At EyeSight, Seeing Is Believing
Interviewed by Guest Writer
Wednesday - July 02, 2008
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Dr. John Olkowski
Chief Surgeon & Medical Director, EyeSight Hawaii
Where did you receive your schooling and training?
I did undergrad and medical school at Georgetown in Washington, D.C., and residency in ophthalmology at George Washington University. Then I did a year of cornea sub-specialty training at Tuft’s University in Boston.
How long have you been practicing?
I’ve been practicing since 1990. I started working with Kaiser for nine years and then started my private practice in 1999.
How often do you travel to the Hilo, Kona and Maui offices?
Once a month for each. I do minor in-office procedures there, but for the main surgical procedures, patients need to come to Oahu.
On an average, how many patients do you see in a week?
A couple hundred a week. I like to spend a good amount of time with each patient.
Can you talk about the procedures offered at EyeSight Hawaii and what problems each helps to correct?
The first is LASIK - those I do here in my office. I have the two lasers here, one is to make the flaps for the LASIK procedure and the other one is to do the vision correcting and the sculpting of the cornea. Patients who require LASIK are people who are wearing glasses and contact lenses and want to get rid of them. So that’s the main reason for doing LASIK. Some of the people who get referred to me for LASIK, which is occasionally covered by insurance, are people who have scarring for one reason or another, or their cornea is irregular due to trauma or a surgery. So those I do in-office here.
The other big thing I do is cataracts, and those I do at a surgery center in town. One of the unique things I do for cataracts is a revolutionary implant lens that I’ve been doing for about three years now. Cataract is a cloudy lens in the eye, and what you do is take that lens out and put in an implant lens. Implant lenses first came out 50 years ago and traditionally have been a single-focus lens, so patients can see far but not up close. The new lens that’s out is a focusing lens called the Crystalens, so patients can see far and close.
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Third is cornea transplants or other cornea procedures. I have the only laser in the state with which one can do cornea transplants. How cornea transplants are traditionally done is using a fancy little cookie cutter that cuts the center part of the cornea and the same thing with the donor cornea. Then you put the donor cornea into place and stitch it into place. What I have is a laser with which I can make those cuts, so instead of just having a straight, sharp edge to the two cuts, I can make a zig-zag cut so that the donor and the host fit together like pieces of a puzzle. The advantages of that, which has only been out for less than a year, is speedier healing, the wound is stronger and the vision is also better after. That’s the new and exciting thing happening with corneal transplants.
How old do you need to be to receive the LASIK treatment?
For an elective procedure, it’s 18 and above. There’s no upper cut off. You can go lower under rare circumstances, so some kids who may develop a lazy eye - and that works really well.
Is there a huge need for eye donors?
I am an associate director of the Eye Bank here locally and we do about 110 cornea transplants a year, and about 40,000 in the U.S. Most of the time I can schedule a cornea transplant and we can get it here locally or nationally. But occasionally we can’t get corneas for a procedure, so in the last year or two there’s been more of a demand. So whenever I give talks, I always encourage folks to be an organ donor. Corneas, fortunately, are more privileged than other organs, in that there are no blood vessels, so we don’t have to match them. So one cornea we can use with pretty much anyone. We do match age to a degree, but we don’t have to match them for blood type. And the fact that they don’t have blood vessels means they don’t reject as much as other organs do.
Does LASIK surgery correct both near- and far-sightedness?
It corrects near-sighted, farsighted or astigmatism. Pretty much any one who wears glasses for something is a candidate for LASIK, unless you have the super Coke-bottle glasses. So probably 98 percent of patients wearing glasses are candidates.
Do you see a lot of sun damage, and is that a concern with eye problems?
Sun damage we see everywhere. Some of the things that we are most concerned with is sun damage long term, in particular macular degeneration, which is the change in the retina in the back of the eye. And that does-n’t happen until 60 or 70 years of age, but it’s just cumulative sun damage. It’s the leading cause of blindness in people over 60, so careful UV protection throughout a lifetime may help to prevent that. There are other risk factors such as family history and dietary changes, but the point is to control the ones we can like UV exposure. One of the things I see in younger people is pterygium, which is a little growth that goes across the eye. You see many surfers who have it, and that again is due to sun exposure. There’s actually a new and exciting way that I remove them, where you take the pterygium off, take a piece of healthy tissue from the top of the eye and glue it into place, so you don’t need any stitches at all.
Is it entirely true that as you age your eyes get worse?
It generally gets worse, but what can happen is what’s called “second sight” and it’s when the lens is changing in the eye, so some people who are near-sighted, their eyes start to change density and their vision actually improves. But generally it means that they’re starting to get cataracts.
Do you work with emergency cases?
I’m on the staff at Queen’s, so all the doctors at Queen’s take turns during the year being on-call for eye emergencies. So it’s not very often, but I still get called.
What do you think is the future of ophthalmology?
Some of the biggest things for vision correction, and where a lot of the industry is going, is to correct the loss of reading vision. There’s only one focusing lens out now and there are multiple versions on the way. Some other technologies will be out to help keep distance vision and restore reading vision as well. There are a lot of people who don’t want to worry about the reading glasses, so I think that’s where a lot of the industry will go. And just the ability to more accurately diagnose and treat conditions ... the computer technology is just getting better and better.
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