Hydroquinone: FDA Frowns on Skin Lightener

Topical creams designed to lighten skin color are enormously popular. Sales of these over-the-counter products have grown tremendously over the past few years. The active ingredients don't actually depigment the skin, rather, they work mostly on freckles, blotches and other pigmented spots to give skin a more even, lustrous appearance.

4% Hydroquinone is the bleaching chemical found in prescription creams like Lustra, Tri-Luma, and EpiQuin Micro. A licensed physician writes a prescription and it is only sold through pharmacies. A weaker 2% formula has been available over-the-counter in products like DDF Fade Gel4 and Philosophy's Pigment of Your Imagination (clever name!)

Hydroquinone has been on the cancer watchlist for decades, both because of animal studies (rats given tons of hydroquinone to ingest) and retrospective health surveys that compared cancer risks by occupation/environmental exposure. Statistically, lifelong excess exposure to hydroquinone is associated with an increase cancer risk, so the FDA wants to ban OTC sales of hydroquinone. Many dermatologists claim limited topical use does not pose a genuine hazard. Either way, the stronger prescription version will likely remain available.

Instead of hydroquinone there are safe subsitutes to reduce the intensity of skin discolorations. Shiseido and Dior use proprietary formulas based on natural plant derivatives. Licorice extract, azelaic acid, mulberry extract and bearberry extract all tend to inhibit skin melanin pigment synthesis. An experienced aesthetic dermatologist or cosmetician can help you decide which skin lightening cream will work best for you.

Related Topics: How Your Skin Can Survive Summer, WebMD Skin and Beauty Center

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UPDATE: Fusarium Corneal Ulcer Mystery

It's been six months since an outbreak of serious fungal infections of the cornea was first publicized. The fungus was Fusarium. The storm has passed and so now multi-disciplinary teams of ophthalmic and public health specialists are analyzing the outbreak (epidemiology) to learn how it happened and how to prevent future occurrences. Recent published findings suggest that important questions remain unanswered.

Here's what we know:

• There were 164 confirmed cases nationwide during the outbreak.
• 94% of affected ulcer patients wore soft contact lenses.
• Nearly one-third of these Fusarium corneal ulcer patients required corneal transplantation to preserve the eye and to restore vision.
• Most (not all) cases used ReNu with MoistureLoc multipurpose contact lens solution.
• Fusarium has never been isolated at the factory, at the warehouse, or from unopened bottles.

We may never know for sure how the infection was transmitted. ReNu with MoistureLoc has been recalled worldwide and permanently removed from the market. Consumers should discard any remaining containers of this product.

Related Topics: Eat Your Veggies, Keep Your Vision, A Fungus Among Us: Prevention


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Use Your New Lens to Read the Fine Print

Options abound for those with above average amounts of nearsightedness (myopia) or farsightedness (hyperopia).

First, there are eyeglasses (remember them?)

Contact lenses: daily disposable, weekly disposable, daily care, extended wear, etc.

Refractive surgery: Radial keratotomy, PRK, AK, LASIK, LASEK

Adjustable explants: INTACS

Clear lens extraction with a calculated intraocular lens (IOL) substitution: Take a corrected 20/20 eye and with some luck make it, er, 20/20!

The newest treatment is IOL implantation without removing the natural lens. Think of it as a piggyback lens providing the missing refractive correction. Phakic is an adjective meaning 'the patient still has the natural lens in the eye' so these are called Phakic IOLs. This device can be placed either in front of the colored iris (photo) or between the iris and the natural lens. Careful! Any physical contact between the phakic IOL and the natural lens will lead to cataract formation (and MORE surgery!)


Delicate intraocular surgery is required in order to implant the phakic IOL. That means a trip to the operating room, sterile procedures, microinstrumentation, and a surgical incision. Sutures are required to close the incision. Anytime there is an incision there is always a risk of infection and postoperative astigmatism (excessive corneal curvature).


Phakic IOLs may be a good choice for selected patients. Today's models will not correct near vision so folks over 40 should expect to buy some bifocals afterwards. Hey myopes! Remember, even though your eye's optics may no longer need those minus lenses your eyeball is still myopic. That means the increased risk of developing peripheral retinal holes and (possible) retinal detachments persists. After phakic IOL implantation you will still need periodic exams of your stretched retina.

It's better that you know all of the proposed benefits and potential risks before deciding to have an elective intraocular surgical procedure. Make sure your surgeon answers all of your questions before giving your consent to any surgery.

Related Topics: Update on Contact Lens Eye Infection, WebMD Video: Focus on DSAEK Eye Surgery

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Lens Implants and UV Precautions

We've previously mentioned how the lens of the eye not only generates near focusing power (accommodation) it also serves as a critical lifelong UV barrier that protects the delicate the retina from these toxic light rays. Invisible ultraviolet light is blamed for postoperative retinal swelling and the progression of Age-Related Macular Degeneration.

Cataract surgery results in the removal of the lens. This leaves the retina vulnerable. Intraocular lenses (IOLs) are implanted to restore the optics of the eye and to restore protection from ultraviolet light. So-called Blu-blocker IOLs are tinted yellow and are very effective, however, like wearing yellow sunglasses all day, color perception contrast sensitivity are distorted.


Now there's a new IOL, the Smart Yellow IOL. Check out the photo. The IOL on the left is a yellow Blu-Blocker. The Smart Yellow IOL only turns yellow while it is actively exposed to UV light. The rest of the time the Smart Yellow IOL is transparent and the user is symptom free.

If cataract surgery is in your future (or someone close's future!) make sure an effective UV blocking IOL is chosen, even if you need to pay a little extra. You have the right to expect (demand) this level of care. Given that cataract surgery is offered to improve eyesight, it is only logical that every step be taken to optimize the postoperative visual outcome and to protect the eyesight in the future.


Regardless of specific product chosen, this investment will generate 'visible benefits' for the rest of your life.

Related Topics: Slew of New Lenses Act Like Real Eyes, Lucentis: New Drug Fights Macular Degeneration

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Eye on Heightened Security

Since Thursday's foiled UK liquid explosives terrorist scare new rules dictate what you can and cannot bring onboard commercial aircraft. A little more inconvenience for a little more security, right?

What about artificial tears?

What about my contact lens solution, even the carrying case?

The Transportation Safety Administration has outlined new rules for onboard liquids. Click here to read all of the details.

Prescribed liquid medications are acceptable so long as the name on the prescription label matches the passenger's name. Those with severe dry eyes should have their doctor write such a prescription and ask the pharmacist to prepare that label for your OTC purchase. Don't pay $30 for a bottle of artificial tears!

I suggest you forget contact lenses altogether. The arid environment in the passenger cabin is reason enough. Pack your contact lenses and all of the supplies in your checked luggage and deal with spectacles for a few hours.

For short flights you could bring a disposable vial of a preservative-free tear supplement like Refresh or Celluvisc and apply it right before entering the security checkpoint. Lubricating ointments will likely blur your vision and may cause you to misread the flight info monitors!

At times like these we all need to be flexible, resourceful, and accommodating.

Related Topics: Travel Without Heartburn, Travel Without Injury

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Eye Surgery Without Sutures

Folks preparing for cataract surgery have a difficult time grasping the concept of sutureless surgery. Years ago a large crescent-shaped surgical incision along the edge of the cornea was used to deliver the mature lens in one piece (roughly the size of a M&M candy!) Afterwards this large incision required multiple sutures to preserve the integrity of the eye. The 'stitches' often irritated the eye and they had to be manually removed several weeks or months later. Sutures also imposed mechanical tension on the healing cornea and astigmatism (excess corneal curvature) was a familiar outcome.

Subsequently, innovative surgeons devised clever ways to debulk the lens while it was still inside the eye. Modern phacoemulsification techniques use ultrasonic energy and a little suction to totally remove the cloudy lens by means of a tiny clear corneal incision. The design of the surgeon's dovetail incision permitted the angled edges of the cornea to fit together perfectly to seal the eye without the need for sutures. At the end of the procedure the surgeon tests to make sure the self-sealing incision in intact and that no fluid is leaking from the eye.

Modern cataract surgery methods permit individuals to enjoy faster, safer, more comfortable healing. The incision heals and no visible scar develops.

If you are anticipating cataract surgery be sure to fully comply with the doctor's postoperative instructions, including eyedrop administration, in order that your suturelsss corneal incision heals without complications.

Related Topics: Cataracts and Your Eyes, Cholesterol Drugs May Avert Cataracts

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Eye Doctors May Someday Screen for Alzheimer's

• A simple x-ray can help diagnose a broken arm.
• A needle biopsy confirms the presence (or absence) of cancer.
• Male-pattern baldness is diagnosed with a glance.

Sadly, one of the biggest challenges regarding Alzheimer's Disease is the inability to definitively diagnose it. Although there are surveys and checklists used to score whether or not an individual's behavior is consistent with Alzheimer's Disease, there is no definitive clinical test that can be applied to living patients. A postmortem brain biopsy is the only surefire way to establish a concrete diagnosis.


A new test developed by researchers at Boston's Brigham and Women's Hospital may be able to detect early dementia using a painless, noninvasive eye test. The test, developed by a team led by Harvard's Dr. Lee Goldstein, uses a laser beam to scan the lens of the eye for deposits of beta-amyloid, a protein found in the brains of those who have Alzheimer's disease.


The lens analysis technique has been successful in a trial using mice: a brief pulse of infrared light into the eyes of four mice with Alzheimer's and four healthy control mice. The laser scan accurately identified which of the animals had the condition. The laser beam detects very earliest stages of amyloid deposits in the lens. Dr Goldstein and his colleagues believe that the test could eventually be used to detect Alzheimer's disease at its earliest stages in humans, and that it may also be able to track disease progression and monitor how people respond to treatments.

Early detection leads to early treatment. Let's hope this device works just as well for humans.

Related Topics: WebMD Video: Daring New Experiment for Alzheimer's Disease, Diabetes Drug May Prevent Alzheimer's

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Polyunsaturated Fats and Macular Degeneration

For the past several years there has been increased awareness of the health benefits attributed to a diet rich in unsaturated fats like the Omega-3 fatty acids. Most of those benefits involved heart disease and improved circulation.

Now there is some scientific evidence that consumption of those same healthy fats may prevent or delay onset of Age-Related Macular Degeneration.

A newly-published study analyzed nearly 3,000 older adults over a five-year period. Those who consumed a diet that favored polyunsaturated fats (especially fresh fish) were compared to other folks who stuck with ordinary animal fats, regularly choosing beef over seafood.

Those who ate fresh fish 3 or more times per week were 40% less likely to develop macular degeneration, as opposed to those who consumed far less Omega-3 fatty acids. Fish was the key dietary source - not margarine, nuts or other foods loaded with polyunsaturated fats.

The authors claim that this is the first long-term study that correlates dietary fat intake with the development of macular degeneration. We know that dietary fats are critical to many metabolic functions inside the eye. Over time it is not unexpected that long-term consumption of unhealthy, saturated fats (like trans-fats) may be harmful to the cells responsible for good vision.

REFERENCE: Dietary Fatty Acids and the 5-Year incidence of age-related maculopathy. Archives of Ophthalmology 2006; 124:981-986.

Related Topics: WebMD Video: Fatty Fish Helps Heart Keep Its Rhythm, Good Fat, Bad Fat: The Facts about Omega-3

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