Best Practices: Mandel Vision
Dr. Eric R. Mandel explains how his research helped advance modern refractive laser vision surgery and his practice’s individualized approach to the procedure.
Voted one of the best doctors in New York, LASIK surgeon Dr. Eric R. Mandel understands that no two patients are exactly alike. He started his practice, Mandel Vision, after playing an instrumental role in the development of the excimer laser. Today, his customized and individualized approach to refractive laser surgery enables his patients to heal faster and easier. Read more to learn about Dr. Mandel’s unique approach to laser surgery and what originally inspired him to choose ophthalmology.
How did you get started in medicine and what inspired you to choose your specialty?
I grew up in Bensonhurst, Brooklyn, where the greatest accomplishment you could achieve was becoming a professional, like a lawyer, accountant, or doctor. I was enthralled by the possibility of making a difference in people’s lives and having a meaningful impact on the world as a doctor, so I decided to shoot for the stars and follow a career in medicine. Soon afterward, I attended a six-year medical program at City College in New York, and I focused on ophthalmology because it was a specialty where you could have a profound impact in a short amount of time. Ophthalmology focuses on procedures that cure diseases, whereas often in internal medicine you can treat but not cure.
Tell us a little bit about your journey to starting your practice, Mandel Vision.
During my residency in Manhattan, I was introduced to a cutting-edge project at Columbia University’s Harkness Eye Institute that was just beginning with a new laser called the excimer laser. Initially, a cow’s eye was treated with the excimer laser at IBM Research in Westchester County New York, and the result was astounding. The researchers discovered that this new laser was the perfect lock-and-key to break apart carbon-carbon and carbon-nitrogen bonds in the cornea without causing any thermal damage. We realized it had the ability to precisely reshape and correct an eye’s refractive error. While most lasers work by burning or blowing up things, an excimer laser is able to resculpt the cornea without causing any damage.
By working on the project at Columbia, I became part of the research team that published the first paper in the world proving the excimer laser can work in refractive surgery. Based upon that research, I was recruited to Harvard’s Eye Hospital, Massachusetts Eye and Ear Infirmary, and was the lead author of the first paper in the world proving the excimer laser works for modern-day refractive surgery. The procedure is PRK, which is still used in a much more advanced form in almost 40% of my patients today. At that point, I knew that I wanted to focus my practice specifically on refractive surgery, but there was one problem: the FDA trials had not begun. I was trained as a cornea surgeon, which is what I did until the FDA approved using the excimer laser to correct nearsightedness in 1994, after which I began transitioning my practice exclusively to refractive laser surgery.
As a leading New York LASIK surgeon, you were instrumental in developing the excimer laser. How has this device changed the scope of laser vision correction surgery?
It was, is, and will be the workhorse of most refractive surgeries of the cornea (the clear window of the front of the eye). It has certainly evolved in the way it delivers the laser energy to the cornea, where we now have three-dimensional eye tracking systems with computerized centration and variable spot sizes and repetition rates, so that the laser energy can be delivered in the most precise way to correct someone’s glasses or contact prescription. But the fundamentals of fixing and changing a human cornea still go back to the basic findings of the excimer laser.
What makes your practice’s individualized approach to LASIK surgery so successful?
Many practices in this field use a one-size-fits all approach, but I didn’t believe that was the best way to get the optimal result in refractive surgery. This is an elective eye procedure where there’s really not much room for error, so you need to individualize the treatments for every patient. Each patient has a unique fingerprint of their visual aberration and has different visual requirements sometimes based on their occupation or leisure activity. I turn away 20% of patients who would not be optimal for laser vision correction. Every patient who comes for our free evaluations spends about two hours with me and my refractive team to see if they are a good candidate. Getting to know who your patients are and what expectations they have are very important to the process.
The laser system I use now is called the Eye-Design Studio, which is the only full-time customized laser system in Manhattan that integrates corneal topography, precisely correcting nearsightedness, farsightedness, and astigmatism. Mandel Vision is a teaching center for ophthalmology residents. For example, one of the things that we do is capture the patient’s unique visual aberration on the day of their procedure (rather than on the day of their consultation). This allows me to handpick and design the laser treatment that is most precise. I also do my own post-operative care — all of which combined, significantly increases the quality of the results. It’s incredible how something so simple, like monitoring or altering the drop regimen or reassuring an anxious patient, can really help create an individualized and successful approach.
Any additional advances in technology that have emerged in the field recently?
About fifteen years ago an important advancement was introduced to the LASIK surgery procedure. In Lasik, you need to create a flap on the cornea. Previously, surgeons were using bladed systems to create this flap, but you achieve greater precision, accuracy, and safety by using a laser to precisely create a flap. The laser that makes the flap is called the femtosecond laser, or Intralase. Using both the Intralase for the flap and the excimer laser under the flap to correct a refractive error, enables up to 99% of my patients to work out, go to work and even drive as early as the day after their LASIK surgery.
What is the most rewarding aspect of helping your patients improve their vision?
It’s an incredibly rewarding feeling to help people who feel visually disabled.
I have patients who come to me with coke bottle eyeglasses and feel totally vulnerable without their glasses or contacts that tell me that I’ve changed their life.
Most doctors who perform the same procedures will tell you how rewarding it is and how incredibly appreciative our patients are. Performing these procedures gives our patients newfound freedom, and that in itself is the reward.
Vital Signs
Favorite meal? I love Mediterranean food. I couldn’t be happier than with a grilled Bronzino, mezze salad with grilled halloumi cheese from Israel, and a delicious glass of New Zealand Sauvignon Blanc.
Next destination on your travel bucket-list? I have another expertise, which a lot of my patients don’t know about, which is that I’m an expert on the Middle East. I brief Congress and write for newspapers on the subject, so I travel often to Israel and the Middle East. This year I’ve been to Bahrain, Abu Dhabi, and Dubai, and later this year I’ll be in Jordan and Kurdistan. I’ll also be leading a seminar on anti-Semitism next year, where we’ll be traveling to Berlin, Budapest, and Israel. The organization I created is called MEPIN, Middle East Political Information Network. For fun, I’m going to Lake Como and also hiking in the Dolomites at the end of this summer.
All-time favorite book? I read almost all non-fiction. I’m currently reading a biography of Winston Churchill and a Great Courses series on the Ottoman Empire. Twenty years ago I read A Year in Provence, a memoir about an Englishman who decided to move to Provence. Reading about the way he enjoyed food and wine made me pause and reflect, and I began enjoying wine and food much more. Carpe diem, seize your moments and appreciate all the blessings you have been given.
How do you de-stress after a tough week? I give my patients my personal phone number, and that actually decreases my stress because I know that if I’m not hearing from someone, I don’t have to worry. But if I need to de-stress, I’ll run around the reservoir in Central Park, play tennis, read, or watch reruns like Frasier, NCIS, or The Big Bang Theory while eating cookies.
What’s the one gadget you couldn’t live without? My phone. I’m attached to my phone all the time, especially for patient communication. Sometimes I make an attempt to not have it with me, but that just stresses me out.
If you weren’t a doctor, what would you be? President of the United States. In fact, I used to think I would go into politics, but I realized that I could make more of a difference as a doctor. While on a macro level the president can make a great difference in the world, doctors do it on a micro level every single day.
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