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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, April 30, 2008

Eyewear Sales Soar Despite LASIK

Photo Credit: Dawn Endico

All that bad news about LASIK complaints could not have come at a better time. Now, many folks who were undecided about laser refractive surgery may simply decide to invest in a new pair of stylish eyeglasses. I hope they don’t mind waiting in line when they get to the optical shop. It appears that they’ll be joining a large number of LASIK patients choosing frames.
Hey, wait a minute! I thought they said LASIK would get people out of their eyeglasses?!?

Yep, that was the prediction. Some industry analysts went so far as to forecast doom for eyeglass and contact lens manufacturers. Surprise! Eyewear sales are bigger than ever.

But, successful LASIK eliminates the refractive error, right?!?

Get ready for this: more and more consumers are paying top dollar for high style frames bearing no-correction lenses. These folks are paying to look good, not to see well.

Photo Credit: Morula

Eyewear marketers report explosive growth in sales of no-correction spectacles. People once again like the look of eyeglasses and the image it communicates. That’s funny. Prior to the availability of refractive surgery the only message eyeglasses communicated was, “I can’t see squat without these stupid glasses!”

In some boutiques sales of inexpensive no-correction spectacles outsell sunglasses. Choosing the right color frame can really enhance the appearance of whatever outfit you’re wearing and really make you stand out…they don’t call them frames for nothing!

Other people simply like the visage of authority and intelligence that goes with wearing glasses. Next time you are at the supermarket checkout peek at a few of the gossip magazines. Meryl Streep, Tina Fey, and Johnny Depp all share that look and (as far as I know) they each could easily afford LASIK, right?

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Posted by: Bill Lloyd MD at 12:10 pm

Tuesday, April 29, 2008

Are You Dealing with a Diva Daughter?

Photo Credit: Andrew Bardwell

Okay, accuse me of eavesdropping!

Having raised three teenagers, my wife and I always enjoy discovering others’ exploits (read CHALLENGES) regarding adolescents and the choices they make. The WebMD Parenting Community for Pre-Teens and Teenagers is a wonderful place to share and learn.

This recent post caught my attention as a parent and as an ophthalmologist (excerpted for brevity):

I have I think the typical 14 year-old daughter that got her eyes checked and needs glasses. She has trouble seeing the board at school. Of course she refused glasses and wanted contacts. We went to go find a nice frame, and of course she goes for only one pair, the one that cost $325!!! I flipped and said, find something similar and cheaper because insurance does not pay for lenses or glasses – just the eye exam. She refused and said nothing looked good on her! So, we left with out making any commitment. We’ve taken her to Costco, and Lenscrafters and she isn’t satisfied with anything and won’t take suggestions about anything from anyone. She just wants the first pair. By the way, they are Gucci, and say so on the side.

She has no extra cash, and babysits once and a while. She has offered to pay for part of them, but she doesn’t have any money. She said she would sacrifice her allowance, which is $15 a month. My daughter has a very spoiled attitude, and won’t take no for an answer. She wants the most fancy cell phone, and my stories can go on and on. It’s not that i don’t think she could pay for 1/2 of these frames, it’s just that she always wants the most expensive thing and is very stubborn. If she gets these Gucci glasses, I just think it’s like feeding her expensive taste and spoiled attitude at 14.

Am I making any sense or am I being unreasonable? When we go out clothes shopping, she has to get her Abercrombie stuff, and I’ll pay 1/2 and she’ll pay 1/2 because Wal-Mart and Target aren’t good enough for her. This is her attitude and it really makes me sick. I was never like that when I was young, I was happy to get whatever was offered, but I don’t know where she gets this attitude (peers I guess). Should I just give in? She would rather be broke long term and help pay for something, then just compromise and be reasonably letting me just buy it all.

Certainly there are multiple overlapping issues in this mother’s desperate appeal: maturity, personal responsibility, adult decision-making, teen independence, and on it goes. I’ll tell you what I think and you are welcome to add your comments afterwards.

Mom, trust your instincts. You are still one of your daughter’s most important teachers. Even at 14 (still a minor) your teenage daughter still has plenty of time to learn (or relearn) life’s lessons.

First rule: Money doesn’t grow on trees. In light of your comments, it sounds like the foliage around your house is not particularly lush. It would be irresponsible to spend a week’s salary for eyeglasses when there are greater family needs. Having said that, it would be troublesome to erect barriers between you and your daughter over this issue.

Second rule: We’re all in this together. Any teen who really – and I mean really – wanted $325 spectacles* ought to be able to pay half. I make the same proposition regarding school-age children who want to start wearing contact lenses. One of the most predictable indicators of personal responsibility is financial commitment. A child who has invested their own money towards the purchase of contact lenses will take very good care of them – not so if merely given them.

Now, let’s combine both rules…

Third rule: Where there’s a will there’s a way! An web-savvy adolescent ought to be able to scour the Internet and find the identical $325 Gucci frames at a steep discount. Once you find them, print the product information and ask your local eyewear retailer to honor the same price. I promise, you won’t be paying $325 and your daughter will learn several powerful lessons… lessons that will last a lifetime.

Use this experience to grow closer together as parent and teen. Both of you can learn more about each other and if you play it right you will both save a substantial amount of money!

* This same advice also applies to the acquisition of Nintendo DS game systems, custom skateboards, and iPods.

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Posted by: Bill Lloyd MD at 2:07 pm

Monday, April 28, 2008

FDA to Examine LASIK Complaints

Nearly 8 million Americans have undergone LASIK, laser refractive surgery and not everyone is satisfied with their results.

Here at WebMD we’ve been monitoring the responses from individuals and groups who claim to have experienced unsatisfactory LASIK outcomes. Refractive surgery is the most frequent topic of discussion on this blog. Click here, here, and here to read three previous blog posts dealing with post-LASIK dissatisfaction.

Now the US Food & Drug Administration is getting involved. They have convened a special hearing to explore ways to comprehend the scope of the problem, ways to reduce LASIK complications and ways to improve preoperative communications with consumers.

Data provided by the American Society of Cataract and Refractive Surgery indicate that 95% of LASIK patients see better after surgery and are pleased with the decision to undergo LASIK (averaging $2000 per eye). 5% are dissatisfied and 1% of all LASIK patients encounter severe complications like chronic dry eye, blurry vision, poor night vision or visual distortion. Here’s some speed math: 5% of 8 million is 400,000 cranky people!

FDA is organizing an expert panel to collaborate with the National Eye Institute and gather accurate information about LASIK results and complications. Skeptics claim FDA is recruiting foxes to study the hen house! Some advocate utilizing non-ophthalmologists to collect and interpret the data as has been done in assessments of coronary bypass procedures and joint replacement surgery. Certainly, ophthalmologists who do not perform LASIK could add valuable input to these proceedings.

Many LASIK experts believe that more scrupulous patient selection can prevent many of these unhappy outcomes. A patient who is told they are ineligible for LASIK will frequently keep shopping until they find a doctor who will agree to perform the procedure. Had the first surgeon spent a few more minutes clearly explaining the reasons for disqualification and the dangers associated with pursuing LASIK.

We will report back with information from this special hearing as soon as it becomes available.

UPDATE: Experts Advise New Warnings for LASIK

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Posted by: Bill Lloyd MD at 12:57 pm

Friday, April 25, 2008

Senior Vision Needs Underserved in Nursing Homes

Photo Credit: Artem

There’s troubling news regarding regarding health care services for elderly nursing home residents.

Many seniors residing in long-term care facilities fail to receive routine vision care services, even though they are eligible to receive such services.

Your first impression may be, “No big problem. All they do is sit in their room and watch TV, they don’t even drive anymore.”

Well, it is a big problem. Poor eyesight (especially when it is correctable) leads to sensory deprivation, social withdrawal, depression and a decreased quality of life. Did you know that nursing home residents in the United States have high rates of vision impairment, with estimates ranging up to 15 times higher than corresponding rates for community-dwelling adults?

Ophthalmologists from the University of Alabama at Birmingham studied 142 local nursing home residents who needed corrective lenses in order to see clearly. Seventy eight of this group received corrective eye glasses immediately and were surveyed again after two months. They were compared to a control group made up of the remaining 64 residents who received their corrective eye glasses after the follow-up survey.

Following two months of corrected vision, the first group (the immediate correction group) reported dramatic improvement in vision-related quality of life activities and less depression than the delayed correction group.

According to findings published in Archives of Ophthalmology, compared to those who did not receive new glasses immediately, the group who received their new glasses promptly reported less difficulty in reading and other activities of life, including writing, using the telephone, playing cards or watching TV. They also reported engaging more in social interactions such as visiting with others and participating in group activities.

The UAB doctors concluded that good vision is associated with a more positive nursing home experience. Such research could serve as a strong impetus to increase the availability of eye care services in nursing homes.

The National Nursing Home Survey found that only half of USA nursing homes have contracts for vision and hearing services. Studies have estimated that more than half of nursing homes residents have no evidence of having received eye care, even when an eye care provider is available.

Bottom line: If you know someone living in a long-term nursing facility inquire when was the last time they had an eye exam. The answer may surprise you!

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Posted by: Bill Lloyd MD at 6:33 am

Tuesday, April 22, 2008

Gene Detectives Launch National Roundup

Vision scientists need your help.

Do you know anybody with a blinding disorder called Leber’s Congenital Amaurosis (LCA)? It has been estimated that 3000 Americans have the condition, a hereditary disorder that becomes apparent shortly after birth. At least 9 different genes are known to cause LCA. Currently there is no treatment available

Geneticists at the University of Iowa are working feverishly to understand how these 9 genes (and possibly others) interact to cause LCA. Success could someday lead to breakthroughs in prevention and treatment.

The fastest way to identify gene abnormalities is to compare the DNA of all available LCA patients against DNA collected from the general population. That means locating all 3000 LCA patients and collecting a blood sample from each of them. This is a radical, first-of-its-kind attempt to create a genetic blueprint for one specific condition. If successful, information gained from this research strategy could be applied to research for other blinding eye disorders – problems that affect far larger numbers of people.

Most affected families are unaware of the enormous progress being made in molecular medicine regarding LCA. This is the impetus for Project 3000, a nationwide initiative to locate and recruit all 3000 LCA patients in this country. The more LCA patients located the greater likelihood of successful research.

Project 3000 will provide hope, advocacy, accurate information, and free genetic testing. In the future LCA volunteers may be invited to participate in clinical trials of novel medical treatments.

Click here to learn more about Project 3000.

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Posted by: Bill Lloyd MD at 12:06 pm

Tuesday, April 15, 2008

10 Things You Probably Didn’t Know About Cataracts


Nearly two million cataract surgeries are performed every year across America, yet most of us still know very little about this very common eye disorder.

  1. Age-related cataract is the leading cause of vision loss worldwide.
  2. The prevalence of cataract doubles every decade after age 40.
  3. Over the past 20 years the annual number of USA cataract operations has quadrupled.
  4. Cataract surgery accounts for 10% of all Medicare reimbursements.
  5. In 1980 an average cataract procedure required 45-90 minutes; today that average is closer to 15-20 minutes.
  6. If a way could be found to delay the onset of cataract for 10 years half of those cataract operations would never be needed, saving billions in health care spending.
  7. Observational studies suggest multivitamin supplements may delay cataract progression.
  8. It is unclear if multivitamins are more helpful for people with clear lenses or for those who are already starting to have cataracts.
  9. 20 million people are blind from cataract worldwide and most have no access to affordable cataract surgery.
  10. In 1980 most cataract surgery patients spent between 2-3 nights in the hospital. Nowadays most are home in time to make their own lunch.

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Posted by: Bill Lloyd MD at 12:11 am

Thursday, April 10, 2008

Individual Poor Eyesight is Expensive for Everyone

Most everybody has giggled at Mark Twain’s categorization of falsehoods: lies, damned lies, and statistics.

Well, did you ever hear Mark Twain’s other quote about statistics? I like this one even better:

“People commonly use statistics like a drunk uses a lamp post; for support rather than illumination.”

This blog post is going to toss around some huge numbers – hope you’re ready to receive them!

A lot of Americans have trouble seeing:

  • 10M are visually impaired
  • 5.5M of the visually impaired are elderly
  • 1.3M are legally blind
  • 185K are totally blind

It is easy to comprehend that this large population of disabled people generates substantial health care costs related to their eyes, but published statistics now demonstrate that these same folks with vision problems also have far more expensive (non-eye related) health care costs compared to people with good eyesight. It’s a double-whammy.

Data collected from Medicare records observed this trend in senior citizens, however, the same phenomenon likely affects all age groups. Researchers have calculated that Medicare recipients with poor vision cost the system an additional $2 billion in non-eye related healthcare needs. On average, individuals with below average eyesight drain the Medicare system an extra $3300 per person per year.

It appears that many Medicare members do not receive adequate eyecare. For example, less than 45% of Medicare diabetics have had an eye examination. Outrageous! How can anybody diagnose and treat diabetic retinopathy if nobody is screening for it? The same applies to macular degeneration, glaucoma and cataracts.

The American Academy of Ophthalmology is making a proposal that is intended not only to help seniors get better eyecare but also save future billions for Medicare. Timely identification of eye problems in eligible Medicare recipients can help preserve the precious vision of these beneficiaries and keep them off the high-spender rolls.

Congress has already budgeted the funds for primary care vision screening exams but they are not widely publicized. AAO is calling on Medicare administrators to be more diligent in identifying seniors in need of ophthalmic services because it serves the best interests of our society and it benefits our struggling Medicare system.

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Image: Library of Congress (Public Domain)

Posted by: Bill Lloyd MD at 3:37 pm

Thursday, April 3, 2008

Donor Corneas: How Old is Too Old?

Tissue transparency is the top feature that distinguishes the eye from other anatomic organs. In the healthy eye the central retina (macula) receives crisply focused light rays transmitted through the clear vitreous, that passed through the clear lens, that had crossed the watery aqueous inside the anterior chamber, that originally entered the eye through the transparent cornea. So, anything that clouds the visual pathway interferes with good eyesight.

Think of the cornea like the windshield of the car. It is a transparent barrier that blocks the wind and filters the oncoming light. If the windshield is dirty, scratched or cracked the driver will have significant problems operating the car due to poor visibility, right? And so it is with the cornea, a very efficient mechanical and optical barrier. Swelling, scarring or other changes to the cornea lead to profound vision changes.

Depending on the diagnosis the eye surgeon may recommend corneal transplantation. The medical term is penetrating keratoplasty. The diseased, cloudy cornea is replaced with healthy, transparent cornea. Nearly 40,000 such procedures are performed every year in America.

Just like heart transplants, donor corneas come from cadavers. The majority are harvested from the local medical examiner’s morgue, typically from young people who died from non-natural causes (motor vehicle fatalities, shootings, accidents, etc.) It appears intuitive that younger eyes would make for better donor tissue – but new research refutes that notion.

In a published series of 1000 corneal transplant procedures patients (all 60 years and older) were divided into two groups: those with donor corneas aged 12-65 years and donor corneas older than 65.

So, did donor age make a difference? After five years both groups had similar favorable outcomes – 86% successful transplantation.

Now, let’s turn the tables.

Note that in this study all of the recipients were seniors, so most won’t need a replacement cornea to last more than 20 years or so. On the other hand, a 30-year-old cornea transplant recipient will need a graft that can survive 50+ years. How would they do receiving the cornea from a 75-year-old donor? We don’t know that answer today, but some experts suggest that so long as the donor cornea is healthy age should not matter. More studies will be needed to test that theory.

REFERENCE: Ophthalmology April 2008, pages 620-626.

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Posted by: Bill Lloyd MD at 11:31 am


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