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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.

Wednesday, May 30, 2007

Another Contact Lens Solution in Hot Water

Take a peek in your medicine cabinet. Do you have any packages that look like this?

For the second time in less than a year a leading contact lens solution is being recalled because serious eye infections have occurred among consumers.

The latest contact lens solution under suspicion is Complete Moisture Plus manufactured by Advanced Medical Optics. You can read AMO’s statement to its customers. An outbreak of corneal infections due to an unexpected germ was originally noted in the Chicago area. Most of the affected patients used this product.

Whereas the previous recall involved a fungus (remember Fusarium?) this time eye specialists are worried about a parasite, a specific protozoa called Acanthamoeba. This is a very challenging organism to diagnose and to treat. In the laboratory it can be very difficult to isolate, unlike ordinary bacteria like Pseudomonas (a frequent cause of contact lens-related corneal ulcers). This bug typically infests the clear cornea, so the presence of the contact lens makes for a convenient incubator. Acanthamoeba lives in fresh water, nonchlorinated water. Believe it or not, one of the oldest and most helpful antimicrobial treatments is medical grade swimming pool cleaner. See? Necessity is the Mother of Invention!

AMO and the CDC suggest that Complete Moisture Plus itself is probably not contaminated but something may be wrong with its formulation. This lens solution may offer little protection from accidental contamination from an environmental source (read ‘dirty fingers’).

So, here we go again. In order to protect yourself from accidental Acanthamoeba exposure that could lead to a painful, disabling corneal ulcer, authorities suggest users of Complete Moisture Plus discard all open containers of the product and return unused packages. Affected customers can call AMO at 1-888-899-9183 for specific details. Go ahead and toss any used contact lenses and contact lens storage cases that came in contact with the product. If you experience any redness, eye discomfort, or change in vision see your eye doctor immediately and be sure to alert the provider that you were using Complete Moisture Plus.

We will follow this story and follow-up with you as new information becomes available.

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Posted by: Bill Lloyd MD at 10:33 am

Tuesday, May 29, 2007

Prescription for Graduates

Photo Credit: Manuel/MC

Nobody asked me but I’m ready anyway.

As we approach peak graduation season, families and young scholars convene for diplomas and a long speech – the commencement address. Did you notice that the last six letters spell ‘cement’? Graduation ceremonies are harder for me to endure than any final examination.

Having sat through enough cheesy renditions of Pomp & Circumstance I put together my own address to the graduates. Here’s what I would tell the Class of 2007 as they prepare to enter the real world.

Do What You Like and Like What You Do

You can only succeed in doing things you like. Sure, you can fake it for awhile, but eventually you will be miserable trapped in a job you hate. Find work that interests you, challenges you, and keeps you engaged. Don’t ever make a career choice to please someone else.

Options Give You Freedom
So long as you have options you have the freedom to make exciting choices in your life. Protect those options. For example, one DUI arrest can scuttle many career opportunities – some employers won’t even consider your application.

Visualize Your Success
I learned about visualization while training for a marathon. The night before the big race I got in my car and actually drove the final 2 miles so that I could see what it would look like. Later that night I dreamt about finishing. Next day the finish line was there just as I had visualized it! Imagine how it will feel to get hired, your first pay raise, your first promotion. Visualization works!

Happiness is Everywhere
Here’s a final secret that will carry you far – be happy. People like to be around those who smile and speak positively. Moaners become loners. No matter how difficult the situation becomes there is always time for an encouraging word and an optimistic attitude. Success tends to gravitate towards positive thinkers. This attitude is best summed-up by a dog lover’s bumper sticker: Wag more – Bark less!

So there it is, my advice to America’s graduates. Remember, if Bill Cosby has to cancel I’m still available!

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Posted by: Bill Lloyd MD at 10:00 am

Wednesday, May 23, 2007

Sicko: Biggest Targets Are Easiest to Hit

On June 29, Michael Moore will bow a new documentary called Sicko.

It’s his usual style — a collection of humorous, frustrating, aggravating and poignant anecdotes to underscore the flaws in the American health care system (or nonsystem, as others have complained). Many of the stories have been previously told in other media, some date back to the 1980s.

To be fair to countless other authors and health policy analysts, much has already been written about ineffective health care delivery in the United States. It is a complex patchwork quilt that includes commercial, private, governmental and other insurers: a quilt that has been become increasingly frayed. In a recent WebMD blog I reiterated the key message that permeates everybody’s argument: How can one nation spend the most per capita on health care yet still have 45+ million Americans uninsured?

Policy experts (yawn!) have spent three decades warning society that the collapse of our health care system is imminent. What happened as a result? No significant change occurred, at least not in the eyes of health consumers.

Next the politicians took a swipe. Much of President Bill Clinton’s first term in office was devoted to a systematic overhaul. The First Lady became Chief Reformer and party partisanship took over. These efforts were smothered by a well-placed advertising (misinformation) campaign that successfully alarmed senior citizens and the working middle class. What happened as a result? Congress retreated. Only the stupid parts of managed care survived, hospital companies consolidated, CEOs and inside traders became wealthier, and more Americans than ever were left out in the cold. President Bush hasn’t had much more luck with change.

Michael Moore is a film writer and cinematographer. He does not claim to be a health policy analyst and he is not a politician (not yet). Those “resume deficiencies” may be his best qualifications to effect real change in American health care. Let me tell you why his voice may make a difference.

Joe and Suzy Sixpack are the reason.

Mr. and Mrs. Average American. The folks who reside in “flyover country.” Change in this country does not occur at the national level (repeal of Prohibition, ending the Vietnam War, threatened impeachment of Richard Nixon) until America’s middle class demands it. (Seen any $2 bills lately? The general public refused to adapt!) Until then the message is shaped and reshaped by powerbrokers and stakeholders then repeatedly served back to the American public. Nothing happens until Joe and Suzy can no longer tolerate the status quo.

But there’s a big obstacle to change. So long as the Sixpack family enjoys good health and is not penalized by their health insurer they perceive no threat. To them the status quo is acceptable.

Like his earlier movies Michael Moore is using Sicko to rock the status quo.

Could we do better as a country to care for our fellow citizens? Is it acceptable that so many Americans are living on the edge – one hospitalization away from bankruptcy? Like all the erudite voices before him Michael Moore believes we can do better, much better. It only takes willpower. Moore seeks to catalyze that willpower where he can best find Joe and Suzy Sixpack – the local movie theater.

I say give the guy a chance. Aren’t you willing to pay $10 to fix health care? In three years we may all be thanking him.

(Watch excerpt from “Sicko”)

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Posted by: Bill Lloyd MD at 11:15 am

Sunday, May 20, 2007

MRSA: Just a Matter of Time

Eye specialists knew it would happen sooner or later.

Now we know it is sooner!

The first series of documented eye infections involving LASIK patients has appeared wherein each of the infections was caused by a highly-resistant bacterium: Methicillin Resistant Staphylococcus Aureus – or MRSA for short. This organism is very hard to kill because it cannot be killed by ordinary antibiotics. Newer, stronger kinds of antibiotics are necessary. It’s expensive and risky because someday MRSA will become resistant to these medications also.


We’ve all heard the news stories about MRSA infections in hospitals. Germs from one patient are inoculated on other patients due to inadequate (or absent) handwashing. MRSA has moved outside the hospital and more and more emergency rooms are frequently encountering skin infections and abscesses loaded with MRSA.

Scared enough yet?

Scared enough to start washing your hands more often?

This new report in the American Journal of Ophthalmology describes 13 confirmed MRSA corneal infections in postop LASIK eyes. Nine of the 13 cases involved healthcare workers or similar hospital exposure.

As explained in an earlier blog, the LASIK flap never really heals, so there is always an open portal for contamination to occur.

Bottom line time: if you’ve had any kind of refractive surgery you’ve acquired a powerful reason to pay more attention to handwashing and personal hygiene.

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Posted by: Bill Lloyd MD at 9:30 am

Thursday, May 17, 2007

Summertime and the BLINDING is Easy!

Warmer weather, longer days, more time spent outdoors.

This is the formula for serious eye injuries, and we’re not just talking about the dangers of fireworks.

This week the American Academy of Ophthalmology is sponsoring the 4th Annual Eye Injury Snapshot Project wherein practicing ophthalmologists are asked to submit clinical data from all trauma cases between 13-20 May. It is an effort to build increased public awareness of eye injury prevention. Hundreds of eye surgeons participate.

Eye trauma is an enormous public health concern. In just a few senseless seconds a life is changed forever

Here are some statistics from the 2006 Eye Injury Project:

  • 73% were males
  • 49% of all injury victims were between 18-45 years of age
  • 40% of eye injuries occurred at home (I would’ve guessed higher)
  • 84% were accidental whereas 12% were due to physical assault
  • 77% of all injury victims were not wearing any type of eyewear

Good news, 57% were able to be treated in the doctor’s office without hospitalization. You can read the full report.

Remember this advice before we get too far along into summertime and those beautiful sunny days. Always think about eye protection whenever operating manual or power tools, using yard trimmers, performing auto repairs, and even while waterskiing (especially if you’ve had LASIK!)

Most eye injuries are preventable, but not all eye injuries are reversible.

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Posted by: Bill Lloyd MD at 7:15 am

Monday, May 14, 2007

Ocular Steroids: Double-Edged Sword

Name something that is potentially dangerous yet may be essential for you to consume?

No, Hershey’s Syrup is not what I was thinking!

The prescribed use of corticosteroids (or simply steroids) is what medicine calls a “double-edged sword.” That means the drug has powerful benefits but also poses a genuine risk for serious complications.

Ophthalmologists prescribe steroid eyedrops to reduce inflammation in the eye. This is important because scarring from inflammation can permanently destroy the eye’s ability to see. Timely and aggressive use of steroid eyedrops has saved eyesight for millions.

Now, the other shoe. Since they inhibit the inflammatory response, steroids make the healthy eye vulnerable to all kinds of infections that normally it would have no problem eliminating.

Here’s a familiar clinical challenge. Let’s say there is a person with an infectious corneal ulcer (viral, bacterial, or fungal). The eye doctor wants to kill the germs quickly. At the same time the doctor needs to mute inflammation to prevent permanent damage to the transparent cornea. Careful! Adding steroids to an active infection is similar to using jet fuel to extinguish a fire!

Most doctors managing a corneal ulcer patient prescribe powerful broad-spectrum antimocrobial eyedrops to quickly eliminate the germs. This alone begins to quiet the inflammation. Gentle, stepwise introduction of steroid eyedrops will further halt the destructive inflammatory cells, reduce swelling, and preserve vital eye structures.

Excessive or unmonitored use of steroid eyedrops can generate new problems for the eye that may be more severe than the original diagnosis that justified steroid use in the first place.

Topical steroid eyedrops, like Hershey’s Syrup, should only be used with great care and respect.

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Posted by: Bill Lloyd MD at 12:15 pm

Wednesday, May 9, 2007

Mother’s Day Gift: Maternal Instinct

Buy those flowers yet?

Better hurry, time is running out.

Having responded to thousands of member inquiries at our WebMD Vision & Eye Disorder message board, I can attest to the accuracy of the claim that mothers perform as a family’s Chief Medical Officer. They handle the children’s eye appointments, help their spouse pick a stylish pair of bifocals, and often assist the grandparents with their health concerns.

Besides offering the unmatched affection and thoughtful care mothers bring something else to the table: maternal instinct.

Nobody could count the number of times WebMD receives messages from a worried mother about a family member. Although the initial health care provider offered reassurance, the mother suspecs that a family member’s symptoms have not yet been accurately diagnosed. So these persistent, loving mothers logon to WebMD and ask what should be done.

It’s not that these worried mothers distrust clinicians, it’s just that mom is most familiar with her spouse’s habits and behaviors.

It’s not that anxious moms know more than the school nurse, it’s just that the mother has been with the child since birth and can tell when something is abnormal.

In a recent interview Dr. Jerome Goopman, author of the best seller How Doctors Think, recalled how his nonphysician wife saved their child’s life. A confident ER physician said their infant son’s intestinal problems were caused by a stomach virus – it would clear in days. Mrs. Goopman didn’t buy it because the baby’s diaper smelled different than usual. The mother pushed, pushed hard. Emergency surgery relieved the baby’s potentially fatal bowel obstruction.

By the way, more than one insistent mother has helped me be a better doctor, too!

So, as you gather the gifts, cards and bouquets for another Mother’s Day, cherish all that your mom has already given you – including that uncanny knack that tells her when something is wrong.

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Posted by: Bill Lloyd MD at 2:13 pm

Tuesday, May 8, 2007

Eyedrops: Stay on Target

Photo Credit: grendelkhan

Imagine having the doctor tell you that you needed surgery to save your eyesight, perhaps even your life. Then imagine getting up and simply walking out of the room because you refuse treatment. Now, I’m not talking about advanced cancer or some wildly experimental, high-risk operation. Maybe it’s as simple as cataract removal or an appendectomy.

Who could deny themself a treatment that would improve/extend their life?

The answer will surprise you.

Every day millions of Americans fail to take their prescribed medications. It’s been estimated that nearly half of all patients receiving drugs to treat their high blood pressure cease taking the pills within a year. Same goes for cholesterol medication, too!

Prescription eyedrops have an equally dismal record.

The problem has two names: drug adherence and patient compliance. Folks simply don’t keep up with their medications, and the likelihood of noncompliance grows with the number of prescriptions. Three or more prescriptions and life gets very complicated.

There are plenty of good reasons: forgetfulness, complex instructions, finances (rising co-pays), unwanted drug side effects, and poor patient education regarding the need to continue taking the medication.

Here’s a great example: many glaucoma patients stop taking their eyedrops because they don’t see any better – no perceived benefit. The problem is that the drops are not intended to restore vision, rather preserve vision, and they can’t do that sitting in the back of medicine cabinet.

Nearly 90% of seniors cannot accurately recite their daily pill schedule.
Most 10-day courses of antibiotics never empty the bottle.

The best solutions to improved patient compliance involve communications. Health care providers know about this vexing problem. They are supposed to ask you about your medications with every visit. During busy clinic visits some things get overlooked. A six-month follow-up appointment isn’t quality ‘follow-up’ is it? In reality the doctor often writes a Rx that never gets filled.

Having trouble staying on-schedule with your medications? Tell your doctor or nurse practitioner. Some medications can be combined. Other dosages can be consolidated (switch from 4x per day to a once-daily pill). Generics can save you plenty of money. What good is an expensive, cutting-edge medication if you don’t take it? Drug substitutions may eliminate unwanted side effects.

Don’t deny yourself the care you deserve. Effective remedies are available; all you need to do is ASK!

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Posted by: Bill Lloyd MD at 3:30 pm

Thursday, May 3, 2007

Early is Already Late

Do you keep a spare tire in the trunk of your car? You probably won’t need it anytime soon, but it’s good to know it’s there in case one of the essential four tires goes flat. In the meantime that fifth tire is redundant.

Redundancy is also a good thing in medicine.

Redundancy is also a good thing in medicine.

The human nervous system, for example, has far more fibers (axons) than it really needs. Since damaged axons cannot repair themselves, there are other axons nearby to carry the load.

Well, that’s it for the good news. Get ready for the worrisome part.

When a tire goes flat, you immediately know it. POW! Some wobbly steering and off to the highway shoulder you go.

When nerve fibers are damaged by a degenerative disorder you don’t immediately know it. There may be no symptoms whatsoever because those neighboring, redundant fibers immediately take up the slack. Okay, but what happens when the progressive disorder damages the redundant fibers? Sadly, game over.

Clinical researchers who study multiple sclerosis now acknowledge that there is far more widespread nerve damage than the isolated plaques that appear on the brain MRI scans. Early is already late. With each subsequent attack (recurrence) more axons are destroyed.

Ophthalmologists are familiar with a similar destructive pattern that occurs in folks with glaucoma. By the time a glaucoma patient starts having visual field changes and decreased vision significant irreversible nerve damage has already occurred.

These findings are the basis for early, aggressive treatment for degenerative neurologic disorders. Whether it’s MS, glaucoma, or other similar diagnoses, there is no time to waste. Far too many axons are already lost or compromised. Any delay will lead to further nerve damage and reduce the potential effectiveness of any medical treatment.

Yes, timing is everything.

Yes, timing is everything.

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Posted by: Bill Lloyd MD at 12:51 pm

Tuesday, May 1, 2007

Activity After Eye Surgery

During the preoperative counseling sessions with my surgery patients one of the most frequently asked questions has been, “Doctor, after my eye operation when can I resume normal activity?”

My traditional answer is, “Well, first we have to understand what is normal for you!”

For example, there are seniors who spend all day sitting in their recliner watching cable TV. I’d advise them, “Go for it!” The same advice does not apply to factory laborers.

See, there are no universal boilerplate rules – everyone is different. Experienced surgeons apply this rule both to available options regarding the most effective surgical approach for an individual patient as well as the recommended length of convalescence.

Times are tough. Many patients insist on returning to work on the day following eye surgery. A simple desk job may be acceptable.

Unbeknownst to me I’ve had patients rope cattle the day after surgery. That’s a double dare: genuine risks exist for both postop trauma and wound contamination. They probably should’ve waited a full week or longer.

One very satisfied patient organized an impromptu cocktail party to celebrate her beautiful outcome. Yes, she drank too much, fell, and ended up back in the hospital. Fortunately for her she experienced an equally smooth recovery from her repeat operation – not everyone is so lucky.

Here’s a generalization: Compared to a generation ago (when I trained in ophthalmology) patients now heal much faster and regain function much sooner. Advanced techniques and technology get the credit. Few folks get an eyepatch anymore, and far fewer stay overnight in the hospital. By all means, lay low at least until your first postoperative visit with your surgeon. No bending, straining, heavy lifting or drinking.

Today’s blog carries an important lesson. Make sure you clearly understand all postoperative restrictions/limitations before you consent to any surgery. It’s wiser to postpone elective surgery than to jeopardize the outcome, right? Planning an overseas cruise? Make sure it does not conflict with the doctor’s plans for your recovery. Bon Voyage!

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Posted by: Bill Lloyd MD at 8:15 am


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