Dr. Dean Dornic
North Carolina Lasik Surgery

Dr. Dean Dornic, MD has had an interest in eye care since 1980.  His background is quite unique in that he has both a doctor of medicine and doctor of optometry degree.  Dr. Dornic's experience as both an optometrist and ophthalmologist gives him a balanced perspective on surgical and non-surgical treatment of ocular disorders as well as insite into the optometric and medical professions.  The purpose of this website is to present a more sophisticated level of information to the healthcare provider or educated professional.  Emphasis will be on peer-reviewed articles appearing in medical journals.

Dr. Dean Dornic is one of the Carolinas’ most experienced and qualified refractive surgeons, having performed thousands of successful LASIK surgery procedures at his Cary practice and at area clinics and hospitals! He is a board-certified, fellowship-trained, vision correction specialist dedicated to the highest standards in ophthalmic surgery.

Dean Dornic is the first Raleigh / Durham-area ophthalmologist to perform IntraLase®, a revolutionary advance in LASIK that utilizes a laser rather than a metal blade to make the LASIK flap. He is also the first area ophthalmologist to provide Intacs®, LTK, and the Verisyse™ implantable contact lens. His extensive experience in a variety of vision correction procedures means that he can offer the procedure most likely to satisfy your visual needs.

Dr. Dornic is an active member of the medical staff at Rex Health Care Center, WakeMed Cary Hospital and Johnston Memorial Hospital.

After completing his ophthalmology training at University Hospitals in Cleveland, Ohio, he underwent additional fellowship training in refractive surgery at the prestigious Sinskey Eye Institute in Santa Monica, California.

Dr. Dornic brought his expertise in refractive surgery to North Carolina in 1998, and has been practicing here ever since. In addition to having a thriving LASIK eye surgery practice in Cary, Dean Dornic is a recognized authority in vision correction procedures, having lectured at international meetings and publishing a book and various papers on ophthalmological topics.

Dr. Dean Dornic has trained other ophthalmologists in LASIK surgery, and his Cary practice has played host to numerous physicians who have requested refractive surgery from him for themselves. He has also successfully performed LASIK on family members and many of his own staff and their loved ones who are now enjoying life with greater freedom from glasses and contacts.

Dr. Dornic is board-certified and is a member of the International Society of Refractive Surgeons, the American Society of Cataract and Refractive Surgery, and is a Fellow of the American Academy of Ophthalmologists. He is the recipient of several awards and honors and has been named one of “America’s Top Ophthalmologists” and “Top 100 Refractive Surgeons.”

In addition to standard LASIK surgery at his Cary practice, Dr. Dornic performs wave front-guided LASIK, LASEK, PRK, LTK, Intacs®, CK®, AK, refractive lens exchange and implantable contact lenses. He would be pleased to meet with you and personalize a treatment that is right for your vision needs.

To enjoy outstanding LASIK and other procedures from Dr. Dean Dornic, contact our laser vision correction center in Cary today.

Just notified:  Dr. Dornic named one of America's Top Ophthalmologist . 

Watch a video testimonial. 

Flomax and Floppy Iris Syndrome

A recent survey of members of the American Society of Cataract and Refractive Surgeons highlights the challenge of cataract surgery in patients taking tamsulin (Flomax).  Many surgeons have expressed frustration over the apparent lack of awareness about IFIS on the part of prescribing physicians.  A number of ophthalmologists have suggested that an eye exam should be performed in patients with cataracts who are about to be started on an alpha blocker, and this suggestion has been debated by the ASCRS Cataract Clinical Committee.

2008 ASCRS IFIS Survey

In March 2008, a link to an anonymous online survey was emailed to the global ASCRS membership. Of the 957 members who completed the 26-question survey, approximately 3∕4 respondents were from the U.S., and there was fairly even representation across the spectrum of lower, medium, and higher surgical volumes. The complete survey results are published in the July 2008 issue of the Journal of Cataract and Refractive Surgery. Excluding those with insufficient experience, nearly 1∕4 respondents feel that IFIS is present to some degree in >90% of tamsulosin patients. Seventy percent of respondents see some degree of IFIS in the majority (>50%) of patients taking tamsulosin; 20% said the same about non-specific alpha blockers. When asked whether IFIS was more likely with tamsulosin versus a non-specific alpha blocker 90% of those who felt they had enough experience to comment indicated that IFIS was more likely with tamsulosin and approximately 2∕3 said that it was “much more likely”.

Complication rates

The overwhelming majority (95%) of respondents finds that tamsulosin increases the difficulty of cataract surgery, with approximately 3∕4 believing that it increases the risk of complications compared to non-IFIS cases [Figure 7]. Self reported complication rates in IFIS eyes during the two year period prior to the survey are shown in Figure 8. The most common complication was significant iris damage, with 52% of respondents reporting this occurring at a higher rate than in non-IFIS eyes. Posterior capsule rupture in IFIS eyes was reported by 1∕4 respondents, with 23% overall reporting this complication occurring at a higher rate than in non-IFIS eyes. Thirty percent of respondents reported no complications in IFIS eyes during the preceding 2 years. Prior surveys have compiled cataract complication rates associated with IFIS that had occurred prior to the original description of IFIS and its association with tamsulosin. This is now the largest survey of complication rates covering a more recent period during which cataract surgeons would have been able to recognize, anticipate, and manage IFIS with a variety of recommended strategies. That IFIS apparently still increases the rate of cataract complications is important new information.

Preferred management strategies

Figures 4 and 5 tabulate the ophthalmologists’ preferences and experiences with a variety of preoperative and surgical management strategies for IFIS. Only about 1∕3 surgeons ever stop tamsulosin prior to cataract surgery. In declining order of frequency, strategies most often used on a routine basis are intracameral alpha agonists (38%), iris retractors (33%), preoperative atropine (19%), Healon 5 viscoadaptive OVD (15%, Advanced Medical Optics, AMO, Santa Ana, Calif.), and pupil expansion rings (4%). However, if those who have never tried a particular strategy are excluded, the following percentages of respondents were not satisfied with these same strategies: intracameral alpha agonists (26%), iris retractors (17%), Healon 5 viscoadaptive OVD (33%), and pupil expansion rings (60%). For the question, “what is your most favored initial strategy for managing IFIS?” there is no clear single preference, with 1∕3 surgeons routinely employing more than one strategy [Figure 6]. Self reported complications with intracameral alpha agonists, such as epinephrine or phenylephrine, were rare, with less than 1% reporting instances of either TASS or systemic hypertensive spikes.


Pre-treatment eye examinations

Twenty one percent of respondents felt that prescribing doctors should routinely refer all patients to an ophthalmologist prior to starting tamsulosin. Another 38% felt that only patients with cataracts or decreased vision should be referred. The remaining 41% felt that a pre-treatment examination was not necessary. For non-specific alpha blockers, the corresponding percentages were 11%, 31%, and 58% respectively. Another question asked whether the respondent would take tamsulosin if he or she had BPH and a mildly symptomatic cataract [Figure 9]. Nearly 2∕3 would not, either electing to have cataract surgery first (24%), taking a non-selective alpha blocker instead (17%), or avoiding alpha blockers entirely (23%).
Finally, there was a strong consensus that prescribing doctors (urology, family practice, internal medicine) should become better educated about IFIS. Ninety one percent agree with this statement (54% strongly agree) compared with 3% who would disagree. On the basis of this survey, the ASCRS Cataract Clinical Committee is launching a national campaign in conjunction with the American Academy of Ophthalmology aimed at better educating prescribing doctors, pharmacists, and optometrists and ophthalmologists about IFIS. In addition to sharing the results of this survey, this educational effort will offer the suggestion of involving the patient’s cataract surgeon before initiating chronic tamsulosin or alpha blocker treatment in someone with a known history of cataract.

Conclusion

In conclusion, this survey supports several clinical implications:
• IFIS is seen more commonly with tamsulosin than with non-specific alpha blockers
• All six preoperative and surgical strategies mentioned are commonly used, but there is no clear preference for a single strategy. Many surgeons routinely combine multiple strategies.
• Despite the ability to anticipate IFIS and to employ multiple operative strategies, the cataract surgical complication rate is still higher than in non-IFIS eyes. The most common complications are significant iris trauma and posterior capsular rupture.
• Because of the increased difficulty and risk of complications during cataract surgery, nearly 2∕3 ophthalmologists would not take tamsulosin if they had a mildly symptomatic cataract. Of this group, some would take a non-specific alpha blocker but not tamsulosin, some would not take any alpha blocker, and some would elect to have their cataract removed prior to starting on chronic tamsulosin treatment.
• Fifty-nine percent of ophthalmologists recommend that patients with cataracts or decreased vision should have an ophthalmic examination prior to starting tamsulosin. Ophthalmologists believe that more must be done to educate prescribing doctors about IFIS and the risks of cataract surgery in these eyes.From Archives of Ophthalmology

Risk of Lasik Surgery vs Contact Lenses

A recent study by Hammond et al¹ on outcomes of refractive surgery was large enough and sufficiently objective to begin comparing the risk of vision loss from surgery vs contact lenses. Previously, the public and ophthalmologists have assumed that refractive surgery, while attractive, constitutes the higher risk. This may not be correct.

This comparison has been slow in coming in part because the risks of refractive surgery vs contact lenses cannot be compared directly. Complications from contact lenses accumulate over years whereas those from surgery occur over a brief time. If one assumes that the risk from contact lenses accumulates steadily and that at least 5% of bacterial keratitis cases will result in vision loss to a visual acuity of 20/50 or worse, then the total risk may be estimated from the yearly rate. Surprisingly, the risk of bacterial keratitis from contact lenses has changed little over the years. If the risk does not accumulate steadily, then at least 1 subset may be at greater risk.

Cheng et al² reported the rate of bacterial keratitis to be 3.5 cases per 10 000 persons per year for daily-wear contact lenses and 20 cases per 10 000 persons per year for extended-wear contact lenses. When extrapolated to 30 years, the lifetime risk of bacterial keratitis becomes 1 case per 100 persons for daily-wear contact lenses. Cheng and colleagues also noted that prior to final transplantation, 5% of these patients have experienced vision loss to a visual acuity of 20/70 or worse. Therefore, the lifetime risk of vision loss to a visual acuity of 20/70 is 1 in 2000. Studies by Lam et al³ and Dart⁴ found essentially the same rate of infection.

The risk of vision loss from Acanthamoeba keratitis may also be calculated using published data. The incidence varies by country from an average of 0.3 to 1.5 cases per 10 000 persons per year, with the highest rate in Scotland.⁵ The low number yields a 30-year risk of 1 in 1000 or higher. If half of these patients, a conservative estimate, sustain vision loss from the infection, the lifetime risk of vision loss is also 1 in 2000. This may seem high, but it is only 1 case per 60 000 persons per year.

The risk of vision loss from refractive surgery can be calculated more directly. Chang et al⁶ reported an average infection rate of 1 case per 800 persons, with 25% of infected eyes experiencing moderate vision loss (1 case per 3200 persons). Covering 32 068 procedures, Hammond et al¹ reported that the incidence of vision loss greater than 1 line, the minimum detectable, was 1 case per 1250 persons. A loss of 2 or more lines, which would be more significant but much less frequent, was not specified. Our own data from the Casey Eye Institute, Portland, Ore, on 18 000 procedures over 10 years found no eyes with vision loss greater than 2 lines. We propose that the incidence of vision loss greater than 2 lines may be 1 case per 10 000 persons.

These calculated risks are obviously approximate and subject to change. Highly oxygen-permeable contact lenses should lessen the risks of wearing contact lenses; however, laser surgery will also become safer. The data sets described earlier cannot be compared directly, and it is difficult psychologically to equate long- vs short-term risks. Nevertheless, data from large, peer-reviewed studies strongly suggest that our intuition regarding these risks needs to be reassessed. We look forward to further investigations of these risks.

AUTHOR INFORMATION

Financial Disclosure: None reported.

William D. Mathers, MD; Frederick W. Fraunfelder, MD; Larry F. Rich, MD

1. Hammond MD, Madigan WP Jr, Bower KS. Refractive surgery in the United States Army, 2000-2003. Ophthalmology. 2005;112:184-190. FULL TEXT | ISI | PUBMED

2. Cheng KH, Leung SL, Hoekman HW, et al. Incidence of contact-lens-associated microbial keratitis and its related morbidity. Lancet. 1999;354:181-185. FULL TEXT | ISI | PUBMED 3. Lam DS, Houang E, Fan DS, et al. Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye. 2002;16:608-618. FULL TEXT | ISI | PUBMED 4. Dart JK. Predisposing factors in microbial keratitis: the significance of contact lens wear. Br J Ophthalmol. 1988;72:926-930. FREE FULL TEXT 5. Seal DV, Kirkness CM, Bennett HG, Peterson M, Keratitis Study Group. Population-based cohort study of microbial keratitis in Scotland: incidence and features. Cont Lens Anterior Eye. 1999;22:49-57. FULL TEXT | PUBMED 6. Chang MA, Jain S, Azar DT. Infections following laser in situ keratomileusis: an integration of the published literature. Surv Ophthalmol. 2004;49:269-280. FULL TEXT | ISI | PUBMED

Arch Ophthalmol. 2006;124:1510-1511.

More Useful Resources

There is an abundance of useful resources available on the net.  For information on refractive surgery, visit the Laser Eye Center of Carolina web site at ww.visionauthorities.com Our practice website www.eyespecialistsofcarolina.com offers more information on cataract surgery and general eye information.

   Also, consider visiting the website of reputable professional eye organizations including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgeons and the Council for Refractive Surgery  Quality Assurance.

   AskLASIKDocs.com is a site where you can post a question about refractive surgery to a panel of respected LASIK surgeons.  Of course,feel free to contact us anytime! We look forward to hearing from you.

Check out: Dr Dean Dornic www.eyespecialistsofcarolina.com[object Text]

Dr Dean Dornic - PR.com Profile:

www.pr.com/company-profile/contact-info-office/42209-40330[object Text]

Every patient who chooses Laser Eye Center of Carolina for his or her vision correction procedure gets the "VIP" treatment. Dr. Dean Dornic and his staff do everything possible to ensure the success and safety of their treatment.

At Laser Eye Center of Carolina, we believe that LASIK surgery for our Raleigh / Durham patients requires aseptic (sterile) conditions. Did you know that some eye surgeons still perform their procedures in street clothes and bare hands? Why not insist that risks be minimized?

To ensure only the safest LASIK surgery for our Raleigh / Durham patients, each receives both preoperative and postoperative antibiotic eye drops. In addition, every member of the surgical team wears scrubs, surgical masks, caps, and gloves. Whenever possible, disposable, rather than reusable, supplies are used. In addition, we are one of the few centers in the region to utilize the Cox dry heat sterilizer, which is felt to significantly reduce the risk of infection and inflammation.

Other features of the center that may be less obvious but still contribute significantly to a positive patient experience include state-of-the-art topography equipment and a climate-controlled laser room, in which both temperature and humidity are regulated to ensure stable laser operating room conditions and results that are more predictable. Our treatment protocol also includes testing the laser and other instruments between every single laser procedure. We constantly track our results in an effort to make sure that we continue to provide the level of excellent vision that patients have come to expect from us.