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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.

Friday, August 22, 2008

Do Lazy-Eye Treatments Really Work?

Photo Credit: Bill Lloyd

Amblyopia (lazy-eye) is the leading cause of vision loss affecting one eye. It develops in early childhood when the brain receives different visual images from the two eyes: one clearer, one blurrier. The brain accepts the clearer image and disregards input from the fellow eye.

Here’s why many children develop lazy eye:

  • The refractive error between the two eyes may be significantly different
  • The eyes may be crooked
  • Something is blocking focused light rays from reaching the retina (like a juvenile cataract)

Click here to read a more detailed post about amblyopia.

True to its name, lazy eye appears to be, well, lazy! So long as the child is being treated (whether with patching or atropine eyedrops) vision recovery is steady and predictable. The problems come when the treatment stops. New research about lazy eye shows that most 10 year-olds previously treated for their amblyopia still have a residual vision deficit.

This national study followed 176 children with moderate amblyopia from the time of diagnosis until age 10. The average age at enrollment was 5 (even though their lazy eye had likely been present for years). As predicted, children whose treatment was initiated before age 5 fared much better than latecomers who enrolled after their fifth birthday. Young brains are more ‘plastic’, more responsive to amblyopia treatment. The earlier the lazy eye is treated the greater the effect of treatment and the more time is available to reverse the problem. Sometime around age 7 years the brain ‘hardens’ and becomes less responsive to lazy eye treatment.

Here’s what they found when they analyzed the entire group at age 10:

  • Most of the vision improvement from earlier amblyopia treatment was maintained
  • Some residual lazy eye persists in most treated children
  • Patching and atropine eyedrops achieve similar benefits
  • Earlier treatment results in better the long-term visual outcome
  • Most children received no treatment beyond age 9

Most of these children continued to wear prescribed eyeglasses. Remember, parents, every case is different and all children respond differently to lazy eye treatment. The key take home message is that early diagnosis and treatment of amblyopia offer the best opportunity to recover lost eyesight. If treatment fails go back and try again because time is on your side.

REFERENCE: Archives of Ophthalmology, August 2008, pages 1039-1044.

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Posted by: Bill Lloyd MD at 9:25 am

Monday, August 18, 2008

Phelps’ Win: Faster than a Blink!

Photo Credit: Sports Illustrated / Getty Images

Did you catch Michael Phelps extraordinary win in the Men’s 100m Butterfly finals at the Beijing Olympics? Were you able to watch it live? Did you actually see him win?

I doubt it. Nobody saw him win. Only the cameras saw Michael Phelps win!

Phelps took the gold by outreaching Serb swimmer Milorad Cavic and winning by one-hundredth of a second.

Gold: 50.58 seconds
Silver: 50.59 seconds

According to Swimming USA experts, one-hundredth of a second is the smallest margin that the touch-sensitive pool panels can record. Thankfully nobody had to rely on a hand-held stopwatch. More thankfully, nobody had to rely on a human’s eyesight to judge the finish.

That’s because human vision cannot discern what happens in 10 milliseconds (the same as one-hundredth of a second).

The eye blinks in 50 milliseconds and we are completely unaware that it has happened. An auto airbag fully deploys in 50 milliseconds and passengers never see it happening. Both of these events took five times as long as Phelps’ winning margin.

It was exciting to watch the ultra-slow motion replay of Phelps’ victory. Funny, the more often I watched it his winning margin appeared to increase – to at least 20 milliseconds!

A great win for Phelps, a great victory for Team USA, and a great achievement for today’s digital technology. Everybody wins, except poor Milorad!

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Posted by: Bill Lloyd MD at 4:21 pm

Thursday, August 14, 2008

Unreal Olympic Moments

Photo Credit: Ligadier Truffaut

How much time have you spent in front of the TV this past week watching the Olympics?

For me it has been a mesmerizing experience:

  • Fabulous opening night pyrotechnic effects (…except for the fake giant footprints China digitally created on screen!)
  • Inspiring singing voices (…except for the little girl whose voice was dubbed!)

I wonder how many other phony parts were incorporated into the opening ceremonies that have not been exposed yet?

Of course show business always involves a certain amount of deceit. And show business doesn’t get any bigger than the Olympics. For example, many movies rely heavily on computer-generated effects. Maybe so, but we enter the theater with the full understanding that we are watching artificially manipulated imagery, right?

We expect every moment of the Olympics to be real…except for the color of Bob Costas’ hair.

When USA hosts a spectacle we don’t feature bogus illusions, we give the people what they came for: costume malfunctions!

Beijing organizers were totally unapologetic. They claim that the end results (wild applause) justified the use of trickery. Every parent of a 9 year-old can refute that argument…”So, you’re saying that the ends justifies the means?”

They just don’t get it.

Maybe they apply the same misplaced logic to their economy, to their environment, to their military: Looks great, but much of it is faked!

Photo Credit: Ligadier Truffaut

Hmmm…do you think they really used 2008 synchronized drummers in the beginning? Replay it slowly. Many of the drummers look alike. I’m becoming suspicious of a cut-and-paste of Olympic proportions!

Please tell me if you think I’m wrong. That’s something very real that we can do everyday here in America!

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Posted by: Bill Lloyd MD at 11:53 am

Wednesday, August 13, 2008

TRUE! More Playtime…Less Myopia

Photo Credit: Eric Lewis

Yes, what you’ve read is true! It now appears that the more time children spend outdoors the less likely they will become nearsighted.

As America’s obesity epidemic continues its expansion, more and more children are growing up chubby. This news creates another powerful reason to get your kids outside and burn some of those excess calories.

A newly published report from the University of Sydney, Australia, examined two large groups of children: 6 year-olds and 12 year-olds. That’s important because myopia (nearsightedness) usually has its onset and greatest progression during school years.

All children received precise refractions after their eyes were fully dilated. This cycloplegic refraction permitted the examiner to accurately measure every speck of refractive error in these children.

Detailed questionnaires were then given to the parents. This survey wanted to know how much time the child spent in school, at play outdoors, reading, computing, video gaming, and other visual activities. Now, since it was Australia the survey also asked about indigenous activities such as bush walking! Statisticians then went back and correlated data from the questionnaires to individual refractions.

Here’s what they found, mate!

12 year-old students who logged the greatest amount of time outdoors had the least amount of myopia. Bookworms who rarely bush walked were far more likely to become nearsighted by age 12.

Vision researchers are still in the dark trying to identify explanation for these results. We’ve known that excessive accommodation in youth contributes to myopia and long-term use of atropine eyedrops paralyzes accommodation and halts the myopic shift. Of course, not much accommodation takes place outdoors in the sun. Bright sunlight shrinks the pupil leading to a greater depth of focusing and less image blur. Additionally, we know that light-stimulated retinas release the powerful neurotransmitter dopamine, and dopamine is a known inhibitor of eyeball growth. Eyeballs physically become myopic when they elongate, so anything that halts elongation of the eye, like elevated dopamine, could theoretically prevent myopia from developing.

Slather them with sunscreen then get your children outside today, and keep them out there until dinnertime. What a bright idea!

SOURCE: Ophthalmology, August 2008, pages 1279-1285.

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Posted by: Bill Lloyd MD at 12:13 pm

Thursday, August 7, 2008

Something Can Be Done!

Photo Credit: Bill Lloyd, MD

Have you felt it?

Recently there has been a run of pessimism on our WebMD Vision & Eye Disorders message board. An unusually large percentage of visitors are suffering, worried, frustrated, or all of the above. A common thread running through these messages is exhaustion…everything has been tried and there appears to be little more for their doctors to offer.

“Isn’t there anything else that can be done?”

This is a critical point in the patient care experience and it can define when doctors actually become healers.

Here’s what I know: There is always something else that can be done.

Trying again – Some treatments don’t work the first time. Laser treatment for diabetic retinopathy often has to be repeated. The trick here is to be patient and give your treatment sufficient time to work. Don’t hesitate to ask the doctor, “Would it help to repeat this treatment?”

Alternatives – When Doctor A informs you she has nothing else to offer, perhaps Doctor B does! It could be clinical expertise or technology. Some physicians are reluctant to refer patients elsewhere for fear of losing them permanently. Keep probing for answers. Don’t hesitate to ask the doctor, “Can you recommend someone else who has experience dealing with my problem?”

Innovative options – If conventional treatments are unsuccessful it may be time to think outside the box. Are any investigative clinical research studies being conducted to explore your condition? Off-label use of FDA-approved drugs frequently leads to drug breakthroughs. Avastin, Topamax, and even the previously-banned Thalidomide found new ways to relieve “incurable” diagnoses. Don’t hesitate to ask the doctor, “Who is doing the most research about this condition?”

Never stop caring – Even if the disease cannot be reversed, even if the eye goes blind, even if the blind eyeball shrinks and disappears, the need for caring never stops. Maybe vision cannot be restored but the patient can still be supported. The fellow eye will require protection and close observation. There will be emotional/behavioral adjustment issues related to the permanent loss of vision. Eye discomfort and cosmetic appearance can always be optimized. Opportunities to care are limited only by the physician’s compassion and creativity.

So, remember this. The next time you hear some doctor declare, “I’m so sorry, but there’s really nothing that can be done,” don’t become angry. Find comfort in the knowledge that you have identified that physician’s limits. Time to find a new physician.

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Posted by: Bill Lloyd MD at 8:00 am

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