Steroids and the Eyes

It has been half a century since glucocorticoids were first prescribed. Now we call them corticosteroids, or simply steroids, or just 'roids' (for fans of Major League Baseball!)

Steroids are chemicals similar to hormones produced by the adrenal glands atop the kidneys. These powerful drugs are a double-edged sword because they quickly relieve inflammation but at the same time can cause complications elsewhere in the body. Chronic steroid use can lead to weight gain, diabetes, high blood pressure, fragile bones, poor tissue healing, mental confusion, and increased susceptibility to infection. Doctors know about these problems and try to manage the patients' health problems with the minimal steroid dose over the shortest possible time.

Steroids can be administered in pill form, intravenously, injectable (preferred by athletes), as well as though oral/nasal inhalers and eyedrops.

We know that one-in-ten people who take long-term steroids such as Prednisone can experience a rise in their intraocular pressure (IOP). We call these folks STEROID RESPONDERS. Serial IOP measurements are required in order to confirm that diagnosis.

Now, what if an existing glaucoma patient is also a steroid responder? There can be a dangerous IOP rise. This can lead to irreversible damage to the optic nerve...the 'TV cable' which connects the eye with the brain.

Beware of that sword! Anyone receiving any kind long-term steroid therapy needs regular eye exams and pressure checks. This applies not only to ophthalmology patients with inflammatory eye disorders like uveitis, but also to asthmatics, allergy sufferers, and folks with chronic conditions like lupus, fibromyalgia, and sarcoid.

Related Topics: FDA: Halt Unapproved Steroid Drugs
, Conquer Allergies!

Equally Clear Vision, Unequally Content

Here's a research breakthrough: a person's quality of life varies with refractive correction!

A recent study in the Journal of Refractive Surgery compared the results of a questionnaire given to a large group of adults. Each volunteer had some kind of refractive error (nearsighted, farsighted, astigmatism) that was corrected with either: 1) spectacles; 2) contact lenses; or 3) refractive surgery. The composition of the three groups was similar for gender, ethnicity, socioeconomic status and refractive error. (For example, spectacle wearers could have afforded LASIK if they wanted it).

According to the results of the questionnaire, refractive surgery patients scored significantly higher than contact lens wearers, who in turn scored significantly higher than spectacle wearers. Convenience issues chiefly drove the differences between groups. Functionality, eye symptoms, economic concerns, heath concerns and well-being were also important. Spectacle wearers with low-strength prescriptions scored significantly higher than those with medium-strength prescriptions. (Maybe the low-strength prescription volunteers didn't wear their glasses!)

Sounds rosy, doesn't it? Have refractive surgery performed on your eyes and live happier. That may be true except for the 7% of refractive surgery patients in the study who encountered postoperative complications and a compromised quality of life.

Lessons learned? You don't need to be a research statistician to recognize that:

• There is no operation that is right for everyone
• All surgery carries risks of potential complications
• A 7% risk becomes 100% if it happens to you!

Here's the reference: J Refract Surg 2006;22(1):19-27

Related Links: Dr. Lloyd‘s Top 10 Tips on LASIK, Disqualifications for LASIK

Technorati Tags: Refractive surgery, LASIK, Post-op complications, Eye surgery

Too Old for Cataract Surgery?

I recently examined a very nice elderly patient. She was accompanied by her son. Her vision had recently deteriorated so she made an appointment to see what could be done.

The woman was essentially blind in one eye and slightly better in the other eye. She admitted that she wasn't seeing as good as in the past, but things slid dramatically over the past two months.

The cataracts were easy to diagnose: dense, opaque, brown lenses. Seeing the back of the eye required maximum illumination with my indirect ophthalmoscope - the instrument with that very bright examination headlight. She never flinched.

Oh, did I mention that the patient was 91 years old?

"So," she politely asked, "when do I get my operation?"

I reviewed her medical records: no diabetes, no high blood pressure, minimal medications. In many respects she was healthier than many obese smokers who have yet to collect Social Security.

Her biggest risk factor for surgery was simply the fact that she was 91. Was this woman too old for eye surgery?

I began my usual explanation about proposed benefits and possible risks of complications. No sooner had I finished when she declared, "Sign me up. Even if it is only one month, I intend to see clearly until the day these eyelids close forever!"

This delightful and feisty lady exemplifies all of the 'quality of life' concerns we have for the elderly. Age is irrelevant in her situation. She is as alive and functional today as any previous time in her life. Her family supports her decision and will be available to help during her recovery from elective cataract surgery, now scheduled for early April.

Related Topics: Study: Fruits, Veggies May Help Avoid Cataracts, Mind-Body Connection

Technorati Tags: cataracts, aging, positive attitude

Wading Beyond the Mainstream

How much are you willing to endure? A person's symptoms often outlast a dedicated physician's attempts to identify the cause. Some doctors may choose to follow the path of 'cautious observation' once all of the serious, life-threatening diagnoses have been eliminated.

Most folks can discern when their physician is ready to throw-in the towel. This happens frequently when pain is the chief complaint: pain following surgery or trauma, pain following serious inflammation (like Shingles), or chronic pain like headache.

Before your doctor reaches for the prescription pad consider asking this question:

"What are my alternatives?"

There is no reason to live in misery, and you may not need daily doses of mind-numbing, potentially addictive narcotics to experience temporary relief. There are alternatives worth exploring within the practice of Integrative Medicine.

Whereas traditional, mainstream medicine is allopathic (meaning remedies are prescribed to reverse the specific disorder), Integrative Medicine simultaneously treats the body, mind and spirit at the same time.

Phobic about herbals? Although Integrative Medicine often employs unconventional treatments, they are based on high-quality scientific evidence.

Acupuncture was ridiculed a generation ago. Nowadays it is covered by health insurers to the great relief of millions of Americans. I have relied on hypnotherapy and biofeedback to help many of my patients and I am an eye surgeon - about as mainstream as one can get. I am excited to be able to offer options to my patients - proven approaches that can help lower blood pressure, relieve discomfort, and deliver a better night's sleep.

There are plenty of alternatives that can complement your current medical treatment or recovery program. Remember, Integrative Medicine is meant to complement (not compete with) traditional health care. Visit WebMD's new Integrative Medicine Center to learn more. It may be the most satisfying surfing you've done in a long time.

Related Topics: Using Imagery For Comfort and Rest, Headaches and the Mind/Body Connection

Technorati Tags: integrative medicine, hypnosis, biofeedback, acupuncture

Second Opinions are Welcome

Second opinions serve an important role in patient care. You should consider asking for a second opinion of your eye doctor whenever these situations occur:

1. Any surprise or unexpected eye condition
2. A diagnosis that abruptly reverses or contradicts earlier doctors' opinions
3. Suspected cancer of the eye or orbit, especially in a child
4. Proposal of life-changing surgery, like removal of the eye!
5. Personal concern regarding the doctor's skill or experience
6. Inadequate physician communications

Don't hesitate to ask for a consultant to review your case. Most physicians gladly welcome the opportunity to share their findings with an expert. The consultant should be independent of your personal doctor. If the consultant agrees with your doctor, you can move forward with confidence. Conflicting opinions? More work needs to be done before any important decisions can be made. Either way, second opinions provide helpful information.

Be skeptical of any doctor who attempts to discourage the involvement of another physician in your care. Frankly, I love to receive consultation reports regarding second opinions because it usually verifies my findings and clarifies decision making.

Finally, don't overdo it. It is rare to need more than one second opinion. Confusion and other problems emerge when too many experts get involved.

Got a sticky situation? Visit the WebMD Vision & Eye Disorder Message Board.


Related Topics: Assess Your Vision Online, Test Your Doctor IQ

Technorati Tags: secondopinion, eyesurgery, eyeproblems

Protect Your Eyes: One Houseplant to Avoid

Sometimes stuff happens and accidents occur. Out of the blue. Totally unpredictable. When you are not in control the best you can do is to react calmly and intelligently to unexpected events.

What about things you can control?

There is a common houseplant that can cause serious eye problems if it gets too close to you. No, I'm not writing about a cactus (also bad news). I want you to know about the Dieffenbachia, also called Mother-in-Law plant. Experienced gardeners know that the milky sap from this plant is extremely toxic. If a leaf makes contact with the mouth there can be a dangerous allergic reaction that could threaten the airways.

Ophthalmologists are also concerned because the sap is loaded with calcium oxalate crystals. If a Dieffenbachia branch or stem is broken (as happens with everyday plant care) special cells spray sap in a projectile fashion. The crystals can penetrate intact skin, mucus membranes and the clear cornea. Think of it like horticultural shrapnel. Victims experience immediate burning eye discomfort and blurry vision that worsens with time. If often takes a week or longer for the eye to recover.

Don't let your green thumb lead to a painful red eye. If you care for any plant with milky sap always wear eye protection and be sure to thoroughly wash your hands with soap and water afterwards.

Related Links: Eye Injuries Twice as Common in Men, Objects in the Eye

Technorati Tags: eye injuries, poisons, houseplant, dieffenbachia

Healthy Vision in Preschoolers

Parents of young children already have plenty to worry about: immunizations, nutrition, child care, toilet training and many other concerns. All of a sudden a lot of attention is being directed at the vision of infants and toddlers.

It seems that many parents are being told that their young children should start wearing eyeglasses and even start vision training. Is it really something to worry about? Some young children certainly benefit from having an abnormal refractive error corrected, but for many families it is an expensive and unwarranted decision.

It's important for parents to know that the child's eye develops rapidly. It reaches adult size by the fifth birthday. For the same reason the focusing power of the preschooler's eye changes continuously.

Most healthy babies are farsighted (hyperopic), probably because the eye is still relatively small. Most young children do not need eyeglasses or vision training to see clearly because they have abundant accommodation that automatically provides the necessary focusing power. As the child matures the eye approaches adult size and the hyperopia goes away. Some experts suggest that early eyeglasses may actually hinder normal development.

Well, how can a parent decide whether or not their child has an eye problem? The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) advocates early vision screening. Here is a summary of their recommendations:

= Vision screening programs should provide widespread, effective testing of preschool and early school-age children.

= All infants by six months to one year of age should be screened for ocular health including a red reflex test by a properly trained health care provider such as an ophthalmologist, pediatrician, family physician, nurse, or physician assistant during routine well-baby follow-up visits.

= Further screening examinations should be done at routine school checks or after the appearance of symptoms. Routine comprehensive professional eye examination of the normal asymptomatic child has no proven medical benefit.

Click here to review the complete policy statement.

Fortunately, most vision problems in young children are correctable with prompt therapy: glasses, eyedrops, prisms, patching, perhaps eye muscle surgery. Intuition usually compels worried parents to get their children the help they need.

If anyone recommends spectacles or vision training for your preschool child consider verifying the findings with a pediatric eye specialist, a pediatric ophthalmologist.


Related Topics: Never Too Late to Treat Kids with Lazy Eye, Your Baby's Vision

Technorati Tags: babyvision, childeyeexam, eyeglasses

Discount Eye Surgery: Shopping for the Best Price?

A recent visitor to our WebMD Eye and Vision Disorders Member Board wanted to know more about discount pricing for eye surgery, specifically laser refractive surgery.

Is there any real difference between a $399 operation and the $2199 procedure?

Several points deserve careful consideration. First, why would you want 'discount surgery' anyway? You will need to live with the outcome for a very long time. Simply stated, you want the very best possible results.

Next, the price for voluntary surgery (elective surgery) is not controlled by insurance companies or Medicare. Competitive forces within your local health care marketplace will determine what is reasonable. Beware! $399 surgery is often a teaser price, so look for lots of fine print. Patients who meet the eligibility requirements for $399 LASIK (very low myopia without astigmatism) probably don't need surgery.

Sure enough, you usually get what you pay for. Lowball prices often exclude services we typically expect as part of the package. Surprise! I had a similar experience when I recently bought my brand new Honda Element, that boxy-looking SUV. Guess what? The dealer charged me $140 for a driver's seat armrest. Suddenly the armrest is an after-market option. An armrest?

I say forget about comparison pricing and devote your time researching surgeons instead. Look for two specific things: word-of-mouth endorsements from satisfied patients and verified credentials that confirm the surgeon's expertise. You will forget about price shortly after the operation so long as you are satisfied with the results.

Related Links: Vision Fact or Fiction: Quiz, Squint at Computer Screen: Eye Risk?

Technorati Tags: LASIK, eye surgery, laser refractive surgery, comparison pricing

Eye Doctor Stories - Push to Replay

Experienced physicians have acquired a collection of memorized patient education presentations in their heads. It's kinda like having one of those multi-disk CD players. Ooops! - it's 2006 - it's like an iPod. Patients ask a question about their health and - click! - the presentation begins. Having delivered the same explanation so many times it becomes a reflex. Here are some examples:

How does my diabetes interfere with my vision?
What will happen during cataract surgery?
Why am I having problem reading small print?

One of my most frequent soliloquies always surprises patients. It's the one that explains how nearly two-thirds of the eye's focusing power occurs alongside the front of the eyeball. Most of the action takes place where room air, the tear film, and the clear cornea combine.

If there are changes to the healthy tear film (a combination of water, oil, and mucus,) the eye will not be able to crisply process the incoming visual image (think Vaseline on your windshield). Learn more about healthy tears.

Dry eye patients frequently complain of blurry vision. Certainly any problem with the cornea can also induce a significant visual blur. Leaping back into the pool, has incorrect pH or chlorine levels given you hazy vision afterwards?

Things not as sharp as they ought to be? You may not need new glasses or eye surgery. Your problem may be remarkably superficial! Maybe I should transfer this information to one of those Video iPods!

Related Topics: Common Vision Problems, Choosing an Eye Doctor

Technorati Tags: ipod, cataractsurgery, eyes, vision

Kirby Puckett: Eye Problem Forecast Tragedy

Baseball fans are still reeling from the sudden death of Hall of Fame Minnesota Twins' legend Kirby Puckett. Puckett's playing career ended prematurely after he developed a blinding eye condition caused by occlusion of a retinal blood vessel. The eye condition occurred in 1996 and wiped out the vision in his right eye. This was a circulatory disorder that was present throughout his entire body - not just the eye. It was an 'eye problem' because of the vision loss and because his eye doctors could see the problem.

That is how it often is. An eye problem is representative of a much larger condition affecting the entire body, a systemic condition. In this situation high blood pressure is usually discovered. Eye doctors know about this dangerous combination and refer the patient to an internist for further evaluation. Retinal vascular occlusions have a disastrous reputation. Eye doctors know that the long-term overall prognosis is grim unless affected individuals act quickly to regain their good health: stop smoking, lose weight, control their blood pressure and lower their cholesterol.

Poor bloodflow in Puckett's right eye led to a special kind of glaucoma. Game over. No more playing baseball. Batters need crisp vision in both eyes to consistently gauge the path of a 95mph baseball thrown at them.

Celebrity deaths often alert the public to preventable health tragedies. Kirby Puckett's situation is no different. If your eye doctor finds hemorrhages in your eye and warns you about blood pressure, diabetes, or high cholesterol it may be the only advance warning you get to protect yourself from permanent disability or death.

Related Topics: Take the Hypertension Quiz, Lower Your Stroke Risk

Technorati Tags: Kirby Puckett, highbloodpressure, stroke, diabetes

Got Cataracts? Something New to Worry About!

There are two very common vision problems in older adults, cataracts (clouding of the lens) and Age-Related Macular Degeneration (damage to the retina in the back of the eye). Other than their chronological association, is there any chance that these two are somehow related?

A newly-published clinical research study out of Australia claims that ARMD occurs more frequently in eyes that have undergone cataract surgery. Ophthalmologists studied a large group of patients aged 60 and older. Their eye findings were tracked for many years before and after cataract surgery. The doctors kept track of how many eyes developed ARMD, when it first appeared and if it progressed.

Compared to eyes that did not receive cataract surgery, postop eyes were nearly 50% more likely to develop ARMD within 3 years of their surgery (15.2% vs. 10.3%). Statisticians standardized the patient data to two large age-matched control groups. That means the results are supposed to be believable.

The researchers do not offer an explanation for their intriguing findings. Given that there is no other treatment option for cataract, seniors may find themselves in a difficult spot if this data is corroborated by others.

This type of study is not new. There are several older published reports that link cataract surgery with heart attack and even shorter lifespans compared to folks who do not have the operation.

Mark Twain once wrote something clever about statistics...

Which Glaucoma Eyedrop Works Best?

Clinicians are justifiably skeptical of glaucoma research that touts the effectiveness of a new prescription eyedrop. The authors (researchers) are often affiliated with the same company that manufactures and markets the medication.

One way to get around this controversy is to perform a meta-analysis - gather ALL relevant published research data about the topic. Of eight popular eyedrops prescribed for the treatment of glaucoma, bimatoprost, latanoprost, travoprost, and timolol are the most effective IOP-reducing drugs in primary open-angle glaucoma and ocular hypertension patients, according to a meta-analysis of randomized clinical trials.

The meta-analysis was recently published in the journal Ophthalmology. After retrieving 820 articles through a computerized search, 793 were excluded due to various ineligibility factors. The remaining articles reported on 28 randomized clinical trials involving nearly 7,000 volunteers.

The results of the study confirmed that all eight drugs evaluated in the meta-analysis do lower intraocular pressure more effectively than a placebo, with Bimatoprost (a prostaglandin analog) achieving the highest pressure reduction (33 percent).

Glaucoma patients might want to share this item with their eye doctor.


Related Topics: Eye Problems Linked to Diabetes, Eye on New Vision Procedures

Technorati Tags: glaucoma, eyedrops, IOP-reducingdrugs

Gift of Sight: Eye Donor Awareness Month

Yeah, you're right. It seems that every week, every month is designated for some special health-related cause. Stop smoking, cure cancer, deliver healthy babies. All of these are honorable, worthy campaigns. Now it's my turn. I want to make you aware that March is National Eye Donor Month.

There are good reasons to consider becoming an eye donor. Most donated eyes are used for corneal transplantation. The diseased, cloudy, scarred cornea is replaced with healthy new tissue. Think of it like replacing a damaged windshield in your car.

Besides the skin, cornea is the most successfully transplanted human tissue. Cornea rejection rates are less than 10% and the recipient does not need lifelong immunosuppression. The visual improvement following a corneal transplant is life-changing!

No helicopters are necessary! Preserved eye tissue can survive beyond 72 hours so long as it has been properly handled. The postmortem gift of eye donation will not alter the appearance of the deceased and it is endorsed by most cultures and faith communities. Eye banks ship donor corneal tissue to wherever it is needed - across town or across the country. Yes, body parts via FedEx!

Click here to learn more about becoming an Eye Donor.

Related Topics: Dr. Lloyd's Eye and Vision Message Board, Organ Transplant Support Group

Technorati Tags: cornealtransplant, eyedonor, organdonor

Anxiety - Something In My Eye!

Folks who get something in their eye are among the most panicky patients around. There are two justifiable reasons for such anxiety. First, stimulated sensory nerves on the eyeball surface immediately signal the presence of foreign particles - it's a very important protective mechanism. We all know that feeling, 'Something's in my eye!'

Making the discomfort far worse is the apprehension that the foreign particle will migrate behind the eyeball. 'It might become trapped back there forever!'

Do the math: Eye discomfort + Anxiety = Panic.

You won't need a calculator to solve this problem. Most debris can be washed away with some fresh water. If it persists seek emergency care to have the offending particle removed.

A little extra knowledge can eliminate anxiety. The surface of the eye is coated by moist conjunctiva. It is a closed system that does not go behind the eye. The termination of the space between eyelid and eyeball is called the conjunctival cul de sac.

Misplaced contact lenses and foreign particles are stopped where the conjunctiva folds back on itself, much like a car that reaches a dead end in a residential cul de sac.

Don't worry, those small specks and dislodged contacts aren't going very far.

Related Topics: Detergent Tablets May Pose Eye Injury Threat, Eye Injuries More Common in Men

Technorati Tags: objectineye, debrisineye, contactlens