Podcast Transcript

Darryl Glover:

What’s up, ODs and eye wear lovers? We’re talking to latest trends in tech and eyecare. So sit back, relax and defocus.

Darryl Glover):

This podcast is in partnership with optometry times.

Jennifer Lyerly:

Well hello and welcome to a new episode of the Defocus Media Podcast. I’m Jennifer Lyerly and I am here with Darryl Glover as always,

Darryl Glover:

Jen, what’s going on? How’s life been treating you?

Jennifer Lyerly:

I mean, I’m not going to lie Daryl the, I don’t want Coronavirus to infiltrate this podcast, but getting a little bit crazy here, locally even, and I know patients are concerned, and, um, optometry goes on. So we’re still seeing patients. We’re still giving great care and things need to happen, like, cataract surgeries and things of that nature. So even though there’s some concern in the local area, it’s full steam ahead with eyecare.

Darryl Glover:

Absolutely. Absolutely. You know, I actually had a couple of patients today that did not come in because they weren’t feeling too well and I was like, man, is it the coronavirus? I got people really thinking about us now because back in the day they just would’ve showed up and just coughed all in my face and sneezed all over me. So you know, I’m actually pretty thankful that people are actually now starting to think about us as physicians more than anything.

Jennifer Lyerly:

You know what, that is such a great point because so many people come to the eye doctor when they are sick and it’s always baffled me why they’re at home from work, but choose to go to the eye doctor to see us and maybe that will kind of keep us a little bit healthier if people continue these personal care and respecting–and I’m like, Oh, I was sick. I shouldn’t go out in public.

Darryl Glover :

I agree. I agree. But Jen, I wanted to circle back. You mentioned something, there’s some cutting edge technology that we’re going to talk about today.

Jennifer Lyerly:

That’s right. And it’s specifically about surgery and optics available for our patients who are ready for it because the truth is, Daryl, when you are ready for cataract surgery, it is not just to medically remove a cataract anymore. This is a refractive surgery and people expect excellent visual outcomes when they have the surgery, then.

Welcoming Dr. Tersigni

Darryl Glover:

You know, here in the triangle, people are very nerdy when it comes to technology, so we always hear about what’s the latest and greatest when it comes to refractive surgery or cataract surgery or whatever it may be. So I know today’s guest is really going to educate us on some cutting edge technology when it comes to this.

Jennifer Lyerly:

Please welcome to the show Dr. Steven Tersigni. He’s an ophthalmologist specializing in cornea and cataract, especially focusing on LASIK procedures and cataract surgeries with refractive outcomes. And he’s going to break down all the technology that we need to understand. That it’s new, that our patients are going to need to understand to make the best informed decision on what surgical techniques or things above and beyond traditional surgery. They may want to pay for our pursuit out-of-pocket to get the very best refractive outcomes.

Dr. Steven Tersigni:

Hey guys, thanks for having me on today. I always love the opportunity to speak to-  with my brothers and sisters in optometry. I, you know, growing up at my training, in residency and fellowship, I worked really closely with a lot of optometrists and they actually contributed a lot to my training and I was able to see, you know, what a good job, you all do in terms of just taking care of patients and educating them and setting it up for success when they come in for procedures to have with us. So I’m happy to talk to you and all the– everybody listening about the different options people have these days.

Jennifer Lyerly:

It’s really such a pleasure to have you on the show because I love what you just said about how, you know, in optometry really what we do is we tee the patient up so that you as ophthalmologist can knock the outcomes out of the park. And the best way for us to do that is to understand what kind of toss you need basically.

Dr. Steven Tersigni:

Yeah, definitely. Yeah. Yeah. The patients who come in who are, are the already educated by their optometrist. Now you guys are on the front lines seeing them every day. You oftentimes have a good relationship with them. They trust you and if you’re able to provide them good, reliable and, you know, accurate information, it just makes our job so much easier. Uh, just and it makes the whole process so much.

Darryl Glover:

Okay. So before we get started, let’s dive into your background. Where did you go to school? How did you get into the wonderful world of eyecare? And also I want to do a little more digging because I was looking you up prior to our podcast and number one, you have a beautiful family by the way. You have management of five kids. I don’t understand how you do all this stuff at the same time. Jen and I are suffering. We just have a one kid. That’s one part. And then number two, I saw that you speak Vietnamese. I mean, tell me more about yourself, your background, and how all take place.

Dr. Steven Tersigni:

Yeah, so I speak Vietnamese. I served a mission for my church for a couple of years in, not in Vietnam, but in the San Jose, California area where there’s a big Vietnamese population. So I learned it kind of serving the Vietnamese community there. I’ve gotten a little rusty over the years just cause you don’t have a whole lot of people to talk to in Vietnamese, but I able to kind of able to get by pretty well. We have patients every once in a while to come in who speak Vietnamese or speak Vietnamese almost exclusively. And I can, I can get by and I can kinda do what I need to do to make sure they understand what they need to understand for, for procedures and whatnot. I originally, I grew up in Oregon. Both my wife and I are from Oregon. We do have five kids together. I’m not sure how we do it sometimes with five kids.

Dr. Steven Tersigni (05:32):

My wife is currently also getting her PhD in education. And she, you know, I think the way that we do it, that she’s, she’s the awesome one. She’s the one that, keeps everything together, you know, even though she’s also busy. She, you know, without her, I don’t know. I don’t know what we’d be doing, but, in terms of, you know, my background, and training, I’ve been kind of all over the place. I did medical school at Tulane university in new Orleans. I did my ophthalmology residency at Buffalo, New York. I did a fellowship at your segment and refractive surgery in Minneapolis, Minnesota. And now I’m practicing here at St. Louis at a practice called Brinton Vision where we focus on, uh, on refractive surgery, uh, kind of full spread spectrum refractive surgery.

Dr. Steven Tersigni:

Um, and that’s kinda where, where we are, where I am now. In terms of, you know, how I got into ophthalmology, it wasn’t what I was planning to get into initially. My dad is a general surgeon, so that’s what I saw growing up. When I went to medical school, that’s what I thought I wanted to do. I wanted to do what my dad did. I liked the idea of, you know, helping people, fixing their problems with surgery. But when I did my rotations in medical school, I didn’t really like the surgery rotation–general surgery rotation as much as I thought, you know, just kind of the work setting and the environment weren’t a good fit for me. The lifestyle wasn’t really conducive to having a family. I like, like I said before, I have five kids. I want to be able to spend at least some time with them.

Dr. Steven Tersigni:

So what I knew that I liked kind of the surgical aspect of fix, fixing problems in a very concrete and objective way, and you know, helping people out in that way. I had a friend who was finishing residency at LSU and ophthalmology when I was in medical school. He just recommended I do a rotation in ophthalmology. I didn’t really have much eye care exposure before that, but I did a rotation and I was just hooked from there. But it checked all the boxes of the things that I wanted to be a part of. You know, I would be helping people in a meaningful way that had a huge impact on their life and their quality of life. And I was fixing problems and the results were often immediate, at very kind of objective. You could see what you were doing. And, uh, I just loved being able to help people like that.

Jennifer Lyerly:

I love how, like you said, you’re interested in objectively, you could fix the parts that were messed up or broken or needing repair. Um, because so much of what we do as optometrists is very subjective when you think about refractive outcomes and how we refract, but we need those objective, oh, this is a clear lens. This is a clear cornea to get to that subjective way for our patients to determine their vision. So we’re, we’re so lucky to have surgeons that can do the objective part of this question that it comes to eyecare.

Dr. Steven Tersigni:

Yeah. And even with, you know, it’s nice to be able to see, you know, after somebody has a procedure, if they were minus six and then now they’re down to Plano, you’re able to see. Like this is what we did and we were able to help them in this way and you’re able to see the results. And that’s what I’d really like to be able to see.

Current Refractive Surgery

Jennifer Lyerly:

Let’s talk a little bit about refractive surgery because you did say that your, your office offers kind of a full spectrum of refractive care. You know, reports after reports on, on LASIK have kind of suggested that the rates of LASIK surgeries in the United States is relatively stagnant. We know during the recession that LASIK, just like most of our economy kind of took a little bit of a hit. Have you been seeing the interest in LASIK begin to perk back up in more recent years?

Dr. Steven Tersigni:

Uh, yeah, so we definitely have, I mean, I wasn’t around practicing during the recession. I was still in, I think I was still an undergrad and like 2008, 2009. Um, so I wasn’t able to see that downturn, but I definitely, you know, definitely saw a kind of a down turn with LASIK, uh, during that time period. But we have definitely seen a kind of a steady increase in patient interest in the recent years. Then I think there are a couple things, a couple of different things that might be driving this. One is increasing kind of patient confidence in improving technology. You know, Lasik… LASIK has been out for over 20 years now– has been, you know, 2019 was the 20 year anniversary of LASIK approval by the FDA. But, it’s just, the technology has gotten better and better over time.

Dr. Steven Tersigni:

People are seeing kind of the longterm outcomes now over the past 20 years. And, you know, patient, I think patient confidence in the procedure is continuing to increase. The other thing I think that is really driving people’s interest in refractive surgery in general is just the increase at options and choices that people have. There are multiple laser options. There’s PRK, there’s LASIK, there’s SMILE, as well as lens-based refractive surgery, which is where we’re seeing a lot of the growth that we’re seeing now, not only with like things like ICLs or we’re able to treat a lot of people who maybe weren’t good LASIK candidates in the past because of thin corneas or irregular corneas or very high prescriptions, but also with refractive lens exchange, which there’s a huge percentage of the population, who, you know, they’re these folks who used to never need glasses, who started to need readers in their forties and now maybe who are in bifocals, who are in an age range where they’re more financially stable and they’re looking into lifestyle improvement technology and they want to be able to see without glasses and have–

Dr. Steven Tersigni:

We have the technology to give that to a lot of people. And I think the, the kind of the word is getting out there. You know, we there more options these days. We’re able to customize, treatments, more as people’s ages and anatomy and health, and all these different things. And we’re able to just treat more people that we weren’t able to before, just opens the door to so many more patients and possibilities for our patients.

Who Makes a Good Candidate?

Darryl Glover:

I’d love to dive a little deeper into the various options. I mean, I would love to be able to break down each one because there’s a lot of young optometrists, millennial optometrists, and even seasoned optometrist that listen to this podcast and with the technology changing so much, let’s just take it from the top and break down the basic parameters of some things that you look for for each one of these refractive procedures that would be the ideal candidate. So when our patients come in, we can just have a little more knowledge and clarity to bring to them when we’re discussing these options for them.

Dr. Steven Tersigni:

Yeah, so I’d say the, the patient who has the most options at their disposal are the young, kind of mid-range myopes. They, they often will have the option of multiple laser procedures, you know, PRK and LASIK, you know, depending on corneal thickness or the regularity of their cornea, there’s also a SMILE, which has been around for a number of years now. It’s continuing to increase in popularity and the outcomes look great with that as well. Some people are more concerned about dry eye issues, sometimes SMILE will be better or, so a lot of times if they’re kind of a minus four range, you could do any of those options. Even sometimes, the right patient to ICL would be a good, good option for them as well. You know, a lot of the things that we’re looking at is the cornea– is the cornea safe…to use a laser to reshape the cornea.

Dr. Steven Tersigni:

If it’s not that’s either they’re not a good candidate for surgery or sometimes, they’re a good candidate for the ICL. ICL patients, you know, it’s not just these days for patients who are, uh, very high myopes. you know, if the patient has the right eye anatomy and they’re a good candidate, if they’re not a good candidate for a laser procedure and they’re in the range that the ICL can correct we’ll, you know, talk to them about the options that they have with ICL. And the ICL can give excellent vision. Uh, I think some of our happiest patients, sometimes are our ICL patients just in terms of the quality of the vision. But, you know, in terms of, it’s really hard to give– paint kind of broad, broad– in terms of, you know– ICL is a, is a great option for, for patients who are high myopes or may not be good candidates for LASIK.

Dr. Steven Tersigni:

Refractive lens exchange, you know, usually is for the crowd has become presbyopic already. And based on their prescription, whether they’re hyperopic or they’re myopic, there are different options in terms of the lenses we can use to, kind of customize their vision to help, you know, give them what they need in terms of distance and up close and, kind of customize it that way. So there’s just a lot of, a lot of great options for people these days. And it all, it all just, there are a lot of things that we look at and there’s a lot of, a lot of nuance that goes into the decision making. But.

Darryl Glover:

You know what, I’m so glad that we’re talking about this today. The other day Jen and I, we were sitting down having a conversation just about myopia, you know. With so many people becoming more myopic, we’ve seen that prescription shift quite a bit, but I was bringing up at one point, you know, Hey, I’m starting to see more people in their mid- to late twenties starting to stabilize because of the high near demand or computer or schoolwork and things like that. But I know, I know also she was telling me that she tends to see it a little younger. What age are you actually seeing people stabilized with their prescription where you feel confident with pursuing refractive surgery?

Dr. Steven Tersigni:

Yeah, so we, you know, it all is based on the patient and what they’re doing. Um, you know, how old they are. We take, you know, getting information from their optometrist, especially if they’re their referral from an optometrist. That’s extremely helpful to say. Yeah, they’ve had a stable refraction for two or three years and even though they’re 20, you know, I think things will be stable. If they’re still at school, like if they’re going to medical school, or optometry school or law school where they’re going to be reading a lot, you know, there have been some studies that show that there’s still some progression and, you know, oftentimes we’re still able to treat those patients and we can, kind of, you know, just treat the base, basically kind of treat them according to how we expect their eyes will age. If we, sometimes we can leave them with a little bit of a, you know, just a quarter, a unit of farsightedness. It gives them some growing room. And if we need to do an enhancement down the road, those, that’s often an option as well too.

Common Myths About Refractive Surgery

Jennifer Lyerly:

Are there any myths that you feel like persist among patients who come in interested in talking to you about refractive surgery? Because I know in my own practice I oftentimes will see patients very confused about, Oh, well I think I should wait till I’m in my forties or fifties, because my eyes might keep changing. And then I, you know, will often be telling them like, Oh, in my opinion, we shouldn’t wait that long. Because at that point your eyes are going to be changing for a totally different reason. But are there some general trends or comments that you hear from patients that are incorrect frequently in your practice?

Dr. Steven Tersigni:

Yeah. So one of the things, so there are a number of different things that I hear. They’re kind of myths. One thing that I’m still surprised that I hear people come in, is the fact they, they’ve told, they heard in the past that we, they, they have astigmatism and LASIK or vision correction can’t treat astigmatism. I still hear that all the time. And that is definitely a myth. That’s not the case at all. We’re able to treat astigmatism very, very effectively these days. And there are other concerns that people have about the safety and the technology. You know, modern LASIK and vision correction is, are some of the safest and most studied medical procedures in the world. Now, there are risks, but there are risks with everything. You know, vision correction has never been better or safer than it is now.

Dr. Steven Tersigni:

You know, we’re able to, you with the saturation of the treatments that’s been approved, with people tracking. I don’t– just– lots of just things over years that we’ve developed itemize and see to reduce incidents of Haze. Uh, our femtosecond lasers have gotten better and better. There are fewer flap complications, you know, glare and halo have been reduced with kind of blended zones. Just the technology is just got so much better over the years. And there’s this, there’s this myth that people have– some people have perpetuated that ophthalmologists, you know, won’t get LASIK themselves. But it’s actually been studied that refractive surgeons, you know, the ones who are doing it the most, to see, see these patients the most are actually four times more likely to have laser vision correction than the general population. And to me that’s just a Testament to how good the technology is that the people who are doing it every day, day in and day out, feel confident enough in it that they are, that they will have a performed on themselves in their, and their family members.

Jennifer Lyerly:

That’s a great stat to hear. I know a lot of times, Darryl patients will ask me why I haven’t done it. And as an optometrist, you know, we all have our individual reasons, but I think it’s great to, for them to hear from surgeons like, Oh yeah, I do this procedure and I believe in it so much. I’ve done it all myself and my family members.

Dr. Steven Tersigni:

Yeah. Another thing that we do here, you know, they, people come in thinking even though they call in, you know, asking about booking an appointment with us, they are concerned, am I too old? You know, some people think or they don’t see us because they think that they’re too old. But with our modern technology, you know, we routinely see patients in our clinic vision correction in their fifties, sixties, seventies and we even have patients that are in their eighties. And so we, you know, pretty much anybody in their twenties on up, we are able to, as long as they’re good candidates, we’re able to help them out usually.

Light Adjustable IOLs

Jennifer Lyerly

Well, let’s talk about some of the really cutting edge technology that’s changing refractive outcomes for patients in that older category that you mentioned. When they get to the seventies and eighties, it probably, if they haven’t already, going to be needing a cataract surgery. And one of the newest things that have come out in that front is light adjustable IOLs. So this is something that you’re using in your practice and you’re one of the early adopters on the technology. What do we need to know?

Dr. Steven Tersigni:

Yeah, so the light adjustable lens lens is an awesome new technology that allows us really to customize someone’s vision after a lens replacement surgery like we’ve never been able to do before. You know, in the past, the way it’s worked is we would use a modern kind of IOL formula that are excellent, but there’s still variables like the effective lens position and where the lens will settle and the capsule surgically induce astigmatism, and just kind of how a patient heals that can affect the outcomes. And especially things like having prior LASIK or RK can make it more difficult to first to predict a patient’s vision is going to heal after a cataract surgery or just any lens replacement surgery. So what the light adjustable lens does, is the procedure’s the same. They’ll, the old lens comes out the same way with phacoemulsification.

Dr. Steven Tersigni:

The new lens is a silicone lens that’s inserted the same as you would insert it for any other surgery. But it’s made up of these, uh, they call the macromers. They’re molecules that when they’re exposed to UV light, they’ll migrate and they’ll change the shape of the lens. And thus the, the refractive power of the lens. So after the initial procedure, that lens replacement procedure, we let them heal for a period of time, depending on the situation. And then we’ll get the refraction real, put that refraction into what’s called a light delivery device. And then we tell the light delivery device, kind of where we want the patient to be refraction wise, if we want them to be plano, or if we’ve gone with mono vision and got the minus one and a half or, or what have you.

Dr. Steven Tersigni:

And then the light delivery device will deliver a UV light in a pattern that causes those macromers to, to activate and kind of migrate, change the, the shape of the lens to give it the desired power. So basically we’re able to change the power of the lens up to three times actually, and allows for a customization of the patient’s vision in a way that we’ve never been able to do before. So especially a patients who maybe we wouldn’t be able to be able to do a LASIK enhancement or they’ve had prior RK or prior LASIK, it really allows us to get a level of accuracy that in a way is, is almost unprecedented.

What Are The Side Effects?

Darryl Glover:

Now, what are the side effects of this? I mean, do you get any PCOs on this? Are there any more issues with increasing maybe dry eyes? I mean, what takes place as a side effect or side result of, of this type of procedure?

Dr. Steven Tersigni:

Yeah, so, PCO, I haven’t yet seen kind of an increase in PCO. It’s still early after the procedure, you know, and most patients at some point in their lives, I would expect them to eventually, you know, get PCO that needs to be treated. Um, I haven’t yet seen any kind of increase at PCO so far. In terms of side effects, you know, the things we really need to watch out for, are there are certain contra-indications to where it’s not, not a good idea to use a lens. And those are things that would, basically where UV light could exacerbate them. So it does give a pretty hefty dose of UV light where if somebody has a bad macular disease, or if they have a prior kind of herpetic infection that could be exacerbated or a comeback back from a lot of UV light.

Dr. Steven Tersigni:

Sometimes those aren’t good-good candidates for the procedure. Just because we don’t want to worsen some, you know, macular degeneration or, or cause a recurrence of, a, you know, HSV or, you know, a shingles infection, something like that. Those are the biggest things we need to watch out for. There are also some medications, that kind of cause your, your retina and your skin also to be more sensitive to light. And sometimes those patients aren’t good candidates if they’re taking those medications or they would need to stop taking those medications just because you know, it’s, you know, the, the UV light, we don’t want it to cause any issues with the retina and you know, in an eye that has, it’s more sensitized to light from a medication. We just want to make sure we’re staying on the safe side of things.

Dr. Steven Tersigni:

In terms of dry eye, I haven’t noticed any increase, you know, of that in my patients who we’ve used the light adjustable lens. The biggest, I guess, I don’t know if you will call the side effect or just something that the patients need to deal with is these, you have to, the patient has to wear a– they’re called UV blocking glasses, up until the lens is fully adjusted and kind of what we call it locked in. So the, the macromers inside the lens, if they’re exposed to UV light from the sun, that same UV light will change the shape of the lens in an uncontrolled manner. So they’re the special glasses that the patients have to wear for a few weeks after the surgery to protect the lens from uncontrolled UV light exposure. And they have to wear these dark ones when they’re outside in the sun.

Dr. Steven Tersigni:

And when they’re inside, they wear, they wear clear ones. It’s just very important for the patient to wear those. So, it’s something we’re, we try to make sure the patient is aware and okay with upfront, uh, that they are going to be wearing these glasses for that period of time. Cause if they’re, if they don’t feel comfortable wearing the glasses, if they don’t want to wear them or they don’t feel like they can be, depended on to, to wear them consistently, then it wouldn’t be a good idea to do the procedures since it could, you know, it’s unsafe to not have a controlled, to have an uncontrolled UV light exposure on that lens.

What Is The Post-Operative Treatment Like?

Darryl Glover:

In addition to the, the sunglasses that you’re talking about, are these special glasses, what other post-op treatment is there? Are we using some type of topical drops, steroid, antibiotic, what else is being used with this procedure?

Dr. Steven Tersigni:

Yeah, so the, the general– in general, the healing with this procedure is pretty much the same as your standard cataract refractive lens exchange procedure. You know, the post-op drop regimen is the same for us, regardless of whether someone was having the light adjustable lens or kind of conventional IOL. The, you know, the only thing really that’s different for the patient, is wearing those blocking glasses and they have to see us more frequently. We do, you can do up to three adjustments. Usually we tell patients just to find two things as, as much as possible, uh, that we’ll plan on seeing them for light treatments about, uh, three to five times just because they’re the lock in procedure could sometimes you need one or two, you know, lock in procedures to really lock in the lens. So it’s what you’ve put in terms of the shape of the lens stays put long term.

Dr. Steven Tersigni:

And so we got, they got to make sure that they like us and they like seeing us, cause we’re going to be seeing them a lot in the first couple months after the surgery. And those, some of those visits can take a little longer, maybe an hour or two just cause they had to be dilated cause you have to, you have to expose the whole lens to the light. So, those are the, the two main things that are different in terms of the post-op experience for the patient. Otherwise drops are the same, and the post-op healing courses is very similar.

A Flexible Treatment

Jennifer Lyerly:

As far as what the lens can adjust for, if there’s astigmatism showing through that is unexpected. Is that something that can be adjusted with the IOL or only spherical equivalence?

Dr. Steven Tersigni:

So, yeah, definitely there, you are able to adjust both a sphere and cylinder with Light adjustable lens, so it’s a great option if someone has a lot of astigmatism to, you know, instead of thinking about maybe a toric lens, where you’re concerned about rotation, you put in a light adjustable lens, you know, have them wear the glasses for a few weeks, tell them, you know, the vision is not going to be perfect for awhile, but that lens will kind of stabilize in the bag. You know exactly where it’s going to be, you know, it’s going to stay where, where it is. And then at the three, three-ish week mark, you can start doing adjustments and correcting that, that astigmatism and dial in the just the right amount of, of kind of a toric correction that that patient needs.

Jennifer Lyerly:

I’d love to get your advice on how to talk to patients about this because you know, a higher technology like this is going to carry an out of pocket expense with it. With traditional cataract surgery, I tell my patients to expect they’re going to need glasses for their best vision afterwards. When you’re discussing this type of technology with patients, is that an expectation that they should have to? Or, or do you tell them like with this lens, our goal is that you won’t have to have the glasses for your best vision afterwards.

Dr. Steven Tersigni:

Yeah. So it’s, it’s all about, uh, the patient education and setting the correct expectations in, you know, in this group of patients, with a light adjustable lens, you know, depending on the patient, the goal can be, a high level of spectacle independence. You know, there are situations where sometimes folks who, let’s say we set them up with monovision, they still may feel like they need a pair of reading glasses every once in a while to kind of fine tune the vision if they’re threading a needle or something like that, or maybe sharpen up the distance at nighttime and bad driving conditions. But you know, we offer this, to our refractive lens exchange patients who are, you know, looking to get out of glasses as much as possible. And we’ve seen great results from that. And, so yeah, it’s definitely when talking with patients, if their goal is to, you know, get out of glasses as much as possible, I think the light adjustable lens is a, is a great tool to, to do that.

Jennifer Lyerly:

Darryl, I’m sure you’ve had this happen in patient care, but I think this is so great to have a flexible option as much as we talk about and we demo to patients a lot of times what I’ve seen, especially our myopic patients, they’re so excited about their cataract surgery, perfecting their distance vision and then they’ll come back in for their postoperative visit and they are like, Oh, I just thought my vision to be better. And I’m like, what do you mean you’re, you’re seeing 20, 20, like, yeah, but now I have to use reading glasses all the time. And it’s kind of like one of those situations where I know we talked about that and that was expected and that was normal. But until they live in those eyes, they really don’t truly understand what those eyes are going to be like. And I love that there’s like, okay, well you don’t like this. Maybe we give you a little monovision now. And there’s that investment after they live in it for, you know, a month or so where that’s editable now.

Dr. Steven Tersigni:

Exactly. Yeah. So you, you know, that situation, you can even, you know, plan for the patient to end up with monovision. And if you could have them live that for awhile and if they don’t like it, you gotta take it away with your first, uh, first adjustment. Have them live that they can say, Oh yeah, this is way better. I’m fine with wearing readers, or oh my gosh, I give me that back. And then, you know, we have another chance with a second adjustment to give him that monovision back. So it just allows us to, lets the patient to kind of test drive it a little bit, sometimes. You know, there are limits, but it does allow us a lot more latitude when, in terms of letting the patients see what their vision can be like at different situations.

Darryl Glover:

That’s very cool. That’s truly making something custom, and I know patients will love that and probably pay the premium for that as well. I mean, can you imagine that Jen telling you patients that, Hey, you can try this out and you know, they go to the surgeon and they come out with distance vision only correction when they may want to try mono and then they go to mono and love it and they have that option to go back and forth. I know it’s limited, but you know how many smiles you’d actually receive in the office and how many hugs you probably get as well?

Jennifer Lyerly:

That’s the most incredible part to this technology is so many people after their outcome probably question like, should I have done this a little bit different? Maybe this wasn’t the type of implant. Maybe I should’ve gotten that toric implant or that multifocal implant they told me about. Knowing that they’re– have some flexibility to make changes if the outcome isn’t what they wanted. You know, to me that is, that’s very much worth the presentation to our patients that this is the technology you should consider. And when the surgeon brings it up, the flexibility of your outcomes is something that is worth that out of pocket expense.

Dr. Steven Tersigni:

Yeah. We, you know, it’s hard. It’s hard for patients. You know, I haven’t gone through the process of, you know, needing cataract surgery, but you know, it’s hard for somebody coming in with no background in, you know, understanding the eyes and how they work and making big decisions that will affect the rest of your life and, you know, making it in the office and having to decide right now and there, you know, there’s money on the line as well. They have to pay money for these, for these, you know, refractive options. And this just gives the patient a little bit of breathing room where, you know, we are able to customize it afterwards and they’re able again to, to kind of test drive it and live it before everything is kind of set in stone.

Where is This Technology?

Jennifer Lyerly:

So, Dr Tersigni, how available is this technology right now?

Dr. Steven Tersigni:

So, as far as I understand, you know, that this has been approved by the FDA for awhile now. It’s been available commercially for I think, the past six months. Um, it could be wrong on, exactly on the timing there. And they’re, you know, not everybody has the technology right now. They’re, they’re only kind of certain practices right now that have the technology. We’re the only one in Missouri as far as I understand as far as I know right now. But more and more practices are, are getting it, you know, you do have to, in addition to having that lens, you have to have the light delivery device. So there’s kind of an investment that has to be made there. So there’s, it’s slowly being rolled out I think. I think we, they’re just kind of taking their time and making sure that the people who, who have it or are using it appropriately and are having good results and that this slowly kind of increased where, where it’s being offered.

What is Coming Next in The Eye Care World?

Darryl Glover:

So Dr. Tersigni, what’s next? I mean, this is cutting edge technology. You’re able to make this more custom for the patient that comes in, whether they’ve walked distance vision, monovision, going back to distance vision, you can deal with the sphere power cylinder. What’s next? I mean this is pretty cutting edge technology. I don’t know what, how much better you can get out than what’s available right now. But what do you see in the future in regards to refractive surgery down the road?

Dr. Steven Tersigni:

Yeah, so there, I, you know, I think there are a lot of things down the road. It’s a very exciting time. There are new lasers right now, LASIK, you know, excimer lasers that are being studied in US trials for FDA approval. They, there are, you know, the ICL is currently in clinical trials right now for, change the lens that would kind of reduce the amount of procedures that you’d need to do for, to have the procedure from two procedures down to just one, really kind of simplifying and improving the process there for patients. And in terms of the light adjustable lens, you know, I believe, I believe that the company is, is looking into, also in addition to adjusting sphere and cylinder also adding kind of extended depth of focus, uh, to the lens as well, so you could give them a little bit of extended depth of focus and see how they like that.

Dr. Steven Tersigni:

And you can, I believe, don’t quote me, but I believe you can, you can take it away if they don’t like some of the side effects they may have with that. So, you know, treating presbyopia in that way as well, kind of an adjust, have being able to adjust it in that way. You know, down the road and you know, there there’s always IOL technology that’s being studied. And, and you know, in my fellowship I was able to see a lot of studies and be involved in studies for, you know, IOLs that are kind of on the, on the road to approval. And it’s, I think there’s, it’s hard to say timeline wise when things will come out, but it’s a very exciting time. And this ophthalmology and refractive surgery, especially with so many new options for patients and different things that we can do at sometimes, things correcting and fixing things in ways that we used to not be able to.

Jennifer Lyerly:

Well, as soon as we can get extended depth of focus with this type of lens, just sign me up, Daryl. I’m just going to go ahead and have cataracts. Can you imagine how great that would be?

Darryl Glover:

Like Dr. Tersigni said, we are in great times in eye care and I’m looking forward to the innovation. If anyone wants to reach out to you and just learn more about you know, this technology or learn more about you, what’s the best way for them to contact you?

Contact Dr. Tersigni

Dr. Steven Tersigni:

So, so, um, if anybody you know is interested, they can always call our office. It’s a, you know, our practice is called Brinton Vision. Uh, you can Google us, there are phone numbers there on the web. You can email me with specific questions. I’m happy to answer any emails from any, you know, optometrists out there who have questions about this type of technology. My email is, S and then my last name, Tersigni, T, E R, S. I, G N. I @brintonvision.com. Have questions about this, this technology or anything else we talked about today.

Jennifer Lyerly:

Thank you again so much for your time and we can’t wait to get back with you in a couple of years when we’ve got the next round of this great technology coming out.

Dr. Steven Tersigni:

It’s been a pleasure to talk to you guys. Thanks for, thanks for having me on.

Darryl Glover:

Okay. It’s a wrap. Thank you for taking time out of your busy schedule. Hang out with Defocus Media and hope something resonated with you today. Please subscribe to our podcast and remember, we keep it 20-20 around here, pun intended. We look forward to seeing you next time.