Macular Degeneration: Is 'Off-Label' Treatment Off-the-Table?

Age-Related Macular Degeneration (ARMD) affects millions of older adults, so it's natural that our WebMD Vision & Eye Disorder member community receives many visits from concerned patients and family members.

This is a hopeful time for those affected by ARMD. New medical treatments may preserve and (in some cases) improve visual function. Click here to see an earlier blog that describes what is available.

The most heated debate concerns use of Avastin, a cancer chemotherapy drug that also stops abnormal blood vessel proliferation in ARMD. Problem is the FDA has only approved Avastin as safe and effective for cancer, not ARMD.

Many ophthalmologists now offer Avastin injections as an 'off-label' treatment. It is legal and ethical so long as you and your doctor agree on what you are both trying to accomplish.

Here's recent guidance the American Academy of Ophthalmology offered to its member physicians regarding 'off-label' therapies:

• Familiarize yourself with the published literature and the experience of colleagues.
  
• Be reasonably confident that patients would benefit from the drug.
  
• Discuss all options with patients, and be clear if your recommendation is an off-label use.
  
• Heed the drug's history of adverse events, and advise and monitor patients accordingly.
  
• Document the decision-making process and the informed-consent discussion that led to using a drug off-label.

ARMD patients can also adapt these guidelines as their own checklist before agreeing to receive 'off-label' use of any prescribed treatment.

Related Topics: New Eye Drugs Treat Macular Degeneration, Diet/Lifestyle May Affect Eye Health

Technorati Tags: age-related macular degeneration, ARMD, Avastin

Make My Floaters Disappear

Newly-acquired floaters are pretty worrisome. All of a sudden there's this blob floating past your field of vision, changing directions with your own gaze. Other floaters can look like dark meteors.

Anyone familiar with our WebMD Vision & Eye Disorder member board appreciates what folks endure when they have floaters. Floater behavior can be very unpredictable: clear as a bell in the morning, sitting behind a boulder in the afternoon.

Naturally, those fighting floaters want a cure. Does such a thing exist?

Other than time the answer is a polite "No!"

There are plenty of websites touting laser evaporation of floaters, even intraocular surgery (vitrectomy) to physically remove the troublemakers. Scrutinize those websites carefully and you will discover there are no guarantees of:

• EFFICACY: The floater will completely, permanently disappear... it won't
• EFFICIENCY: The treatment will not create new floaters... it might
• SAFETY: The treatment is free of potential complications... it ain't!

The litmus test: Insurers do not reimburse for such treatments. You'll need to bring your checkbook.

What about eyedrops to dissolve the floaters? Same story, different verse.

I'm gearing-up for some enthusiastic responses to this post. I'm not intimidated. Floaters are a natural (physiologic) consequence of aging. Most folks tolerate them and eventually ignore their presence. No, I'm not against innovative therapies, nor am I against common sense!

Related Topics: First Aid for Eye Injuries, What's Wrong with Your Eyes?

Technorati tags: floaters, eyedrops

DARN! My Favorite Color is Declared Toxic!

Isn't BLUE the most beautiful color? I have more blue neckties than all other colors combined. Science has proven that people actually see better when there is a little blue mixed-in.


This concludes this meeting of the BAS (Blue Admiration Society)!


Most of you know that the spectrum of visible light is situated in a very dangerous neighborhood, right in-between evil ultraviolet (shorter wavelengths) and dangerous infrared (longer wavelengths). New research suggests that the boundaries between safe and unsafe visible light are very blurry!

Visible blue light is felt by some vision scientists to be potentially toxic to the human retina. They say blue light causes excess oxidative stress to the irreplacable photoreceptors and the underlying retinal pigment epithelium. These cells do not regenerate - you get a lifetime supply at birth and that's it!

If you accept the premise that blue light can be harmful (like ultraviolet and infrared) you'll want to protect yourself and loved ones.


First, get rid of those stylish blue-tinted sunglasses. These shades filter visible wavelengths other than blue, exactly what you want to avoid!


Yellow or amber lenses do a good job at blocking visible blue light. Good for your retina but bad for how you perceive the world. Most folks have trouble adapting to a muted, azure-free world and there are good reasons why.

We know that visible blue light stimulation makes your visual field wider and increases brightness. Want more proof? Notice how your pupils shrink to bright light? It's the blue wavelengths that trigger that pupil response. So, if you eliminate the color blue from your visible palette you will not only have trouble seeing in dim environments your world will appear dimmer, less vibrant, and a bit blurrier.

There is no concensus regarding whether or not visible blue is truly dangerous. We've all been through this before with coffee, red wine, and artificial sweeteners. For now moderation is a reasonable approach to take. Hey, you never looked good in those blue shades anyway!

Related Topics: First Aid for Eye Injuries, Low Vision and Your Eyes

Technorati Tags: vision, sunglasses, ultraviolet

Like Anybody Needed Another Reason to Avoid Diabetes

During clinical research scientists test theories by comparing groups of volunteers (treatment vs. no treatment, etc.) to determine if relationships exist that identify unknown factors that contribute to a specific disease.

I like clinical research studies with HUGE numbers of volunteers because it tends to eliminate selection bias and subjective interpretation. When thousands of volunteers are studies there is less chance for sampling errors as compared to eight or eighty participants.

A soon-to-be-published study identified Type 2 diabetic females as being at greater risk for developing Primary Open Angle Glaucoma (POAG) compared to age-matched nondiabetic females. POAG is the most common type of glaucoma. Oh, yeah, the numbers. Over 76,000 women were eligible for the study. Was that number big enough for you? Researchers eliminated all of the known confounding variables that would unfairly tilt the results.

Here's a nutshell summary:

After controlling for age, race, hypertension, body mass index, physical activity, alcohol intake, smoking and family history of glaucoma, Type II diabetes was positively associated with POAG. The association did not strengthen with longer duration of diabetes for duration less than five years compared with duration of five years or longer.

You likely know most of the chronic health problems linked to diabetes: peripheral neuropathy, kidney failure, high blood pressure, heart disease, chronic skin problems, retinopathy. Now we can add glaucoma to the list of anticipated diabetic complications.

There are 23 million diabetics in America and one-third do not know they are diabetic. Make sure you and your doctor confirm that you are not among America's invisible diabetics.

REFERENCE: Pasquale LR, Kang JH, Manson JE, et al. Prospective study of type 2 diabetes mellitus and risk of primary open-angle glaucoma in women. Ophthalmology 2006 (in press).

Related Topics: (WebMD Video) Diabetes Disaster: One Man's Struggle with Type 2 Diabetes, Type 2 Diabetes: New Cases Rising

Technorati Tags: glaucoma, diabetes, type 2 diabetes

Bush Gaffe Puts Spotlight on Serious Eye Disorder

Make the best of a awkward situation, right?

Something about lemons and lemonade?

Wednesday, President Bush, a well-known tease, was poking fun at a reporter wearing sunglasses at a press conference despite the gloomy, overcast skies. It turns out the reporter suffers from a progressive, hereditary eye disorder that requires the dark shades to limit painful light rays. Ooops!

The President personally apologized for the ribbing and the reporter graciously brushed the matter aside. At the same time, however, the world quickly learned about Stargardt's Disease.

Stargardt's is also called "Fundus Flavimaculatus". This is an inherited condition that affects the cells underneath the retina -- the retinal pigment epithelium (RPE). Visual symptoms can precede clinical changes to the inside of the eye. People experience decreased visual acuity, especially in environments where the lighting changes (light-to-dark or dark-to-light). Most folks with Stargardt's do not experience complete vision loss.

The diagnosis is established by performing a test called fluorescein angiogram. Affected patients exhibit a highly characteristic pattern with this study. Supplemental electro-physiological tests (ERG, EOG) are confirmatory.

The core problem is the abnormal accumulation of a cell product (lipofuscin) in the RPE. There is no current treatment, however optimistic researchers are working on ways to correct for the abnormal responsible gene that has been localized to chromosome 1.

Once confined to the secretive domain of medical arcania, Stargardt's Disease is being catapulted to global recognition because of an inappropriate statement made at 1600 Pennsylvania Avenue. The Foundation Fighting Blindness could only pray for such wonderful free publicity!

Related Topics: The Amazing Human Eye, Eyesight Need a Fix? You're not alone.

Technorati Tags: stargardt's, vision, President Bush

A New Wrinkle About Sun Protection

Wrinkles are big business.
CORRECTION! Getting rid of wrinkles is big business.

Folks concerned about maintaining a youthful facial appearance abhor wrinkles. The most common methods to eliminate wrinkles are:

• BOTOX injections that paralyze the muscle fibers that create the wrinkles;
• INJECTABLE FILLERS like collagen or hyaluronic acid to puff-up the underlying skin;
• COSMETIC SURGERY to tighten the flaccid skin; and
• TOPICAL CREAMS to rehabilitate damaged skin; prescriptions like Retin-A and Avage.

Now, here comes a new wrinkle to this story. Since most of the aging changes are due to lifelong sun exposure it is important to apply a quality sunblock frequently after the facial wrinkles have been treated. Choose SPF15 or stronger. Otherwise, the aging changes will reappear before you know it. That means wasted time, wasted money, and overall dissatisfaction.

Here's a special tip for those who rely on topical creams to eliminate wrinkles. Many of the chemicals in popular sunblock lotions are irritating to the skin, especially skin that is treated with Retin-A or Avage. Check the label before buying. Make sure your sunblock does not contain Parsol or Avobenzone - either will recreate the effect of pouring gasoline on a campfire! The only widely available sunblock that has neither Parsol or Avobenzone is Purpose (Johnson & Johnson). Remember, only YOU can prevent forest fires!

Ready for another wrinkle? In most stores you won't find Purpose alongside the suntan lotions and other sunscreens. They stock it with the high-end moisturizers and expensive aesthetic rejuvenation products. It's worth the few extra steps to protect your new face!

DISCLAIMER: Product recommendations are based on published data. I have no financial interest in J&J and I was not compensated for any published statements. I have facial wrinkles.

Related Topics: Wrinkles Predict Smokers' Emphysema, Guide to Summer

Technorati Tags: wrinkles, aging, skin care, Purpose

Wise Words for Water-Skiers

Hey, this makes Blog #100 for me. Smoothies for everyone!

Now, on to more important issues. Do you like to water ski?

I first learned to be dragged through the water back in 1972 in Lake LBJ near Austin, Texas. After a full day on the water I can't recall what hurt more - my sore shoulders or the sunburn!

In addition to an experienced instructor and a sturdy sunblock, today's water-skiers have something new to consider...their corneas!

Millions of Americans have undergone LASIK refractive surgery and a significant chunk of them (chunk: note sophisticated statistical terminology) like to water ski. Be careful LASIK veterans! Before you grab the tow bar make sure you are wearing some type of strap-on goggles, like the kind competitive swimmers wear.

No matter how long ago you had LASIK performed, that slender flap of superficial clear corneal tissue can easily dislodge or tear off (yikes!) from the forceful spray of water generated during water skiing. Have trouble navigating those wakes? A rough landing could cause the same problem.

Click here to review an earlier blog about why the LASIK flap remains so vulnerable years after surgery.

C'mon, don't complain, water-skiers. Goggles won't interfere with your enjoyment of being yanked by that speedboat. Most of you can't really see much anyway while water skiing, many keep their eyes closed. I know, I used to be one of them!

Related Topics: Drowning Prevention Tips, Hydration: The Key to Exercise Success

Technorati Tags: LASIK, water skiing, eyesurgery

MaxSight: Visualizing Every Advantage

Competitive athletes, their coaches, and the athletes' parents will try everything possible to get an edge: customized diets, personalized performance training, and the best gear. Things have just been jacked-up another notch. Get ready for contact lenses that claim to enhance the athlete's view and optimize what the wearer sees.

MaxSight is a high-performance contact lens jointly marketed by Bausch & Lomb and Nike. These are prescription tinted contact lenses that come in two different styles: Grey contact lenses are for bright light situations and the Amber lenses are for cloudy, variable situations. In theory, use of these sports contact lenses will reduce glare, eliminate aberrations and improve visual performance. These contacts can be ordered with or without refractive correction for nearsightedness/farsightedness.

Golfer Michelle Wie and baseball player Ken Griffey Jr. wear MaxSight lenses, but I doubt they had to pay for them!

MaxSight lenses will distort color perception somewhat, so they are not for everyday use; they are supplemental lenses only worn during athletic activity.

For years sports eyewear has utilized various tints and filters to achieve this same effect. One beneficial advantage of wraparound polycarbonate sports eyewear is eye injury protection.

There are other ways to help athletes keep their eye on the prize. Tennis and golfballs are made bright yellow for a specific reason. The retina is most sensitive to the wavelength of visible light represented as that funky yellow-green color. Skeptics say at 95mph the color of the ball doesn't make much difference! I'll be eager to learn how MaxSight contact lenses affect real world athletes' perception of these colored balls.

Related Topics: (WebMD Video) Kids' Sports: 7 Questions Can Prevent Injuries, Keeping Kids Playing Injury-Free

Technorati Tags: contacts, maxsight, sports safety

GOOD Doctors Should Not Practice BAD Medicine

I've waited too long to get this blog off my chest.

Recently I have encountered a run of visitors to our WebMD Vision & Eye Disorder Community that seek specific clinical diagnoses and/or treatment recommendations for their eye concerns.

Usually there may be one or two such inquiries per week and I typically dispatch them with kind words that remind the member of what online services are available at WebMD. Rendering diagnoses, offering consultation referrals, and providing treatment recommendations are not included. Simply stated - it's not what we do.

Lately there has been a barrage of visitors seeking immediate online clinical services; immediate as in 'right now, doc!' Simply restated - it's not what we do.

Because WebMD is not a clinic, and because WebMD cannot perform online eye exams, WebMD cannot speculate about a person's health problems. Such behavior would be unethical and the purest form of bad medicine.

Click here to read WebMD's complete Terms & Conditions regarding the information it shares. I have included this one excerpt:

THE SITE DOES NOT PROVIDE MEDICAL ADVICE.

The contents of WebMD are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the WebMD Site! If you think you may have a medical emergency, call your doctor or 911 immediately. WebMD does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by WebMD, WebMD employees, others appearing on the Site at the invitation of WebMD, or other visitors to the Site is solely at your own risk.

I love responding to members' posts. Sometimes, whether due to volume or time constraints, I cannot reply to every message and when that happens I am occasionally flamed. After 3 or 4 replies to the same visitor I need to move on in order to be fair to others patiently waiting their turn. We all are trying to find balance in our lives, right?

There, I've said it! I hope you will continue frequent visits to our member community. All I ask beforehand is that you remember that the Internet has limitations. Nothing will replace face time or phone time with your individual doctor.

Related Topics: Becoming a More Informed Patient, About WebMD: FAQs

Technorati Tags: webmd, internet, online medicine

Not Greedy, Just Wants Second Eye Surgery

Would you like to know the most impossible patients for an eye surgeon to manage? It's not whom you might expect:

• Not a screaming, cross-eye child
  
• Not a 'high maintenance' plastics patient
  
• Certainly not the bogus disability applicant
  

The most challenging individual is a satisfied postop cataract surgery patient after having the FIRST eye treated.

They had no idea they could see that well again. To them it's miraculous. A day earlier they couldn't drive, couldn't read comfortably. Can you see what's coming?

"Doctor, when can I have my other eye done?"

There are no absolute rules, but the first eye ought to completely heal before tackling the second eye. This means no inflammation, full visual recovery and good eye comfort.

The patient's vision on Day 1 postop doesn't mean much to a surgeon. It's the vision on Day 42 (six weeks down the road) where valid, long-term results are assessed.

Long ago there were some surgeons who operated on both eyes during the same procedure. It only took one infection (wiping out vision in both eyes) to get most ophthalmologists to reconsider that approach!

Three months is a safe timetable for the second operation, but satisfied patients are not always patient patients. Now that they have experienced the clear, bright and colorful new world after cataract surgery they are eager to fix the fellow eye.

Truthfully, it's a wonderful dilemna to be confronted with happy patients who want to have more surgery. Even so, there's no guarantee that the second operation will achieve the same results. It's smart to approach each procedure independently, reviewing the justification for surgery, recalculating the precise focusing power of the intraocular lens, and carefully reassessing the preop eye for the patient heading back for a second cataract procedure.

If your local eye surgeon makes you wait before proceeding with a repeat operation on the fellow eye don't be discouraged. Your ophthalmologist wants you to have every chance for another excellent outcome. Who could argue with that?

Related Topics: Cataract Prevention, Eyes and Age

Technorati Tags: cataracts, vision, eyes

Buying Eye Glasses? Don't Overpay!

People tend to think eyeglasses are expensive. They are! It is very easy to drop $200 for a new pair, but if you are going to wear them 2-3 years it is a reasonable investment. My current glasses are six years old and work fine (having said that, you may want to review an earlier post describing how I denied symptoms of a ruptured appendix!)

Given that eyewear is not cheap, you have all the more reason not to overpay for new spectacles. Prescription glasses are sold by licensed opticians who are also savvy marketers and retailers. Here are a few ways to get the most value at the optical shop.

Add on lens coatings and anti-scratch lenses may not be worth the money.

Bundle your new eyeglass purchase with a pair of prescription sunglasses and see if you qualify for a discount.

Buy eyewear insurance only if it provides full value replacment against loss or damage. Shop around, some local optical shops provide free insurance in order to compete with the huge discount optical franchise retailers.


Related Topics: Eye exams, Eye glasses for infants and children

Technorati Tags: eyeglasses, eyewear, opticalshops