Wrong Eye Surgery: Could It Happen to You?

Medical treatment can be dangerous, even fatal: errors, wrong medication, wrong dosage, surgery performed on the wrong patient or the wrong body part.

Ophthalmologists are not immune to this problem. Take a good look at the photo. Once the patient is prepped and draped the only thing the surgeon sees is the eyeball. Since the OR crew usually handles the prep and drape chores the surgeon has to trust others not to make any mistakes. Memo to all: mistakes happen!

A recent review of 106 eye surgery errors (dating back 23 years) were analyzed in the prestigious Archives of Ophthalmology. The authors wanted to know the outcomes if the so-called Universal Protocol was applied to these cases. The records were obtained from one malpractice insurer and one state health agency. The actual nationwide number of mistakes is much, much larger.

The Universal Protocol is a series of safety steps designed to prevent operative mistakes. This protocol includes consistent preoperative verification (patient and O.R. team agree which eye needs surgery), site marking to identify the surgical eye, and a mandatory time-out before making the first incision.

Those 106 cases included incorrect intraocular lens implantations, wrong-eye surgery performed, wrong-eye preoperative anesthetic block, wrong patient in the operating room (?!?), even wrong-eye corneal transplantation (duh, the eye that needed it didn't get it!)

Careful reconstruction of the details in these 106 lawyer-friendly disasters revealed that 85% of these mishaps would never have happened if the Universal Protocol was in effect at that time.

This is wonderful news so long as surgeons and hospital staff observe the rules.

If you are scheduled for surgery don't hesitate to ask if the Universal Protocol is practiced. Make sure the non-operated eye is covered with a shield before entering the operating room. Finally, make no apologies for repeatedly announcing a statement like, "Dr. Brown is operating on my left eye!" Let others think what they want, you'll be able to see their smiles afterwards.

REFERENCE: Archives of Ophthalmology Nov 2007; 1515-1522.

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• WebMD Video: High Tech IV Pump to Catch Errors
• Preventing Medical Errors

Technorati Tags: eye surgery, medical errors

Ashton Kutcher and the New Celebrity A-List

By now you may have heard that sitcom star and cougar prey Ashton Kutcher had a birthday party earlier this month. Now we learn it was a surprise party. The bartender had an active case of Hepatitis A...surprise!

Hepatitis A is a very contagious virus that infects the liver. It takes a few weeks for the infection to generate symptoms: nausea, fatigue, loss of appetite, and jaundice.

Jaundice is yellowing of the skin and eyes. Whenever the liver is sick it stops doing all the ordinary tasks assigned to it - synthesizing proteins, neutralizing toxins, and metabolizing bilirubin. Huh?

Bilirubin is a breakdown product of old, worn-out red cells. Liver enzymes convert unconjugated bilirubin to the conjugated form. From there the conjugated bilirubin is transported to the gallbladder where it aids in food digestion.

What about Ashton and Demi? Oh, I learned that Bruce (legendary good sport) was also in attendance.

Healthy people usually quickly recover from Hepatitis A. It takes a few weeks longer for the jaundice to resolve.

Folks with active Hepatitis have too much unconjugated bilirubin in circulation. It binds to connective tissues including the deeper layers of the skin as well as the moist conjunctiva, giving both eyeballs that yellowish-orange color.

Hepatitis A can be acquired from eating contaminated seafood. It is also transmitted person-to-person by direct contact, usually from the unwashed hands of infected individuals. This is a big reason why you see those 'Employees Must Wash Hands" decals on the washroom mirrors of restaurants. A very effective vaccine is available to protect you from Hepatitis A as well as a different one for Hepatitis B. We also know that prompt immunizations with Hepatitis A may prevent the disease or reduce the symptom severity.

You should consider getting both Hepatitis vaccines before your next birthday celebration.

You don't think Bruce picked the restaurant, do you?

Related Topics:

• WebMD Video: How and When to Wash Your Hands
• Hand Washing is Best MRSA Weapon

Technorati Tags: Ashton Kutcher, Hepatitis A, jaundice, liver disease, hand washing

Bigger Problems Elsewhere

Maybe it gets old after awhile.

Vision is so "special".

Vision is so "precious".

An entire WebMD member community devoted to Vision & Eye Disorders?!? Perhaps my view of things is just too...well, myopic! (pun definitely intended!)

Most folks see fine and as they read this post they are probably wrestling with bigger alligators than their dry eyes - for example, their 2007 income tax returns.

And, yes, many people see fine but are coping with other serious health problems.

But, you know what? Like it or not, it still gets back to the eyes.

Let's take a moment and talk about high blood pressure (HBP) - also known as systemic hypertension. It is a huge problem.

One-third of American adults have HBP, over 60 million.

One-third of those 60 million hypertensives don't know they have HBP and remain untreated (that's 20 million at risk).

Roughly one-third of those being treated for HBP are poorly controlled (add another 13 million at risk).

Many people are aware of the connection between uncontrolled HBP, kidney failure, heart disease and stroke. Did you know that vision loss is another major complication of HBP?

Chronic high blood pressure damages the delicate retinal blood vessels. This can cause bleeding inside the eye or (worse) complete occlusion of retinal vessels. If the retinal circulation is interrupted irreversible blindness quickly follows. Sadly, some cases of undiagnosed HBP are first identified in the eye doctor's office when the patient presents with sudden loss of vision.

See what I mean? Sooner or later it all comes back to the eyes.

Most people with HBP have no symptoms whatsoever. How long has it been since you had your blood pressure measured? Are your BP medications up to date? Save your life, save your eyesight!

Your taxes can wait. Take care of yourself first, then worry about Uncle Sam.

Related Topics:

• WebMD Video: Hypertension Equals Heath Risks
• WebMD Video: Implant Could Help High Blood Pressure
• WebMD Video: Soy for High Blood Pressure

Technorati Tags: high blood pressure, hypertension, HBP, vision, health and wellness

Is There a Doctor in the House?

I travel a lot and find myself onboard a commercial jetliner once a week or so. Since my hometown airport is not a hub, trips usually involve connecting flights. On average I experience 4 takeoffs and 4 landings per trip. Yes, I memorized the safety briefing long ago!

Get out your calculator: multiply the annual number of flights by 28 years (since graduating from medical school) and you'll arrive at a pretty substantial figure.

After all that air travel it wasn't until last week until I heard for the first time: Is there a doctor onboard?

The announcement came about twenty minutes after takeoff and I had already dozed off. Don't be jealous but I usually fall asleep the moment the jet pulls away from the gate. My wife gently poked me, "The stewardess needs you." Rising from my seat I responded, "These days they're called flight attendants".

I was directed to the rear galley (where they store the peanuts, stale crackers and darn little else). Funny, I expected to see someone laying prostrate across a row of seats or perhaps resting on the floor. A flight attendant stands alone and points to the restroom door. Yikes! Maybe I'll get to deliver a baby at 36,000 feet - start boiling some water! I opened the door and discover a middle-aged woman slumped over in a pile. How long had she been unconscious?

No history. No clues. The flight attendant alerts me to the overhead AED (Automated External Defibrillator). Since the passenger had a strong pulse and was breathing without assistance I figured we were in pretty good shape. Time to arouse the patient.

A brisk slap of the hand and she immediately came back to life, "I'm here! I'm okay! I'm okay!"

Reciting her name, the date, and the aircraft destination, the woman proved to me that she was fully oriented. We give her some oxygen and let her have some water. She made quick work of two bottles of water - those tiny, 8 ounce, cheap airline bottles.

When patients are alert and communicative a medical encounter typically begins with a good history. In an emergency the medical history is often the last step. Here's what I learned:

• The woman woke up very early to get to the airport


• Ate a quick breakfast but drank nothing


• Traveling to resolve a family crisis


• Stressed out about leaving two sick daughters at home


• Doctor changed her two seizure medications yesterday and she took them for the first time before boarding the plane

Thirsty, tired, stressed, and centrally medicated. Yep, that'll just about do it to anybody.

After a few more minutes the woman laid down on an available row of seats with plenty of blankets and pillows. I stayed with her to check her vital signs and to offer reassurance. Then I informed the pilot that we would not need to divert the flight. The grateful flight attendant offered me a free cocktail. "It's not even 8 o'clock in the morning! Could I get a cracker instead?"

That was that. It finally happened to me. I suppose the biggest lesson from this adventure was that folks ought not change medications immediately before traveling out of town. Sure, there are always extenuating circumstances, but most folks should continue their existing pill regimen until they return home.

Oh, and keep up on your fluids.

Related Topics:

• WebMD Video: AED Training
• Epilepsy: Treatment & Care

Do you have questions about epilepsy? Come visit our Epilepsy support group!

Technorati Tags: travel, emergency, epilepsy, seizure

Can Restasis Help Dry-Eye Contact Lens Wearers?

Our understanding of how the eyeball uses tears to maintain a moist, protective surface has expanded enormously over the past decade.

Dry eyes exist for a reason. Identify and treat the reason and the dryness will improve. Sounds simple enough, right?

Inadequate wetting is often caused by smoldering inflammation triggered by an underlying condition like rheumatoid arthritis, Sjogren's syndrome, or lupus. We also know that sex hormones play a critical role in tear synthesis - one reason why many menopausal/postmenopausal women experience dry eye discomfort.

Can folks with chronic dry eyes safely wear contact lenses? Years ago the answer was a flat 'No!'. More precisely, the answer was 'No, and don't ask me again!' Now it appears that some dry eye patients can tolerate contact lenses.

You may not know this but the puddle of tears that rests between the backside of the contact lens and the clear cornea serves as the actual focusing system. By itself the contact lens has very little focusing power. The contour of the contact lens shapes the tear puddle to create the desired refractive correction.

Not too long ago I wrote about how the mere presence of the contact lens numbs the corneal nerves. This phenomenon is also a big reason why some contact lens wearers experience dry eyes for the first time.

With any new dry eye patient it is essential that a complete dry eye evaluation be performed to exclude contributory (...and treatable) medical conditions. The specific type of contact lens will also need to be considered. Some brands of contact lenses behave like sponges, absorbing what little moisture remains on the ocular surface, whereas other brands are less thirsty.

Frequent use of preservative-free tear supplements is the mainstay of dry eye therapy. Topical cyclosporine (sold as the prescription eyedrop Restasis) quiets the smoldering inflammation mentioned above and allows the lacrimal glands to produce more abundant tears. Intuitively this sounds like a good solution for contact lens wearers. Sadly, recently published research cautions that Restasis offers no measurable improvement for contact lens wearers compared to only using artificial tears. Why pay more for a prescription eyedrop when an OTC remedy works just as well?

Remember, even if your doctor gives you permission to wear contact lenses, dry eye patients need to frequently apply their tear supplements and immediately remove the contact lens if there is any redness or discomfort.

REFERENCE: Eye & Contact Lens: Science & Clinical Practice, Jan 2008, pages 43-45.

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• WebMD Video: Comfortable Contact Lenses
• WebMD Video: Tips for Better Vision

Technorati Tags: dry eye, Restasis, eye drops, vision

TV That Narrates Action for Visually Impaired

Ever stumble across the 'SAP' setting on your television? It is available on most TVs and video recorders manufactured since the early 1990s. The initials stand for 'Secondary Audio Program.'

Most of the time SAP carries simultaneous Spanish language translation of the original broadcast. No, not scripted subtitles, actual voices.

Since more and more Spanish language programming is now available - even HBO has a Spanish language channel - SAP is available for other uses. One such application is called Audio Description and it is very cool.

Audio Description involves the accessibility of the visual images of television for people who are blind, have low vision, or who are otherwise visually impaired. It is a narration service (provided at no additional charge to the viewer) that attempts to describe what the sighted person takes for granted - images that a person who is blind or visually impaired previously could only experience through the whispered asides from a sighted companion.

Viewers still hear the original program's sounds like voices and music. Audio Description is commentary and narration which guides the listener through the presentation with concise, objective descriptions of new scenes, settings, costumes, body language, and "sight gags," all slipped in between portions of dialogue or songs.

"Now Michael is hitting Dwight over the head with a large box of marshmallows!"

You'd be surprised at the large number of people unable to clearly watch their television. Many keep it on merely for company but they do not recognize what is on screen.

Audio Description technology is already in use by selected broadcasters. Lifetime Television and all four broadcast networks offer it for selected programs.

Click here to learn more about locating Audio Description programming.

Beware, SAP does not run on digital HD channels so don't throw away all of your older TV sets!

I'd be eager to learn if any readers have already tried the Audio Description service and their impressions about the experience. For example, did it help to be told that Michael struck Dwight on the head?

Related Topics:

• Coping with Vision Loss
• Adapting to Reduced Vision

Technorati Tags: TV, SAP, Audio Description, vision impaired

Half Man, Half Tree - All Curiosity

Curiosity. That's why carnival sideshows attract people. They hook you with something so bizarre, so unbelievable that you cannot walk away. Good news, we're not talking about two-headed goats; rather a medical curiosity involving a very common condition complicated by very rare genes.

This is Dede, a 35 year-old fisherman living in remote Indonesia.

Besides the numerous large plaques on his skin Dede 's extremities have developed large, claw-like growths. It kinda reminds me of the Wolverine character from the fictional X-Men.

An American TV production company arranged for Dede to receive on site consultation from Dr. Anthony Gaspari, an expert dermatologist from the University of Maryland School of Medicine (pictured alongside Dede).

After an examination and some lab studies Dr. Gaspari confirmed that Dede has an unusual (and untreated) case of runaway warts. Yes, warts!

Here's what happened. Like all of us, at some point earlier in life Dede came in contact with human papilloma virus (HPV), the ubiquitous virus responsible for the common skin wart (official terminology verruca vulgaris). Most of the time folks get one wart at a time, right? Dede, however, is different than most other people. Because of a serious genetic defect Dede's immune system was unable to defend his skin from the proliferating virus and so it showered his complete body with those large, ugly bumps.

Leave a wart alone long enough and the infected skin cells start making keratin, the same material that makes your fingernails rigid. We call these growths 'cutaneous horns'. In time they become large, curly appendages. Years of neglect resulted in the hideous appearance of Dede's extremities. As you can imagine, the worse the growths got, the more society rejected him, leaving him with a lonely life and the option to work in a circus side show.

Liquid nitrogen won't help much here. This is going to need a world-class manicure and pedicure! Dr. Gaspari is optimistic that high doses of Vitamin A will fire-up Dede's skin so it will eventually shed the horns and allow the skin to rid itself of HPV. Additional surgery can help Dede regain use of his hands and feet. Things should be much improved in about a year.

As an ophthalmologist I would caution Dede to be very careful whenever taking lots of Vitamin A because it can be toxic to the retina. Periodic blood measurements and color vision testing are good ways to monitor for any toxicity. Certain strains of HPV can provoke sun-induced skin changes that can transform into malignant squamous carcinoma. Given his tropical locale Dede ought to be applying lots of sunblock throughout the day.

I'll be eager to see how Dede responds to treatment. Audiences love extreme makeovers. Hopefully the TV crew will return to Dede's village to capture his recovery and return to his society.

Related Topics:

• Treating Common Warts
• Preventing Eye Problems

Technorati Tags: HPV, Vitamin A, warts, genetics, Dede, vision

Photo courtesy of Discovery Channel and Dr. Gaspari. Used with permission