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Dr. Lloyd's blog has now been retired. We appreciate all the wisdom and support Dr. Lloyd has brought to the WebMD community throughout the years.

Monday, April 30, 2007

Presidential Politics Not Always 20/20

presidential sealTake a good look at the huge flock of presidential hopefuls: Democrat, Republicans, and other parties. They share markedly divergent opinions about the role of the federal government, foreign policy, the economy, homeland security – you name it.

Here’s one thing that elicits unanimous consensus from the entire mob: “Don’t wear any eyeglasses!”

Quick. Who was the last American president who routinely wore eyewear? You’ll need to go back 40 years; it was Lyndon Johnson. By the end of his presidency he wore his bifocals everywhere, even on TV.

Campaign image consultants are down on eyewear. They claim it makes a candidate appear impaired, older than their age. Truth be told, some candidates might do better to appear a bit older.

Maybe they’re all wearing multifocal contact lenses. That would be brutal given their 20-hour campaign days.

Back to the bifocals issue: since most candidates are age 50 or older they definitely need a little help reading the fine text. Okay, speeches today are delivered with the aid of a teleprompter with bright, JUMBO type. Skeptics will immediately pounce on this idea by claiming, “If the candidate is nearsighted (myopic) they can read for many extra years without needing bifocals!”

My response is that those applying for the most powerful job on earth are either seeing poorly at distance (can’t get the big picture, can’t see beyond their nose) - or - they may someday accidentally sign some blurry treaty or tiny-print legislation that could endager all of us. They can’t have it both ways.

Oh, my bad!

They’re politicians – of course they can!

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Posted by: Bill Lloyd MD at 2:14 pm

Tuesday, April 24, 2007

Vision of the Masters: Artistic or Impaired?

Do you have a good ‘eye’ for art?

Let’s turn it around: Do artists have good eyes?

I have written in an earlier WebMD blog how some of the great masters continued to paint magnificent works of art while enduring progressive visual deterioration.

Now, an ophthalmologist who has devoted much of his career to studying the role of visual sciences in the creative process has attempted to recreate what selected artists were experiencing at the time their masterpieces were being created.

Dr. Michael Marmor, Professor at Stanford University, relied on computer simulations plus his own expert knowledge of visual disabilities to offer a hypothetical vision of what Edgar Degas and Claude Monet probably saw when applying paint to canvas. Degas had some form of progressive retinal degeneration and, as previously reported, Monet suffered visual complications from both cataracts and cataract surgery.

According to Marmor, Degas and Monet were both founders of the Impressionist era, and the style of both painters was well-formed before their eye disease affected their vision. But their paintings grew significantly more abstract in later life as, coincidentally, their eye problems increased. Art afficionados are left to wonder if the stylistic changes in the paintings were intentional (artist’s vision) or more likely a reflection of chronic progressive eye diseases (impaired vision).

Click here
to learn more about this interesting analysis and to view some of Dr. Marmor’s simulations.

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Posted by: Bill Lloyd MD at 1:52 pm

Monday, April 23, 2007

Better Vision A “Swipe” Away?

I had the most amazing conversation the other day. The information was so remarkable I couldn’t wait to share it with you.

Most of us (99.9%) are extremely naive as to what is going on about us. Are you surprised?

Speaking with a marketing expert/statistical analyst, I learned about something called predictive modeling. Never heard the phrase before but apparently it’s been around a long time.

Predictive modeling is the science of developing mathematical constructs that enable reliable prediction of future events or measurements based on past information. Please, don’t run away! It gets better, I promise!

Short version: predictive modeling uses data about you to predict your future.

Retailers rely heavily on predictive modeling. Every time I go to my favorite electronics store they already know how often I visit, what I usually purchase and what brands I prefer. This information is collected (mined) from previous credit card purchases. When sorted by zip codes and other criteria, local merchants know in advance what I’m more likely to buy (Bluetooth wireless remote for my laptop) and more likely to ignore (Borat DVD).

Predictive modeling is migrating over to other areas in our lives like healthcare.

Thoughtful analysis of patient care data (millions of records) can give health professionals a more precise view of an individual patient’s medical status. Done correctly, predictive modeling can help doctors warn patients of imminent diabetes, heart disease, cancer, even stroke.

This approach can be more effective than the present model:

Instead, a discussion based on predictive modeling may sound like this:

  • “When we compare information in our database to information about you and your eye exam we discover that there’s a 95% chance that you will develop glaucoma before your 40th birthday. Let’s talk about treatments that can prevent you from losing your precious eyesight.”

Privacy concerns? This type of data mining can be performed anonymously. Paperless electronic health record systems are already collecting data that may one day allow you to know more about your future.

Did you buy the Borat DVD? Hope you paid cash for it!

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Posted by: Bill Lloyd MD at 11:15 am

Monday, April 16, 2007

Tax Crunch Time is Over: Plan Now for 2007!

Feeling stressed about the tax filing deadline?

Here’s why you should always think about your precious eyesight whenever the time rolls around for preparing your income taxes:

Those tax forms get more crowded, more complex every year. Some of the type is pretty small. If you are 40 and older you might need some reading glasses.

You can pay for those reading glasses with funds from your pre-tax Flexible Spending Account.

Of course, if during 2006 you made any kind of charitable contribution to a nonprofit organization dedicated to helping those with vision problems you might qualify for a generous tax deduction. (It’s not too early to be thinking about 2007!)

While we’re on the subject of vision research, the National Eye Institute (NIH) has an annual budget of nearly $700M to fund scientific research that explores the causes and treatments of eye disorders. Guess where that money came from? Yep, your income taxes!

Finally, people keep asking me about tax relief for the legally blind. Years ago, as a consequence of the so-called ‘reform’ of our income tax program, Congress eliminated the additional personal exemption awarded to folks with severe visual field loss or whose best-corrected eyesight was 20/200 or worse in the better eye. Our clinic was always busy during March and April generating signed statements that qualifying taxpayers included with their IRS returns. In the final analysis tax reform may not have saved much money for the visually impaired but my office staff was refunded lots of lost time by no longer preparing all that IRS paperwork.

I wish I had more time to write but, you guessed it, I haven’t finished my taxes yet either!

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Posted by: Bill Lloyd MD at 11:37 am

Friday, April 13, 2007

Visual Changes AFTER Cataract Surgery

Photo Credit: Bill Lloyd, MD

Most people with healthy eyes who undergo cataract surgery report a dramatic improvement to their vision: brighter, clearer, more colorful. It’s great to be around these patients when they discover how well their ‘new eyes’ can see – one of the most rewarding aspects of being an eye surgeon.

For a minority of patients cataract surgery makes vision better but also different. Yes, uncomplicated cataract removal and intraocular lens implantation significantly boosts visual acuity, but some folks experience other changes that were never present before surgery. There is enormous variability. Some people describe halos, ghosting, slight overlapping of images (not double vision) and unexpected flashes of light. The medical term for all these changes is dysphotopsia.

As a result of uncomplicated surgery it appears that patients replace one type of visual symptom with an entirely different (and annoying) problem.

In the past eye surgeons often dismissed these symptoms as temporary optical phenomena that could be expected to disappear once healing is complete. New information published in the American Journal of Ophthalmology contradicts those assumptions.

55 healthy patients undergoing routine cataract surgery were enrolled in this volunteer study. All of the surgery was performed with no complications and all experienced satisfactory recovery of good postoperative vision. It is important to note that 18 patients (roughly one-third of the group) observed dysphotopsias after their surgery and these visual distortions persisted one year after surgery. Halos and starbursts were the most frequently reported symptom. Repeat exams revealed no anatomic explanation for the dysphotopsias such as mild corneal edema or clouding of the posterior lens capsule. There was no correlation between dysphotopsia and patient age, final visual acuity, or contrast sensitivity.

So, how does this information apply to the individual patient? The report suggests that far more people endure postoperative vision changes following uncomplicated cataract surgery than originally believed. Equally important, since one-in-three may experience unwanted photopsias after cataract surgery the decision to perform surgery ought to be postponed until visual performance truly interferes with daily activities.

SOURCE: American Journal of Ophthalmology 2007; 143:522-524

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Posted by: Bill Lloyd MD at 2:15 pm

Tuesday, April 10, 2007

IMUS: Help Me Draw the Line

‘Don Imus must go.’ There, I’ve said it.

His hurtful words were unacceptable, especially to the dedicated young athletes from Rutgers. They didn’t deserve any of it.

I can’t reverse historical bigotry. Don Imus must go.

I can’t comment on other offensive radio programs that I have not heard. Don Imus must go.

A two week suspension (READ vacation) only makes things worse. Don Imus must go.

We need to draw a line for our society, for our children. Don Imus must go.

Speak up and help draw that line. Don Imus must go.

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Posted by: Bill Lloyd MD at 12:32 pm

Monday, April 9, 2007

LIVE! Long Distance Eye Exam

Hard to believe it, but not everybody has immediate access to an eye doctor. Despite those billboards mounted on the sides of buses and the full-page phonebook advertisements, everybody cannot see the eye doctor tomorrow. Or even next month!

Folks in rural locations have limited access to health care specialists. Who wants to drive six hours for an eye exam when the patient has no symptoms? This is especially true for Type 2 adult diabetics. Although there may be dangerous changes to the fragile retinal blood vessels, changes that warrant immediate treatment, the patient may have no visual symptoms whatsoever.

There are many other comparable scenarios. How can effective health care be delivered over such long distances?

The answer is simple: Be in two places at once!

Telemedicine is real medicine simultaneously practiced in two locations. Live clinical images from a remote site are transmitted to an observer physician far away. A primary care physician or nurse is usually present with the patient. Concurrent voice communications are also utilized so that the expert can ask questions of the patient. The central observer can view images from many different clinics across a network to maximize specialist availability. Examinations can also include microscopic slides of biopsies, CT/MRI scans, and mammograms. Telemedicine is also frequently used to provide specialty care to incarcerated prisoners.

Now, back to our diabetic model. Does telemedicine provide quality eye care for rural diabetics? A recently published study looked at 495 adult volunteers who were given the choice between commuting to a far-away medical center versus expert telemedicine eye evaluations for their retinas. 67% opted for the camera instead of the toll booth!

When the telemedicine volunteers were examined half had no abnormal retinal findings and were advised to return in one year. Nearly 40% were referred to the medical center clinic for non-urgent treatment and in 11% of volunteers the telemedicine camera documented serious changes that necessitated immediate treatment. Overall, the telemedicine failure rate was less than 1% (meaning a volunteer had to travel to the medical center for a confirmatory eye exam because the camera equipment could not adequately image the diabetic retina).

Insurers and Medicare now reimburse for live and stored telemedicine examinations, so it is likely more and more institutions and practices will embrace this technology. Time for your eye exam, say “Cheese!”

SOURCE: Diabetes Care March 2007:574

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Posted by: Bill Lloyd MD at 10:32 am

Tuesday, April 3, 2007

New Glasses Boost Fall Risk

Staff Photo

Even among the healthiest seniors, getting older is often accompanied by a slow, progressive deterioration of the senses, especially hearing and vision. Short-term memory is often impaired as well.

It may appear intuitive that any treatment that reverses or halts such deterioration would be beneficial. One new study out of Australia challenges that notion.

Prescribing new eyewear doesn’t necessarily reduce the risk of accidental falls. In fact, new spectacles may actually increase that risk! Vision researchers followed over 600 randomized elderly study volunteers from the Sydney area – average age was 81.

In this prospective study volunteers completed monthly postcards that reported any falls during the previous thirty days. The study ran for one year and the data was tabulated and analyzed.

65% of the seniors who received new spectacle prescriptions during the course of the study sustained at least one fall. This number was significantly greater than the control group who kept using their old glasses. Fractures were also more common among those with new eyewear.

Accidental falls is a leading cause of hospitalization for senior citizens. Survivorship from hip fracture in folks over 80 is dismal. Do what you can to help prevent this tragedy.

Getting back to this study, what do the findings mean? Was it a fluke or did the new prescription abruptly disorient these older study volunteers? More work needs to be done.

In my personal experience I have had older patients who rejected their scrupulously accurate new prescription lenses. Maybe they could see better on the vision chart but they were miserable in the real world and switched back to their old frames.

Certainly, if you know a senior with new glasses you might encourage them to be extra careful until they fully adjust. If they refuse to wear the new glasses, even after the correct prescription was verified, they may be happier going back to their earlier prescription. I’d take a little blurriness over a hip fracture anyday!

SOURCE: Journal of the American Geriatrics Society 2007; 55:175–181.

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Posted by: Bill Lloyd MD at 11:53 am


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