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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.

Tuesday, December 9, 2008

Shortest Days Approaching

I’m a calendar watcher.

Some folks are clock watchers, but I prefer a wider horizon. In my mind I’m frequently playing with days and dates. On the first day of each month I commit to memory on which day of the week the 7th, 14th, 21st, and 28th appear – they fall on Sundays this month. From there I can easily create a mental calendar.

I can’t say it helps my memory. It simply helps me track days and dates.

In my mind, for some reason, the summer solstice and winter solstice are important calendar mileposts. The winter solstice is just a few days away. It occurs at the instant when the sun’s position in the sky is at its greatest angular distance on the other side of the equatorial plane from the observer. Depending on astronomical shifts, winter solstice occurs some time between December 20 and December 23 each year in the northern hemisphere. (Trivia buffs: 7:04 a.m. ET, Sunday, December 21, 2008!) You recognize this as the date with the shortest daytime elapsing between sunrise and sunset.

Since childhood I have kept track of whether the days are getting longer (happy news) or shorter (gloomy news). Back then, winter solstice traditionally meant surviving grade school in an underheated building and summer solstice heralded a long vacation, although nowadays most schools close by late May.

For the past 15 years I have been in Maine when the summer solstice occurs. Combined with its northern latitude, daylight on this special day appears before 4am and persists until 10pm or so. It’s usually a mild June day with happy memories. Conversely, I am on a family ski vacation in late December when the sun makes an all too brief appearance atop the peaks. By 2pm long shadows have already formed that direct skiers to the waiting village below.

Maybe mood is actually linked to sun exposure – kinda gets you thinking.

With regards to good vision and astronomical phenomena, I’m far more concerned about the shorter winter days and the well-documented increased risk of bodily injury related to poor visibility. If you can’t see well you are more prone to trouble, and if others can’t see you then those same risks are magnified

Here are a few ways to make yourself more noticeable when outdoors this winter, whether it is clear, foggy, drizzly or snowing:

  • Wear bright colorful clothing when outdoors
  • Adhesive reflective tape will boost your visibility (any hardware store)
  • Wear large funny hats, especially in mall parking lots, so drivers can identify you
  • Apply clip-on lights to your apparel or headwear when you jog or bike (available at any sporting goods store)
  • Keep a supply of self-igniting flares in your car in case of emergency
  • Store an ultra-bright flashlight in your car
  • I also keep a lightweight ‘coal-miner’ headband lamp in my car for changing tires…keeps the hands free

My mother always encouraged me to blend-in with the crowd, “William, you don’t want to be too conspicuous.” Sorry, Mom, but when the days get this short it helps to stand out and be recognized…from a very far distance!

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Posted by: Bill Lloyd MD at 8:50 am

Friday, December 5, 2008

FDA Ponders Prescription for Luscious Lashes

Talk about your unintended consequences!

Back in 2001, shortly after the FDA approved marketing of the eyedrop bimatoprost (trade name Lumigan) for use in treating glaucoma, doctors and patients began noticing something very unusual.

Patients who used bimatoprost observed that their eyelashes were growing longer and more plentiful – males and females alike. The women were ecstatic! Besides providing effective control over elevated intraocular pressure, an unanticipated side effect was further boosting its popularity (and sales!)

This phenomenon was first reported during controlled placebo studies wherein one eye got bimatoprost and the fellow eye received the same eyedrop solution without the active ingredient. Yep, the bimatoprost eyes had lower pressures and lustrous lashes.

Now, drugmaker Allergan is ready to take it to the next level. Allergan has applied to the FDA for permission to sell the prescription eyedrop as a cosmetic treatment to enrich lashes.

So far the regulatory journey has been relatively smooth. A randomized study involving 278 volunteers proved that bimatoprost was a safe and effective way to enhance eyelash appearance. No serious adverse events were reported.

Cosmetic bimatoprost (sold under the brand name Latisse) will be applied directly to the upper eyelids only – not plopped into the eye like its predecessor. True, if Latisse gets into the eye the intraocular pressure may temporarily go down a few points but there are very few patients (clearly identified) for whom this may cause problems.

This isn’t the first time Allergan has successfully identified new uses (and new revenue streams) for its products. Ever hear of Botox? Eye doctors were the first to use Botox to weaken overacting eye muscles and to quiet blepharospasm. Then Allergan found a profitable new wrinkle for the drug!

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Posted by: Bill Lloyd MD at 3:07 pm

Wednesday, December 3, 2008

Can YOU See in 3-D?

3-D movies are making a comeback in a big way.

Earlier this year Brendan Fraser produced and starred in a remake of ‘Journey to the Center of the Earth’. A special version screened in 3-D at IMAX theaters and was instantly declared, “The best and most spectacular 3-D movie ever made”. Nice buzz. (Personal note: Last week I got to see this film on a 5 inch screen while flying across the country. Can’t say I was nearly as impressed with it in tiny 2-D!)

Now the Disney animators are taking a shot at 3-D with their new release “Bolt”.

So, how do the eyes see in 3-D? Can you see in 3-D?

First of all, 3-D is a manmade construct. Think of it as a marketing term to describe the visual mechanics of stereopsis. The total visual input into each eye is different. Stereopsis is the product of integrating what the two (different) eyes see.

You really need both eyes to appreciate stereopsis because it represents the DIFFERENCE between what the two eyes are seeing…a microscopic difference. For example, those tossaway 3-D specs have different colored lenses (often red/green) to project the image at different areas of the retina. The goggles INTENSIFY the difference between what the two eyes experience. Guess what? Even if you are colorblind the 3-D specs should still work!

Don’t confuse 3-D with depth perception. Depth perception helps you pick the best apple in the basket on your first attempt. Many people with ONE EYE exhibit excellent depth perception. Subtle components to the visual image (color, texture, shading, shadows, and more) communicate to the visual cortex (in the brain) not only WHAT the object is, but its position with relationship to other elements of that same image.

I have had patients who underwent surgical removal of one eye for various reasons. Some (not all) of these people could still pass the tests for stereo vision, depth perception and distance estimation. Perhaps some of these skills are LEARNED…you get better over time. To date there are no hard scientific explanations to account for this not-uncommon phenomenon.

The holidays offer plenty of time to take in a movie. If your children choose to go see ‘Bolt’ in 3-D (which means you will be attending the movie as well) take time to experiment with the screen images – cover one eye, etc. and share your 3-D experience with us over at our WebMD Vision & Eye Disorders message board.

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Posted by: Bill Lloyd MD at 1:35 am

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