High Tech Eyedrop Bottle

Don't look now, but Big Brother may soon be watching you administer your eyedrops.

Drug compliance is a huge concern in diseases like glaucoma. Since glaucoma patients rarely have symptoms it is understandable that many neglect to take the prescribed pressure-lowering eyedrops. The problem is magnified if two or three different eyedrops are prescribed at various times of the day - just way too complicated!

A new microchip-enhanced eyedrop bottle developed at the University of Cologne was recently featured in the British Journal of Ophthalmology. The microchip assembly is mounted to the base of the standard eyedrop bottle. It records the time whenever the bottle is inverted for eyedrop instillation.

Besides doses, the chip can also record whether the bottle was properly shaken and if it was stored at the recommended temperature.

Patients bring the eyedrop bottles along with them for each clinic visit and the microchip data is downloaded to an office computer for analysis. To verify chip accuracy study volunteers maintained a manual logbook. Handwritten information about scheduled eyedrop doses was then compared to the microchip data printout.

The irreversible damage and loss of precious eyesight caused by glaucoma cannot be prevented if the patients are unable/unwilling to take their medicines as directed. Chip data may help counseling efforts to bolster eyedrop compliance. Documented drug noncompliance may advance some patients to laser treatment and conventional glaucoma surgery much earlier in the course of their disease. Without the valuable objective information provided by the eyedrop bottle microchip eye doctors are left to wonder if their patients are really taking their medicines - a very dangerous waiting game.

Related Topics: WebMD Video: Shedding Light on a New Therapy for Glaucoma, WebMD Video: Glaucoma: New Surgery May Offer Hope

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Hot Weather Vision Threat

Feeling the heat? In our area we have had a scorching summer.

I'm gonna keep this brief because it's just too darn hot to be sitting here typing on such a warm day (way over 100 degrees F!) I need to go splash in the pool.

Besides heat exhaustion and dehydration there is a different kind of health threat generated by extreme termperatures - Uhthoff's Phenomenon (pronounced OO-toffs). It was first described in 1890 by Wilhelm Uhthoff - who else?

This relates mostly to people with previous bouts of optic neuritis or full-blown Multiple Sclerosis. Perhaps you have a loved one being treated for these conditions.

A rise in the body's core temperature can lead to a temporary loss of vision in folks with demyelinating disorders like MS. Vigorous exercise and hot tubs can provoke Uhthoff's Phenomenon but severely warm weather can also be responsible.

Although the textbooks describe this form of blindness as temporary there have been reports of prolonged vision loss and rare permanent blindness attributed to Uhthoff's Phenomenon.

Remember that I said I'd keep this brief? Take it easy and don't overdo things when it's hot outside.

Related Topics: High Humidity Boosts Heart Attack Risk, Emergency First Aid for Heatstroke

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Disqualified from LASIK? Never Say 'Never'!

It's a familiar maxim in medicine:

Never say 'Never'
Never say 'Always'

The message is 'Don't be too rigid', always allow some room for exceptions. It sounds like the advice is now applicable to modern laser refractive surgery (LASIK).

When LASIK was first introduced its use was restricted to folks with modest refractive errors and otherwise healthy eyes. The precautions were understandable since anything that interfered with corneal healing could adversely affect the surgical result. A newly published research study challenges that conservative approach.

275 LASIK procedures were performed on patients who were being actively treated for all kinds of systemic medical problems: diabetes, arthritis, lupus, even Sjogren's Syndrome (severe dry eye). Many were taking strong immunosuppressive drugs. They compared results from this group with 358 LASIK surgeries performed on healthy adults.

Guess what? Both groups had similar success rates and comparable (rare) complication rates. As expected, a subgroup with connective tissue diseases had less accurate refractive corrections. The cornea is pure connective tissue! Nevertheless, according to this one case-control study, LASIK is not necessarily more dangerous in adults with underlying medical problems.

Were you previously denied LASIK? Perhaps your eye surgeon may have a change of heart after reading this article.


REFERENCE: LASIK Outcomes in Patients with Underlying Systemic Contraindications. Ophthalmology 2006; 113:1118-1124.

Related Topics: Fish Oil May Help Save Your Eyes, FDA Okays Macular Degeneration Drug

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When 'Pinkeye' Becomes Red Eye

Twice this week I've seen patients with simple viral pink-eye. It's usually caused by the same virus that causes the common cold, hence the expression 'cold in the eye'.

When it came time to counsel and discharge the patients they both asked, "What about the antibiotics?" Each had been referred to my clinic by an outside provider who was not an ophthalmologist, and both had already been prescribed an expensive, broad-spectrum antibiotic eyedrop. Hmmm...should I continue the use of antibiotic eyedrops for viral pink-eye?

The concern is superinfection, a second bacterial infection piggybacked on top of the viral infection.

I do not find the specter of superinfection persuasive and usually do not superprescribe antibiotics. Healthy folks with an uncomplicated common cold usually do not start taking Amoxicillin or Zithromax, right?

Most healthy folks have an intact immune system, that's how they got pink-eye in the first place! The same inflammatory cells mobilized to attack a virus will pounce on a bacteria with even greater ferocity. Compared to viruses, bacteria are huge, clumsy targets.

I also worry about something called medicomentosa. All eyedrops sting when applied to inflamed eyes. The chemistry of antibiotics are especially prone to further irritate the eye, making it appear even more inflamed. Should the patient return to clinic 2 days later with an intensely red eye it could be difficult to determine with confidence its true cause - it might simply be a reaction to the antibiotics eyedrops. It often is!

Contracted a case of viral pink-eye? Wash your hands frequently, avoid contact with others, and use preservative-free artificial tears to keep the eye comfortable. Things should resolve (just like a cold) in 5-7 days.

Related Topics: Antibiotics: Good Choice for Pinkeye?, Back-to-School Health Checkup

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Blind Web Surfing

According to the American Foundation for the Blind there are 10 million blind or visually impaired Americans. Of this group only about 200,000 (who cannot read print) use the Internet.

More and more Internet developers are producing websites that are accessible to those with poor eyesight. Many webpages now offer a 'large type' option. Some resourceful users who have difficulty reading the screen resort to printing everything in very large type. Google now offers an 'Accessible Search' feature whereby it ranks search results based on the simplicity of the webpage layout: the easiest-to-read sites appear on the first page. Cool!

Innovative voice-generating software can read screen content but it is not a foolproof system.


Freedom Scientific has a full catalog of adaptive solutions, including several refreshable braille displays marketed under the brand name JAWS. Prices vary between $1400-$7000. These devises convert screen content into braille characters. Again, there can be technical wrinkles when links are encountered.

Finally, VISTA, Microsoft's upcoming next-generation operating system, is supposed to be loaded with a variety of user-friendly assistive devices that will convert screen content and email alerts into an audible format.

Reference: 'Web Sites Improve Service for Blind People'. Wall Street Journal, 20 Jul 2006, page D1.

Related Topics: WebMD Video: Tabletop Reader Helps the Visually Impaired, Eyeglasses Can Be Hazardous

BOTOX for Therapeutic Lid Paralysis

The medical use of Botulinum toxin (BOTOX) is not new. In fact, it recently celebrated its 20th Anniversary! Microdoses of BOTOX were originally developed for folks with specific kinds of eye muscle problems. In specific clinical situations where one muscle was overpowering its partner muscle (think unbalanced suspenders) a tiny amount of BOTOX was injected to weaken the stronger muscle. All of this happened long before anyone thought about eliminating facial wrinkles.

Ophthalmologists have discovered a new way to use BOTOX to help with a serious neurologic problem affecting the eyes - Bell's Palsy. This is paralysis of the Facial Nerve, the nerve that controls the muscles of facial expression including the muscles that close the eyelids (orbicularis oculi). Most cases are temporary. When Bell's Palsy occurs the eyeball is threatened because the blink reflex is lost along with voluntary lid closure. The nerve that opens the eyelids is still intact, so the eye tends to stay open 24/7. Chronic exposure can lead to severe pain, loss of vision, and other serious complications that might lead to loss of the eye.

Patching and lubricants are usually inadequate to protect the eye, so surgery is often performed to partially or completely close the lids. The procedure is called a tarsorrhaphy and it has its own set of potential problems. So, this is where BOTOX offers a novel solution.

By injecting a tiny amount of BOTOX into the upper eyelid the muscle fibers that would ordinarily open the eyelids are paralyzed for 2-3 months. This temporary lid droop neutralizes the effects of the Bell's Palsy, leaving the eyelid closed and the eye fully protected without the need for multiple surgical procedures.

By 3 months most folks with a temporary Bell's Palsy recover good use of their Facial Nerve - about the same time the BOTOX wears off. Lid elevation and lid closure are both restored.

Related Topics: Botox May Ease Facial Pain, Are We Pushing the Anti-Aging Envelope?

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Watch LASIK Surgery As It Happens

Heard about YouTube? This website is a warehouse of video clips. The number of entries runs into the millions: educational, technical, recreational, travel, humor, classic TV, etc. Most are amateur quality.

Folks wondering about LASIK refractive surgery can now view an actual LASIK procedure on YouTube.

If you visit YouTube enter the word LASIK in the search field and you will locate many of these clips. I screened many different LASIK video files. This one of my favorites.

Related Topics: WebMD Videos: Focus on DSAEK Eye Surgery, Home Vision Therapy

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Eye-Popping Party Trick

More and more people are asking me about eye-popping. This is a physical phenomenon wherein folks can relax their eyelids and eye muscles to the point that the eyeball prolapses out of the normal orbital space. Several patients of mine could pop their eyes. Some people are aware they posess this awesome super power and find a way to get themselves 15 minutes of glory on TV.

Click here to view a brief video of two eye-poppers.

Some people can roll their tongues, others can redirect milk from their mouth out through their nostrils.

Be careful of eye-poppers. There have been instances where the eyelids have slipped behind the eyeball and trapped it outside the orbit. Besides the discomfort caused by loss of moist blinking the blood supply to the eyeball can be compromised.

I remember my mother warning me about my humorous attempts to cross my eyes, "If you keep doing that they might just stay that way!" Yes, I stopped.

Related Topics: Medical Mysteries, She Wrote, Mortifying Moments

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New Drug Approved to Treat Macular Degeneration

After years of waiting older folks with Age-Related Macular Degeneration (ARMD) have renewed hope for their precious eyesight and hope for the future.

Lucentis is the name of a brand-new medical treatment for ARMD. The active chemical inhibits the growth of abnormal, leaky blood vessels underneath the retina - the core problem in wet form ARMD. About ten percent of all ARMD patients suffer from this condition, however it accounts for about 60% of all ARMD vision loss.

Click here to review the FDA's approval statement.

Lucentis is administered through a monthly series of painless injections directly into the eye, dispensing the drug exactly where it is needed. Believe me, the patient feels no discomfort whatsoever. Rare complications from the injections included infection, persistent inflammation, and retinal injuries. The vast majority tolerate the drug extremely well.

Nobody is talking about curing ARMD yet, but they are talking about Lucentis' ability to preserve eyesight and halt progressive loss of vision. In years past, laser burns were applied to eradicate the vessels but it also sacrificed the overlying retina and it had no effect on future vessels. After 12 months use 95% of Lucentis patients maintained stable vision without the use of laser.

Related Topics: WebMD Video: Retina Implant: Helping Blind People See, Macular Degeneration

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Keep It A Happy July 4th!

The upcoming 4th of July holiday is one of the busiest days of the year for eye surgeons and others who treat victims of accidental trauma.

Fireworks are best enjoyed at a community display, not in your backyard. The American Academy of Ophthalmology has launched a vigorous campaign to discourage the purchase and use of fireworks by amateurs - folks like you, me, and our children.

Here are some powerful numbers about fireworks injuries:

• There are approximately 8,500 fireworks-related injuries each year in the United States. Of these, about 2,000 are eye injuries.
• One-third of these injuries result in permanent eye damage and one-fourth in permanent vision loss or blindness.
• Almost one in 20 victims lose all useful vision or require the removal of the injured eye.
• 25% of all eye injuries caused by consumer fireworks happen to bystanders.
• 75% of all fireworks-related eye injuries happen to boys between the ages of 13 and 15.

Did you know that the most dangerous kind of firework is the bottle rocket? Bottle rockets fly erratically, often causing bystander injuries. The bottles and cans used to launch bottle rockets often explode, showering fragments of glass and metal.

Sparklers account for three-quarters of all firework injuries in preschoolers. Young children find these sticks of fire - burning as hot as 1,800 degrees Fahrenheit - irresistible to touch.

Eye safety experts make these suggestions:

• Never let children play with fireworks of any kind, including sparklers.
  
• View public fireworks displays from at least 500 feet away or up to a quarter of a mile.
  
• Respect safety barriers set up to allow pyrotechnicians to do their jobs safely.
  
• Leave the lighting of fireworks to trained professionals.
  
• If you find unexploded fireworks, don't touch them. Immediately contact your local fire or police department.

Fireworks injuries are so devastating yet so preventable. Make it a safe Independence Day for all!

(Portions excerpted from American Academy of Ophthalmology Fact Sheet)

Related Topics: Poll: Do you have a fire extinguisher?, Summer BBQ

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