Corneal Crosslinking

Recently, the FDA has approved the use of corneal crosslinking for the treatment of keratoconus in the U.S.A. In general, a B vitamin and UV light is used to stiffen the cornea of the keratoconic eye. The exact specifics are still evolving. The important point is that crosslinking doesn’t eliminate the keratoconus but it does stabilize it! Early diagnosis is more important now than ever. If progression can be halted, glasses may be used to improve vision in early stages. Contact lenses will improve vision in moderate stages, as well as in severe stages when extreme scarring is not present. It is hoped that corneal crosslinking will eventually eliminate the need for corneal transplant surgery in the treatment of keratoconus.

Posted In: Keratoconus

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Corneal Transplant Surgery

When keratoconus progresses to end stage, corneal transplant surgery is the only way to restore sight. The central area is removed from the cornea of a keratoconic eye and a central “button” from the donor eye is then sewn on in its place. In large part due to the fact that keratoconus is non-inflammatory, corneal transplant surgery is very successful for treatment of end stage keratoconus. Even when successful, however, this surgery is not a cure. Post-surgical care is continuous and may be needed forever to maintain the health of the transplant and avoid rejection. If the transplanted cornea comes out to be irregular, contact lenses may still be necessary for clear vision. This poses a whole new set of fitting difficulties but results can be very good.


The question is: when is surgery necessary? As far as I am concerned, as long as the central cornea is clear, contact lenses should be used, not surgery. This is even if the keratoconus is severe, with extreme thinning and bulging of the cornea. Some people experience scaring of the central cornea. If the scaring is dense and centrally located, contacts cannot improve the vision because the central cornea is no longer transparent. This is the only time that surgery should, be considered. It is a treatment of last resort.

Posted In: Keratoconus

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Don’t Be a Chicken

Over the years we have noticed that people with keratoconus often make and confirm an appointment for an initial evaluation and then don’t show up. That’s curious. The people that could benefit most are least likely to show up. I have to wonder why. I think that the idea of having an eye exam is just too scary – they are afraid to hear the bad news. When you think about it, it’s hard to blame them. Every day they are reminded of their eye problem by their poor vision, and glasses don’t help. Many can’t even hold a job, and those that work, have to struggle through the day.


If this sounds like you, I just want to say – don’t be a chicken. Chances are I’ll be able to restore your good vision with contact lenses. It might take some time initially but, once fitted your keratoconus is just a minor inconvenience. I have succeeded with many patients who were told they can’t be fitted. We have so many choices of different lenses and techniques that I have almost never had to refer a patient for surgery. So take a deep breath, make your contact lens evaluation appointment, and show up. Get ready to hear the good news!

Posted In: Keratoconus

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Vision is learned

Vision develops during the early years of life, and the process in which vision is learned is called DEVLOPMENTAL VISION. Children who are slow to learn often experience lags in vision development. Our doctors are trained to recognize these lags and know how to treat it.

Some children have learning problems that are caused by vision deficiencies. This is not limited to blurred vision as in myopia, hyperopia, or astigmatism. Sometimes vision is clear but the child has not developed certain visual skills. Here is a list of a few possibilities.

  • Strabismus (see that page)
  • Accommodative dysfunction (poor focusing skills)

Accommodative insufficiency (not enough focusing power)

Accommodative infacility (difficulty changing focus)\

  • Binocular dysfunction: any or a number of problems which result in poor coordination between the two eyes – the eyes don’t work together as a team.
  • Ocular motor dysfunction: inability to move the eyes smoothly and efficiently.


Vision Training is a specialty in which visual skills problems are diagnosed and treated. Dr. Shakir is residency trained in vision training.

Posted In: Vision

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Amblyopia is commonly called Lazy Eye. It begins to develop early in life; in fact, it results when one eye is slower to develop the ability to see than the other. This can occur if the vision in one eye from early childhood is less clear than in the other. Anisometropia is when one eye is much more nearsighted, farsighted, or has more astigmatism than the other, so that one eye sees more clearly than the other. The blurry eye becomes the lazy eye. Amblyopia also occurs when the eyes don’t work together because of Strabismus – when one eye turns in (crossed eyes or Esotropia), or when one eye turns out relative to the other (wall-eyed or Exotropia).  Regardless of the cause early diagnosis and treatment is the only way to prevent amblyopia. THIS IS ONE IMPORTANT REASON WHY YOUR CHILD’S EYES SHOULD BE EXAMINED BEFORE THE AGE OF 3 YEARS.

Posted In: Amblyopia

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Myopia is commonly called nearsightedness. Objects in the far distance appear blurred, while closer objects remain clear. It generally begins to develop in the early school age years. If your parents are myopic, you will be more likely to develop myopia. Very often as time goes by myopia gets worse; that is, far distant objects become more blurred. Stated differently, the farthest distance that can be seen clearly comes closer. As myopia increases the glasses needed to correct it need to be made stronger, resulting in thicker lenses. Sometimes myopia continues to progress until you are done with school, and sometimes even longer if your work load is all close up. Good news: myopia is associated with greater intelligence; new eyeglass lenses can be made with lighter weight and thinner materials; eyeglasses may be considered a fashion accessory; advanced contact lens technology makes for an excellent contact lens wearing experience for almost anyone; remarkable refractive surgery options are available.

Posted In: Myopia

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If you look directly at an object and one of your eyes is looking in a different direction, you have strabismus. If the eye is turned in, you have esotropia (crossed eyes); if the eye turns out, you have exotropia (wall eyed); if the turned eye points upward or downward it is vertical strabismus. If the amount of the turn is great enough it can be a cosmetic issue. If the same eye is always turned, AMBLYOPIA can result. Strabismics often have poor depth perception; they may see double constantly or intermittently, (diplopia). Strabismics may have any number of problems with eye strain, headaches, or discomfort. If strabismus is present from early childhood there may be few, if any, symptoms.


Babies often have an extra fold of skin on their eyelids near the nose. This is called an epicanthalfold. When an epicanthal fold is present, the baby may appear to be cross-eyed, when, in fact, the eyes are straight. Even baby doctors can be fooled by this. If your baby appears to have crossed eyes bring him or her in, we can tell you if treatment is needed or if there is no cause for concern.

Strabismus can be treated with eyeglasses, prismglasses, VISION TRAINING (eye exercises), or with surgery.

Posted In: Strabismus

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Hyperopia is commonly called farsightedness, and is poorly understood by most people. In hyperopia, the image of a far distant object falls behind the retina (part of the eye on which the image is supposed to fall – often compared to the film in a camera). A young hyperope is able to use the focusing muscles of the eye to move that image forward onto the retina, resulting in a clear image. When the object moves close to the person, the image moves back again and the young hyperope focuses a little harder and clears the image again. So the young hyperope can see clearly at all distances. THEY CAN EASILY PASS THE SCHOOL VISION SCREENING.      The problem is that in order to see clearly they have to focus hard and strain their eyes. The strain is even worse for reading than it is for long distance. This is because the closer an object is the more focusing power it takes to clear it.

Focusing closer cause’s convergence of the eyes so the harder an individual focuses, the more the eyes will tend to cross.

The hyperope may not complain of blurry vision, instead, symptoms may include eye strain headache, intermittent blur, intermittent double vision, fatigue, short attention span, avoidance of reading, poor school performance, crossing of the eyes, and other symptoms. EARLY DETECTION AT OUR OFFICE WILL AVOID THESE PROBLEMS RELATED TO SCHOOL ACHIEVEMENT, LEARNING, AND COMFORT.

Posted In: Hyperopia

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The eye has a built-in focusing system which can increase its focusing power, and can return the focus back to start. The school age child can see the board clearly, then look at a book and see it clearly, then refocus back to the board. This change in focus is usually so natural that the person is not even aware that his eyes are changing focus.  The closer an object is the more power it takes to focus in.

Alas, this system doesn’t last forever the ability to change focus gradually diminishes over time so that by the mid 40’s the remaining focusing power has declined so much that reading has become difficult; and by the age of about 55 years there is no ability to change focus left. This loss of focusing power is called presbyopia. It is the reason that people find themselves moving their book further away when they get to their 40’s. It is the normal way that the eyes change with time and is experienced by everyone.

Benjamin Franklin, one of America’s founders, invented the bifocal. This is an eyeglass lens that focuses the long distance when looking through the top, and the close range when looking through the bottom. The bifocal lens compensates for presbyopia.

Bifocal lenses of the 20th century and earlier had a variety of lines on them which separated different zones of focus. Now multifocal lenses may or may not have lines. Progressive addition lenses have no lines. The top section of the lens focuses far away. As your eye looks gradually lower down the lens, gradually closer distances come into focus. In order for progressive addition lenses to work properly it is essential that they are positioned properly in your eyeglasses and in front of your eyes. This depends on the skill of the person helping you select an eyeglass frame and making the proper measurements. In addition, your eye care practitioner should help you select the correct type of lens for your individual needs. There are many ways that contact lenses can be used to correct presbyopia.


Posted In: Presbyopia

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Be Informed about Glaucoma

Be Informed about Glaucoma

Dr. Salvatore J. Shakir of Brooklyn Eye & Vision Care

There are several types of glaucoma. The following information will be about PRIMARY OPEN ANGLE GLAUCOMA, which is by far the most common form.

The optic nerve is like an electrical cable that connects the eye to the brain. Without it the brain gets no visual information, and even if the eye and the brain were both healthy, the eye would be blind. Glaucoma is a process that gradually damages the optic nerve over a period of months, years, or even decades. The damage occurs in such a way that the side vision is generally affected first. Because of these two factors, very slow damage and peripheral vision affected first, glaucoma has no symptoms. In fact, even people who have lost much of their vision are often not aware of their loss. Sadly, any vision lost from glaucoma is gone forever and cannot be restored. Early diagnosis is key to preserving vision.

The eye is filled with water-like fluid; this is on the inside of the eyeball, not the tears which are on the outside. A gland inside the eye makes this fluid all the time, and a drain in the eye removes it into the blood, keeping the pressure of the fluid in the eye fairly constant. Some variation in pressure is normal. As the years go by, the drain can slow down, causing the pressure to go up. If the pressure goes too high, it gradually begins to damage the optic nerve; that is what we mean by glaucoma. High pressure in the eye generally does not hurt, nor does it cause the eye to get red. This is another reason that glaucoma has no symptoms.The diagnosis of glaucoma is often difficult to make because of its gradual nature and absence of symptoms. Very early glaucoma is impossible to diagnose. Advanced glaucoma is easy to discern. The trick is to make the diagnosis and begin treatment before significant damage has been done.

Glaucoma cannot be cured yet. What we can do is reduce the pressure in the eye with eyedrops. This will slow or stop vision loss for as long as the drops are used as directed. If a patient stops using the drops the eye pressure will go up and gradual vision loss will resume. If the pressure cannot be controlled with eye drops, certain lasers can be used to control the pressure for a few years. If that also fails to control vision loss, surgery can be done to lower the pressure. As with any medical or surgical treatment, there are associated risks and benefits which should be discussed with the eye doctor.

We regard early diagnosis and treatment of glaucoma to be an important part of our practice mission. Through patient education we strive to obtain compliance with the treatment plan, and we carefully monitor our glaucoma patients to assure protection of their precious vision.


Brooklyn Eye & Vision Care
Dr. Salvatore J. Shakir
2074 Flatbush Ave., Brooklyn, NY


Posted In: Glaucoma