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Intacs: More options for Keratoconus

With the FDA approval of Collagen Cross-linking many patients suffering with keratoconus have resurfaced asking what options are available.  Dr. Josephson, a fellowship trained Cornea Surgeon, is a pioneer in the latest technology for keratoconus.  We offer FDA approved collagen cross-linking in our office.  We also offer INTACS which with a very quick and easy laser approach we can place a segment that allows the cornea to mold into a more normal shape.  Intacs with cross-linking can make a reshaped-better cornea a permanent reality.  If you are having haloes and glare with suboptimal vision you may have this debilitating condition that now is treatable.  Furthermore many insurers are recognizing these procedures and providing coverage.  Call our office at 571-349-2191 or visit us at to schedule your evaluation.

Happy New Year and Eye Healthcare in 2018

A Happy and Blessed New Year to you all!

We understand the excitement a new year brings but 2018 also brings a lot of anxiety in regards to healthcare.  At Eye Specialists we could not be more aware of the ever changing healthcare landscape in our region.  The Healthcare Exchange in Fairfax County has left little options for many of our patients and possible future patients.  You are not alone.

We want to ensure you that we are here for your eye care needs even if we are not in your network or if you do not have insurance.  We have implemented a fee schedule that is fair and discounted to allow for those in need of expert care to have access.  This is not only for exams but for tests and procedures.  During your exam we will discuss tests that may need to be done and the cost before we do them. If you need a procedure we will review the options so there are no surprises.

We look forward to seeing you soon.

All the best for 2018

John Josephson MD and ESSNV team

Going Deeper into a Cataract

(Posterior subcapsular cataract)

I’m often asked what grade is my cataract? or is my cataract ripe?  This is a difficult question to answer because a cataract comes in many forms.  There are actually over 20 different types of cataracts.  There are cataracts that younger people can have and then there are those we see in the more advanced in age.  Some are due to trauma or medications.   All of this information is important for your surgeon to evaluate not only for surgical approach but also to determine if a work up is needed.   An medically trained eye specialist can often diagnose diabetes, medication toxicity, autoimmune disease, and various other ailments just by a thorough eye evaluation.  At the same time a superficial exam may miss many of these issues and leave them diagnosed.  In the picture above this cataract was seen in a young person and we were able to diagnose an autoimmune condition from one eye exam.

Once it is determined that a cataract is there and is causing visual issues we are fortunate to have the latest advancements in vision correction and laser cataract surgery to obtain the highest in patient satisfaction.   If the cataract is very mature we have access to the ORA calculator to ensure proper measurements in the Operating room.

If you having blurred vision, glare, trouble driving at night, or any other visual concern a thorough eye evaluation from an Eye Specialist may reveal a cataract or many other issues that may be occurring.  We would be glad to take care of you.  Please call us at 571-349-2191 to schedule an evaluation.

Is this lump on my eye anything to worry about?

Many times we see a spot on the eye and we do not know if it is concerning or not.  During my fellowship in San Diego I had the privilege to see many Sun related growths on the eye.  Most of these were a growth called a pterygium.  A pterygium is a common growth on the eye that can grow onto the cornea.  Thankfully we can remove these and restore the look of the eye. It is best to remove before scarring occurs on the cornea.

The picture here is of an elevation or growth on the eye that had a peculiar look to it.  Three different eye doctors passed this patient along but were not sure what to do.   The patient was sent to us due to our specialty training in Cornea and external disease.  With special staining and testing we determined this growth was more likely a carcinoma of the eye and set her up to have excisional biopsy with us right away.  We are confident with continued care and treatment we can preserve vision in this otherwise detrimental situation.

If you have a growth on your eye or any changes in your vision it is important to have an evaluation with an EyeMD familiar with the subtleties of these conditions.  We would be honored to see you at Eye Specialists and Surgeons of Northern Virginia.  Call us at 571-349-2191 or check us out at

I had Lasik many years ago and now I have a Cataract?!?!

Cataract Surgery Ora Lens Calculator


I was asked this week as I have been before “is there any increased risk in having cataract surgery since I had lasik years ago?”  It is actually a great question and I’ll try to answer in this post.  There are many important points.  First of all, Lasik is done on the cornea (the window of the eye) and it molds the shape of the cornea to allow images to be in focus.  Cataract surgery is done where we remove the cloudy lens material.  Surgery-wise there is no technical difficulty doing cataract surgery when you had prior lasik, especially in the hands of fellowship trained cornea cataract and refractive surgeon.

The challenge is making sure that we place the correct lens in place of the cataract with the right power to help give you the focus you desire.  Cataract surgery has become to our patients an opportunity to enhance vision better than what they could see before they developed a cataract.  Your surgeon has to use special formulas and calculations to ensure proper measurements and lens power is being used.  Even a smooth uncomplicated surgery will have a poor vision outcome if time and detail is not put into the calculations before the surgery.

At Eye Specialists and Surgeons we pride ourselves on getting to know our patients. We take time to understand your goal in surgery.  We then take time to make sure our measurements are as accurate as possible and our formulas are correct. Nothing is one size fits all.  We have the latest in office calculators in our LENSTAR and PENTACAM to measure your eye in the office. To go even a step further we have access to the latest technology including Femtosecond laser incisions (Catalys)  and ORA Calculator (Intraoperative Measurements) to try our best for your precise visual outcome.  The ORA calculator is crucial, especially in those with prior eye surgery, to allow for an additional REAL TIME measurement in the operating room during cataract surgery.  This REAL TIME measurement is actually the most accurate time to measure the eye and we offer this technology option routinely to our patients.   

If you have any questions about your eye condition or would like to know more about our world class care and technology offered by Dr John Josephson at Eye Specialists and Surgeons of Northern Virginia please see our website at or call and schedule a consultation at 571-349-2191.

Our greatest gift: You!

We would like to thank our wonderful patients for trusting in us to take care of one of their most important senses: Vision.  Recently in the same week Dr. Josephson was asked to take a picture with two different patients as they finished their surgery.  We were reminded of the gift we have in treating and restoring vision.  It is a blessing!  The pictures were shared with us and we were given permission to share on our blog. Our first patient traveled from Overseas to have her only eye operated on by Dr Josephson and was happy to go back home seeing once again.  Our other picture is of 2 sisters post surgery with Dr Josephson after one recommended to the other.  It is a great honor to serve you.  Thank you for the opportunity.

No Stitch Pterygium Surgery

A pterygium is a growth of tissue on the cornea, the window of the eye, often from exposure to sunlight, trauma, or eye surface disease.  It is often surprising how advanced pterygia can become before people seek treatment.  This picture is of a young woman with advanced pterygium in both eyes that were scarring the cornea who had surgery in her left eye recently.  If not removed delicately a pterygium can cause permanent vision issues.  Fortunately, even though it was more advanced then her other eye awaiting surgery, we were able to remove her pterygium with a no stitch, 20 minute out patient procedure and restore her vision and appearance.  She is excited to have her other eye done soon.

If you notice any growth on your eyes or changes in your appearance or vision please call and schedule a consultation with Dr. Josephson at 571-349-2191 or find an ophthalmologist specializing in cornea disease in your area.