Newest generation of multifocal intraocular lens implants allow some to free themselves of glasses
This is an exciting time for new developments to help people with vision problems, said Jonathan Casciano, MD, Arkansas Ophthalmology Associates in Little Rock.
"Our cataract patients are having great results with the newest generation of multifocal intraocular lens implant, the Panoptix lens," Casciano said. "This is an exciting lens that allows some patients to become mostly free of glasses, and is a significant improvement over previous versions on these types of lenses."
There are several new minimally invasive glaucoma surgeries on the market now, and the new version of the iStent inject is allowing many of his glaucoma patients to reduce the number of medications they use every day. Also, there is a new injectable steroid on the market, Dexycu, which allows cataract post-op patients to use a lot fewer eye drops after surgery. This is a huge improvement in their post-op experience.
"And there are many new developments in corneal transplantation, which is a constantly evolving field," he said.
Eye care touches on so many areas of medicine, making it really important to ensure patients are seeing an eye doctor on a regular basis - especially people older than 60. Most providers know that diabetics need to see an eye doctor on a regular basis, but Casciano said most other chronic diseases can also lead to some sort of eye problem that will impact the course of their illness.
"Ophthalmology is a very focused area in medicine, but patients depend on their vision and we have a role in many chronic disease processes," he said.
Ophthalmology as a specialty appeals to Casciano's personality and career goals.
"I love performing surgery, and because of today's advanced surgical tools and techniques most patients experience great outcomes," he said. "Most of the problems that I deal with have the immediate effect of improving people's day-to-day lives with low rates of morbidity. It is also great career for people like myself who don't necessarily want to spend a lot of time in a hospital setting. The majority of my time is spent either in the clinic seeing patients or in the operating room performing surgery."
Casciano finds it an advantage that ophthalmology is one of the last areas in medicine where it is possible to be relatively independent; he can have a solo practice and thrive.
"Today it is very difficult to remain both efficient and provide high-quality medicine because so much of our time is wasted on electronic charting and compliance," he said. "I can structure my practice how I want, hire people who are great, choose my own electronic record system, and decide where to focus resources so my clinic can be successful," he said.
Casciano spent six years working at the Central Arkansas VA and was chief of service for three years. He oversaw a major expansion of services to veterans and raised the profile of the residency program by greatly increasing the number of cataract cases performed by the surgical trainees.
"The VA is a very special part of our health care system and I absolutely loved working with our veterans," he said. "Many of us hear about the problems at the VA, but I can tell you that most people who work at the VA are absolutely dedicated to their job."
During his tenure there, he set a record for the most surgeries per year at the facility because so many patients needed cataract surgery and he operated most days of the week.
"I was able to offer updated equipment and techniques to improve surgical safety and post-op care," he said. "We put in a great deal of effort to expand the number of patients we cared for in order to meet the ever-increasing demand for services. A large portion of our job at the VA was training new surgeons and making sure that they learned the safest, most up to date techniques. We were able to expand our patients' access to care at the same time that we greatly increased our trainees' surgical volume. I still see many of my patients thru the VA's outsourcing of care."
His favorite part of the job is helping people improve their lives. Patients with vision problems give up on a lot of their favorite activities, and restoring vision allows them to live the lives that they want.
A difficult part, though, is telling an elderly patient that they can no longer drive due to vision loss. He said that has become more of an issue, and finds it is much easier when the family helps.
Casciano grew up in Little Rock, and attended Brandeis University near Boston on a music scholarship for violin. He received his bachelor's and master's degrees in American history there in 1996. After college he spent a few years working in the biotech industry in Boston, and became really interested in the new drugs and medical products that were in development. He greatly enjoyed some volunteer work at Mass General Hospital, and so decided to try for a career in medicine.
Casciano graduated from the University of Arkansas for Medical Sciences with a 4.0 GPA and was elected to the Alpha Omega Alpha Medical Honor Society. He studied ophthalmology at the Jones Eye Institute, and spent a year as a medical intern at the UAMS Internal Medicine department. He did his residency at UAMS, Arkansas Children's Hospital, and the Central Arkansas VA hospital. Then he spent a year studying corneal transplants, external eye disease, and LASIK in Ann Arbor, Mich., followed by several years in private practice in Manchester, N.H., before returning to Little Rock.
Casciano married a fellow Brandeis graduate while in medical school. He and his wife, Shelley, have two boys, 10 and 13, who currently attend Little Rock public schools - as did their father. In his leisure time, he enjoys swimming and hiking with his family.
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