Eye On Vision

Adult Learning: SEE What I Mean?

2008-05-16T05:45:00.003-04:00

I read something very interesting the other night that I wanted to share with you.

Adults are different than children.

No, wait, there's more!

Adults learn differently than children.

Photo: Jason Taellious

Parents send their children to school to acquire the basic learning in order to function in society: language skills, arithmetic, spelling, etc. Things change as you get older. Adults don't have to go to school unless it is something they choose. The entire process of adult learning varies tremendously compared to what is experienced by children. It begins with motivation: adults seek more education in order to create change (involving skills, behavior, knowledge level, even attitudes). Previous experiences and the personal level of engagement also shape adult learning.

So, what does any of this have to do with vision, Doctor Lloyd?

Adult learning styles vary enormously from childhood learning patterns. Think about when you were in grade school. With few exceptions most elementary school classes were pretty much taught the same way.

Photo: Matt Biddulph

Lots of research has been performed on this topic and it appears that there are three major adult learning styles:

Visual learners (aha!) absorb new information by seeing it. They enjoy PowerPoint presentations, video demonstrations, and lots of illustrations in the reading materials. Use of computers in the adult classroom really stimulates visual learners. I have to admit that I enjoy dynamic lectures with lots of interesting images, graphics, and animations.

Listen to this - auditory learners prefer to hear the new material. They tend to recall verbal information far better than written material. In fact, they don't want to read anything. Perhaps this is why I often doze-off during sermons on Sunday mornings.

The final group of adult students are kinesthetic learners. These are the 'hands on' students - teach them by showing them what's important to know. My military career gave me enormous exposure to the time-honored technique: 'see one, do one, teach one'!

Successful adult educators know that adults learn best when classwork combines visual, auditory, and kinesthetic activities.

Do you see what I mean? Does this sound right to you? How do you feel about it?

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Technorati Tags: learning styles, adult education, visual, auditory, kinesthetic

What's the BIG IDEA?

2008-05-12T13:18:00.000-04:00

I greatly admire innovators. Sure, discoverers and pioneers are daring and courageous because they seek something that appears unattainable (like the summit of Mt. Everest or a cure for pneumonia).

Innovators are different because they find a new way, a smarter way to do something that already exists. The iPod is an innovation that replaced tapes and CDs.

Surgeons can be great innovators, too, and the simplest tweaks often generate the most profound results.

Take surgical drapes as an example. These are large disposable sheets of plastic-lined paper that are used to create a sterile field in the operating room. Typically, the patient's body is totally covered in these sterile paper drapes - even for eye surgery. The surgical team wears gloves and gowns and all of the surgical equipment that enters the surgical field is also sterile.

There can be problems with paper drapes. They are big and bulky. They are relatively expensive. They are flammable. Yes, the surgical drapes can catch fire, and you'd be surprised how often fires erupt in the O.R. There are plenty of sparks, plenty of fuel, and lots of heat in a busy operating room. Surgical lasers are particularly dangerous, but even routine cautery (applied to stop bleeding) can ignite an inferno. This is a ripe opportunity for innovation!

Ophthalmologists at Brown University developed surgical drapes made of aluminum foil. This flexible material is lightweight, nonflammable, easy to manipulate, sterilizable, and cheaper than disposable paper drapes. Ophthalmologists at Brown used aluminum foil surgical draping in 300 surgical cases and presented their results at the recent Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO).

The team reported exciting news: no infections, no fires, and no patient-related complications. It appears that a major hospital safety threat can be eliminated.

Will aluminum foil totally replace paper drapes? It's doubtful. Since aluminum is a powerful conductor of electrical current it may not be suitable for some cases when electrical energy is applied, perhaps planned cardioversion following heart surgery. Accidental contact between a live electrical lead and the foil drape could cause serious injury.

More studies will be needed before aluminum foil makes its way into mainstream surgical practice. In the meantime innovators will keep dreaming up ways to build that better mousetrap!

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Technorati Tags: medicine, vision, health and wellness, invention

May 2028: Where Is Your Doctor?

2008-05-08T14:42:00.007-04:00

We are beginning to learn more and more about the major health care crunch that is expected to develop in America. Sure, most of us will live longer, healthier lives. The over-85 age group is the fastest growing USA demographic. This 'good news' will create an enormous burden on our already-stretched health care system.

Photo: Salim Fadhley

To make matters worse we will likely not have enough doctors. There are two reasons: an insufficient supply of new physicians and a steady exodus of existing practitioners.

The American Association of Medical Colleges calculates that there is an immediate need for an annual 30% jump in medical school enrollment in order to keep up with the exploding demand for services. This past year the increase was a measly 6% boost. It appears that we will not be able to rely on medical schools to meet the challenges of 2028.

So, what can be done to encourage doctors to keep working? Glad you asked!

According to a recent report published in Forbes, doctors are leaving the profession because they are overworked and underpaid. Many specialists accrue monstrous debt during their training and begin their practices under a dark financial cloud.

Medicare is chopping reimbursements by 15.6% between now and January 2009. That automatically means that other insurers will do likewise. Would you keep working with a 15.6% pay cut?

Let's recap: Overworked, tired, broke, disillusioned. Hey, we didn't mention sued!

Many hardworking physicians cannot afford malpractice insurance. Some surgeons pay over $250,000 a year (if insurance is available at all). Sure, let's identify and deal with unsafe, reckless doctors, but at the same time we need to curtail frivolous malpractice claims. Did you know that only 6% of malpractice claims ever go to trial, and the plaintiff loses 91% of the time.

Bottom line: Over half of practicing physicians discourage their children from becoming doctors.

Twenty years from now I'll be needing cataract surgery and coronary artery bypass surgery. What will you and your family need? There will not be enough experienced medical professionals around in 2028 unless we take action now.

REFERENCE: Reasons Not to Become a Doctor. Forbes 05/05/2008.

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Surgeons Given New FDA LASIK Guidelines

2008-05-05T20:21:00.007-04:00

On April 24 the FDA's Ophthalmic Devices Panel heard from both satisfied and dissatisfied LASIK patients, as well as representatives from the American Academy of Ophthalmology and the International Society of Refractive Surgery (ISRS) who spoke about the extensive track record of safety and effectiveness for LASIK.

Following a long day of testimony and presentations, the panel has announced several recommendations for consideration by the FDA, including:

Adding photographic illustrations of certain side effects to the FDA Web site

Better explanation of certain outcomes, such as myopic patients who have LASIK eventually needing reading glasses post surgery

More understandable information about the potential risks of LASIK (such as dry eye, halos, glare, starbursts, etc.)

Clearer explanations of disqualifying conditions that might make a patient a poor candidate for LASIK (such as a family history of keratoconus and a history of depression)

Additional information or guidance in the labeling about postoperative intraocular pressure

More detailed guidance for lens implant measurement for post LASIK cataract surgery

Nobody knows if/when such guidelines will become federal regulations. In the meantime it is worthwhile to share these supplemental guidelines with anyone you know who is considering laser refractive surgery.

Adapted from American Academy of Ophthalmology media release, April 28, 2008

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Technorati Tags: eye surgery, LASIK, FDA, vision

Eyewear Sales Soar Despite LASIK

2008-04-30T12:10:00.005-04:00

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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Technorati Tags: eyeglasses, sunglasses, frames, fashion, LASIK, vision

Are You Dealing with a Diva Daughter?

2008-04-29T14:07:00.001-04:00

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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Technorati Tags: teens, parenting, glasses, contact lenses, vision

FDA to Examine LASIK Complaints

2008-04-28T12:57:00.000-04:00

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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Technorati Tags: LASIK, laser refractive surgery, FDA, vision

Senior Vision Needs Underserved in Nursing Homes

2008-04-25T06:33:00.002-04:00

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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Gene Detectives Launch National Roundup

2008-04-22T12:06:00.001-04:00

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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10 Things You Probably Didn't Know About Cataracts

2008-04-15T00:11:00.003-04:00

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.

Age-related cataract is the leading cause of vision loss worldwide.

The prevalence of cataract doubles every decade after age 40.

Over the past 20 years the annual number of USA cataract operations has quadrupled.

Cataract surgery accounts for 10% of all Medicare reimbursements.

In 1980 an average cataract procedure required 45-90 minutes; today that average is closer to 15-20 minutes.

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.

Observational studies suggest multivitamin supplements may delay cataract progression.

It is unclear if multivitamins are more helpful for people with clear lenses or for those who are already starting to have cataracts.

20 million people are blind from cataract worldwide and most have no access to affordable cataract surgery.

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.

Individual Poor Eyesight is Expensive for Everyone

2008-04-10T15:37:00.000-04:00

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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Technorati Tags: medicare, vision, healthcare, prevention

Image: Library of Congress (Public Domain)

Donor Corneas: How Old is Too Old?

2008-04-03T11:31:00.001-04:00

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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Technorati Tags: corneal transplant, cornea, vision, donor, eye health

Is There A Visual Gender Gap'?

2008-03-31T15:54:00.001-04:00

The discussion of 'women's health' often centers on breast disease, hormone replacement and poorly communicated gynecologic issues. That's unfortunate because women experience many other familiar health maladies disproportionately more than males. For example, more women over age 65 die from heart attacks than do men. This kind of information doesn't get publicized enough. By the way, two-thirds of adults over 40 with diabetic retinopathy are women. I bet you didn't know that either.

The same thing applies to Age-Related Macular Degeneration (AMD). About 200,000 new cases of AMD are diagnosed yearly in America, females almost double the number of males. Since advanced age is the top risk factor for developing AMD and because women typically live longer than men there are more older females and more of them develop AMD.

Other known AMD risk factors include smoking, obesity, family history, and race.

The early stage of AMD may have no symptoms (or the symptoms may overlap with the development of cataract or other active eye conditions). It takes a dilated retinal evaluation in order for AMD to be diagnosed. Early AMD is followed conservatively since most folks do not progress to the more worrisome intermediate and advanced stages of AMD.

Routine eye exams and at-home testing with a handheld paper chart is all that's necessary for early AMD. Any changes in vision warrant prompt re-examination.

Aggressive consumption of vitamins, minerals and antioxidants may delay progression of AMD from the intermediate stage to the advanced stage. When abnormal blood vessels grow and leak underneath the retina the advanced stage of AMD has arrived. Laser treatment and injectable biologic compounds can stop these abnormal vessels and preserve precious reading and driving vision.

Did you know that April has been declared 'Women's Eye Health and Safety Month'? You can learn more by visiting the national nonprofit Prevent Blindness.

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Technorati Tags: women, health, eye health, diabetic retinopathy, AMD

Image: istockphoto.com

Airbags Save Lives, May Sacrifice Eyesight

2008-03-26T14:48:00.002-04:00

Compared to 25 years ago, today's motor vehicle occupants survive high impact collisions 32% more frequently thanks to the use of seat belts (primary restraints) and vehicle airbags (supplemental restraints). Believe me, I would much rather drive around with these devices in my car than without them. As with every safety system there have to be compromises. For example, above 50 mph seat belts are pretty useless in a head-on collision because the mechanics of the crash exceed the physical tolerance of the seat belt webbing. At low speeds an unrestrained front seat passenger is in grave danger if the airbag deploys. The airbag may cause more injuries than the crash itself.

Five percent of motor vehicle accident victim injuries involve eye trauma caused by facial contact with a deploying airbag. With sudden deceleration the body is moving forward to meet the exploding airbag. That's right, exploding! The airbag inflates in less than 50 milliseconds - faster than a blink. The expanding gas used for rapid airbag inflation is generated by a small controlled explosion inside the dashboard.

Ophthalmologists from Brown University and Penn State University medical schools wanted to analyze the variety of eye injuries that occur in airbag-deployed collisions. They scoured over 9,000 records from a single metropolitain Level 1 trauma center between 1997-2005. They discovered 47 documented eye injuries.

Here's how the numbers broke down with the occupants of the 47 airbag-worthy crashes:

21 of 47 occupants did not wear seatbelts and 71% of them sustained serious eye injuries
Only 76% of this group recovered 20/40 vision or better
14% of this group ended up legally blind

Meanwhile

26 of 47 occupants were wearing seatbelts and only 31% sustained serious eye injuries
96% of this group recovered 20/40 vision or better
Nobody in this group ended up legally blind

The authors conclude that seatbelt use is associated with fewer airbag eye injuries, less severe eye injuries, and better visual outcomes.

So, now you have two reasons to wear your seatbelt: to protect your life after colliding with other vehicles and to protect your precious eyesight from your own airbag.

REFERENCE: Rao SK. Ophthalmology, March 2008, pages 573-576.

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Technorati Tags: auto, safety, airbags, eye, injury

Photo: iStockPhoto.com

'Robo4' Gene May Unlock Cure for Blinding Conditions

2008-03-20T11:55:00.004-04:00

Age-Related Macular Degeneration (AMD) and Proliferative Diabetic Retinopathy (PDR) are two leading causes of permanent vision loss. Their clinical presentations and their causes are very different. Even so, both severe eye disorders share one important feature: an abnormal proliferation of weepy blood vessels that leads to hemorrhage, inflammation, membrane formation and progressive retinal obliteration.

Until recently both AMD and PDR were treated in similar fashion: perform photographic studies to document new vessel growth followed by laser treatments to temporarily arrest the new vessels. The above photo shows what the retina looks like after hundreds of therapeutic laser spots have been applied. It was a real cat-and-mouse game. Injectable medications have recently been FDA-approved for AMD and many patients do enjoy a vigorous response. Neither laser or injectable anti-vessel drugs are permanent cures.

According to recent findings published in the journal Nature Medicine, there may be an easier and more effective way to protect the eye from these ambitious new blood vessels.

Vision researchers from numerous teaching centers collaborated in the discovery of a natural protein expressed by a strip of DNA called the 'Robo4' gene. When activated, Robo4 deactivates the powerful chemical signals that stimulate growth of those leaky blood vessels.

According to a press release from the host laboratory at the University of Utah:

"Many diseases are caused by injury or inflammation destabilizing blood vessels and causing them to leak fluid into adjacent tissues as well. We found a natural pathway - the Robo4 pathway - that counterattacks this by stabilizing blood vessels. Robo4 tells the vessels not to grow, to stabilize, not to explore. The blood vessels have an instruction system that tells them to do the opposite, to stabilize. This is a major breakthrough in an area where the advances have been minimal. We are excited about taking this opening and moving the frontier forward with real hope for patients who have but few, often disappointing, options."

The researchers tested the power of Robo4 in mice eyes because they are very similar to human eyes. They successfully demonstrated that Robo4 activation curbed new vessel development.

It is theorized that some type of gene therapy involving Robo4 could be prescribed for humans at-risk for either AMD or PDR - perhaps an injection or an eyedrop. Lengthy clinical studies must prove that Robo4 treatment is safe and effective, so it will be years before it could be available to AMD and PDR patients. Impatience aside, if Robo4 can deliver as promised a huge number of adults could be spared permanent visual disability.

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Technorati Tags: Robo 4, blindness, AMD, macualr degeneration, PDR, diabetic retinopathy, vision

Is Red Your Favorite Color?

2008-03-17T11:38:00.002-04:00

Photo Credit: Chris Vaughan

Anybody who visits our WebMD Eye & Vision Disorder member community quickly discovers that many online visitors are dealing with red eyes. Some are inflamed, painful red eyes that need emergency attention. Some red eyes are mildly irritated or itchy. Others are red from time-to-time but generate no other symptoms.

I enjoy helping people understand the likely reasons for the redness and offering sensible precautions in order that they protect themselves from serious problems.

The most challenging red eye inquiries involve contact lens wearers:

My eyes turn red only when wear my contact past 18 hours.

The redness starts as soon as I insert my contact lenses.

I removed my contact lens but the redness and pain persisted.

I have dry eyes but I cannot function without my contact lenses.

Any of these sound familiar to you?

There's good reason to be paranoid about contact lenses. Sometimes the most fastidious (germophobic, soap-loving) person can get into serious trouble (corneal ulcer, for example), and redness is often the earliest clue. I have some powerful advice to share.

Here it comes, and I hope that you are sitting down:

If your eye turns red while wearing a contact lens immediately remove and store the contact lens. Do not reinsert the contact lens until your eye doctor gives permission.

Even if the contact lens is not the cause of the eye's redness, its presence may add to the irritation. This occurs all the time with viral pinkeye.

Now let's say that whatever problem causing the red eye is resolved. When is it appropriate to resume contact lens wear? All too often impatient contact lens wearers jump the gun and end up right back at square one. Once the inflammation/irritation has cleared and the eye turns white give yourself 5-7 days before resuming contact lenses. It would also be wise to begin with an abbreviated wearing schedule: 2-4 hours on the first day and build up from there. If redness recurs, remove the contact lenses and contact your prescribing eye doctor.

If you need to visit the eye doctor for any contact lens-related symptoms always be sure to bring your contact lenses, the carrying case and all lens solutions with you to the clinic. Should infection be suspected, each of these items may be tested for contamination.

Remember, red is universally recognized as a warning, and that applies to your eyes as well.

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Contemplating LASIK? Medication Checklist

2008-03-14T17:11:00.001-04:00

Photo Credit: Drew McKinney

As part of routine preoperative counseling ophthalmologists give lots of instructions to their surgery candidates. Do this, don't do that...you know the drill.

Even so, it often comes as a surprise to LASIK patients that there is a long list of outlawed medications. These are drugs that can suppress tear production.

Why should tear formation matter in a young, healthy pre-LASIK eye?

When the LASIK corneal flap is created many delicate nerve fibers are severed. These nerves usually signal when fresh tears are needed. Until those nerves heal the tear output signal is interrupted.

It's very important to know before your surgery if you are a borderline dry-eye patient. Be sure to discuss the situation with your surgeon before giving your consent to undergo any kind of refractive surgery.

LASIK causes dry eyes in over 80% of healthy individuals. Most folks quickly recover and bide their time with artificial tears. Upwards of 2% develop chronic dry eyes. On the other hand, if you already have dry eyes or almost have a dry eye problem LASIK can definitely make things worse.

Here comes the list. Be sure your LASIK surgeon knows if you are currently taking any of the following medications (whether prescribed, over-the-counter, or natural herbal remedy):

Antihistamines

Decongestants

Diuretics

Antidiarrheal agents

Antihypertensives (lower blood pressure)

Tranquilizers

Antidepressants

Antipsychotics

Remember, never change or discontinue any medication without notifying the prescribing physician. Feel free to print this page and share it with your ophthalmologist.

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Rebuttal: Glasses for Preschoolers Often Unnecessary

2008-03-11T12:00:00.009-04:00

Photo: Mark Probst

Just last week we explored new research regarding the cognitive benefits to children who wear corrective eyewear. Traditionally most eye doctors do not prescribe for small amounts of hyperopia (farsightedness) because they will grow out of it on their own. Click here to learn more.

Well, another published clinical research study says, "Not so fast!" Eye specialists at Vanderbilt University reviewed the records of over 100,000 Tennessee preschoolers who received vision screening. 3,600 were referred to the eye doctor. 890 of these referred youngsters were found to have no eye problems yet 20% of them received a prescription for glasses anyway.

The prescribing trend varied with the qualifications of the health provider:

Optometrists prescribed glasses for 35% of their patients

General ophthalmologists prescribed glasses 12% of the time, and

Pediatric ophthalmologists (the acknowledged experts) recommended eyewear for children only 2% of the time

Given that the costs for the exam and any spectacle prescription averaged $250 per child, the authors contend that universal comprehensive eye exam programs for preschoolers are unnecessary and possibly wasteful. Parents, pediatricians and existing school screenings do an adequate job in identifying the children in need.

Those same funds could be better used for teachers' salaries or child obesity prevention programs.

The big argument concerns the small number of children who may 'fall through the cracks' in the current system. Funny thing about cracks, they tend to appear in whatever system is developed. No system is perfect no matter how much money you throw at it. Expect to hear much more about this debate!

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Technorati Tags: vision, children, preschoolers, toddlers, eye exam

Do Preschoolers Need Glasses?

2008-03-05T12:22:00.000-05:00

We previously mentioned how a child's eye grows between birth and age 5. Once a child reaches their fifth birthday (hello, Chuck E. Cheese!) the eyeball has acquired adult dimensions. All along, the optics of the eye are frantically trying to keep up with the dynamic anatomy. Beyond age 5 the anatomy remains stationary but the optics continue to progress. Most refractive errors stabilize around age 30.

Following this explanation, the refractive error in infants and toddlers is very liquid. Most preschoolers are hyperopic (farsighted) because their growing eye is still a bit short. This physiologic hyperopia tends to disappear by first grade or so. Doctors traditionally declined to prescribe glasses for this age group because:

Eyeglasses are expensive

The child won't wear them

The child involuntarily relies on their abundant accommodation (near focusing power) to provide clear focusing

The child won't wear them

Nobody has ever performed a controlled clinical research study on the topic, and finally

The child won't wear them!

Vision scientists from the University of California San Diego wanted to know if spectacle wear made any measurable behavioral difference in preschoolers. They have published the findings of their research in the Archives of Ophthalmology.

This is the first controlled study to document that preschool children with uncorrected refractive errors score significantly worse on visual-motor integration and cognitive ability tests. Within six weeks of wearing glasses, the visual-motor function of the children wearing eyeglasses was similar to normal children. Since low visual-motor skill scores correlate with lower academic achievements, the authors conclude that spectacle correction might lead to improved cognitive and verbal performance.

Before heading off to the optical shop it's important to note that the study only evaluated children between ages 3-5 with +2.00 diopters or more of hyperopia. Today a refractive error less than +2.00 diopters would still probably not warrant spectacle correction.

Astigmatism (excessive corneal curvature) is a very different matter. Most eye doctors would correct for astigmatism, especially if it was present in one eye only. A significant refractive error between the two eyes could lead to amblyopia (lazy eye) in the blurrier eye.

Parents can expect to hear more about the results of this groundbreaking study. We will keep you up-to-date here at WebMD if changes occur to published eyecare recommendations.

REFERENCE: Archives of Ophthalmology, February 2008, pages 252-258.

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Technorati Tags: preschool, glasses, education, learning, eye health

Wrong Eye Surgery: Could It Happen to You?

2008-02-25T14:45:00.003-05:00

Medical treatment can be dangerous, even fatal: errors, wrong medication, wrong dosage, surgery performed on the wrong patient or the wrong body part.

Ophthalmologists are not immune to this problem. Take a good look at the photo. Once the patient is prepped and draped the only thing the surgeon sees is the eyeball. Since the OR crew usually handles the prep and drape chores the surgeon has to trust others not to make any mistakes. Memo to all: mistakes happen!

A recent review of 106 eye surgery errors (dating back 23 years) were analyzed in the prestigious Archives of Ophthalmology. The authors wanted to know the outcomes if the so-called Universal Protocol was applied to these cases. The records were obtained from one malpractice insurer and one state health agency. The actual nationwide number of mistakes is much, much larger.

The Universal Protocol is a series of safety steps designed to prevent operative mistakes. This protocol includes consistent preoperative verification (patient and O.R. team agree which eye needs surgery), site marking to identify the surgical eye, and a mandatory time-out before making the first incision.

Those 106 cases included incorrect intraocular lens implantations, wrong-eye surgery performed, wrong-eye preoperative anesthetic block, wrong patient in the operating room (?!?), even wrong-eye corneal transplantation (duh, the eye that needed it didn't get it!)

Careful reconstruction of the details in these 106 lawyer-friendly disasters revealed that 85% of these mishaps would never have happened if the Universal Protocol was in effect at that time.

This is wonderful news so long as surgeons and hospital staff observe the rules.

If you are scheduled for surgery don't hesitate to ask if the Universal Protocol is practiced. Make sure the non-operated eye is covered with a shield before entering the operating room. Finally, make no apologies for repeatedly announcing a statement like, "Dr. Brown is operating on my left eye!" Let others think what they want, you'll be able to see their smiles afterwards.

REFERENCE: Archives of Ophthalmology Nov 2007; 1515-1522.

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Technorati Tags: eye surgery, medical errors

Ashton Kutcher and the New Celebrity A-List

2008-02-22T18:10:00.004-05:00

By now you may have heard that sitcom star and cougar prey Ashton Kutcher had a birthday party earlier this month. Now we learn it was a surprise party. The bartender had an active case of Hepatitis A...surprise!

Hepatitis A is a very contagious virus that infects the liver. It takes a few weeks for the infection to generate symptoms: nausea, fatigue, loss of appetite, and jaundice.

Jaundice is yellowing of the skin and eyes. Whenever the liver is sick it stops doing all the ordinary tasks assigned to it - synthesizing proteins, neutralizing toxins, and metabolizing bilirubin. Huh?

Bilirubin is a breakdown product of old, worn-out red cells. Liver enzymes convert unconjugated bilirubin to the conjugated form. From there the conjugated bilirubin is transported to the gallbladder where it aids in food digestion.

What about Ashton and Demi? Oh, I learned that Bruce (legendary good sport) was also in attendance.

Healthy people usually quickly recover from Hepatitis A. It takes a few weeks longer for the jaundice to resolve.

Folks with active Hepatitis have too much unconjugated bilirubin in circulation. It binds to connective tissues including the deeper layers of the skin as well as the moist conjunctiva, giving both eyeballs that yellowish-orange color.

Hepatitis A can be acquired from eating contaminated seafood. It is also transmitted person-to-person by direct contact, usually from the unwashed hands of infected individuals. This is a big reason why you see those 'Employees Must Wash Hands" decals on the washroom mirrors of restaurants. A very effective vaccine is available to protect you from Hepatitis A as well as a different one for Hepatitis B. We also know that prompt immunizations with Hepatitis A may prevent the disease or reduce the symptom severity.

You should consider getting both Hepatitis vaccines before your next birthday celebration.

You don't think Bruce picked the restaurant, do you?

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Bigger Problems Elsewhere

2008-02-21T15:19:00.001-05:00

Maybe it gets old after awhile.

Vision is so "special".

Vision is so "precious".

An entire WebMD member community devoted to Vision & Eye Disorders?!? Perhaps my view of things is just too...well, myopic! (pun definitely intended!)

Most folks see fine and as they read this post they are probably wrestling with bigger alligators than their dry eyes - for example, their 2007 income tax returns.

And, yes, many people see fine but are coping with other serious health problems.

But, you know what? Like it or not, it still gets back to the eyes.

Let's take a moment and talk about high blood pressure (HBP) - also known as systemic hypertension. It is a huge problem.

One-third of American adults have HBP, over 60 million.

One-third of those 60 million hypertensives don't know they have HBP and remain untreated (that's 20 million at risk).

Roughly one-third of those being treated for HBP are poorly controlled (add another 13 million at risk).

Many people are aware of the connection between uncontrolled HBP, kidney failure, heart disease and stroke. Did you know that vision loss is another major complication of HBP?

Chronic high blood pressure damages the delicate retinal blood vessels. This can cause bleeding inside the eye or (worse) complete occlusion of retinal vessels. If the retinal circulation is interrupted irreversible blindness quickly follows. Sadly, some cases of undiagnosed HBP are first identified in the eye doctor's office when the patient presents with sudden loss of vision.

See what I mean? Sooner or later it all comes back to the eyes.

Most people with HBP have no symptoms whatsoever. How long has it been since you had your blood pressure measured? Are your BP medications up to date? Save your life, save your eyesight!

Your taxes can wait. Take care of yourself first, then worry about Uncle Sam.

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Is There a Doctor in the House?

2008-02-17T23:38:00.002-05:00

I travel a lot and find myself onboard a commercial jetliner once a week or so. Since my hometown airport is not a hub, trips usually involve connecting flights. On average I experience 4 takeoffs and 4 landings per trip. Yes, I memorized the safety briefing long ago!

Get out your calculator: multiply the annual number of flights by 28 years (since graduating from medical school) and you'll arrive at a pretty substantial figure.

After all that air travel it wasn't until last week until I heard for the first time: Is there a doctor onboard?

The announcement came about twenty minutes after takeoff and I had already dozed off. Don't be jealous but I usually fall asleep the moment the jet pulls away from the gate. My wife gently poked me, "The stewardess needs you." Rising from my seat I responded, "These days they're called flight attendants".

I was directed to the rear galley (where they store the peanuts, stale crackers and darn little else). Funny, I expected to see someone laying prostrate across a row of seats or perhaps resting on the floor. A flight attendant stands alone and points to the restroom door. Yikes! Maybe I'll get to deliver a baby at 36,000 feet - start boiling some water! I opened the door and discover a middle-aged woman slumped over in a pile. How long had she been unconscious?

No history. No clues. The flight attendant alerts me to the overhead AED (Automated External Defibrillator). Since the passenger had a strong pulse and was breathing without assistance I figured we were in pretty good shape. Time to arouse the patient.

A brisk slap of the hand and she immediately came back to life, "I'm here! I'm okay! I'm okay!"

Reciting her name, the date, and the aircraft destination, the woman proved to me that she was fully oriented. We give her some oxygen and let her have some water. She made quick work of two bottles of water - those tiny, 8 ounce, cheap airline bottles.

When patients are alert and communicative a medical encounter typically begins with a good history. In an emergency the medical history is often the last step. Here's what I learned:

The woman woke up very early to get to the airport

Ate a quick breakfast but drank nothing

Traveling to resolve a family crisis

Stressed out about leaving two sick daughters at home

Doctor changed her two seizure medications yesterday and she took them for the first time before boarding the plane

Thirsty, tired, stressed, and centrally medicated. Yep, that'll just about do it to anybody.

After a few more minutes the woman laid down on an available row of seats with plenty of blankets and pillows. I stayed with her to check her vital signs and to offer reassurance. Then I informed the pilot that we would not need to divert the flight. The grateful flight attendant offered me a free cocktail. "It's not even 8 o'clock in the morning! Could I get a cracker instead?"

That was that. It finally happened to me. I suppose the biggest lesson from this adventure was that folks ought not change medications immediately before traveling out of town. Sure, there are always extenuating circumstances, but most folks should continue their existing pill regimen until they return home.

Oh, and keep up on your fluids.

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