How Will You Spend Your Tax Rebate?

I still can't get over how abrupt all this talk about our country's economic slump seemed to bubble-up over a 10-day period. We're supposed to be talking about Super Bowl XLII. Prior to last week's financial crash we all seemed fat, dumb, and happy, except for those who had lost their jobs to outsourcing and families uprooted from their foreclosed homes.

Like I said: fat, dumb, and happy.

So now Uncle Sam is sending 2007 taxpayers a check to make things right. Found money!

No two families are going to get the same amount. We may get $150...who knows? The politicians don't want you to save this money - you must spend it in order for it to stimulate our economy. It is your patriotic duty.

Well, how are you going to spend your tax rebate?

Here's my first rule: Spend it only on products manufactured in the United States. Guess that means no trip to Best Buy, Wal-Mart, etc. Widening the trade deficit would only make matters worse.

What could you do with $200? Instead of buying a new DVD player, get a family membership to the nearest museum or nature park. You can support your local community and always have something to do every weekend for a year!

Are you expecting $500? Get yourself some quality new or used exercise equipment. The 'USA only' rule does not apply to used merchandise because 'used' revenue stays here in America. Visit the global want-ad website Craigslist. You will find an awesome bicycle for under $500.

Did you say $1500 is heading your way? Now you're talking! Maybe you'll find the nerve to go ahead and get evaluated for LASIK. The signs on the buses advertise $399 LASIK, so it should run about $800 for both eyes, right? Hmmm, we need to talk. Check out the (very) fine print at the bottom of the ad. Yeah, go get the magnifying glass, I'll wait.

Discount LASIK typically applies to patients with very small amounts of nearsightedness and no astigmatism...someone wearing -1.00 glasses. Guess what? Most -1.00 myopes don't wear their glasses and tool around in a mild blur. Discount LASIK is usually performed with an older, less precise refractive surgery laser - you get what you pay for.

If you still want to splurge on LASIK, $1500 will likely cover about half of your total expenses: surgery, facility fees, postop eyedrops, etc.

Make sure your surgeon has loads of proven experience, loads of satisfied patients (ask for references), and adequate time to care for you before, during and after your LASIK. Specifically ask if an ophthalmologist is directly managing the postoperative care - not a 'physician extender'.

Old laser? Unhappy clients? Hidden charges? Nonphysician followup? Take your bundle of newfound money somewhere else. Caveat emptor!

Remember, it is your patriotic duty to spend your tax rebate. Spend wisely.

Related Topics:

• Health Matters in the 2008 Election
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Technorati Tags: tax rebate, LASIK, vision

Fishing for Answers About Retinal Detachment

A recent visitor to our WebMD Vision & Eye Disorders Message Board asked for information regarding the use of oil in the surgical repair of retinal detachments. Did she mention oil?

For years eye surgeons have relied on sterile, transparent silicone oil and various other expansile fluids and gases to keep the delicate retina where it belongs. Hmmm...how can I explain this more clearly?

I want you to think about a round fishbowl. This is kind of like a human eye when a person is laying on their back - just like in the operating room. Instead of water, the eyeball is filled with clear vitreous gel. In older adults the vitreous gel turns to water. See? It is very much like our eyeball example.

Now, the thin retina is similar to a very thin layer of transparent wallpaper lining our fishbowl. How thin? Try using Saran Wrap as the wallpaper.

Okay, now for whatever reason if a hole develops in the cellophane water will seep underneath and elevate the wallpaper. This is precisely what happens in most retinal detachments.

If traditional surgical techniques fail to repair the floating retina an operation is performed to remove the water (vitrectomy) and replace it with silicone oil or other synthetic substance that is heavier than water. The new fluid will push the retina (wallpaper) back onto the wall of the fishbowl (eyeball). In time the retina will heal and its reattachment will stick. Was that clear enough?

In time the silicone oil can be removed and replaced with sterile water. Most gas bubbles slowly reabsorb and the eye produces its own fluid to maintain the eye's volume. Interestingly, patients who undergo vitreous-gas exchange should not fly in an airplane because at higher altitudes the gas bubble will expand too much and possibly damage the eye.

Know someone dealing with a retinal detachment? Help them better understand their situation by sharing the story of the fishbowl.

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• WebMD Video: An Implantable Retina
• Retina Stem Cells May Restore Sight

Technorati Tags: retinal detachment, vision

New Eyeglasses Don't Work? Get Results!

Few discoveries disappoint more than putting on brand new prescription spectacles and not being able to see clearly.

What happened? Things were so sharp, so crisp in the eye doctor's examining room!

Could I have been imagining things?

Is my eyesight not as good as I believed?

Relax, you have not lost your mind. Odds are there is a clear explanation and an easy solution.

The most likely answer is that an error has occurred. Yes, a mistake! Somewhere between the vision chart and the cash register somebody goofed-up. Let's break it down:

• Measurement errors made by the doctor leave your poor eyes over-corrected or under-corrected.


• Transcription errors are extremely common in a busy clinic. For example, accidentally putting a MINUS sign where a PLUS sign was intended. Sometimes measurements for each eye are accidentally switched.


• Tabular errors happen when data from one form (or screen) is incorrectly transferred to a different form (or screen). Your doctor's written prescription may be precise but the clerk in the optical shop copied it wrong.


• Processing errors also happen in busy workplaces. Mrs. Anita Jones' new lenses are mistakenly fitted into Mrs. Anna Jones' new frames.


• Fabrication errors can be discovered by verifying the lens correction. Opticians and lab technicians are humans, too!

Some estimates claim one-third of all prescription eyewear harbor a significant measurable error. If you suspect that your new glasses have a problem, bring them back to the local optical shop and ask the manager to remeasure the lenses and verify that the optician's numbers precisely match the eye doctor's prescription. If the optical shop says their glasses conform to the original prescription bring the new glasses back to your eye doctor. Be sure to bring all paperwork, receipts, and prescriptions. The eye doctor's staff can also remeasure the lenses and verify that the numbers on your most recent clinic chart match the doctor's prescription.

If everyone says that the glasses are exactly as prescribed then consider asking for a follow-up appointment and a repeat refraction.

Related Topics:

• Eyeglasses That Do the Job: Appropriate Lenses for Computer Work, Sports – and More
• Eyeglasses for Infants and Children

Technorati Tags: eyeglasses, eyewear, vision correction

SUPERBAD: The Superbug, not the Teen Movie

More publicity regarding MRSA, the so-called 'Superbug'. Yes, it is bad publicity.

Methicillin-resistant Staphylococcus aureus (abbreviated MRSA, pronounced Mersa) is becoming a bigger public health concern than originally predicted.

Just a few months ago I posted a WebMD blog describing how MRSA was becoming prevalent in the general population. When MRSA was first identified it thrived in hospital environments and was passed from patient-to-patient by health care workers. Nowadays contaminated wound cultures from people with no hospital exposure whatsoever are loaded with MRSA.

Ophthalmologists are now beginning to experience the MRSA epidemic. According to a recently published study in the eye journal Ophthalmology MRSA is the most frequently isolated germ in patients cultured for bacterial pink-eye. During a ten-year period in one teaching center 43% of all adult pink-eye cultures grew MRSA.

What is the impact of a 'Superbug' pink-eye? Since MRSA does not respond well to routine antibiotic eyedrops eye specialists must resort to the more expensive medicines. In time MRSA will become resistant to the newest antibiotics as well - then what will we do?

MRSA infections need to be treated according to a strategy that maximizes use of traditional antibiotics first. In other words, don't use a bazooka to kill a fly! Culture studies identify both the responsible germ (like MRSA) but also its specific sensitivity to a battery of antibiotics. Wherever possible, doctors are encouraged to treat MRSA with effective conventional antibiotics first and save the cutting-edge formulations for the most difficult strains.

2008 may be remembered as the year MRSA swept across America. As mentioned in my earlier blog post, a rigorous hand washing habit is all that's necessary to stop MRSA in its tracks. How many times have you washed your hands today? Was it more than once?

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• WebMD Video: How and When to Wash Your Hands
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Technorati Tags: MRSA, pink eye, vision, health and wellness

Do You Ask Your Doctor If Brand X is Right for You?

America is quickly approaching another anniversary. It's been nearly 10 years since drug companies have been able to market prescription medications directly to consumers. Back in the day peoples' jaws dropped when former Presidential candidate Bob Dole became the spokesperson for that revolutionary blue pill. What a stiff! (pun intended)

Nowadays you can't make it through the nightly newscast without 5 or 6 commercials for prescription medications to help you sleep, to relax your bladder, to strengthen your bones, and to reduce cholesterol.

How ironic to commemorate this "anniversary" with the disclosure that a very prominent physician who promotes a top-selling prescription drug is under increasing scrutiny for his marketing efforts. There is no need for any spoiler alert - you'll figure it out sooner or later. It could not have occurred at a better time because it typifies all that is wrong with our so-called managed health care system. I do not want to further skewer this individual but his embarrassing situation may help America launch a long-overdue debate about the future of our health care system.

The physician-pitchman was never a licensed practicing clinician yet he wore a long white coat in the ads. This physician claims the commercials are actually 'patient education messages' yet treatment options like cheaper generics are never mentioned. Some education! Disclosures regarding his generous compensation never appear in the commercial yet the physician made a fortune encouraging viewers to ask their doctor to initiate treatment.

Direct-to-consumer marketing works. One study documented that doctors obey their patients and write new prescriptions 40% of the time when requested even in the absence of legitimate indications. This takes the practice of medicine and stands it on its head. Nielsen ratings now have a greater impact on the quality of USA health care delivery than do JAMA or The New England Journal of Medicine!

A generation ago a patient described their symptoms, the doctor performed an examination with appropriate testing, and prescribed the necessary treatment based on the established diagnosis. Critics saw this approach as too paternalistic, lacking sensitivity to the patient's needs. The new paradigm appears to be: advertising, patient inquiry, new prescription. Since today's clinician only gets 6-minutes per patient this almost makes sense.

According to ABC News, New Zealand is the only other country on this planet that permits direct-to-consumer prescription drug marketing. That's interesting because NZ has a highly socialized health care system wherein doctors can only prescribe what is available on the approved formulary. Under our system there are limitations as to what (and when) new drugs are dispensed but, in general, most physicians have the necessary wherewithal to provide what their insured and self-pay patients want.

Attention policy wonks: a GAO report notes that prescription medications continue to be the fastest growing (read least controlled) segment of health care spending. Direct-to-consumer advertising is an enormous revenue engine for drug makers. Sure, they still budget plenty to persuade health care providers of product and brand superiority; that hasn't changed. What has changed is the methodology by which the experienced clinician is able to decide which medical treatment best suits the needs of the individual patient. For at least 40% of American doctors, TV commercials make that call.

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• Spending on Drug Ads Soars
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Technorati Tags: medicine, drugs, advertising, health and wellness

Mid-January Reality Check

I'll share a secret with you. Gymnasiums are crowded in early January but you'll find plenty of available workout space by mid-month.

Funny, the gym manager doesn't seem concerned.

It's something I learned from an acquaintance who operates several fitness centers.

Businesses like fitness clubs make monstrous profits in January. Hordes of well-intentioned adults are lured into joining with the prospects of improving their health as a New Year's resolution. Many are offered a significant discount (more later) if they sign-up for a full year. Another discount is added if you let your bank or credit card handle the automatic monthly payment.

At least half of new members disappear before the end of January. Discount notwithstanding, they will continue to pay for the full year. Ouch!

Fitness club owners depend on human nature to stay in business. They want 1000 people to join their 200-capacity facility because they know many will lose their resolve and quit. The remaining 200 stalwarts enjoy the modern equipment and amenities underwritten by the quitters.

Bottom line: Goals cannot be achieved unless there is suitable motivation for behaviors to change.

• Diabetics want to better control their blood sugar and protect their eyes and kidneys.


• Heart attack survivors want to reduce their cholesterol.


• Nearly 100% of all smokers say they want to quit tobacco.


• Glaucoma patients want to take their eyedrops as prescribed to lower their intraocular pressure

Don't approach health challenges as a New Year's resolution. Nothing magical happens by signing a membership contract or by picking up a prescription. Before you can commit to making positive changes you need to analyze the situation carefully:

• What am I trying to achieve?


• Why has this goal previously eluded me?


• What resources are available to help me?


• Can I afford to pay for these changes?


• What are the biggest obstacles that will hinder my progress?


• How will I keep myself motivated?


• Who can I turn to if I get myself into trouble?

If you cannot answer the above questions you're really not prepared and motivated to effect lasting change. Save your time and money until you are truly ready.

Take as much time as necessary to develop a realistic strategy that will bring healthy changes to your life. Believe me, the secret's out. If you launch an exercise plan on February 1 there will be plenty of vacant space at the fitness club!

Related Topics:

• WebMD Video: Diet and Exercise Part of Your New Year's Resolution?
• New Year's Resolutions, 1 Month Later

Technorati Tags: healthy lifestyle, resolutions, health and wellness

Cranky LASIK Survivors

I just did a little search of the Eye on Vision blog archives and came up with an interesting statistic. Among the 258 posted blogs, 25 specifically address LASIK corneal refractive surgery. That's ten percent of all blogs...who knew?!

It's funny, I did not start out intending to flood the blogosphere with so many accounts of this very common procedure. There is just so much news about LASIK developments combined with rabid consumer interest in refractive surgery.

Well, here goes #26!

What happens to that small minority of refractive surgery patients who undergo "successful, uncomplicated LASIK" but end up miserable with blurry, uncomfortable eyes?

Where do they go? Most of the time they go somewhere else!

Some experienced refractive surgeons have expanded their practices to include consultation and management of 'challenging LASIK outcomes' (read TRAINWRECKS). From a medical liability standpoint it's a pretty bulletproof niche practice since all of the bad stuff has occurred long before the unhappy patient arrives.

A new report in the Journal of Cataract & Refractive Surgery offers a rare glimpse into one of these referral clinics. Patient data over a three-year period tracks the findings and results of 157 unsatisfactory outcomes. Half of the patients were referred by an ophthalmologist who did not perform the LASIK operation; another one-in-four patients were self-referrals.

These were the patient complaints in descending order: poor vision (63%), dry eyes, redness/eye pain, and glare. Many patients had already received one or more enhancements (repeat LASIKs).

These were the experts' diagnoses in decreasing frequency: clinical dry eyes (28%), irregular astigmatism, and abnormal cell growth underneath the LASIK corneal flap.

Was anybody able to help these poor souls? 27% of the patients needed even more surgery to fix their problems. However, the remainder were successfully managed with medical treatment. Interestingly, 7% were simply told to be patient and wait for things to heal on their own.

Can we profit from others' misery? Yes, we can!

Many of the complications noted in this study trace back to preoperative conditions that were overlooked when decisions were made by the surgeon and the patient.

This detailed analysis of LASIK disasters reminds us that there is no such thing as minor eye surgery. Furthermore, not every patient is a good candidate for LASIK. It is clear that too many folks with borderline dry eyes consent to undergo surgery and quickly develop full-blown dry eyes. The same is true for folks with pre-existing eyelid inflammation and pre-existing corneal abnormalities.

#26 wraps up this way: Don't be afraid to pursue laser refractive surgery. Equally important, don't abdicate your personal responsibility to make sure that you are the best possible candidate for whatever procedure is recommended. You can prevent yourself from becoming a cranky LASIK survivor!

REFERENCE: Journal of Cataract & Refractive Surgery. January 2008; 34: 32-39.

Related Topics:

• WebMD Video: Eye Surgery 101
• WebMD Video: Eye Surgery to Improve Vision

Technorati Tags: LASIK, refractive surgery, eye surgery, vision

Can Light Bulbs Stimulate Migraine?

Have you started replacing your old incandescent lightbulbs with those expensive, energy-saving compact fluorescent lamps? They're supposed to save energy, reduce environmental carbon dioxide, and pay for themselves within a year (unless you are clumsy like me and you drop one!)

America has been relatively slow to adapt. Kinda reminds me of those telemarketing charities that pester us nightly:

Salesman: Want to buy a box of 10-year lightbulbs and support spotted owl research?

Customer: Mine are still buring bright! Why not call back in 7 or 8 years?

The British government has mandated elimination of conventional lightbulbs by 2011. Wait a minute! Critics claim health concerns related to these new lamps are being overlooked. Specifically, one advocacy group representing migraine sufferers suggests that the new eco-bulbs actually trigger migraine attacks. They are unclear regarding the proposed mechanism: erratic flickering of the bulbs, toxic (visible) wavelengths, or perhaps some combination of effects.

For decades we have known that some folks are physically uncomfortable in environments with exposed fluorescent tube lighting but controlled studies comparing the rates of acute migraine among age-matched population groups have never been performed.

The UK Migraine Action Association has plenty of anecdotal stories from migraine sufferers that link more frequent migraine headaches with use of these high-efficiency lightbulbs.

Millions of Americans have been diagnosed with migraine and a comparable number have evaded diagnosis. Three-fourths of migraine patients report specific 'triggers' that appear to stimulate new attacks. Here's how these triggers break down in decreasing frequency:

• Stress (80%)


• Hormone imbalances


• Hunger (57%)


• Fatigue


• Changes in weather


• Specific aromas/odors (44%)


• Specific foods


• Heat


• Lighting (38%)


• Exercise


• ...even Sexual activity (5%)

It makes little sense to debunk whether or not visible light emitted from a fluorescent lamp causes migraine when we know the same thing can happen to some people who smell pumpkin pie!

If traditional lightbulbs are doomed to extinction then those vulnerable to this migraine 'trigger' need an action plan to protect themselves.

Good news! Migraine researchers know that medications prescribed to prevent acute migraine attacks seem to work best on individuals with known triggers.

Regarding the known relationship between adverse visual stimuli (glare, flickering, harsh light) and migraine, recent research has shown that wearing a mild green-blue spectacle tint greatly improves fluorescent light tolerability. This could be helpful for anyone who finds it difficult to remain in any fluorescent-illuminated area. Hopefully, future advances in compact fluorescent lightbulb design will overcome the problem with flickering, slow warmups, and harsh illumination.

Once they eliminate any migraine hazard they can get to work on how to make them cheaper!

Related Topics:

• Make the Switch!
• Heading off Migraine Pain

Technorati Tags: migraine, fluorescent light, environment, health, wellness

Can 'Lazy Eye' Be Reversed in Older Children?

Have you heard the word amblyopia before?

Amblyopia, commonly called 'lazy eye', is a healthy eye with poor eyesight. The eyeball itself is not the problem, rather, the brain's receptive fields recognize a difference in the visual quality between the two eyes. In young children the brain will not tolerate this difference and so it indiscriminately disregards the visual input from the weaker side. In time the vision in the affected eye gets weaker and weaker.

How does the brain know which side is 'weaker'?

• If there is a significant refractive error in only one eye then the uncorrected eye will be blurrier...and soon amblyopic.
• If a child has congenital cataract in one eye (cloudy lens) the brain will preferentially process visual images only from the noncataractous eye.
• If one eye is crooked so that it cannot fixate on a central target the brain will also ignore its wayward images.

Quickly fix the problem (eye muscle surgery, cataract removal, spectacle correction) and the weaker eye can be rehabilitated by temporarily patching the stronger eye. For some children atropine eyedrops work as well as patching.

Here's the wrinkle: Amblyopia therapy works best when begun in early childhood. By age 5 the visual pathways are mature. By age 8 it is near impossible to reverse 'lazy eye'. Until now.

It has now been shown that for a select group of amblyopic children, those whose 'lazy eye' was due to marked astigmatism in only one eye, a favorable response to amblyopia treatment continues after age 8. The traditional deadline may not apply.

Vision researchers from the University of Arizona followed nearly 500 children between ages 5 and 13. Visual recovery after one year of patch therapy was insignificant in most older children except for those with marked astigmatism. Older children responded as well as patients half their age. This was an unexpected finding.

Here are a few cautions: Only a minority of amblyopia is attributed to marked astigmatism in only one eye. 'Lazy eye' due to crooked eyes or farsightedness did not improve in older children. Most school-age children would find it extremely difficult to tolerate daytime patching, especially among their fellow students. In the earliest stages of treatment, patching the stronger eye leaves the child with a very blurry, uncomfortable world. Treatment failures are common because the child is unwilling to comply with the rigorous patching schedule.

Now the upside: If it is now possible to reverse traditional teaching and correct this particular type of amblyopia, hope remains strong that researchers can discover new ways to help millions of other children recover useful eyesight in their 'lazy' eye.

REFERENCE: Harvey EM. Optical Treatment of Amblyopia in Astigmatic Children. Ophthalmology 2007; 114:2293-2301.

Related Topics:

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Technorati Tags: amblyopia, lazy eye, vision