At least once every clinic I encounter a new patient with eye findings that indicate early signs of Age-Related Macular Degeneration (ARMD) Without alarming the patient I explain that ARMD is the leading cause of irreversible vision loss in people over 55, more than glaucoma. WebMD features accurate and timely information about all aspects of ARMD.

Most patients are eager to preserve their precious eyesight, so the discussion invariably shifts to the role of vitamins, nutritional supplements, and antioxidants.

We know that damage from ARMD accumulates from life-long biochemical changes to the delicate layer of pigmented cells underneath the retina called the Retinal Pigment Epithelium. Genetics, sunlight, diet, and other environmental factors all play a role in causing the oxidative damage.

Current recommendations for ARMD patients include supplemental vitamin A, vitamin C, vitamin E, carotenoids like lutein, as well as the minerals selenium and zinc. Click here to learn more about nutritional supplements and their role in preventing ARMD. You and your doctor can decide which specific formula is best for you.

Now here’s the hook. Given that these supplements are known to delay or halt the damage, wouldn’t it also make sense for younger adults (even children) to consume appropriate doses of these nutrients throughout life in order to maintain the health of the retina? They recommend sunblock for infants to protect their skin from UV damage, right? Skin, eye, what’s the difference?

Think of it this way: Asking a 65 year-old to begin taking antioxidants is like asking Mrs. O’Leary to install a fire extinguisher in the barn after the cow has already knocked over the lantern! Maybe it wouldn’t hurt, but it would have been even more useful if it happened years earlier.

Related Topics: New Eye Drugs Treat Macular Degeneration, 10 Overlooked Reasons to Quit Smoking

Technorati Tags: supplements, macular degeneration, ARMD

Have you been following the unholy fracas taking place over at Rod Moser’s WebMD blog All Ears? Scroll down to the posting dated January 20. He wrote a candid and contentious tome regarding clinic booking practices and the many reasons why patients are left waiting.

I encourage you to visit and add your two cents.

The response was overwhelming!

= Overwhelmingly hostile

= Overwhelmingly sarcastic

= Overwhelmingly judgmental

= Overwhelmingly passionate

Everybody hates to wait. There, I’ve said it!
Everybody wants more time with their provider. There, I’ve said it again!

It makes no difference how busy or how (in)efficient my individual clinic may be. I was surprised that so many respondents blamed the waiting on GREED. If that were the case only private practice clinics would have problems with overbooking. University-based clinics, institutional, military, and missionary charitable health care facilities would hum along. Ha! Ha! Ha! In Honduras they wait for DAYS in order to be seen by the visiting eye doctors and no money changes hands.

About time management. Is it possible that all clinic administrators are idiots? They usually prepare the schedules. Many have MBA degrees. The core struggle is the provider’s inability to dehumanize the practice of medicine: listening, thinking, educating, comforting, balancing so many conflicting priorities while trying to compress 16 hours of compassion into 8 hours of clinic.

For example, a walk-in patient with a new corneal ulcer (serious threat to eye!) will unmercifully consume at least one hour of my clinic. One hour, POOF! What happens to the four waiting patients?

In 25 years’ practice the following gesture has never failed me. When things get backed-up I walk into the waiting room and ask for everybody’s attention. Without violating HIPAA I inform the group that the schedule has been sabotaged. I give my promise that patients who are willing to wait will receive the same care and attention. Those who cannot wait are invited to rebook. My final word is that I will not leave the clinic until every patient is seen and satisfied. Usually there is some soft laughter and a little applause. It really decompresses things.

Congratulations to Rod Moser for giving all of us a change to express our perceptions and our attitudes about outpatient health care delivery. Now, Rod, when are you going to tackle serious issues like hospital food?

Much of the writing I contribute to WebMD concerns prevention of vision loss and innovative ways to restore lost eyesight. Unfortunately, for some folks with serious eye conditions, permanent blindness occurs despite everyone’s best efforts. Given these tragic circumstances, the story does not need to have an unhappy ending.

Guide Dogs provide a valuable service to blind individuals. They offer independence, continued mobility, and physical protection to the legally blind. You’ve likely encountered Guide Dogs in the mall or at the airport. I’ve never seen an unattractive or unhappy Guide Dog.

Do you know the four common breeds that are the best candidates for training?

= Labrador Retrievers

= Golden Retrievers

= Lab/Golden Retriever crosses

= German Shepherds

These animals are always so beautiful and docile. You just want to run up to the Guide Dog and pet the animal! Trainers will tell you that is a bad idea; not because the dog will bite but because the distraction will interfere with the Guide Dog’s primary function. Both the Guide Dog and its partner require extensive training in order to become a reliable team.

Want to learn more? Click here for interesting stories about Guide Dogs for the Blind.

Related Topics: Animal-Assisted Therapy , Health Benefits of Having a Pet

Technorati Tags: blindness, guide dog, handicap, disability

Patients often ask me about anti-scratch lenses, additional UV protection and anti-reflective coating. Here’s my take on all three:

Extra UV protection isn’t necessary, the lens material (glass or plastic) already has an effective UV filter. Think of it like buying ‘undercoat protection’ at the new car dealership. Didn’t Detroit already take care of this?!?

Don’t buy anti-reflective coatings unless you are a TV personality (in which case have the broadcaster buy your eyewear). This add-on spray utilizes a clever optical principle called destructive interference to eliminate the harsh reflection of lightbulbs on the front surface of your glasses. Yes, the observer is the beneficiary, not the wearer!

Those indestructable anti-scratch polycarbonate lenses have a soft surface that tends to scratch fairly easily. Plastic (CR39) lenses should not scratch. The protective coating will likely wear out before the lens does.

Related Topics: Eyeglasses & Contacts, Eyeglass Prescriptions

Technorati Tags: eyeglasses, UV, antiscratch lenses

Months before WebMD launched its own blogs each of us bloggers were encouraged to surf the web and research other health-related blogsites. I quickly found a few favorites. One of the most consistently interesting health blogs is the self-titled Kevin,MD posted by Dr. Kevin Pho, a New Hampshire internist. Kevin has a strong interest in medicolegal issues, ethics, medical malpractice, and contemporary health stories in the media. His blogs are terse, logical, and well written.

Good doctors share what they know and this applies to medical blogs as well. A consortium of medical bloggers hosts a weekly collection of contributed posts that are appropriately labeled Grand Rounds. This week Kevin,MD hosts Grand Rounds and WebMD was included. Thank you for the warm welcome!

We’re grateful to Kevin,MD and all partner blogs for generously inviting us to join this outstanding online forum.

Speaking of Grand Rounds, where are the doughnuts?

Technorati Tags: Medicine, Medical Blogosphere, Blogs

Parents of newborn children are always anxious. Chief among their concerns is learning how well their baby can see.

At birth the healthy infant has not yet developed clear eyesight. Although the eye anatomy is intact there is still some last-minute wiring that needs to be completed. Over two million nerve fibers connect the healthy eyes with the brain at various locations, and the brain has to learn how to integrate the visual signal.

It might not surprise you to learn that during the first few weeks of life the newborn has very crude vision. They are aware of moving images, shadows, and they can recognize dark versus light. Parents may become alarmed because they sense that the child cannot see their faces; there is no cause for alarm.

By age three months visual perception develops to the point where the baby can recognize specific images such as a caregiver’s face and the baby will usually greet the person with a smile. Thereafter visual resolution steadily improves.

So, how can a parent tell if a genuine vision problem exists?

If an infant consistently does not appear to respond to different sounds, gentle touching, or visual stimuli you should also have the baby examined by the pediatrician. Find answers to other questions about healthy vision by visiting the WebMD Message Board

Related Topics: Strabismus Infant Milestones

A good amount of my time is spent replying to visitors’ inquiries posted at the WebMD Eye & Vision Disorders message board. It is a lot of fun helping others learn more about their eyes. Folks often visit with questions about recent diagnoses or proposed treatments. Many are anxious to know more about their symptoms and this anxiety can lead to impatience. They are hoping that the Internet will render an accurate diagnosis for them. In theory it sounds good; fast and free – does it get any better?

How tempting it is to bundle a visitor’s findings and burp-off a diagnosis. Truth be told, it is often possible to discern the most likely cause for an individual eye problem, whether it be refractive, medical, or even a lid lump. Consider this – I’ve been listening to people’s complaints in a dimly lit exam room for 25 years – is it really that different?

“Doc, why can’t you just tell me if this scaly lid lump is cancer?!?”

First of all, I am not your physician. That’s a pretty good reason right there. Sure, I meet folks at social gatherings who want me to look at their eyes, their eyelids, or their glasses. However well-intentioned, these folks are asking for substandard care. In other words, “Don’t bother with a careful history and exam – just guess!”

Good medical care is more than answers (or guesses). It is the composite experience: conversation, examination, testing, treatment decisions, and more dialogue. Patients are denied good care if their problems are analyzed in a vacuum. The physician-patient relationship is more valuable to good health than any expensive scan.

Let me summarize by saying that the practice of rendering online diagnoses without the benefit of a comprehensive evaluation (history, examination, pertinent testing) is unhelpful, potentially harmful to the patient, and downright arrogant on the part of the provider. Last time I looked medicine was still considered a healing profession.

WebMD strives to provide the best information possible; see your doctor for the best care possible!

Related Topics: Eye Problems Symptoms, Health Information Online

Okay, this installment is not about eyes or vision disorders. WebMD encourages us to talk about other experiences from time to time. Consider yourself warned!

As a full-time faculty member at UC Davis School of Medicine I have the responsibility to deliver lectures and presentations, many lectures and presentations. I am always on the lookout for ways to improve my teaching technique and my visual presentations.

These days, regardless of the venue, almost every kind of oral talk is supported by a PowerPoint presentation. I remember using PowerPoint to make 35mm word slides before it was a Microsoft product; back when the top software was a clunky DOS product called Harvard Graphics. PowerPoint remains popular because it is a quick and easy way to organize your thoughts and clearly deliver those thoughts to an audience.

The current version of PowerPoint has so many bells and whistles I am overwhelmed. Nevertheless, I want to discover and fully exploit PowerPoint innovations that will make my lectures memorable. Scientific content is always top priority, but why not a little sizzle with that juicy steak?

Hey, ‘Dummies’ and ‘Idiots’! I have finally found a comprehensive guide to help me prepare consistently attractive and dynamic PowerPoint presentations. I think this is the one book you’ve been looking for.

This blog is not a commercial endorsement. Consider it a strongly-worded recommendation from an experienced educator. Get hold of a copy of Perfect Medical Presentations by Irwin (a physician) and Terberg (a graphics artist). It won the 2005 Best Book Award (Basis of Medicine) by the British Medical Association.

No, you do not need to be in the medical profession to appreciate this book. It is loaded with extremely practical and outrageously creative tips for basic and advanced PowerPoint users. It comes with a CD loaded with original templates and useful graphic examples.

Besides helping you navigate PowerPoint, this book shows you step-by-step how to create your own high-end graphics with Adobe Photoshop Elements (a software program bundled with most scanners). If you already use the full version Adobe Photoshop you are good-to-go!

PowerPoint simplifies my job as a teacher. Perfect Medical Presentations has helped me do that job better.

Related Topics: Top 10 Stories of 2005

Technorati Tags: review, software, powerpoint, medicaleducation

Although it’s only January I can already predict with confidence that cataract surgery will be the #1 most commonly performed surgery in the United States during 2006. Two million or more procedures will be performed, far more than hernia repairs, tonsillectomies, even hysterectomies.

The reasons eye surgeons are kept so busy are pretty obvious: America has a maturing population (some baby boomers have already reached their 60th birthday) and both eyes eventually need cataract removal.

Patients and families often ask, “When is it the right time to have cataract surgery?” Because of the superior technology available today cataract surgery is very effective and carries a low (maybe 1%) potential risk of long-term complications. Forty years ago cataract surgery was feared because one-third of all cataract surgery patients ended up worse after their operation.

Cataract surgery should be considered when the cataract interferes with daily activities like reading and driving. The eye surgeon first needs to be sure there are no other active eye conditions that need attention.

There is no hurry to operate on both eyes. Symptomatic cataract in one eye often advances faster than the fellow eye. Many people function very well after having the first cataract removed and can wait months or years before returning for more surgery.

So, cataract removal will be number one in 2006. Check back with me in December and see if I’m right!

Related Topics: Cataract Surgery: The Innovations Continue, Eyes and Age

Here’s your dose of weekend weirdness.

Check out this story about a kitten born with one eye. They named it ‘Cyclops’ – how adorable! Other eye doctors have sent it to me to ask if I felt it was legitimate. Click here for an enlarged photo of this phenomenal feline. (Someone stop me, I can’t help myself!)

It’s probably not truly one eye, but two eyes that failed to divide…something called synophthalmos. I can’t speak for cats, but this kind of anomaly is incompatible with life in humans because other structures besides the eye (like the brain) are also maldeveloped. It would require a CAT scan to know for sure!

Enjoy this blog while you can before WebMD’s editors use it to line the kitty litter box!