Our picturesque island is teeming with beautiful sights — and nestled among them are offices housing doctors dedicated to preserving the eyes to take it all in.
Dr. William (Bill) Bigham, of Crown City Eye Center, knows about the importance of sight. He soloed in a single-engine T-34C aircraft, earned his flight surgeon wings and served with the First Marine Aircraft Wing in Iwakuni, Japan, and squadrons at NAS North Island.
Following his flight surgeon tours and completion of his ophthalmology residency at Naval Medical Center, San Diego (Balboa) in 1988, the Navy sent Bigham to fellowship training in oculoplastic surgery at the world-renowned Wills Eye Hospital in Philadelphia.
He then became director of ophthalmic plastic and reconstructive surgery at Balboa. Bigham’s training allowed him to help military personnel with injuries in the peri-orbital area (the upper face and around the eye). Bigham has performed hundreds of reconstructive surgeries on patients as a result of aviation mishaps, automobile accidents, and shipboard and combat injuries during the gulf wars. The combat injured were initially treated elsewhere, stabilized, and eventually arrived at Balboa and other stateside hospitals, for further reconstructive surgery.
“They would arrive having sustained a severe gunshot or shrapnel wound to the orbit and surrounding area. We would have to remove the eye, repair any orbital fractures, and replace the lost volume with an orbital implant. In addition we would rebuild the eyelids so that hopefully they could later be fitted with a prosthetic eye,” Bigham said. “It often takes multiple procedures over months and years — including skin grafts.”
Many of these same techniques are used to reconstruct eyelids and other tissues following the removal of skin cancers in the area around the eyes.
As a result of this intensive reconstructive work, Bigham says, “Doing cosmetic eyelid surgery is relatively straightforward.”
Bigham has been treating patients through his practice at Crown City Eye Center since 2006. His experience with complex military-related eye injuries makes him a valuable asset to Coronadans in need of eye care.
Bigham recommends that people looking to undergo certain surgeries around the eye have the procedure done by an ophthalmologist with additional fellowship training in plastic and reconstructive eye surgery.
“We are the ones who have spent the most time studying the physiology of that anatomic region,” he said. He cautioned that if delicate procedures such as eyelid surgery are done too aggressively, the outcome can result in problems. “I’ve seen surgeries where the patient’s eyes won’t close well and they begin to suffer from severe dry eyes.”
Bigham offers a number of services in addition to repairing eye injuries. One such service is Botox injections; ophthalmologists, he noted, were some of the first medical professionals to do so. “We’ve been using Botox for upward of 25 years to treat facial spasms and other conditions,” he said. “It was later that doctors began to figure out that using Botox helps facial lines disappear.” And although Bigham does offer fillers along with Botox injections as a means of emphasizing facial contours, his approach with his patients is still a relatively conservative one.
Dr. Glenn Cook, who practices at 801 Orange Ave. and has recently opened Outpatient Surgery of Del Mar, has been a pioneer in several ophthalmological procedures over the years and is the first eye doctor in California to offer “Dropless Cataract” surgery. The surgical technique administers an infusion of antibiotic and anti-inflammatory medication at the same time as cataract surgery, a procedure that uses ultrasound energy to remove the cloudy lens (cataract) that causes blurred vision. It is then replaced with a synthetic intraocular lens (IOL) made of acrylic.
“Dropless cataract surgery eliminates the need for patients to remember to place drops in their eyes, which they can find cumbersome,” Dr. Cook said. “Some patients have to rely on others to provide their drops due to physical limitations like arthritis. The dropless technique assures me that the patient is receiving the medication they need.”
There’s also a cost savings involved, he added. “Prescriptions in general these days are getting more and more expensive. Some of my patients have told me that pharmacies were charging almost $400 for these medications.”
IOLs are not new to cataract surgery, said Bigham, but have improved in their ability to help people see well after the procedure. The IOLs today can also help eliminate astigmatism (curvature in the cornea) and minimize the need for reading glasses. “This advanced technology was not available 10 years ago,” Bigham said.
Holding up an enlarged model of an intraocular lens, Bigham noted a series of small dots on the lens’ periphery that an eye doctor can line up to fit an eye’s curvature. He also explained advances in multifocal lenses that feature a series of round ridges. “Light rays coming in are acted upon by the many concentric rings of the lens. Your brain then interprets these many images, sorting out those far objects from the near objects.
“It’s call neuro-adaptation,” said Bigham. “The brain knows how to adapt to the lens to correct sight.”
Optometrist Stephen Moffett regularly screens patients for another ocular concern: macular degeneration. His office on Eighth Street has a sophisticated retinal camera and a retinal imaging screening test that can show changes related to macular degeneration. “We can see under the surface to determine what’s being effected,” he said.
Bigham also sees patients for macular degeneration, and feels hopeful about some of the advancements that can slow vision loss associated with the disease.
“There have been some developments in the form of intraocular injections that can slow down the progression of abnormal blood vessel growth in the eye,” he said. Nutritional supplements are also available, without prescription, which can slow the progression of the disease. “The Areds2 Formulation,” said Moffett, “provides the recommended supplements to delay progression through high doses of Vitamins C and E and zinc. Luteins, which provide another protective effect, can be found in foods like kale and spinach.”
Bigham explained, “Though heredity is considered a strong risk factor when it comes to the disease, macular degeneration can develop in people without a family history. And, it can be worsened by anything that restricts oxygen flow to the eye, including diabetes, hypertension and cigarette smoking,” he explained. Moffett concurred: “The No. 1 risk factor a patient can modify is smoking.”
Bigham does try to reassure his patients that even though the disease tends to be progressive, they will never go completely blind: “Their central vision will become blurry or fuzzy, making it difficult to see faces and other fine detail” he explained “but they usually retain their peripheral vision. It’s a small comfort, but a comfort nonetheless.”
But the aging population is not the only one that needs to pay attention to ocular health. Moffett emphasized the importance of bringing in children — even those as young as six months — for comprehensive yearly eye exams. “By age 3,” he said, “it’s important to check a child’s binocular vision to see if the eyes are working as a team and to screen for childhood eye diseases like pediatric cataracts or strabismus (commonly known as ‘lazy eye’).” Moffett further explained that if children are favoring one eye, the brain adapts through “suppression” — or by “turning off” the other eye. “If children are far or near-sighted and not screened early, they can have delayed vision development,” he said.
Moffett can fit children as young as four with contact lenses when they are medically necessary for things like extreme near- or far-sightedness, but typically he fits children around age 11 with contacts — especially for sports. “Kids who play sports like baseball, lacrosse, tennis — those that require a lot of hand/eye coordination — can really benefit,” he said. Children younger than 11 are usually prescribed glasses.
Bigham explained that medical science has made great strides in many fields and ophthalmology has been fortunate to benefit: better treatments for macular degeneration and glaucoma; advanced technology IOLs for cataract patients and improved reconstructive procedures. People can help themselves, too, he advised, by wearing sunglasses, using sunscreen to protect their facial skin, and seeing their ophthalmologist annually for eye exams (Moffett also emphasized the importance of a yearly comprehensive eye exam over basic vision screenings).
“The future looks bright,” Bigham said, “for those who learn how to care for their general and ocular health.”