LASIK Los Angeles, Cataract, Presbyopic Implants, ICL, Pterygium Specialist
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All posts by Rajesh Khanna, MD

ReSTOR+2.5 D VS ReSTOR+3.0 D

Comparing and contrasting Presbyopia implants ReSTOR+2.5 D VS ReSTOR+3.0 D


ReSTOR ® +2.5 D IOL with ACTIVEFOCUSTM optical layout for the patients with energetic lifestyles, such as those who

  • Participate in activities requiring more intermediate (53 cm/21 in) and distance (4 m/13 ft.) vision
  • Are not willing to compromise distance vision for a full range of vision
  • Desire more opportunity for a range of vision versus mono-focal
  • Might prefer an alternative to mono-vision
  • Desire increased spectacle independence

The ACTIVEFOCUS optical layout is crafted to take those patients’ distance vision a step further while offering the well balanced near as well as intermediate efficiency with the objective of reducing spectacle dependency for tasks like:

  • Driving and dashboard viewing while driving
  • Playing or watching live sports
  • Attending theater or performance events live

* Active-lifestyle individuals join activities that need intermediate as well as distance vision such as golf, tennis, home cleaning and also driving.


Using sharp distance vision plus well balanced efficiency at near as well as intermediate focal points, the AcrySof® IQ ReSTOR®+2.5 D IOL features:

  • 7 diffractive steps
  • 3.4 mm diameter diffractive region (8.4 mm2 total diffractive area)
  • Large peripheral zone that allocates more light to distance as pupil size increases
  • 0.94 mm-diameter central refractive zone dedicated fully (100%) to distance vision
  • -0.2 μm negative asphericity

The result?

  • ReSTOR ® +2.5 D IOL designates a lot more light to the distance focal point at every pupil size, however particularly in mesopic problems.

Light distribution at a 3.0 mm pupil aperture:

  • Distance: 69.4%
  • Near: 18.0%
  • Total: 87.4%

ReSTOR®+3.0 D Multifocal IOL

Ophthalmologists should recommend IQ ReSTOR ® +3.0 D IOL with a pupil-adaptive layout for their appropriate patients who desire:

  • A broad range of vision from 16 inches (40 cm) to distance
    • The greatest opportunity for spectacle independence
    • To engage in a variety of activities requiring near, intermediate and distant focal points

Developed to minimize spectacle dependency in all distances for the broadest array of vision, this sophisticated IOL can aid your patients refocus on the activities they love:

  • Reading
    • Cooking
    • Playing cards
    • Watching TV

Pupil-Adaptive Optic Design

Providing exceptional performance at whatsoever distances, the AcrySof ® IQ ReSTOR ® +3.0 D IOL includes a pupil-adaptive optical layout crafted to maximize efficiency in all lighting conditions with the following features:

  • 9 diffractive steps spaced closer together
  • A larger diffractive region (3.6 mm diameter, 10.2 mm2 area)
  • A 0.86 mm-diameter central diffractive zone dedicated 60% to the near focal point (40% to distance)
  • Negative asphericity of -0.1 μm

The result?

ReSTOR ® +3.0 D IOL disperses light much more uniformly in between the near and distance focal points in photopic problems, preferring distance much more as the pupil broadens in mesopic problems.

Light distribution at a 3.0 mm pupil aperture:

  • Distance: 59.0%
  • Near: 25.5%
  • Total: 84.5%

We would like to summarize that both ReSTOR+2.5 D VS ReSTOR+3.0 D are PIE manufactured by Alcon. Dr. Khanna has experience with both the styles.

MIGS- minimally invasive glaucoma surgery


MIGS is a solution for Open Angle Glaucoma, a disease of increased pressure in eye.

Open angle glaucoma (OAG) is an illness impacting an estimated 2.8 million people in the USA. It represents an approximate cost of $1.5 billion annually.  Preliminary therapy for OAG usually consists of drops that can assist in lowering aqueous humor production or boosting aqueous humor discharge uveoscleral pathway. Furthermore, laser trabeculoplasty is an additional alternative for the therapy of very early, mild, open angle glaucoma. Long-term efficiency has actually been discovered to be comparable to clinical management with drops. Commonly, pharmacologic and also laser therapy have actually been the mainstays of treatment up until the condition advances to a phase that calls for the need for trabeculectomy. This treatment is commonly reserved for those with moderate to advanced cases of glaucoma as a result of the invasiveness of the treatment and also possible complications.  While surgical alternatives had been reserved for individuals with moderate to severe glaucoma, creating micro invasive glaucoma surgical treatments (MIGS treatments) are creating brand-new alternatives for those that do not fulfill the requirements for trabeculectomy. These treatments have a greater safety profile with fewer complications and also a much more quick recovery time than various other intrusive methods. They have actually been revealed to be reliable in lowering IOP along with a patient’s need for medications, which is necessary provided a commonly reduced conformity rate for medication adherence.


Patients that are prospects for micro-invasive glaucoma surgery are:

Patients with mild-moderate glaucoma.

Primary open-angle glaucoma, pseudo-exfoliation glaucoma, or pigmentary dispersion glaucoma.

Glaucoma is uncontrolled with optimum pharmacologic treatment or there are obstacles preventing sufficient medication dosing.

Age more than 18.

Those Patients who have clinically significant cataract, their surgery may be performed simultaneously.

All patients should have a pre-operative extensive eye examination including gonioscopy and a thorough case history.


Contraindications for this treatment may include angle-closure glaucoma, secondary glaucoma moderate-advanced glaucoma, previous glaucoma surgical treatment, or significantly unrestrained IOP. Various other factors to consider include patients with previous refractive procedures along with monocular patients.

Minimally invasive glaucoma surgical treatment work by increasing trabecular outflow.

  • Trabectome.
  • iStent.
  • Hydrus stent.
  • Gonioscopy aided transluminal trabeculotomy.
  • Excimer laser trabeculotomy.
  • Suprachoroidal shunts.
  • Cypass micro-stent.
  • Reducing aqueous production.
  • Endo-cyclophotocoagulation.
  • Sub-conjunctival filtration.
  • XEN gel stent.


Trabectome is a surgical treatment established by NeoMedix (Tustin, CA). It was introduced in 2004 that allows a trabeculotomy to be executed through an interior technique. The system works by eliminating a strip of trabecular meshwork and also the internal wall surface of Schlemm’s canal in order to produce a course for the drainage of aqueous humor. The device itself consists of a one-use, disposable hand piece that is utilized for electro-cautery, irrigation, and aspiration. It is connected to a generator with a frequency of 550 kHz that enables adjustments in 0.1 watt increments as well as is managed through a 3-stage Foot Pedal Control that initiates irrigation, aspiration, as well as electro-cautery in sequence. Constant irrigation as well as aspiration allows for removal of debris as well as regulation of temperature. Furthermore, the suggestion of the Trabectome is curved at a 90 ° angle to develop a protective triangular footplate and also enable less complicated insertion right into Schlemm’s canal as well as coated to allow smoother movement within the canal. Ablation of 60 ° -120 ° enables re-establishment of the water drainage pathway. Maeda et al reviewed the end result of surgical procedures making use of Trabectome in 80 eyes of 69 patients. A mean preoperative IOP of 26.6 ± 8.1 mmHg was found to reduce to a mean postoperative IOP of 17.4 ± 3.4 mmHg within 6 months after the surgical treatment. Average number of medicines likewise lowered from 4.0 ± 1.4 to 2.3 ± 1.2 at 6 months. The research study reported no major complications, including chorodial effusion, chorodial hemorrhage, or infection.


The device is a heparin-coated, non-ferromagnetic titanium stent with a snorkel shape to assist in implantation. The device is placed using a single-use, sterilized inserter through a 1.5 mm corneal incision. The applicator is inserted right into the anterior chamber and across the nasal angle. The pointed tip allows penetration of the trabecular meshwork and insertion into Schlemm’s canal as well as 3 retention arches ensure that the device will certainly be held in place. The iStent itself is the smallest FDA approved device, measuring at 0.3 mm in height and 1mm in length. In a prospective randomized clinical trial, the effectiveness of phacoemulsification as well as stent placement compared to cataract surgery alone was assessed in 239 patients, with 116 patients receiving the stent. Patients associated with the research were those with mild-moderate glaucoma who had an un-medicated IOP in between 22 and 36 mmHg.

CyPass Micro-Stent

The device itself is a polymide, supraciliary device for ab-interno implantation. The objective of the device is to create a regulated cyclodialysis with stented outflow to the supraciliary space. The stent is 6.35 mm long with an outer diameter of 0.51 mm. throughout surgery, the implant is loaded onto a retracting overview wire, inserted through the preliminary phacoemulsification incision, and also advanced towards the sclera spur. The overview wire is utilized to execute blunt dissection of the ciliary body in order to permit passage into the supraciliary space where the stent can be placed. In the CyCLE study, 238 patients received the CyPass Micro-Stent in addition to cataract surgery treatment. In general, the device has actually shown in initial trials that there can be a considerable decrease in number of medicines used in addition to a considerable reduction in uncontrolled IOP or maintenance of a controlled IOP. This device has been recalled due to corneal problems.

XEN Glaucoma Implant

The XEN Glaucoma Implant (AqueSys Implant) was created by AqueSys Inc and is an investigational device that is presently going through medical trials. The implant itself is constructed out of a soft, collagen-derived, gelatin that is known to be non-inflammatory. The goal of implantation is to create an aqueous humor outflow path from the anterior chamber to the sub-conjunctival space. The implant is infused through a small corneal incision with using an inserter similar to those used for IOLs. Similar to various other implants, it can be done along with cataract surgical treatment. While minimal, there is company offered data readily available from worldwide trials. In general there have actually been 118 topics that have actually received the implants. The mean preoperative IOP was 23 mmHg with approximately 3 medicines. At the 12 and 18 month postoperative follow ups, the mean IOP had actually decreased to 15.4 ± 4.5 mmHg and after that 14.5 ± 3.1 mmHg, respectively. At 24 months, it was 14.3 ± 5.1 mmHg. At all-time points, the typical variety of medicines was one and 33% of patients were using no medications at 24 months.

Hydrus Microstent

It is a device which is implantable, flexible, a metal nitinol (Nickel Titanium) tube with windows (open-back stent) pre-loaded onto a hand-held delivery system which is used to implant the stent. The Hydrus ® Microstent is meant to decrease eye pressure (intraocular pressure, or IOP) in grown-up individuals with moderate to modest primary open angle glaucoma (POAG) by functioning as a support structure in one part of the natural drainage path of the eye (Schlemm’s canal). POAG is a kind of glaucoma where there is associated eye disease causing increased eye pressure and also where the eye pressure normally increases gradually. This progressive increase in eye pressure can be related to damages to the optic nerve which will impair vision significantly.

Gonioscopy Assisted Transluminal Trabeculotomy (GATT)

GATT is a kind of ab interno trabeculotomy which was defined by Grover et al in 2014. Under the guidance of a gonioscopy lens, a goniotomy is made in the nasal trabecular meshwork which functions as the entry point for the iTrack micro-catheter (iScience Interventional Corp, Menlo Park, CA), which has a 250 micron diameter. A customized method has actually likewise been explained using 4-0 nylon suture rather than the micro-catheter. Microsurgical forceps are used to advance the micro-catheter into Schlemm canal circumferentially 360 degrees, tracking its development with its illuminated distal suggestion. Once it has actually been gone through the entire canal, the catheter is externalized to create a 360-degree trabeculotomy. In their original evaluation, Grover et al reported on the 6 as well as yearend results of 85 patients; 57 patients with primary open angle glaucoma showed an average IOP decrease of 11.1 ± 6.1 mm Hg as well as fewer medications. For the 28 patients with secondary glaucoma, IOP reduced approximately 19.9 ± 10.2 mm Hg and 1.9 fewer medications. One of the most usual problem was a short-term hyphema reported in 30% of patients which resolved by one month. Considering that the original publication, Grover and colleagues have actually reported the effective use of the GATT technique in primary congenital glaucoma, juvenile open angle glaucoma, and also even eyes with prior incisional glaucoma surgical treatment. These very early results an appealing, conjunctival sparing method that can be utilized in conjunction with, or independent of cataract surgical procedure.


In patients with mild-moderate glaucoma with an IOP that has actually been unable to be controlled by medicines or who have poor medication compliance, micro invasive glaucoma surgery appears to be a feasible option. Clinical trials have actually revealed there to be a substantial decrease in IOP over periods of up to 24 months along with a significant reduction medication usage. The procedure has maintained a high safety and security profile with minimal adverse impacts. While the Trabectome as well as iStent are presently the only FDA authorized devices, there are several brand-new devices pending. Micro invasive glaucoma surgery can provide a technique of treatment for glaucoma patients that reduces dependence on medicines without the risks of more invasive procedures.



With reference to Presbyopia Correcting Implants, it is an accepted fact amongst ophthalmologists that  extended depth of focus lenses have actually increased interest in presbyopia-correcting lenses for surgeons as well as patients. As this topic relates, these implants provide an extended focal range rather than 2 unique focal points as in a multifocal lens. Although optically the Tecnis Symfony uses a unique system, functionally the Tecnis Symfony works likewise to a low add multifocal in offering patients distance as well as intermediate vision.

However like any type of lens that prolongs beyond a single focal point, the EDOF Symfony does have its constraints. Despite an ideal emmetropic result, a couple of patients complained about “spiderweb” glare, specifically while driving at night. These complaints become much more common when there is residual refractive error. These implants are certainly much more flexible of residual refractive error than conventional high add multi-focals, however, Doctors have actually learned to avoid doing mini-monovision with them due to these undesirable visual phenomena.

Around 60% of cataract patients choose presbyopia-correcting lenses, and here’s an approach the eye surgeons actually found to be extremely rational based on data from several research studies they have actually performed on patient satisfaction.

Initially, we’ll just talk about patients who are good prospects for a multifocal or EDOF lens. They have healthy and balanced maculas, controllable completely dry eye as well as fairly aberration-free corneas.

If a patient has astigmatism more than 0.5 D and also desires distance and intermediate vision, the Symfony toric is a an option.

For patients who prefer distance, intermediate as well as near, I do not recommend targeting a mini-mono-vision with an EDOF Symfony lens. A lot of these patients do not tolerate the spider-webs in the non-dominant, near eye. With low astigmatism, it likewise makes sense to do this with a Tecnis multifocal 2.5/3.25 also.

Now lets look at Restor active focus. It is yellow in color. It also provides ability to correct astigmatism.Again we do not recommend monovision with these. We have tried mini monovision in patients who were aleready employing that strategy with contact lenses. Those pateints did well. A better option, these patients will certainly do well with a ReSTOR ActiveFocus 2.5 in the leading as well as a +3.0 ReSTOR in the non-dominant eye. Therefore, we can achieve goal of reducing spectacle dependence for activities like Driving and Dashboard viewing, Playing or watching live sports & attending theatre or performance events. While Tecnis SYMFONY IOL lessens the effects of presbyopia and enable the patients to see clearly.


  SYMFONY   Tecnis Symfony is an extended depth of field lens. It works  a low add multifocal in offering patients distance as well as intermediate vision.   Patient’s complaints about “spiderweb” around lights, specifically while driving at night.         Tecnis Symfony is certainly much more flexible of residual refractive error than conventional high add multifocals for patients who prefer distance and also intermediate (but not near) vision and if they have low astigmatism.   Appropriate for patients who prefer distance, intermediate as well as some near vision.   It has high refractive accuracy but can rotate.   ReSTOR ActiveFocus 2.5   While ReStOR works on those patients who have astigmatism more than 0.5 D     With ReSTOR, patients have complaints of glare and also halos. They do not face “spiderweb” glare problems. They do well with a ReSTOR ActiveFocus 2.5 in the leading as well as a +3.0 ReSTOR in the non-dominant eye.   ReSTOR one may have desire more opportunity for a range of vision versus monofocal.         For patients who are not willing to compromise distance vision for a full range, ReSTOR is an appropriate answer. ResTOR is having more rotational stability for both eyes, again targeting emmetropia. This is important with toric lenses        


In the present scenario, multifocal intraocular lenses (MF IOLs) are the most stable,reliable and dependable method for the surgical correction of presbyopia.  While looking at the facts, residual astigmatism is one of the leading causes of dissatisfaction after the implantation of a MF IOL.  

These IOLs require emmetropia for the attainment of the best visual results, and small amounts of astigmatism that may limit visual performance significantly.  Thus, astigmatism has to be completely corrected in order to obtain the maximum efficiency of a MF IOL. Hence, we like to correct astigmatism by various methods. If it is astigmatism with spherical equivalent of zero, we perform limbal relaxing incisions at the time of cataract surgery or during follow-up period. When there is associated myopia or hyperopia we deploy advanced wavefront idesign laser vision correction achieve emmetropia.

symphony toric presbyopic implant

Symfony or Tecnis Multifocal lens for Presbyopia Treatment

Today our topic of discussion will be Symfony or Tecnis Multifocal lens for Presbyopia Treatment.

Hi. I am Doctor Khanna, here with some models of intraocular lens implants when we do cataract surgery or we want to get rid of glasses and you are not a candidate for Lasik surgery. For example, if you are 56 years old and you want to be able to see far, middle and near, then you are up for presbyopic implants. There are different types of presbyopic implants. Today, we are going to talk about the differences between ‘Tecnis’ and ‘symfony’, which are both from Johnson and Johnson.

This is how the lenses look like. This is a clear lens and this is ‘Tecnis’ and ‘symfony’. ‘Symfony’ has less rings than ‘Tecnis’ and it is considered an EDOF (extended depth of field) lens. Whereas, ‘Tecnis’ has certain ridges, which splits the incoming light into distant and near. You can see distant and near and the bimodal curve, lets you see middle. ‘Symfony’ acts like a pin hole camera where you can see middle, distance and somewhat near.

How are you going to choose between the two? If you have long hands, then choose ‘Symfony’ but if you want to real closely then choose ‘Tecnis’. If you have had previous surgery like radial keratotomy then ‘symfony’ might be a better choice. In terms of side effects, ‘Tecnis’ has glare initially which faded away and ‘Symfony’ you can see a spider web. The best option is to discuss these various choices with your surgeon and to make sure that the surgeon is comfortable with the choices.

If you have more questions about Symfony or Tecnis Multifocal lens for Presbyopia Treatment call (310) 482 1240.  You can always read my book on amazon ‘The Miracle of PI in Eye’.

Have a wonderful day.

Hydrus Microstent for Early Glaucoma

Hydrus ® Microstent is a new type of MIGS

What is it? The Hydrus ® Microstent

It is a device which is implantable, flexible, a metal nitinol (Nickel Titanium) tube with windows (open-back stent) pre-loaded onto a hand-held delivery system which is used to implant the stent. The Hydrus ® Microstent is meant to decrease eye pressure (intraocular pressure, or IOP) in grown-up individuals with moderate to modest primary open angle glaucoma (POAG) by functioning as a support structure in one part of the natural drainage path of the eye (Schlemm’s canal). POAG is a kind of glaucoma where there is associated eye disease causing increased eye pressure and also where the eye pressure normally increases gradually. This progressive increase in eye pressure can be related to damages to the optic nerve which will impair vision significantly.

How does it work?

The Hydrus ® Microstent is implanted right into the eye of glaucoma patients to help fluid in the front part of the eye anterior chamber, or AC flow much more easily through Schlemm’s canal.


When is it used?

The Hydrus ® Microstent is intended to be used during cataract surgery. This is important for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate POAG.

What will it accomplish?

In a medical research of 369 individuals, 77.2% who obtained the Hydrus ® Microstent attained a 20% or higher reduction in their IOP (intraocular pressure) compared to 57.8% (108/187) of the individuals having cataract surgery alone.

When should it not be used?

The Hydrus ® Microstent should not be used in patients who have any of the following problems:

  • When the colored part of the eye (iris) is pushed up against the drainage pathway (Schlemm’s canal) or when various other material obstructs the drainage pathway (Angle closure glaucoma);
  • Traumatic glaucoma, malignant glaucoma, or inflammation of the eye tissues (uvea);
  • Glaucoma related to the growth of abnormal blood vessels in the eye (neo-vascular); or
  • Visible birth abnormalities of the anterior chamber (AC) angle.

Treatment options of Astigmatism

Astigmatism – Everything you wanted to know about it

Diagnosis of subtle refractive errors

Nearsightedness also called myopia is a condition where objects up close appear clearly, while objects far away appear blurred. In nearsightedness, light comes to concentrate before the retina after passing through the eye lens instead of on the retina. Clinically evaluated this common eyesight problem makes distant objects appear blurry, while close objects still appear sharp. Nearsightedness affects about 25 percent of all individuals in the United States, according to the National Eye Institute.

Farsightedness, likewise called hyperopia is also a common type of refractive error where distant objects might be seen much more clearly than objects that are near. However, people experience Farsightedness differently. Some people may not notice any type of problems with their near vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any type of distance, near or far.

Causes of Nearsightedness

The majority of nearsightedness cases result from an eyeball that's too long which prevents light from focusing directly on the retina (the "screen" at the back of the eye). Nearsightedness can be caused by a cornea (clear layer at the front of the eye) that's not shaped correctly. In fact, these two problems intercept light from focusing directly on the retina. Rather, light focuses in front of the retina, which makes distant objects appear blurry. Although researchers still don't know exactly why some people develop nearsightedness while others don't, it's possible that the problem may be genetic. If one or both of our parents is/are myopic, our chances of having the problem is higher those of a person whose parents aren't nearsighted.

Nearsightedness: Signs and symptoms

Nearsightedness might develop gradually or quickly. It usually initially occurs during childhood, and also can intensify as time goes on. Signs and symptoms of nearsightedness might consist of:

• Distant objects appearing blurry.

• The need to squint to see objects clearly.

• Headaches.

• Difficulty driving because of poor eyesight, especially at night during the night.

Identifying Nearsightedness

A complete eye examination by an optometrist can quickly detect nearsightedness. Commonly, eye-clinic vision tests will certainly be the first time a parent learns about a child’s nearsightedness. Sometimes parents or teachers will find nearsightedness after seeing a child squint in order to see distant objects. Grownups may start to realize that they have the problem when they have trouble watching movies, can't see distant objects clearly while driving, or participate in other activities that involve looking at far-away objects. If someone is having trouble seeing things that are far away, it's an excellent idea to get an eye examination. Even if he/she has no symptoms of nearsightedness, it's a good idea to get an eye examination around the time you turn 40.

Then, after that experts recommend getting an eye examination:

• Every 2 to 4 years between ages 40 and 54.

• Every 1 to 3 years between ages 55 and 64.

• Every 1 to 2 years beginning at age 65.


John who is a 10-year-old shy kid came to our clinic for a consultation reporting ‘blurry vision in one eye’. His mother searched online and learned about myopia, also known as nearsightedness. She had been told by a previous ophthalmologist that her son did not need to wear glasses since the kid had said he was ‘seeing well’ last year. However, in early February, John had started complaining his right eye was getting tired very easily and he could not concentrate well when he was reading or doing near work. John enjoys playing robotic games on the computer in his leisure time, and he said that he could no longer play as much as he used to without complaining of eye strain. His mom got concerned about the rapid change in his vision and the discomfort he experiences. As she did more in-depth research about myopia or nearsightedness, she found out about the unique ‘myopia control service’ offered by Khanna institute on Google.

Interestingly, neither parent has vision issues or need for glasses. Upon further evaluation, Dr. Khanna found that John had myopia in the right eye while his left eye displayed mild hyperopia and astigmatism. This condition is generally known as ‘anisometropia’ in which the shape and prescription is distinctively different in each eye. Given the fact that he was not prescribed with glasses last year, when they were checked, it was assumed that the level of myopia at that time might have been miniscule or considered ‘asymptomatic’. The onset of myopia often begins with a low amount of nearsightedness which can often go undetected. If left untreated for long, however, myopia can suddenly spike up and result in noticeable blurry vision for long distance vision. The case of John also raised the suspicion of ‘lazy eye’ or amblyopia due to the distinct anatomical and optical differences between the two eyes. Fortunately, he can be corrected to 20/20 perfect vision with no indication of lazy eye.

 Upon extensive educational talk and discussions with John and his mother, Dr. Khanna recommended an individualized myopia control treatment for him using K.I.D.S. (Keratometric Induced Dioptric Steepening) or overnight contact lens for the right eye to slow or halt myopia progression at that time. The untreated left eye would be monitored closely to ensure that it would not develop myopia in the long run.

 After the first day of overnight lens wear, John’s unaided vision in the right eye was 20/20 or perfect vision. He noticed that not only had his distance vision improved significantly after just one night of wearing the corrective contact lens in one eye, he also reported that he could read more comfortably with little stress or strain. His mother was amazed about the great result in such a short period of time, and the mother and kid were grateful to witness the shy kid who initially hid behind his mother’s back finally showing a grin and becoming more relaxed after knowing that he could see much better than before.

If you are concerned about your child’s myopia, please visit our website and schedule a complimentary evaluation with Dr. James Giraldi at our Westlake Village office..

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Scleral Contact Lenses – a new hope


If you have actually been told in the past that you cannot wear contact lenses due to an irregular cornea or various other problems, you might wish to get a second opinion and also ask your ophthalmologist regarding scleral contact lenses.

Scleral contacts are large-diameter or larger in size than normal contact lenses or gas permeable contact lenses specially designed to vault over or cover the whole corneal surface area and also hinge on the "white" of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a flawlessly or perfectly smooth optical surface area to correct vision problems caused by keratoconus and various other corneal irregularities.

Additionally, the space in between the cornea and the back surface area of a scleral lens acts as a fluid reservoir to provide convenience for individuals with extreme dry eyes that otherwise might not endure contact lens wear.

Types of Scleral Lenses

Scleral contacts are significantly bigger than conventional gas permeable General Practitioner contacts and have a diameter equivalent to or greater than that of soft contact lenses. The smallest sclerals are around 14.5 mm in diameter, and also the biggest can be approximately 24 mm.

How a scleral lens vaults over a misshapen cornea to assist somebody with keratoconus see far better.

Large-diameter scleral and semi-scleral General Practitioner lenses hinge on the sclera and vault over the irregular cornea of an individual with keratoconus, for better vision. Increase the size of generally lenses that are 18 mm or smaller are subcategorized as mini-sclerals.

The ordinary human cornea is around 11.8 millimeters in diameter, so also the smallest scleral contacts are developed to cover the entire} corneal surface area.

In contrast, the majority of traditiona General Practitioner contact lenses are 9.0 to 9.5 mm in size and cover only 75 to 80 percent of the cornea.

An additional category of gas permeable lenses bridges the size gap between traditional General Practitioner lenses and mini-sclerals. These lenses, called corneo-scleral lenses, normally are roughly 13 to 15 mm in diameter.

Corneo-scleral lenses often} are a great {option for people who require larger-than-normal General Practitioner lenses for betterconvenience}. They also are frequently used when contact lenses are required after LASIK or other corneal refractive surgical treatment to correct irregular astigmatism.

The dimension of lens used usually is identified by the level of complexity of the condition. Milder types of keratoconus and irregular astigmatism from corneal grafts as well as refractive surgical treatment frequently are conveniently managed with scleral lenses at the smaller sized end of the spectrum.

Smaller sized scleral and mini-scleral contacts can be much easier to apply, can be less expensive and need less} care products

Much more complicated problems, consisting of advanced keratoconus, pathologically dry eyes or serious eye surface condition that may call for a huge tear storage tank, commonly are fitted with bigger scleral lenses, as they have a lot more capability to hold liquid or bridge huge adjustments in corneal curvature.

Throughout your contact lens examination as well as fitting, your eye treatment expert will certainly establish the most effective scleral lens type and also size for your particular requirements.

Scleral Contact Lenses for Keratoconus

Several optometrists as well as ophthalmologists advise scleral contact lenses for a range of hard-to-fit eyes, consisting of eyes with keratoconus.

In instances of very early keratoconus, a common GP lens might be made use of.  Nevertheless, if the lens does not center correctly on the eye or moves excessively with blinks and also triggers discomfort, switching over to a large-diameter scleral contact lens might solve the problem.

Since scleral lenses are developed to rise the corneal surface and also hinge on the much less sensitive surface area of the sclera, these lenses usually are much more comfy for an individual with keratoconus.

Additionally, scleral lenses are developed to fit with little or no lens activity or movement during blinks as they are hinged on the sclera, making them much more stable on the eye, compared to conventional corneal gas permeable lenses.

Scleral Contact Lenses for Various Other Eye Troubles

Along with keratoconus, scleral contact lenses can be utilized for various other eye problems such as eyes that have actually undergone a corneal transplant, and also for individuals with serious completely dry eyes triggered by problems such as Sjogren's disorder, graft-versus-host disease (GVHD) and also Stevens-Johnson disorder.

Advancements in lens design technology are enabling makers to develop scleral lenses that can remedy a lot more problems than ever, consisting of bifocal sclerals for the correction of presbyopia.

Special-Effect Scleral Contacts

Often the term "scleral lenses" (or "sclera lenses") additionally is used to explain special-effect contact lenses that significantly change the look of the user's eyes.

Nevertheless, these costume contact lenses also called theatrical contact lenses, Halloween contacts or gothic lenses generally are soft lenses that bear little resemblance to scleral gas permeable contacts in -- apart from their big diameter size to completely mask the cornea. Likewise, soft theatrical contacts generally are made for aesthetic functions just and not for vision correction.


Scleral Contact Lenses Aid Celebrity Perform Crazy Movie Stunt

Star Tom Cruise is known for doing his very own adrenalin-pumping, in some cases crazy film stunts. In his 2015 movie Mission Impossible Nation, Cruise put on scleral lenses during one of his stunts.

Enjoy as Tom Cruise prepares for one of his most talked-about motion picture stunts. See if you can catch the clip where they insert his scleral contact lenses.

Cruise put on the scleral lenses to safeguard his eyes as well as enable him to open them while dealing with {high speed winds. Why did he require them? Due to the fact that the star did a scene hanging onto the wing of a turboprop armed forces transport airplane the Airplane that flew 5,000 feet in the air.

Scleral contact lenses are tailor-made for every user, so suitable scleral contacts needs better know-how as well as even more time than fitting conventional soft or GP contact lenses.

Typically, computerized maps of the curvature of the whole cornea are produced to assist in the lens installation, as well as a number of test lenses of various dimensions and also curvatures might be related to the eye during the fitting process.

PERFECT Pterygium surgery



Today we are going to discuss a novel technique develope by an Australian Surgeon and adpted by Khanna

What Is pterygium 

A pterygium is a light reddish or pinkish, triangular growth of tissue on the cornea, which is the outer layer of the eye from which light enters the eye. It usually begins on the cornea near the nose. It might also gradually expand to a bigger size, however rarely expands so big that the pupil is covered by the growth. Usually both eyes are included but the reason for this is uncertain.

A pterygium is an elevated or extended, wedged-shaped bump or growth on the eyeball that begins on the white of the eye also known as sclera and then can get into the cornea or the outer layer of the inner circle from which light enters the eye. If someone has more than one of these eye growths, the plural form of the word is pterygia.

Though it's generally called "surfer’s eye," you do not need to be a surfer or ever before have seen the sea to suffer from a pterygium. However being in intense sunshine for lengthy hours-- specifically when you get on water, which reflects the sunlight's harmful UV rays - raises your risk.

Pterygia are benign (non-cancerous) growths, however they can completely damage the eye. They additionally can create pain as well as a fuzzy vision.


Although ultraviolet radiation from sunlight seems the main reason for the growth and also development of pterygia, dirt as well as wind are in some cases linked also, as is completely dry eye illness.

Pterygia generally establishes itself in 30- to 50-year-olds, and also these bumps on the eyeball hardly ever are seen in youngsters. Having light skin as well as light eyes may place you at enhanced risk of getting a pterygium.

Symptoms and signs

Pterygia typically occurs on the side of the eye closer to the nose, yet they can likewise develop on the side closer to the ear and also can affect one eye or both eyes.

Many people with mild surfer's eye or pterygium might not experience signs and symptoms or require treatment. However large or growing pterygia frequently can cause a gritty, itchy or burning sensation or the sensation something is "in" the eye (called a foreign body feeling). Likewise, these pterygia usually end up being inflamed, causing unappealing red eyes.

If a pterygium dramatically gets into the cornea, it can misshape the form of the front surface area of the eye, triggering astigmatism as well as higher-order aberrations that affect vision.

In some cases individuals confuse pterygia with eye growths called pingueculae, however they are different. Find out more regarding what a pinguecula is.

Pterygium Treatment

Treatment of surfer's eye depends upon the size of the pterygium, whether it is growing as well as the signs and symptoms it triggers. Regardless of severity, pterygia needs to be kept track of to avoid scarring that could lead to vision loss.

If a pterygium is tiny, your ophthalmologist might recommend lubes or a light steroid eye drop to lower swelling and also redness. Contact lenses are in some cases utilized to cover the growth, safeguarding it from a few of the effects of dryness or possibly from more UV exposure. Topical cyclosporine additionally might be recommended for completely dry eye.

If pterygium surgical treatment is required, a number of medical methods are available. Your ophthalmologist who carries out the treatment will certainly identify the very best method for your particular requirements.

Pterygium excision may be executed either in a room at the medical professional's workplace or in an operating room. It is essential to keep in mind that pterygium removal can cause or enhance astigmatism, specifically in people who already have astigmatism.

Surgical procedure for pterygium removal normally lasts no more than half an hour, after which you likely will need to put on an eye spot for protection for a day or 2. You ought to have the ability to go back to work or regular activities the next day.


However, pterygia usually return after surgical removal, perhaps because of oxidative stress and anxiety and/or continued UV exposure.

Direct exposure to ultraviolet light from the sun is a presumed cause of pterygia; covered sunglasses will certainly safeguard your eyes from all angles. Some researches reveal recurrence rates are approximately 40 percent, while others have actually reported recurrence rates as low as 5 percent. Some research also shows higher rates of recurrence in those who have had pterygia actually removed during the summer season, possibly due to their increased exposure to sunshine.

So how can we avoid recurrence? And get the best cosmetic outcome? The PERFECT technique

Meticuolous attention to detail is the fundamental hallnmark of this method. The outlines of the pterygium are marked. It is entirely excised. Careful dissection seprates conjunjctiva from the underlying tenons capsule is pulled, cut and removed.

​A conjunct suture or glue a piece of surface eye tissue onto the afflicted area from where the pterygium has been removed. This approach, called autologous conjunctival auto-grafting, has actually been shown to safely as well as effectively minimize the risk of pterygium recurrence.

A medication that can help restrict abnormal tissue growth and also scarring during injury recovery, such as mitomycin C, likewise might be used topically at the time of surgical treatment and/or afterward to decrease the threat of pterygium reappearance. Dr. Khanna has been performing the latest techniques for many years.

After removal of the pterygium, the medical professional will likely also recommend steroid eye drops for a number of weeks to reduce swelling and also protect against regrowth. In addition to using your drops, it's extremely essential to safeguard your eyes from sunlight with UV-blocking sunglasses or photochromic lenses, given that direct exposure to ultraviolet radiation might be a vital factor in pterygium reccurrence.

see far and near

New Technology Allows You to See Near and Far Without Glasses

Los Angeles Lasik, Cataract, Presbyopic Implants, ICL, Pterygium Specialist
See Near and Far and everything in between. Without the need of any visual aids


Say Bye Bye Trifocals, Bifocals and goodbye Readers too.

While  bidding adeu you may say Good riddance to contact lenses too.

Imagine getting up in the morning and looking at the alarm clock with your naked eyes. You then grab your smart phone to check on your email and the latest from your friends on face book.  While eating breakfast you skim through the newspaper. Continuing the trend, you drive with no glasses to work and then go on to play golf.  After playing the best golf of your life, you get a quick swim in which is a pleasure without glasses or contact. On way home you pick up groceries without squinting. Then you cut some organic veggies for a nice dinner. Catching up on bedtime reading, you wonder why you did not get this unbelievable rejuvenating therapy before.


see far and near and everything inbetween

Man playing golf, stuck in bunker needs to see far and near.

No more glasses ever?

How is that possible? But first why not talk about why you even need glasses for reading. or I think I may have presbyopia. 

Presbyopia is medical jargon for ageing eyes.

What causes presbyopia?

There is increasing stiffening of natural lens and decreasing strength of eye muscles. The zoom mechanism of the natural lens undergoes deterioration.

  • Is it something only older people get?

Old is difficult to define. This condition is present in mid forties. It may appear a little earlier in farsighted people. People with smaller pupils may display a delay in onset of presbyopia.


    Or How can I see near and far ?


We have a few choices to overcome this natural malady.

  • Glasses – Cheaters, readers, bifocals, trifocals, progressives.
  • Monovision
  • Multifocal Contact lenses

And the new technology _ PIE

Pie is the creme de le creme of methods to rejuvenate ageing eyes. Let us explore how it is superior to other methods which combat effects of taking too many revolutions around the sun.

PIE is more advantageous than Glasses

Heck yeah. You agree with this or you would not be reading this page.

  • Glasses can fog  in the rain
  • Not possible to swim with glasses
  • Scuba diving is no fun
  • Always forgetting where you kept them.
  • Dont let your pet bit them
  • or your grand kids scratch them
  • You can add your own problems with glasses here _____

It’s safe to say PIE overcomes all these nuisances.

Pie gives binoucularity which is better than Monovision
This is a process of setting the focus of one eye on close-up objects and the focus for your other eye on far-away objects. In doing this, your brain combines the two images to create a clear picture. This is a relic from the twentieth century. Primary disadvantage is one looses binocular vision.

PIE allows you to preserve binocular depth of field vision.

Brain prefers PIE to multifocal contact lenses

Multifocal contacts move with every blink. The image presented to the brain fluctuates confusing it. That is why many people are not able to adapt to multifocal contact lenses.

PIE are stable and do not move. Brain neuroadapts improving vision.

Contact can lead to sight threatening cornea infections for as long as you wear them.

PIE is not exposed to the elements or bugs.

Types of PIE

Multifocal PIE let you see far and near
These include the ReZoom, ReSTOR, Symfony and Tecnis lenses. Multifocal IOLs are lenses that have concentric rings of varying focal power, like a bullseye. Some rings provide focus for near objects, others for mid-range objects, and some for seeing objects at a distance.

The Tecnis Multifocal Foldable IOL also has concentric rings for different distances. It received FDA approval in January, 2009 for use in cataract surgery, where the natural lens is replaced. In the clinical trials most participants achieved 20/25 distance vision or better and 20/32 or better for near vision. It is designed using Wavefront data – the same precise level of information that is gathered when you are having Wavefront LASIK.

Accommodating PIE implants mimic natural lens

These lenses are designed to change focus. An accommodating IOL allows you to see distant objects, and then is can change focus and allow you to see objects that are close up. The only accommodating IOL approved in the United States is the Crystalens. This was true in 2005 and is still true in 2014. We even have toric crystalens called trulign.

Wherever you live you will want to enjoy good vision. If you want to see near and far , please contact our

Beverly Hills, Los Angeles, CA

office today. Los Angeles ophthalmologist Dr. Khanna and his staff can help you find the new technology PIE that is best for your lifestyle and needs. Please call today to schedule your free vision screening so that you can see far and near and your computer too.

By Rajesh Khanna MD

lasik doctor nearby

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