How Many Drops Are in That Eyedrop Bottle?

"Doctor, you better write me for two bottles, there's no way that will last a full month!"

It's a common response when patients receive a new eyedrop prescription, especially for a long-term condition like glaucoma. There doesn't appear to be much fluid inside.

Most eyedrop containers are designed to last a month or more. As a result, most insurers will only pay for one bottle per month; patients cover any extras at $30 - $150 per bottle!

The core issue, of course, is the volume of a single drop of medication. Try and guess:

A. 0.0005 ml

B. 0.0050 ml

C. 0.0500 ml

D. 0.5000 ml

E. 5.0000 ml

The correct answer is C. Did you guess correctly? A standard eyedropper dispenses 0.05 ml per drop, meaning there are 20 drops in 1 milliliter of medication.

Let's do the math: a 5 ml bottle has 100 doses and a 10 ml bottle has 200 doses. (Most eyedrop prescriptions are dispensed in either 5 or 10ml bottles.) Evaporation is not a big problem so long as the cap is replaced after every application.

Calculating for a 30-day month, once-a-day drops and twice-a-day drops in a 5ml bottle will easily last a month. A 10ml bottle will usually accommodate higher doses.

Here's one last tip. If you cannot recall whether or not the instructions called for shaking the bottle before use, go ahead and shake away - it will not hurt the medicine! Conversely, failure to shake certain prescription eyedrop solutions will likely lead to inadequate dosing.

Related Topics:

• How to Use Eyedrops and Eye Ointment
• Glaucoma, Alzheimer's Disease Linked

Technorati Tags: eyedrops, vision, health and wellness

Patients Have Responsibilities, Too!

We just came back from a wonderful weekend trip to visit friends. As it happens, my wife uses flight time to catch up on her reading - piles of Sunday NY Times, unread medical journals, and plenty of magazines.

"Here, this will keep you busy!" says my wife as she hands me the current copy of Martha Stewart Living. Like I need help organizing my collection of shrunken gourds! Anyway, I start paging through the magazine when I tumble across the health section. It is devoted to breast cancer awareness. Hmmm...given the readership it seems to be a perfect match.

My attitude changed after I read the tragic story of a woman with undiagnosed widespread breast cancer. I became enraged!

The physician author was attempting to make the point that everyone should undress and get an annual head-to-toe physical exam. Sounds reasonable. To reinforce that argument the doctor relates an anecdotal past encounter with a female ER patient complaining of fatigue. The woman had a regular physician monitoring her blood pressure but always skips 'the full monty'. Sure enough, the author discovers a huge, fungating breast mass and extensive metastasis. If only her primary care doctor performed routine comprehensive exams. Arrgghhh!!!

Here's a brief excerpt:

"How long has your breast been like this?" I asked.
"Three years," she replied, almost apologetically.

"Did you tell your doctor about it?"
Her answer was simple, direct, and tragic: "He didn't ask."

"Did he examine your breast?"
"No," she answered. "He only treats my blood pressure."

Click here to view the entire story online.

Every medical student in America knows this story and every licensed physician has had similar experiences. Given all that happened in this sad case (or didn't happen), the patient neglected some individual responsibility in this matter. "Doctor, I'm worried about a small lump I've discovered in my breast." The woman continued to revisit the doctor fully aware that no exam would ever be performed, nor would the doctor ever ask probing questions.

The bigger story is the woman's monumental denial of her breast disease to permit it to advance to such an untreatable stage. Of course a 'paper gown' exam would likely have led to an earlier diagnosis in this case, but the patient put herself in a situation where that would never happen.

So why does this sad tale turn up on a WebMD blog about healthy vision? Far too many people are afraid about their health - and this includes the fear of going blind. They are so fearful that they neglect to make appointments to see the specialists who could help restore their failing eyesight. Family history and knowledge of others' experiences often shape a person's decision whether or not to seek medical care. If a grandmother went blind after cataract surgery (back in 1957!) then the adult grandchild may be reluctant to seek help in 2007.

If I don't hear bad news there is no bad news.

Like the doomed woman with advanced breast cancer, if you fail to be proactive about your own health, darn few other people will care enough to intervene. Given the current managed care environment there are plenty of other people to blame for any misfortune and you will get exactly the kind of care you seek - no care.

Got a problem? Get over yourself and get help!

Related Topics:

• Breast Cancer - Health Tools
• Annual Physical Exam: Unneeded Expense?

Technorati Tags: breast cancer, mammogram, cancer, wellness

Do You Let Your Doctor Shake Your Hand?

How much actual face time do you get with your doctor during clinic visits, especially during a first-time visit? It might be 15 minutes or less, depending on the clinic and the specific type of health concern: 15 minutes might be sufficient to handle a wart on the finger but totally inadequate for new-onset chest pain!

Since time is so brief, it is essential that the doctor and patient be able to quickly establish some type of rapport. Without mutual trust (however superficial) the exchange of patient information and the comprehension of treatment options will be severely limited.

Forgive this digression: Why is the 't' silent in rapport but spoken in support?

Anyway, what are the most effective icebreakers? (HINT: Whassup usually doesn't work!)

According to data collected by the Feinberg School of Medicine at Northwestern University (Chicago) a friendly greeting and handshake are the most-preferred techniques to quickly open communications between patients and their doctors. Sadly, today's rushed clinicians often arrive loaded down with charts and exam equipment. They may already be wearing gloves and everybody knows that nothing says "howdy" better than a moist rubber glove!

Telephone surveys were performed involving health consumers in every state except Alaska and Hawaii (not sure why they were excluded). Videotaped interactions involving hundreds of clinic encounters were also studied to observe the effect of different approaches used by physicians attempting to engage their new patients.

Here's how patients responded to the question: "How would you want doctors to greet you the first time you meet?"

• 78% want the doctor to shake their hand (hopefully after it is washed!)


• 50% want to be addressed by their first name


• 56% want their doctors to introduce themselves by their first and last name

Analysis of the videotapes recorded handshakes 83% of the time, but in half of these initial visits the doctor never addressed the patient by their name in any form whatsoever, as in, 'This may feel cold, er, pal!'

What works for you? Do you care about creating a relationship or would you rather just get down to business? Do you suspect the doctor feels the same way? With so many visitors to this WebMD blog I bet we can generate our own statistical summary.

SOURCE: Archives of Internal Medicine (June 2007) pages 1172-1176.

Related Topics:

• WebMD Video: Practicing the Human Side of Being a Doctor
• WebMD Video: Coping With Wait Time in Your Doctor’s Office

Technorati Tags: doctor, patient, medical practice, health and wellness

IT'S HERE! Stupid Artificial Intelligence

The Internet can be a very funny place.

Sometimes humorous things are deliberately posted online, like footage of that wacky Britney superfan Chris Crocker.

At other times legitimate, genuinely serious stuff can inadvertently be even funnier. Ooops!

For example, not too long ago if you asked Google Maps for driving directions between "Las Vegas, NV" and "London, England" step 29 actually read "Enter water and swim 2,476 miles". Absolutely hysterical - somebody took the time to program those crazy instructions. Sadly, it has since been eliminated (another act of Google censorship?)

Get ready for some great news. Now something even goofier is hurling through cyberspace, and it launched right here from WebMD.

It appears that our knows-all, senses-all WebMD Symptom Checker has self-realized.

Artificial Intelligence run amuck. Be among the first and check this out:

1. Go to the WebMD Symptom Checker


2. Click START NOW


3. Fill in form (doesn't really matter what you type) and click: SUBMIT


4. Locate the Symptom Search text box above the androgynous human figure and type: TREMBLING (Check your spelling, it has to be precise!)
5. Click GO and view your results.

I wouldn't dare spoil things for you, it's worth it.

Hmmm? What would happen if somebody typed in: BRITNEY ?

Umbilical Cord = Visual Lifeline

The herpes virus causes havoc for eye patients and their doctors. Whether it is the familiar herpes simplex virus (also responsible for cold sores and genital sores) or reactivated herpes zoster (adult shingles from childhood chickenpox) it is an extremely destructive infection that leaves patients with chronic poor vision and eye discomfort.

Yes, there are powerful antiviral medications, however timing is critical. Delays in diagnosis can give the herpes virus a devastating head start. Even if the virus is eradicated it leaves behind inflammation, tissue damage and scarring.

The herpes virus thrives inside nerves and surface epithelial cells and the transparent cornea has plenty of both. We use the term neurotrophic keratitis to describe a chronic, recurrent herpes infection of the cornea. These patients are miserable due to the vision loss and constant eye discomfort (pain). At this stage of disease antiviral medications offer limited benefit and long-term recovery often involves corneal transplantation.

Ophthalmologists know that these sick corneas need a variety of special substances to halt inflammation and to promote healing - proteins like IGF-1, NGF, and something called 'Substance P'. Synthesized versions of these neurotrophic substances cause redness, irritation and eye pain. Ordinary blood contains these vital proteins, and some researchers have created eyedrops from human serum. Korean researchers have advanced this approach one step further by identifying a natural source of concentrated neurotrophic substances: blood from the newborn baby's umbilical cord.

Serum extracted from purified samples of cord blood are loaded with all of the powerful healing substances the cornea needs to fight neurotrophic keratitis. This photo comes from a recent article that demonstrated how topical eyedrops made from umbilical cord serum promoted complete healing in an eye with advanced herpes. Not too long ago this eye would've been abandoned as a treatment failure.

Besides herpes virus infections there are other corneal conditions that result from nerve damage (like diabetes, stroke, trauma, radiation therapy, etc.) that can also benefit from the application of umbilical cord serum eyedrops.

Here's a good example of what the body needs to heal is readily available in human blood and more effective than any synthetic compound. You can expect to hear more and more about the remarkable healing properties of umbilical cord blood. Once something is proven effective others quickly adapt it to different problems elsewhere in the body - therapeutic copycats!

Related Topics:

• Herpes and the Eye
• Should I bank my baby's umbilical cord blood?

Technorati Tags: herpes simplex, umbilical cord stem cells, vision, eye care

LASIK: 20/20 and Still Unhappy?

Laser refractive surgery (LASIK) is enormously popular - over 2 million Americans undergo the procedure every year. Many ophthalmologists have re-engineered their practices to accommodate more of these patients - and for good reason:

• Most LASIK patients pay cash


• No insurance pre-approvals


• Many patients apply for financing (doctor collects interest!)


• No insurance paperwork


• Candidates have healthy eyes, healthy bodies


• Very high success rate


• Prompt recovery


• Complications are few, yet manageable

Given all this happy news, some postop patients are unhappy. Yes, they can read the 20/20 line without glasses, perhaps the smaller 20/15 line. Even so, some complain that surgery changed their eyesight...they just have a hard time explaining it.

Vision scientists don't have trouble explaining the situation.

Although most LASIK patients are very satisfied with their 'new eyes' some individuals are bothered by what's called higher order aberrations.

Some people are sensitive to extraneous noises in restaurants, traffic noise, right? Most of us are oblivious to it and carry on with life's activities.

Higher order aberrations pester some 'uncomplicated' LASIK patients.

These aberrations have to do with changes to the outer clear cornea that result from creation of the delicate flap that's created right before the laser energy is applied. Watch WebMD's video demonstration of laser refractive surgery.

Secondary astigmatism, spherical aberration, and something we call coma (no, not that kind of coma!) can interfere with both optimum image resolution and night vision. They can also cause LASIK patients to see more halos around bright objects day or night. For some this can complicate driving in the dark. Compared to individuals who never underwent eye surgery, LASIK patients were more that twice as likely to encounter this the halo phenomenon.

So, what should you do if you are considering refractive surgery? You should get as much information as possible! Have a thorough conversation with your surgeon before consenting to any surgery. Know all of the potential risks and the real-world chances that they might happen to you.

REFERENCE: British Journal of Ophthalmology, Aug 2007, pages 1031-1037.

Related Topics:

• WebMD Video: Age-Related Vision Loss
• WebMD Video: Glaucoma Laser Treatment

Technorati Tags: LASIK

The Power of Postoperative Eyedrops

During cataract surgery patients often ask, "When will it be over?" Fortunately, cataract surgery is a relatively brief procedure but, as I advise my patients, the real healing doesn't even begin until the operation is concluded.

Surgery is the easiest part about recovering vision loss due to cataract!

There is much that needs to be done before clear, long-term vision can develop. All of that rehabilitation occurs away from the hospital, away from the surgeon. Twenty years ago patients remained in the hospital for 3-5 days after uncomplicated cataract extraction. Today you are back home before lunch.

In 2007 the savage truth is that patients manage their own healing.

Besides avoiding strenuous activity and observing careful hand-washing, proper application of the prescribed eyedrops is the most important thing a patient can do to relieve post-op discomfort and to prevent complications after surgery.

New research data supports this time-honored advice.

Patients who faithfully instilled their nonsteroidal anti-inflammatory eyedrops after surgery were more comfortable than those who did not use their drops. Feeling no pain is a good thing, but keeping your eyesight is even more valuable. Folks who used their NSAID eyedrops (products like Xibrom, Acular LS, Nevanac and others) were far less likely to develop Cystoid Macular Edema (CME).

CME is a common cause of vision loss after cataract surgery. Weepy retinal blood vessels cause the delicate tissues to swell and visual clarity is lost. Most patients recover from CME but it greatly delays their visual recovery. Appropriate use of NSAID eyedrops has been shown to prevent this complication and accelerate healing.

Know somebody getting ready for cataract surgery? Remind them that the real work begins once they get off the operating table!

SOURCE: Journal of Cataract & Refractive Surgery (Sep 2007) pages 1550-1558.

Related Topics:

• Should I Have Cataract Surgery?
• Crystalens instead of Cataract Surgery

Technorati Tags: cataract surgery, eyedrops, vision, health and wellness

Licensure Responsibilities for Drivers and Doctors

This blog posting marks a first for me.

Most ideas for my blog entries jump out of my head. There's a lot going on inside my head (as well as ample space for ideas to 'bounce around') so I always find useful topics. This time the topic came to me in the form of an inquiry on our WebMD Eye & Vision Disorder Message Board.

Here is an excerpted version of Iceman's message:

Do you think an eye doctor has a moral obligation to intervene when a patient has vision impairments that make driving a vehicle dangerous? I know this is a deep question - but it is one that should be discussed more often. I finally quit driving after pulling in front of a tractor trailer I didn't see and almost hitting two city workers along the road .

I was told that I shouldn't be driving by about 4 doctors, but was actually legal to drive with 20-50 20-60 vision at the time. I also had blind spots. One doctor did write a note that I should not be operating a vehicle but then told the nurse that he wasn't going to fill out a form because they would take my license. Having driven with reduced vision I can honestly say that it is dangerous and I was dangerous to both myself and others . It has been hard not driving and I have had to walk 12 blocks to drug store, bank, etc., but I just wouldn't want to be responsible for someone getting killed by driving with poor vision.

I even know a man with macular degeneration to the point that he has to turn sideways to see me - yet still drives to the store 2-3 times a week. What do you think? What would YOU do?

Licensure is a public trust and it automatically imparts important responsibilities that protect the community as a whole. When the state grants you a driver's license it expects you to operate the vehicle safely, observe the traffic laws, and maintain adequate insurance. Failure to honor that license makes the community less safe.

Since you mentioned it, the minimum corrected vision standard for driving is 20/40 in the better eye with full visual fields. Any person with poorer eyesight (20/60, 20/80, 20/400!) has a personal responsibility to cease driving until the vision improves. If the vision deterioration is permanent the driver's license should be surrendered. This behavior is totally dependent on individual responsibility. People with poor eyesight who continue to drive are irresponsible, plain and simple. They may have 1,000 perfect excuses to justify their irresponsibility but it remains their choice, and it is an unwise choice.

Have you noticed, up until now, the doctor has not gotten involved?

Medical licensure also carries enormous responsibilities: to put patient care first, to render emergency assistance, to practice ethically. Many of these responsibilities are assumed; as an example, do not recommend unnecessary surgery. Other responsibilities are enacted as legal requirements; another example, patients diagnosed with Extreme Drug Resistant TB must be reported to the Public Health department. Additionally, a physician must report any suspected neglect or abuse involving children or senior citizens. Simply stated, the doctor has the responsibility to observe the law on behalf of society.

One of a physician's legal responsibilities involves identifying impaired drivers. Whether it is because of poor eyesight, seizure activity or other disabilities, physicians are required to inform impaired drivers of their situation and to take action. The specifics vary from state-to-state but if the impaired driver does not voluntarily discontinue driving, the physician is required to notify the authorities and retrieve the driver's license.

Is failure to identify an impaired driver any more acceptable than a doctor's failure to report suspected child abuse? The law is the law. If you don't like the laws run for public office!

You probably know where I'm going with this. In 27 years of medical practice I have never had to play 'bad cop'. A quiet, unemotional conversation (often rescheduled away from the busy clinic) usually delivers the desired results. Success often requires the commitment of a friend or family member so that the patient does not feel abandoned. Having knowledge of available transportation resources (low cost community van service, etc.) relieves anxiety and makes this difficult situation a bit more tolerable.

Given this information, impaired drivers who insist on breaking the law deserve the same kind of justice meted out to repeat drunk drivers. Alternatives to driving are always available. The resistance to conform signals a deeper issue regarding the individual's unwillingness to accept change in their life and to adapt.

Tough love? Sure.

A year from now, with the impaired driver still alive, I'm happy to listen to their complaints.

Related Topics:

• Trading the Car Keys for a Bus Pass
• WebMD Video: Macular Degeneration and Depression

Technorati Tags: vision, driving, eye health

Birth Month Linked to Nearsightedness

This goes to show you what you can discover if you have lots of data.

Vision researchers wanted to test the theory that the development of myopia (nearsightedness) is linked to the amount of sunlight the baby receives in the immediate period following birth. They call it the perinatal photoperiod.

They reviewed the complete health records of over 275,000 children and tracked their refractive errors. Next, they did a statistical analysis of those with myopia using a technique called multivariate logistic regression. Stay awake - here comes the good part!

There were seasonal variations in moderate and severe myopia according to birth month, with prevalence highest for June/July births and lowest for December/January. In the northern hemisphere nearsightedness correlates with sunny birth months. It would be very cool to repeat the study in Sydney or Cape Town to see if such numbers are reversed, just like their seasons.

Remember, this information came from looking at piles of old records, a retrospective study. Retrospective studies are far less meaningful because there can be all kinds of obvious and subtle errors in data gathering that escape detection. For example, was every child in every family enrolled? Did some families opt out and disappear from the database?

Having said that, seasonal associations are a familiar oddity to the practice of medicine. Did you know that appendicitis is more likely to occur in the spring? Just least year a different team of researchers reported that you are 27 times more likely to have a heart attack on your birthday than on any other day of the year. Go figure!

Related Topics:

• WebMD Video: Contact Lenses for Your Child?
• Menopause Symptoms Set by ... Birthday?

Technorati Tags: myopia, nearsighted, birthday, vision, health and wellness