Myopia Persists After LASIK

I'll begin with a gentle warning. You may need to read this post TWICE in order to grasp its full meaning. Here goes!

Most folks receiving LASIK refractive surgery are nearsighted myopes. The nearsightedness is usually due to longer-than-normal axial length of the eyeball. Axial length is the total distance from the front of the eye to the back of the eye. Myopes wear spectacle corrections with minus lens corrections: -3 diopters, -6 diopters, -12 diopters, etc. As most folks know, LASIK changes the optics of the clear cornea so that after LASIK many nearsighted patients end up with zero diopters of refractive error. Are you with me so far?

Now the hook, even though post-LASIK nearsightedness is eliminated the eyeball itself remains myopic. The axial length of the eye remains long. Only the cornea had surgery - everything else is unchanged. Why should this matter?

Let's use wallpaper to explain the point. Three homeowners are each given six rolls of expensive wallpaper to decorate their dining room. One home has a small dining room, one has an average-sized dining room, and the last has a huge banquet hall. Each has to make do with the wallpaper they were given.

Regardless of eyeball size we are all born with the same amount of retina. Longer, myopic eyes have a much larger internal surface area, and so the myope's retina is often stretched thin to completely line the inner eye. Thin, overstretched retinas are more prone to retinal detachment (RD) and other related problems.

A recent study in the Journal of Refractive Surgery statistically analyzed 59,000 LASIK cases. Fortunately, the LASIK procedure itself does not appear to increase the risk for developing RD - that's good news. The authors did emphasize, however, that moderate and high myopes (-8 diopters and more) corrected with LASIK experience RDs with the same frequency as comparable myopes who never had LASIK performed. Once a myope always a myope.

Bottom line: Even if refractive surgery eliminates your need for glasses it never eliminates the need for regular periodic evaluations by an experienced eyecare professional.


REFERENCE: Faghihi H, Jalali KH, Amini A, et al. Rhegmatogenous retinal detachment after LASIK for myopia. J Refract Surg 2006; 22:448-52.

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• WebMD Video: Eye Surgery 101
• Over 40? Eye Surgery Succeeds

Technorati Tags: LASIK, nearsighted, eye surgery, laser surgery, myopia

2008: Resolve to Make Your Eyes Comfortable

Join a gym? Study yoga? Open an IRA account?

Many readers are busy prioritizing their 2008 New Year's Resolutions.

Most of these promises fall flat. Fitness clubs see a 50% attendance drop come February. Smokers keep lighting up, right?

Why not try something easy and achievable for 2008 - Why not have more comfortable eyes?

To some degree or another, most adults experience eye irritation due to dryness. For some it may only occur in the morning hours whereas others suffer all day long.

Here are some proven steps that can give you comfortable eyes all year long:

1. Stop smoking! (this will also protect you from macular degeneration).


2. Take a daily multivitamin loaded with Vitamins A, D, E, and C.


3. If you are menopausal consider hormone replacement therapy. Studies have shown that estrogen alone may eliminate dry eye symptoms.


4. Frequently add a preservative-free tear supplement (available over-the-counter).


5. Take frequent breaks when working at the computer. Folks tend to blink less when reading or concentrating.


6. Talk to your eye doctor if you are not getting sufficient relief. There are plenty of other available therapies.

From everyone at WebMD here's to a healthy and irritation-free 2008!

Related Topics:

• Pinkeye: Easy to Catch, Spread
• Do You Have Dry Eyes?

Technorati Tags: resolutions, eye health, dry eyes

Holiday Peace! Macular Degeneration Drug Controversy Resolved

Let there be Peace on Earth - and good vision, too!

A few weeks back this blog reported on a controversial decision by drug-maker Genentech to limit access by ophthalmologists to its inexpensive cancer chemotherapy drug Avastin. Genentech also makes Lucentis, an expensive injection to treat age-related macular degeneration (ARMD).

It just so happens that Avastin and Lucentis are very similar formulas, so ophthalmologists wanted to offer injectable Avastin as a cheap alternative to Lucentis. Click here to read more about the situation.

Great news! As predicted here, all parties have resolved the standoff and ophthalmologists will continue to have legal, unrestricted access to Avastin.

The American Academy of Ophthalmology and the American Society of Retinal Surgeons negotiated a resolution with Genentech. Here is an excerpt from AAO's recent press release:

The American Academy of Ophthalmology and the American Society of Retina Specialists (ASRS) are pleased to report that a solution has been found that addresses Genentech's decision to no longer allow compounding pharmacies to purchase Avastin® (bevacizumab) directly from authorized wholesale distributors. The Academy and ASRS believed that this change in distribution could have impacted access to Avastin for some physicians and patients.

Working together, we have determined that physicians can prescribe Avastin and purchase it directly from authorized wholesale distributors and wholesalers can ship to the destination of the physician's choice, including to hospital pharmacies, compounding pharmacies or directly to their office.

Genentech also remains committed to ensuring that eligible patients have access to Lucentis® regardless of their ability to pay. Physicians or patients who have questions related to access and reimbursement services offered by Genentech can call Genentech's Lucentis Commitment™ helpline at 1.866.724.9394.

So it appears that AMD patients needing genetically-engineered medical therapy to preserve their failing eyesight will continue to have choices in 2008 - a fine holiday gift indeed!

Related Topics:

• WebMD Video: Eye Test Finds Early Signs of Macular Degeneration
• WebMD Video: New Surgery for Macular Degeneration

Technorati Tags: macular degeneration, ARMD, Avastin, Lucentis, vision

Ready for Some Snow?

It's about time I talked about winter snow skiing. The extended mild autumn delayed the ski season in many parts of the country but the past two weeks have been magnificent for ski resorts across the USA. Colorado already has 90 inches so far - Lake Tahoe has received 2 feet of powder in just the last 48 hours.

If you've read my comments regarding Rod Moser's WebMD blog All Ears, you already understand my family's passion for skiing.

Here I am at 12,000 feet with my daughter, Maggie, during a trip to Winter Park, Colorado. Pay attention: there are lots of informative tips in this photo that will help you enjoy a safe and memorable winter vacation.

See that bulge? Yeah, that bump in the right pocket of my ski jacket. That's where I put the bottle of sunblock when we are outside in the snow. Sunscreens and sunblocks are needed year-round. At elevation there are more of those harmful UV rays that can prematurely age the skin. (Prematurely age the skin? HA! Get over it...my skin is already mature, thank you!) I just don't want to acquire any skin cancers.

Note the Squinting? Both of us wear high quality 100% UV blocking ski goggles...except for this snapshot. Again, reducing UV exposure protects against cataract and macular degeneration. Goggles also protect you from a very painful corneal injury (UV solar keratopathy - also called "snow blindness") that is akin to sunburn of the ocular surface. This condition would definitely keep you off the slope - wasting valuable ski rental and chair lift ticket dollars. Now that's really painful!

Alert dispositions! Beyond the euphoria of reaching the summit, Maggie and I are thoroughly hydrated. Boosting daily water consumption helps your body adjust to the elevation and definitely improves your disposition. Many newcomers resemble zombies - pour them a glass or two of water, please. At altitude we drink lots of water and apply lots of nasal saline to keep sinus passages moist and comfortable.

On behalf of everyone at WebMD I hope that you and your loved ones enjoy a delightful holiday season. I look forward to seeing you frequently in the New Year!

Related Topics:

• WebMD Video: UV Contacts - Blocking Harmful Rays
• Winter Means Wearing Sunglasses

Technorati Tags: snow safety, vision, eyes, skiing

Your Invitation to a Holiday Free-for-All

What? You haven't joined the fracas yet?!?

Get over to Rod Moser's WebMD Blog 'All Ears' and discover what you most dislike about:

• Christmas
• The Holidays
• The Holiday Season
• 23 November through 7 January
• All of the above!

Enlightenment can be very healthy, so open your eyes!

Click on the links below; you don't want to miss it. The outrageous commentaries (including one from yours truly) hit the bullseye with humor, wisdom and a little venom. Not a hint of nutmeg anywhere!

• The 8,765 Reasons Why I Do Not Like Christmas
• More of the 8,765 Reasons Why I Do Not Like Christmas

I was going to blog about snow skiing and winter UV hazards...maybe tomorrow!

Technorati Tags: Christmas

Terminal Condition

Sorry not to have posted over the past few days. While traveling to the East Coast on family business I got caught twice in icy, snowy winter weather. Tonight I am on the floor (literally) of NYC's LaGuardia Airport with hopes of flying home before the next storm arrives.

I had to borrow this laptop so I cannot stay online too long!

The place is crowded with many displaced, grumpy people. Lots of humbug happening here!

The entire experience is so destabilizing because the travelers feel so helpless - they have no control over their own (short-term) destiny. 24 hours from now it should all pass and it is likely that we will all be reunited with our families.

Have I mentioned hunger? All of the concessions have closed for the night. That pretzel booth is STARING defiantly at me!

All in all, this is a good exercise in maintaining patience, exhibiting self-control, and demonstrating good will during the holiday season. Tomorrow morning I plan to share my freshly-baked pretzel!

Thanks for your good wishes. Regular blogging should resume soon.

Related Topics:

• WebMD Video: Tips to Reduce Holiday Travel Stress
• WebMD Video: Travel Without Injury

Technorati Tags: travel, weather

LASIK As An Economic Barometer?

Whenever a news broadcast features stories concerning business and the economy, I tend to zone-out. Who cares? I have a fixed-rate mortgage, college tuitions are (almost) fully paid, and the bank still clears my checks. Let's get on to sports, okay?

Traditionally, the consumer confidence index is represented by conventional datasets like the amount of credit card debt and the rate of late credit payments...Zzzzzzzzzzzzzzzz. Wake me up when they roll the NBA highlights!

Now I've learned that eye surgery may have a profound influence on Wall Street, the money markets and the power brokers at the Federal Reserve.

In calculating the monthly consumer confidence level, the Conference Board includes data that tracks the number of vision-correction surgeries performed. It also counts the number of eyelid tucks (blepharoplasties). Who knew?!?

Both of these operations are elective - patients ask to have the surgery. Insurance plans do not cover elective surgery. Individuals who want LASIK or cosmetic surgery pay out of their own pocket, either with cash or a healthy line of credit. So the thinking is that folks who can spend $2000 or more for LASIK must have plenty of discretionary money to spend.

The economists are right! I just returned from the Annual Meeting of the American Academy of Ophthalmology and there was plenty of dialogue about a downturn in elective, self-pay surgery. According to CareCredit, a company that specializes in consumer lending for elective surgery, there was a nationwide 10% drop in LASIK cases in October 2007 - the steepest single month decline ever recorded. Overall, USA refractive surgery cases are expected to decrease 2.6% (1.38M procedures) compared to 2006.

Maybe I'll start paying more attention to business news. Who cares about the Super Bowl anyway?

REFERENCE: 'Evidence Grows That Consumers Are Pulling Back'. Wall Street Journal 12/08/2007

Related Topics:

• WebMD Video: Eye Surgery 101
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Technorati Tags: LASIK, eyelid tuck, blepharoplasty, elective eye surgery, economy, vision

Unhappy With 20/20 Vision After Cataract Surgery?

Cataract removal is the most commonly performed conventional surgical procedure performed in America. Medicare alone reimburses for over 2 million operations yearly.

Removing the lens from an expensive camera renders it useless - the same goes for the eyeball. Cataract surgery subtracts a whopping 18 diopters of focusing power from the normal adult eye. That is approximately one-third of the eye's focusing ability. Eye surgeons compensate for this loss with implantation of an artificial intraocular lens (IOL).

Over the last 30 years there have been tremendous improvements in IOL materials and optical design, so much so that implantation of an ordinary IOL generated dissatisfaction among some recipients. These unhappy individuals could see the 20/20 line on the eye chart but claimed the vision was inferior to the kind of eyesight they experienced prior to cataract formation. Sometimes they said unkind things to the doctor. Were they just too picky?

Today we recognize that patient post-op expectations outpaced IOL technology. Those cranky patients were right! Sure they could see the 20/20 line but their vision fluctuated in different lighting conditions. Contrast sensitivity, a superior method of assessing visual function, was markedly diminished. Back in 1980 anything approaching a 20/20 outcome was cause for celebration. Today it takes more to make folks happy.

What was the explanation for the unsatisfactory post-op vision? A lot of it is attributed to something called spherical aberration. No man-made lens is perfect (spectacle, contact lens, IOL). The optics may be precise at dead center but as you travel towards the outer edge of the lens the focusing can change dramatically. Spherical aberration (SA) distorts and degrades the visual image. To make things worse SA is magnified in high-power lenses like an +18 diopter IOL. In dim light the pupil enlarges and that also exposes the eye's visual system to more SA. Finally, if the IOL shifts the tiniest bit (decentration or IOL tilt) there can be an abrupt loss of crisp vision because the center of the IOL is no longer aligned with the visual axis.

Mother Nature's lenses aren't much better. The natural lens has measurable minus-power SA; however the clear cornea compensates for this situation with it's own plus-power SA. So, even if the surgeon precisely implants an optically perfect IOL the eye still has to deal with leftover positive-power SA from the cornea. Getting bleary-eyed yet?

The current solution for this dilemna is Aspheric IOLs. They have brand names like Technis, Acrysof IQ, and Sofport AO. These IOLs have restored the minus-powered SA that was present in the natural pre-cataract lens so that the net effect is minimal post-op spherical aberration.

If you got this far I must congratulate you for your intellectual curiosity! Patients receiving Aspheric IOLs report an extraordinarily crisp visual image. All they want to know is, "Doc, when can you do my other eye?" That's the nicest thing anyone can say to an ophthalmologist!

Related Topics:

• WebMD Video: Lens Implant Restores Woman's Sight
• WebMD Video: Crystalens vs. Cataract Surgery

Technorati Tags: cataract, spherical aberration, 20/20, vision

Eye-Opening Holiday Gift Ideas

Omigosh, just a few weeks to go!

Have you finished/started your holiday shopping yet? I shudder every time I know that I'll be driving anywhere near our local mall. Who says the economy is crumbling?

Let me ask you: Earlier this year did you promise yourself that you would complete your gift list long before December? Now it's crunch time and you're probably still looking for ideas, right?

If you're still scratching for suggestions consider these two great gifts:

Flash Focus for Nintendo DS: A few months back I posted a blog about the introduction of this interactive vision training system for the popular Nintendo DS handheld. Click here to learn more about it. I was so intrigued by its claims that I went out and bought one for myself! Flash Focus is loaded with all kinds of activities that are supposed to sharpen your eyesight, visual perception and hand-eye coordination. The games are hypnotically addictive and the more often you play the more games become available. Wireless is built-in so you can share/play with others within 65 feet even if they do not have the game on their system - very cool! I always carry this with me whenever I have to travel. Shop wisely - many retailers will bundle Flash Focus (or Brain Age 2...another great title) free of charge when you buy DS.

Large Type Computer Keyboard: It's amazing how many seniors enjoy using their computers. For some, it is their lifeline to the outside world. If you agree that grandpatents ought to have the best online experience possible (especially when visiting WebMD) think about getting them an upgraded keyboard that offers improved visibility.

Many computer peripheral vendors carry large-type keyboards. Take a look at some of the illuminated versions as well that make the letters big and bright. Both wireless and wired keyboards are available. Before you buy make sure you know the specific computer model that will use the keyboard as well as the type of input connector (USB, PS2, etc.) If you know the model you can be sneaky and confirm the specs by visiting the manufacturer's webpage. That way you can preserve the surprise without risking a merchandise return.

One final suggestion: If you'd rather not fight the traffic, not worry about online identity theft, and not hassle with gift wrapping consider a holiday donation in your loved one's name to a deserving nonprofit that serves the sight impaired: vision research, support organizations for the blind, even seeing eye dog charities.

If you have any great ideas why not submit them to our WebMD Vision & Eye Disorder Member Board? Happy holidays!

Related Topics:

• How to Choose Healthy Holiday Gifts
• How to Keep Holidays Healthy and Happy

Technorati Tags: gift ideas, holidays, accessibility, keyboard, Nintendo DS