invited to be a speaker to a group of ophthalmologists in Lehigh Valley on Crystalens, the advanced technology cataract implant with its paired use with Xibrom.
  

Inside MEA's Spring/Summer 2008 Newsletter

• Positive family history of glaucoma
• Diabetes
  
• Steroid use (oral, inhaled, topical, or drops)
• African-American race
  

• MEA staff has fun bowling.

  MEA doctors and staff attended the annual Vision Expo on Saturday, April 12 at the Jacob Javits Center in NYC to learn about the latest options in contact lenses and eye testing equipment.
  
• Cynthia Matossian, MD was invited to be a consulting participant at an ophthalmology meeting in Miami this February.
  
• MEA doctors and staff went bowling in March for some fun & time together outside the office.
  
• Clayton Grinage, COE, Practice Administrator, attended the ASCRS (American Society of Cataract and Refractive Surgery) annual conference
  in Chicago this April. He took multiple courses on practice management.
  
• Alan Szczesniewski, DO attended a conference for continuing education in Scottsdale, Arizona in May.
• In January, Joan Micucci, COMT presented a talk on THE AGING EYE to a group of senior citizens.

• avoid wearing your contact lenses longer than necessary
• do not sleep in your contact lenses
• adhere to the recommended replacement schedule
• clean and sterilize your contacts daily with the recommended solution
• rub the contacts between your fingers for daily cleaning
• do not mix and match contact lens cleaning products
• keep your contact lens case clean and refill with fresh solution daily

Steroids:Glaucoma and Cataracts

• Clayton Grinage, our Practice Administrator, passed the Certified Ophthalmic Executives exam. The COE is a standard measure of achievement in ophthalmic practice management. There are only about 200 COE certified administrators within the USA. Congratulations!
• Victor Chin, MD passed the written part of the national ophthalmology boards. Congratulations!
• Frank Lee, MD passed the oral part of the national exams and is now fully certified by the American Board of Ophthalmology. Congratulations!
• Benjamin Rowe, OD is lecturing on dry eyes in Doylestown, PA.
• Jennine Lutz, OD is lecturing on dry eyes in Hamilton, NJ.
• 6 staff members attended a conference in NYC on multifocal intraocular lens implants in September.
• Dr. Matossian attended a course on cataract surgery updates in NYC in October.
• Drs. Alan Szczesniewski and Cynthia Matossian are attending the American Academy of Ophthalmology annual conference in New Orleans this November.
• MEA is scheduled to perform multiple glaucoma and vision screening events throughout our NJ and PA communities over the next few months. This is our way of giving back and helping those we can reach.

• Proper fit & appropriate choice of lens material
  
• Diligent & correct lens care
• Adherence to recommended replacement schedule
• Minimize lens wearing time to give the cornea a healthy break
• Use of the new lipid restorative lubricating drops before insertion and after removal of contacts

• MEA Practice Administrator, Clayton Grinage, will be taking an exam in San Diego during the American Society of Ophthalmic Administrators annual meeting to become one of only 200 nationwide Certified Ophthalmic Executives. This is the highest level credential that an Ophthalmology Practice Administrator can achieve. We all wish Clayton the best of luck!
• Jennine Lutz, OD and Jennifer Viscusi, OD took a 30 hour Continuation Education course called 2007 Credentialing for Oral Pharmaceuticals in New Jersey. They also took an 8 hour CPR course for the Professional Rescuer.
• Ophthalmic technicians Joan, Cathy, Debra, and Betsy attended the Wills Eye Annual Conference on cataract surgery in Philadelphia this March.
• Ben Rowe, OD is scheduled to speak on Dry Eye Syndrome at the Health and Wellness Center (PA) on Wednesday, May 2nd at 6:00 PM. Please call Aliceann at 609-323-1560 Option 4 to sign up.
• Almost the entire MEA staff attended the Vision Expo conference in New York City on March 24th at the Jacob Javitz Center.
• Kristina completed her certification as an ophthalmic assistant in late 2006. Congratulations!
• Cynthia Matossian, MD and Benjamin Rowe, OD are official preceptors for Pennsylvania College of Optometry interns.
• Megan and Kristina, ophthalmic assistants, attended an A-scan course. This ultrasound procedure helps in the calculation of the implant power required for cataract surgery.

A PERSONAL MESSAGE FROM DR. MATOSSIAN
Lots of good things are happening at MEA. My daughter is about to complete her
Freshman year at Davidson College outside of Charlotte, NC. She absolutely loves it. She is concentrating on math yet completing all the requirements. She is spending hours on Lake Norman practicing for crew. Their team has done very well throughout the Southeastern region.

Dr. Szczesniewski and his wife are expecting their second baby. Dr. Viscusi and her husband just had their 2nd child. Dr. Viscusi will be on maternity leave for 4 months. We have interim optometrists in Ewing and Hyde Park covering for her.

My husband and I will be traveling to France this spring to visit friends and family. My Mom had some heart problems early last winter. She is doing well and is back on the road to recovery. Thank you for all of your well wishes and concerns. Enjoy the glorious spring weather.

Inside MEA's Fall/Winter 2006 Newsletter

Michael Starrels, MD & Doylestown Eye Associates have joined Matossian Eye Associates
This fall, Michael Starrels, MD and his practice of Doylestown Eye Associates have become a part of Matossian Eye Associates. We are proud to welcome Dr. Starrels aboard. As an honored member of Doylestown Hospital and its dedicated medical community, Dr. Starrels has been in private practice for 27 years. Dr. Starrels completed his residency in ophthalmology at Wills Eye Hospital, one of the country’s highest regarded training centers.

Dr. Starrels is continuing to see patients in the Bailiwick office of Matossian Eye Associates. Appointments can be made with Dr. Starrels by calling 215-345-8142 as before. With this partnership, we reinforce our commitment to provide you with the finest eye care available in the area.

Glaucoma and compliance
Many studies have shown that compliance with glaucoma medications is very poor, especially if there are several different bottles involved. In other words, we are all human and either forget or ignore our prescribed glaucoma drops. To boost compliance, doctors need to know how individual patients use their drops and what prompts them to miss doses, such as travel or weekend activities. The Travatan Dosing Aid (TDA) is the first tool that makes it easier for patients to use their eye drops. The TDA makes it more comfortable to hold and squeeze the bottle without wasting the expensive medication. The TDA also acts as a monitoring system alerting the patient that it is time to use the drops. The TDA records the time and date when the drops are used. By plugging the TDA into the computer at each office visit, the drop utilization history is printed. We are proud to announce that MEA was selected as 1 out of 500 study sites across the US for the
TDA. This new technology will help us better understand your pressure patterns at each office visit and thereby individualize your anti-glaucoma therapy.

Higher risk of multiple falls among elderly women with decreased vision
A recent study by Coleman et al. has linked a decrease in vision with an increased incidence of falls in women 65 years or older. This study involved 2,002 women. Those who had lost 10 letters or more of visual acuity during a 5 year period were associated with 43%greater odds of frequent falls than their counterparts who either had no decrease in their vision or those who had improvement in their vision through cataract surgery. The authors conclude that in an effort to prevent falls, older individuals should be referred to ophthalmology in order to ensure best corrected visual acuity. The latest technology in intraocular implants for the correction of vision loss from cataracts is available at Matossian Eye Associates. The Tecnis implant with its wave front designed surface is the only implant approved by the FDA for improved contrast sensitivity. This feature not only helps reduce falls but it also helps reduce accidents while driving by enabling a person to react 0.5 seconds sooner at dusk going 55 MPH. The ReZoom multifocal implant with its 5 concentric zones allows patients to see both at distance, intermediate and near 92% of the time without spectacles. Please call our office if you are interested in being evaluated for cataracts.

Day Care Centers a source for indoor allergens
Day care centers are an important source of exposure to items such as animal dander, dust mites, fungi, and mouse allergens, which can cause allergies in infants and toddlers. Most of these microscopic findings were detected in the carpets at the facilities. According to a press release from the American Academy of Allergy, Asthma & Immunology, 97% of day care centers tested positive for dog and cat allergens although animals were not permitted in most of the facilities. Carpeted surfaces had significantly higher levels of allergens indicating that carpets act as a reservoir. Symptoms of itchy, red, and watery eyes in kids attending day care centers may be a sign of an allergy.

Mandatory protective eyewear for sports
The State of NJ law # 2091 effective July 2006 requires anyone who wears corrective eyeglasses while participating in racquetball, squash, tennis, women’s lacrosse, basketball, women’s field hockey, badminton, paddleball, baseball, softball, or volleyball sponsored by a school, community, or governmental agency to wear protective eyewear that meet specified frame and lens standards. Every 13 minutes a person in the United States goes to the emergency room because of a sports related eye injury. New Jersey is the first state to mandate sports protective eyewear in an effort to decrease the needless loss of sight that occurs while playing sports.

Eye pressure and Yoga
There was a consistent 2-fold increase in the intraocular pressure (IOP) during Sirsasana (Headstand posture) in Yoga practitioners. The asanas (postures) are part of a form of yoga called postural yoga, practiced since the 2nd century AD in India and now in many parts of the world. At least 7.5% of Americans and 7% - 48% of Europeans practice some form of yoga as either a form of well being or an alternative form of therapy for chronic illnesses. This pressure elevation was maintained during the posture in all age groups. There was no correlation between major risk factors for glaucoma such as age or optic nerve cup size with the magnitude of IOP increase owing to habitual Sirsasana. The prevalence of ocular hypertension among yoga practitioners was not higher than that of the normal population. Based on these findings, this study from Ophthalmology August 2006, a publication of the American Academy of Ophthalmology, found no evidence to rule out glaucoma in young subjects practicing Sirsasana; older subjects at higher risk of glaucoma should undergo routine eye evaluation.

WHAT’S NEW with MEA

• Victor Chin, MD has started at MEA. Dr. Chin graduated from Princeton University, attended Mt. Sinai School of Medicine in NY, and completed his ophthalmology residency at Tufts’ New England Eye Center in Boston. His focus is eyelid surgery.
• Congratulations to Kristina Farley for passing her national certification test as an ophthalmic assistant. She is now a certified ophthalmic assistant, COA.
• Joan Micucci, COMT and Dr. Matossian will be attending the American Academy of Ophthalmology annual meeting in Las Vegas next month. Both will be taking many courses.
• Alan Szczesniewski, D.O. is attending the American Osteopathic College of Ophthalmology Midyear Seminar in Philadelphia this Fall.
• All of the staff at MEA just renewed its CPR training. We are proud to let you know that everyone is certified.
• Congratulations to Jenny Kauffman for passing her exam & becoming a certified ophthalmic coding specialist. She also just had her second child, a son named Jalen.
• Cynthia Matossian, MD attended a recent conference on refractive cataract surgery in NYC to acquire the latest techniques for spectacle independence by using multifocal implants for improved distance, intermediate, and near vision.

A PERSONAL MESSAGE FROM DR. MATOSSIAN
Our daughter, Nora, started her Freshman year at Davidson College just outside Charlotte, N.C. Davidson was her first choice. Ranked 10th in the country for small liberal arts colleges by US News and World Report, I am sure she will be appropriately challenged. She is very happy, with an initial interest in math as her major. My husband and I are getting used to the “empty nest syndrome.” We plan to travel when time permits. Our next trip is to California for a visit to one of the pharmaceutical companies so I can better understand their research and development strategies.

Our MEA family continues to grow. Dr. Rowe’s son and Dr. Lutz’s daughter are growing beautifully; Dr. Viscusi and her husband are expecting their second child this spring.

Our Hamilton office will be open 5 days per week Monday through Friday with 2 evening sessions on Tuesdays and Wednesdays starting October 2006. Please let us know if you would like your chart transferred from our Ewing office to Hamilton. Wishing you a healthy Fall and upcoming holiday season.

Inside MEA's Spring/Summer 2006 Newsletter

New Contact Lenses for the Dry Eye
Although millions of new patients try contact lenses each year, an equal number of patients give up lens wear. Most of the patients who drop out of contact lenses do so because of discomfort. Often, this discomfort is described as a sensation of “dryness” that gets worse as the day wears on. Several types of materials have been suggested as optimal choices for the dry eye patient. These include high and low water content soft lenses as well as silicone hydrogel materials. In addition to traditional hydrogels, several contact lens brands are specifically designed for dryness. What sets the silicone hydrogel contact lenses apart from others is their ability to transfer high amounts of oxygen through the contact lens material to the cornea. Some studies suggest that getting more oxygen to the cornea translates into more comfort. While added oxygen may contribute to comfort, it is clearly not the whole story.

Attention to contact lens cleaning systems must be paid. Cleaners and disinfectants from different brands cannot be mixed since they can cause a subtle chemical reaction leading to mild irritation. This, in turn, can be mistakenly interpreted as “dryness” by the patient. Please adhere to the specific cleaning system that your Contact Lens specialist has recommended for you.

Over-wearing contact lenses can also cause a sensation of “dryness”. Researchers have found that corneal infiltrates or ulcers occur eight t i m e s more frequently in extended wear patients. Sleeping in your contact lenses increases your risk of corneal infections. Systemic medications such as anti-histamines or allergy medication can cause dryness of mucous membranes, which becomes more noticeable in the contact lens wearer.

Even though end-of-day dryness and discomfort are not medically serious conditions, they are more than an inconvenience. It is important, therefore, to be using the most appropriate contact lens for you. Please contact our office to be fitted with the special contact lens that is just right for you.

Glaucoma screening for siblings of glaucoma patients
Siblings of glaucoma patients have an increased risk of developing glaucoma, and the risk increases with age, according to a study by British researchers. Between 1994 and 2003, a group of siblings of open-angle glaucoma patients underwent extensive ophthalmic examinations.

At the initial evaluation, 12% of the siblings were classified as glaucoma and 5.5% were classified as glaucoma suspects. In the follow up study, an additional 7% of the “normal” siblings were classified as glaucoma and 20% as glaucoma suspects. Researchers noted increasing prevalence of glaucoma among
siblings with age. The lifetime risk is estimated at approximately 20% by age 70. If you have glaucoma or are diagnosed as a glaucoma suspect, please urge your siblings to have their eyes checked.

Soccer Eye Injuries are a Global Concern
Severe ocular injuries can be sustained on the soccer field according to an analysis of soccer-related eye injuries at the São João Hospital in Portugal. The worldwide popularity of soccer makes the risk of injury a public health issue. Researchers found that many of the injuries involved the lids and the front part of the eye resulting from blunt trauma from the ball. Because of the force and impact angle of the ball, bleeding inside the eye as well as retinal injuries were quite common. Most injuries occurred around the goalpost. More injuries occurred in indoor soccer compared to outdoor soccer. The need for protective eyewear in soccer has remained far less clear than for other sports such as hockey or racket sports. Though protective eyewear is not mandatory, researchers recommend adequate eyewear for soccer players of all levels that conform to the American Society for Testing and Materials (ASTM) Standard guidelines.

New Sutureless Corneal Transplant Surgery
2005 marked the 100 year anniversary of the first successful organ transplant. In 1905, Dr. Eduard Zirm, in what is now the Czech Republic, transplanted a cornea into a patient who had been blinded by an industrial accident. Since that time, advances in instruments, medications, and eye banking have dramatically increased the success of such operations, but the basic surgical technique has remained the same - until now. Over the last century, the premise of the surgery has been to replace the entire central cornea with a new donor cornea. However, scientists have long realized that many corneal diseases are caused by a malfunction of only a very thin layer of corneal tissue. Recently, techniques have been developed to allow replacement of only the diseased layers of cornea, allowing the normal layers to remain. Selective surgery such as this allows for sutureless surgery with much faster healing time, less visual aberrations, and lower risk of wound problems. Dr. Gerald Rosen is one of few cornea specialists who is trained in this new surgery, and is proud to offer this advance in corneal transplant surgery to our patients.

Eating Tuna & Walnuts Could Prevent Dry Eyes
Dry Eye syndrome in post-menopausal women is very common and may be linked to their intake of dietary fat, according to a study published in the American Journal of Clinical Nutrition. Consuming foods rich in omega-3 such as tuna may reduce dry eye risk by 68% according to a recent study at the Brigham & Women’s Hospital and the Schepens Eye Research Institute both in Boston. B. Miljanovic, MD analyzed data from more than 37,000 women. “We found that a high intake of omega- 3 fatty acids, often referred to as a ‘good’ fat commonly found in tuna and walnuts, is associated with a protective effect. Conversely, a higher ratio of omega-6, a fat found in many cooking and salad oils and animal meats, increased the risk of dry eye syndrome,” Dr. Miljanovic wrote in the report. In conclusion, women with the highest levels of dietary intake of omega-3 reduced their risk of dry eye syndrome by 20%, compared to women with lower levels of omega-3 in their diets. Other kinds of fish that contain lower levels of omega-3 did not seem to help protect against dry eye syndrome.

Insurance plans and referrals:
We value our relationship with you and the fact that you have selected Matossian Eye Associates (MEA) as your eye health care provider. Health care coverage has changed, especially for a specialty like Ophthalmology. We deal not only with hundreds of different insurance plans and their variations, but also with stringent requirements regarding visits that must be categorized as either medical or routine vision care.

It is your obligation to know your insurance plan, what it covers and does not cover, and what authorization for treatment is required. It is not fair to expect us to figure out for you what your plan requirements are. If you are not familiar with your eye care benefits, please call the customer service number on the back of your insurance card. Thank you for your consideration and cooperation. We are pleased to serve you and care for your vision.

Congress approves legislation to ban decorative contact lenses from over-the-counter sale
The risk of vision-threatening infections is increased when individuals purchase cosmetic contact lenses over the counter instead of visiting an eye care professional. Until recently, decorative contact lenses were available at some beauty parlors, T-shirt shops, delis, and gas stations. Contact lenses require precision fitting and extensive care instructions. Decorative contact lenses purchased from non-licensed vendors were not accompanied by proper instructions or fit. The rate of vision threatening infections was on the rise. This led Congress to pass a ban on these contacts. If you have any decorative contact lenses, please discard them immediately. They may be very harmful to your eyes.

Smoking and the risk of macular degeneration
There is evidence that smoking is a risk factor for age related macular degeneration (AMD). A British study compared current and former smokers and non-smoking patients and determined that smoking was a risk factor for AMD. Researchers found a strong association between AMD and pack-years of cigarette smoking, the odds ratio increasing with the amount smoked. Stopping smoking was associated with reduced odds of AMD and the risk in those who had not smoked for more than 20 years was comparable to those of non-smokers. The risk profile was also similar for men and women. Passive smoking exposure was associated with an increased risk of AMD in non-smokers. The authors believe that the results provide a causal relation between smoking and AMD.

WHAT’S NEW with MEA

• Several staff members along with Cynthia Matossian, MD attended
  Vision Expo at the Javitz Center in NYC in April.
• Nina Yepez, MD attended the annual Academy of Ophthalmology and Retina sub-specialty day conferences in Chicago this October. She also attended a recent conference at Wills Eye Hospital: Changing Innovations in the treatment of macular degeneration.
• All MEA staff and physicians were recently certified in CPR.
• Cynthia Matossian, MD attended a two day glaucoma conference as well as the complex cataract surgery symposium at Wills Eye Hospital this winter.
• Megan and Kristina, two of our ophthalmic assistants, attended a cornea course at Scheie Eye Institute. Cathy and Kristina attended a B-scan and A-scan course in Philadelphia.
• Robert Cherewich, Practice Administrator, attended a conference in March sponsored by the Medical Group Management Association (MGMA) addressing Practice Performance. He also attended the American Society of Ophthalmic Administrators (ASOA) Conference this spring focusing on practice management.
• Gerald Rosen, MD has been promoted to "Assistant Surgeon" rank at Wills Eye Hospital.
  
• Joan Micucci, COMT, supervisor of our ophthalmic assistants, attended a comprehensive course in Plymouth Meeting, PA on technician skills.
• Cynthia Matossian, MD was selected as one of “America’s Top Ophthalmologists – 2006” by the Consumers’ Research Council of America. She is among a select few who have earned this prestigious recognition.

A PERSONAL MESSAGE FROM DR. MATOSSIAN
We were blessed with a mild winter and little inconvenience due to snow. But it was a very busy season in the baby department for Matossian Eye Associates. Dr. Lutz & her husband had a girl at the end of October; Sue, our receptionist in Doylestown, gave birth to her honeymoon baby, a boy in February; and Dr. Rowe’s wife is expecting their baby any minute now. All are back to work at MEA. Jenny, of our billing department, is due to deliver her second child in June. Congratulations to all! My daughter, Nora is finishing her senior year in high school. She is rowing crew this spring. She is trying to decide which college to attend this fall. Her choices are all small liberal arts schools in the south. It amazes me that she was born at the beginning of my second year in practice! That means MEA will be celebrating its 19th birthday this June, just before Nora turns 18.

We are delighted that Frank Lee, MD, will be joining us in July after he completes his fellowship in glaucoma at the Scheie Eye Institute in Philadelphia. Please join me in welcoming him to our community. I love the spring and summer seasons, especially the warm weather. I hope all of you will enjoy it, too!

Inside MEA's Fall/Winter 2005 Newsletter

VIAGRA AND VISION LOSS
Recent news reports have implicated Viagra with potential loss of vision from non-arteritic anterior ischemic optic neuropathy (NAION).

NAION is the most common acute optic nerve disease in adults over 50. Although the exact etiology of NAION is unknown, many of its risk factors are similar to those of erectile dysfunction, such as ischemic heart disease, hypertension, hypercholesterolemia, diabetes, smoking, and increased age. Vision loss due to NAION is believed to be caused by a reduction of blood flow to the optic nerve. Most affected patients describe a sudden onset of decreased vision in one eye. The degree of visual loss can vary and, and in most cases, does not include complete blindness. Usually, the visual loss is permanent and there is an increased lifetime risk of having the second eye involved.

The phenomenon of blue-tinged vision experienced by a small percentage of men in the Viagra clinical trials was found to be a temporary side effect with no long-term consequences to vision. The effects of Viagra on ocular blood have been assessed in a number of studies some of which were funded by independent research grants. Data from these studies have consistently demonstrated that Viagra shows a positive to neutral effect on blood flow in the eye.

Pfizer, the manufacturer of Viagra, has completed a comprehensive review of its clinical data base to better understand any relationship between Viagra and NAION. Based on this review, Pfizer states that men taking Viagra are no more likely to develop serious vision-related adverse events including NAION than men of similar age and health who do not take Viagra. They feel there is no causal link between Viagra and loss of vision.

More independent long term studies are required to better understand any potential association between visual impairment and Viagra.

ReZoom: A new multifocal Intra-ocular lens implant now available
The ReZoom Intraocular lens (IOL) is a new second generation multifocal IOL that lets certain cataract patients resume their lives with a full range of vision. This new implant distributes light over five optic zones similar to its predecessor called Array. There is a large distance dominant central zone for distance viewing in bright light conditions as well as a distance dominant 3rd and 5th concentric zones. The remaining zones are for near and intermediate vision.

Patient selection is key for this implant. Adults need to be farsighted and have very little astigmatism. For those patients who meet the criteria, the ReZoom IOL can provide independence from spectacles in most situations. According to the manufacturer, 92% of patients with the ReZoom IOL seldom need to wear glasses to see distance, intermediate, or near. If you are interested in this new technology, please call our office and ask for an appointment with Dr. Matossian.

Ocular Complications of Weight Reduction Surgery
Bariatric Surgery, commonly referred to as gastric bypass surgery, is a treatment option for obesity in the United States that is gaining popularity. The dramatic rise in bariatric procedures is reflected in the rise of morbid obesity in our country. Because of the anatomic alterations and dietary changes resulting from this surgery, concern for adequate vitamin absorption with the potential for vitamin deficiency, including decreased Vitamin A, is a real worry.
Vitamin A is one of the essential vitamins that must be acquired through the diet. Deficiency in Vitamin A could result in malnutrition, malabsorption syndromes, or a breakdown of ocular metabolism. A recent report found the prevalence of Vitamin A deficiency at 54% for patients 1 year after gastric bypass surgery and 69% for patients 4 years after surgery.
Vitamin A plays a key role in maintaining the health of the ocular surface. This fat-soluble vitamin is needed to keep the conjunctiva, the cornea, and the retinal pigment epithelial cells viable. With prolonged vitamin A deficiency, the cornea and the conjunctiva can become extremely dry with a dull, leathery, and scarred appearance. In extreme cases, this could lead to blindness.
Although obesity is a disease that needs aggressive treatment, the serious threat of vision loss must be considered. Adequate vitamin supplementation can prevent ocular complications in many cases.

Tinted Contact Lenses serve to give Athletes a Competitive Edge
A performance enhancing contact lens scheduled to hit the market soon allows the wearer to see an object, such as a ball, with greater clarity than with the naked eye, according to the manufacturer of the lens.

The Nike Maxisight lens, developed by Bausch & Lomb, uses “Light Architecture” to selectively filter specific wavelengths of light to enhance key visual elementswhile reducing glare.

A gray-green tinted lens was designed for sports played in bright sunlight, such as golf, football, running, and rugby. An amber-tinted lens was designed for fast-moving ball sports, such as soccer, tennis, baseball, and softball.

If you are interested in these new contact lenses, please call our office and ask for an appointment with Drs. Rowe, Lutz, or Viscusi, who specialize in contact lenses.

Retinal Hemorrhages–No Two Are Alike
One of the more serious conditions that can be detected on an eye exam is blood on the retina. These hemorrhages can be symptom free or cause significant blurred or blocked vision.

Basically, blood on the retina is not normal. The three most common reasons for retinal hemorrhages include: diabetes, high blood pressure, and high cholesterol. These conditions block the circulation of the tiny retinal arteries and veins leading to bleeding. In medical terms, they are referred to as retinal vascular occlusions. Additional causes of retinal hemorrhages can be eye trauma or age related changes in the vitreous jelly that tug on adjacent retinal blood vessels precipitating a hemorrhage. For persons 65 and older, another important cause is the growth of abnormal fragile blood vessels behind the macula, the central portion of the retina responsible for detailed vision. This blinding condition is commonly known as “wet” macular degeneration.

There is a whole host of other less common causes of retinal hemorrhages. These not only include infections & blood disorders but also side effects from medications and radiation treatments. Did you know that even pregnancy and pancreatitis can lead to retinal hemorrhages? Depending on the patient’s medical history, appropriate tests will be ordered at the time of your eye appointment.

As you can see, keeping your eye physician informed of your updated medical history and medications, along with undergoing a complete exam of the front and back of your eyes can be critical not only for the future health of your eyes but also for your entire body.

WHAT’S NEW!
Matossian Eye Associates was selected as one of 500 practices nationwide to participate in an upcoming “smart” glaucoma medication dispensing device trial to ensure better patient compliance.

Cynthia Matossian, MD attended the Advanced Techniques and Technology Cataract Surgery Symposium at Bausch & Lomb University in May in New York City.

Nina Yepez, MD was interviewed on WZBN Mercer 25 NJ Capital News Station, "WZBN En Espanol" Spanish Cable Show - - - How to maintain eye health and common eye diseases.

Jennifer Viscusi, OD just attended the OptoEast Conference where she completed courses focused on "Eyecare of the pregnant patient" and "New developments in contact lenses for keratoconus."

Cynthia Matossian, MD will be attending the American Academy of Ophthalmology meeting in Chicago mid-October.

Nina Yepez, MD attended a Johns Hopkins University sponsored conference called "Current Concepts in Retina" in early July in Montana.

Jennine Lutz, OD will be holding a seminar on the newest treatment options for Dry Eye Syndrome in our Hamilton office complex on Wednesday, October 19th, 6:30 to 8:00 pm. Please call Aliceann at 609-323-1560if you wish to register for this no charge seminar.

PERSONAL MESSAGE FROM DR. MATOSSIAN
The summer flew by. It is back to school for Nora to begin her senior year in high school. She is busy playing varsity tennis and completing those “dreaded” college applications. She wants to go to a small liberal arts school in the south.

As a family, we went to Florence and Venice this June. We all had a terrific time in Italy despite the swarming tourists (like us) everywhere.

Our office staff family continues to expand; we are planning 3 baby showers for winter babies. With our new Argon and Yag lasers, we have expanded the availability for laser procedures in all 3 offices. Our Optomap units for non-dilated digital fundus imaging are interconnected between our offices for your convenience.

Enjoy the lovely fall weather and the upcoming holidays.

Spring/Summer 2005 Newsletter

MEA OPENS HAMILTON OFFICE
Matossian Eye Associates recently opened its new office in Hamilton, New Jersey. This office is in the beautiful state of the art medical building developed by Capital Health Systems. The 46,000 square foot medical mall features an ambulatory surgical center, diagnostic radiology, a medical laboratory, and multiple primary care and specialists offices in the heart of Hamilton. All of these services are provided to patients and family in a welcoming environment featuring lots of natural light, ornamental and healing gardens. The new complex is located at 1445 Whitehorse Mercerville Road. Our office is in Suite 106. The phone number is 609-890-0772. Please call now for an appointment.

The opening of MEA's new office in Hamilton will not affect our existing offices in Ewing and Doylestown. These two offices will remain open and will continue with the current patient schedules.

Smoking: the universal risk factor
Smoking is not only a cause of heart and lung disease, it is also a trigger for the development of cataracts and age-related macular degeneration (AMD). Although the exact mechanisms of damage are not known, it is thought that smoking may increase the number of free radicals in the blood molecules that are capable of corroding tissue in the macula and lens said Lylas Mygk, MD, chairwoman of the Visual Rehabilitation Committee for the American Academy of Ophthalmology. The risk of disease may depend on how much a person has smoked and for how long. This risk may be reduced by smoking cessation but not brought down to zero. Another article by Tomay et al in Ophthalmology, the journal of the American Academy of Ophthalmology, showed pooled data to support that smoking is related to an increased risk of AMD. Current smokers were at higher risk of AMD than both past smokers and those who never smoked.

Fluorescein Angiography-- What's That?
Fluorescein ('flor-is-seen') angiography, which is better known as "the dye test," is the most common test performed by retinal specialists to help diagnose, treat, and manage retinal disease.

This in-office test should not be confused with the iodinebased tests like CT scans or MRIs people have performed in hospitals. Fluorescein is a vegetablebased dye that has been used in ophthalmology for more than 100 years. It was not until 1955, however, that this dye was first used as an intravenous injection to help identify key structures in the back anatomy of the eye. Four years later, in 1959, two medical students experimented with this dye and developed a technique of injecting the dye into the large vein of the arm in concert with rapid sequence photography of the eye. The fluorescein dye has special properties that allow it to "illuminate" in the retinal tissue when photographed by a camera equipped with special lens filters.

The photos obtained by this test enable the ophthalmologist to determine if a patient has normal blood flow or damage occurring to the blood vessels or to the retina. It is only through extensive training that the physician can develop the knowledge and expertise to interpret angiogram results accurately.

Fluorescein angiography is an essential test for evaluating conditions such as diabetic retinopathy, macular degeneration, blockage of retinal circulation, macular pucker, and various inflammations of the retina. Fluorescein angiograms can often detect subtle problems that the examination with the naked eye alone cannot pick up. Thus, this test is a critical tool that helps retinal specialists monitor and track the stability or deterioration of various retinal conditions, similar to the way glaucoma specialists use visual field testing in patients with glaucoma.

These test results are then used to plan the course of treatment. For example, the angiogram assists the retinologist in determining the exact location of a laser application on the retina. In other words, the angiogram acts as a retinal "map."

In summary, although fluorescein angiography can never replace the keen eye of the ophthalmologist, it can clearly give the retinal physician a tremendous amount of information that ultimately benefits the management and care of the patient with retinal problems. If you have any retinal or macular conditions, please call our office to make an appointment with Dr. Yepez now.

Physician neckties may harbor bacteria, spread disease.
Neckties worn by doctors were eight times more likely to harbor pathogens than were those of hospital workers not normally in contact with patients, according to a new study. Ties become contaminated when they come into contact with patients' bed sheets. Authors suggest tie tacks to hold ties to shirts, switching to bow ties, or abandoning them altogether. American Academy of Ophthalmology, Academy Express Vol. 3, No. 18 June 2004.

Prevalence of Diabetic Retinopathy among U.S. Adults
Approximately 4.1 million U.S. adults 40 years and older have diabetic retinopathy, and one of every 12 people with diabetes in this age group had advanced, vision-threatening retinopathy, according to the Eye Disease Prevalence Research Group. Among an estimated 10.2 million Americans 40 years and older known to have diabetes mellitus, the estimated crude prevalence rates for retinopathy were 40.3 % and for vision threatening retinopathy were 8.2%. Future projections suggest that diabetic retinopathy will increase as a public health problem both with aging of the U.S. population and increasing prevalence of Diabetes over time. Review of Ophthalmology Volume 4 Number 18 May 2004.

Principles leading to contact lenses date to 15th Century
Contact lenses as we know them today began in the late 1940s with the introduction of the corneal contact lens although larger sclero-corneal contact lenses were first used in the late 1880s. Even though use of contact lenses is approximately 120 years old, the basic concepts date back to the 15th century with the classic writings of Leonardo da Vinci (1452-1519). Many technological advances have been made in contact lenses over the past few years with better fitting multifocal and bifocal designs. If you are interested in contact lenses, please call our office and request an appointment with one of our 2 contact lens specialists, Ben Rowe, OD and Jennine Lutz, OD.

Computer Vision Syndrome
Surveys show that 14% of well eye exams uncover vision problems associated with computers. The most frequent symptoms include eyestrain, blurred vision, dry & irritated eyes, tired eyes and headaches. Neck and backaches can also be related to the way patients use their eyes at the computer or to the type of spectacles they wear. Physicians at Matossian Eye Associates are committed to helping our patients who suffer from Computer Vision Syndrome.

Prospective Study of Intake of Fruits, Vegetables, Vitamins, and Carotenoids and Risk of Age Related Macular Degeneration (AMD).
A total of 464 cases of early AMD and 316 cases of neovascular (wet) AMD all with visual loss of 20/30 or worse due primarily to AMD were examined. Fruit intake was inversely associated with the risk of wet AMD. Participants who consumed 3 or more servings per day of fruits had less of a pooled relative risk compared with those who consumed less than 1.5 servings per day. The results were similar in women and men. However, intakes of vegetables, antioxidant vitamins, or carotenoids were not strongly related to either early or neovascular AMD. Archives of Ophthalmology vol 122 June 2004.

Nina Yepez, MD attended an update on the management of Diabetic Retinopathy in NYC recently.

Cynthia Matossian, MD was recognized as an EyeCare America Volunteer for 2004.

Jennine Lutz, OD took courses, and several staff members attended Vision Expo East in NYC in March.

Gerald Rosen, MD attended the World Cornea Congress in Washington, DC in April.

Cynthia Matossian, MD along with Joan Micucci, COMT (supervisor of the ophthalmic assistants at MEA) and Robert Cherewich, COE, practice administrator for MEA, attended the American Society of Cataract and Refractive Surgery Society meeting in Washington, DC. in April 2005.

Ben Rowe, OD attended a recent conference on Ocular injuries and Trauma in the greater Philadelphia area.

Gerald Rosen, MD has been certified to perform VISX CustomVue myopic LASIK treatment for nearsightedness and was just certified to perform VISX CustomVue hyperopic LASIK treatment for farsightedness which was recently approved in Dec. 2004.

Betsy Leary and Vinka Monaco attended a 3 day comprehensive course for ophthalmology assistants at Georgetown University in Washington, D.C.

Fall/Winter 2004 Newsletter

MATOSSIAN EYE ASSCOCIATES WELCOMES NEW PHYSICIANS

Robin Antonacci, MD, is now part of the Matossian Eye Associates team. Dr. Antonacci specializes in comprehensive and diagnostic ophthalmology and the surgical treatment of eyelid disorders. She is certified by the American Board of Ophthalmology. Dr. Antonacci is a graduate of Georgetown University, where she also completed medical school and her residency in ophthalmology. Dr. Antonacci brings to MEA excellent experience from her private practice work in Massachusetts and Princeton prior to joining Matossian Eye Associates.

Dr. Antonacci is a resident of Hopewell Township, NJ where she lives with her husband and their three young children.

Retina specialist Maria Cristina Yepez, MD joined the staff of Matossian Eye Associates this fall. A board certified ophthalmologist, Dr. Yepez specializes in the medical and surgical treatment of retinal diseases including diabetic retinopathy, macular degeneration and the repair of retinal tears, holes and detachments.

A cum laude graduate from Rutgers College, Dr. Yepez received her medical degree from the University of Medicine & Dentistry of NJ. She then completed her residency in ophthalmology at Hahnemann Hospital in Philadelphia, PA and a fellowship in medical and surgical retina from the renowned Wilmer Eye Institute at Johns Hopkins University in Baltimore, MD. Dr. Yepez has been a co-investigator in retinal clinical trials for major pharmaceutical and biotech companies and has published five papers in peer-reviewed journals. She is a member of the American Society of Retina Specialists and the American Academy of Ophthalmology.

A native of Ecuador who grew up in New Jersey, Dr. Yepez is fluent in Spanish. She lives in Hopewell, New Jersey with her husband and two children.

Dr. Matossian Certified by the American Board of Eye Surgery

Cynthia Matossian, MD was recently awarded certification in cataract with implant surgery by the American Board of Eye Surgery. The certification program was established to identify those ophthalmic surgeons who maintain the highest standards of eye surgery as measured by their peers. Dr. Matossian is one of only 250 ophthalmic surgeons nationwide and 14 in the New York / Philadelphia area who have earned the ABES award of excellence.

Dr. Matossian was required to submit a detailed record of 50 consecutive cataract with implant procedures so that examiners could assess her competence in the type of surgery performed, frequency of surgical complications, and visual outcomes achieved. The examiners then observed and videotaped three consecutive surgical procedures for presentation to a board of surgeons for evaluation.

Many patients ask us "What can I do to help control my glaucoma?"
The most important thing you can do if you have glaucoma is take your medications exactly as prescribed and have regular eye examination. In addition, maintaining a healthy lifestyle and eating nutritious foods may be helpful in the prevention of visual loss from glaucoma.

Exercise

Getting regular exercise is a component of maintaining good overall health. There is some preliminary evidence that regular aerobic exercise and strength training may help reduce eye pressure, a significant risk factor for glaucoma. In addition, regular exercise can improve blood flow to the entire body including the retina and the optic nerve. Some studies indicate that patients Page 3 who had sedentary life-styles and then began a regular exercise routine (20 minutes of aerobic exercise at least three times a week for 3 months) were able to reduce their eye pressure by 10 to 20 %. However, once you stop exercising, the effect wears off.

You should not stop taking your glaucoma medications. Glaucoma patients should not undertake activities in which they stand on their head or turn their body upside down such as yoga, scuba diving, or bungee jumping because this has been shown to elevate eye pressure. Also, some forms of glaucoma are unresponsive to exercise, such as angle closure glaucoma. In addition, patients with pigment dispersion syndrome or pigmentary glaucoma run a risk of increasing eye pressure from bouncing-type or high-impact exercises.

Diet 

Although no conclusive studies have shown a link between glaucoma and diet, eating healthily is the best way to ensure your body receives the proper nutrients it needs to function well. Some of the vitamins and minerals that may contribute to overall eye health include antioxidant vitamins A, C, E and minerals zinc, copper and selenium.

WHAT'S NEW!

Robert Cherewich, MEA Practice Administrator, passed the written exam for certification by the American College of Medical Practice Administrators.

Drs. Antonacci and Matossian attended a lecture in Philadelphia on Selective Laser Trabeculoplasty (SLT), the newest laser technique for the treatment of glaucoma.

The Optomap laser retina imaging technology is now available in our Hyde Park, PA office. Ask about it during your next visit.

A Personal Message From Dr. Matossian:

It feels really good to finally have warm weather again. It sure seemed like winter would never end.

It's been a period of wonderful growth for Matossian Eye Associates. Over the last six months, we have welcomed Nina Yepez, MD (retina) to the practice. We just opened our third office in Hamilton, NJ. This spring, we have two staff weddings and four staff members are expecting mothers about to give birth as you read this newsletter. We extend our congratulations to these women and look forward to them continuing with us at MEA.

My husband, my mother and I recently traveled to Argentina to visit relatives that I had never met. It was a great trip. My daughter, Nora, is now driving and about to finish her junior year in high school. She is playing varsity lacrosse and enjoys it a great deal. Since she was away at spring lacrosse training with her school, she could not accompany us to Argentina. She will be a counselor at a girls sports camp in upstate Pennsylvania this summer.

I wish all of you a healthy and enjoyable summer.