Tiny Chip Accelerated Huge Advances in Eye Care

Did you hear about last week's big anniversary? Maybe not, but most geeks were partying!

The very first working integrated circuit was introduced 50 years ago. That means the so-called Digital Age is now half a century old.

Integrated circuits (microchips) gradually replaced traditional vacuum tubes and discrete electrical components. This innovation reduced the size, reduced the weight and greatly imporoved the overall functionality of nearly everything electrical in our lives. Beyond a simple on/off switch, integrated circuits allowed devices with semiconductors to store data and display information to the user.

Yes, the personal computer was one important outgrowth of the digital revolution. Back in college we had to feed punch cards into huge (room sized) computers in order to develop simple computer programs. Ugh, how primitive! Today's laptops reliably store more data and process it much faster than any of the giant central computers.

If you walk around your house you will locate ICs in your TV, telephone, DVD player, Gameboy, home security system, as well as your electric toothbrush and digital alarm clock.

Eye specialists are especially appreciative for semiconductor technology. Most of the phenomenal imaging equipment in the eye clinic relies on ICs. Sophisticated tests can be quickly performed and instantly compared to previous exams. Many clinics are going 100% paperless thanks to electronic medical recordkeeping.

Laser therapy for retinal disorders would not exist without ICs, nor would LASIK. Enough said.

Heard about the miraculous 'artificial retina' microchip coming down the road? Yep, it's a tiny IC implanted into the eye!

Want more proof? When I began performing my earliest cataract operations we relied on gravity and suction to perform intraocular surgery. Need more fluid pressure? Simply raise the bag of irrigating solution! Today the eye surgeon benefits with sophisticated instrumentation that is precisely controlled by ICs. Nowadays the confident surgeon controls the equipment with delicate foot pedals or a voice-activated sensor. Integrated circuits can rightfully take ample credit for the tremendous improvement in surgical outcomes over the past generation.

The development of integrated circuits has truly revolutionized our world. In 1990 Jack Kilby of Texas Instruments received the Nobel Prize for his invention. According to the President of the Semiconductor Industry Association, "The integrated circuit has proved to be the single most important driver of increased productivity and economic growth in history."

And remember, this all happened in the past 50 years. 2058 is just around the corner!

Related Topics:

• WebMD Video: An Implantable Retina
• WebMD Video: Technologies to Improve Quality of Life

What Should You Expect After Eye Surgery?

Many individuals are understandably anxious during the days leading up to an eye operation, especially if it is a first time thing. Fortunately, most folks sail through their procedure and are back home before they know it.

But for many that's just when the real anxiety sets in.

"My eye looks somewhat red. Is there a problem?"

"I'm not seeing as clearly as I had expected. Is there a problem?"

"My eye sure feels a bit scratchy. Is there a problem?"

Compared to past decades, surgeons today spend more time engaged in preoperative consultation and that's a good thing. Nobody should consent to undergo any kind of procedure until they fully understand the proposed benefits, the potential for complications, and the availability of effective alternatives.

Nowadays more often it's the postoperative counseling that gets short shrift.

(Etymological digression about the phrase 'short shrift': A shrift is a penance imposed by a priest in confession to forgive past sins, often when the confessor was near to death. In the 17th century, criminals were sent to the scaffold immediately after sentencing and only had time for a 'short shrift' before being hanged. Who knew?)

Many patients head home from surgery with inadequate guidance. There are several explanations for this oversight:

• Busy surgeons are eager to move on to their next scheduled patient because O.R. time is extremely precious.


• Many patients receive a preoperative sedative to relax them during surgery. That sedative often renders them incapable of remembering anything. We call this anterograde amnesia.


• Many clinics bundle preoperative and postoperative counseling for the sake of administrative efficiency - only to leave the patient totally overwhelmed with instructions and a handful of handout materials.

And so, patients are prone to worry about anything that seems out-of-the-ordinary following an eye operation. Who can blame them?

Scratchy eye: Is it a temporary bout of postoperative dry eye or has a suture come loose?

Eye pain: Is it normal healing or an early warning sign for infection?

Bloodshot: Did this hemorrhage result from surgery or is something amiss?

Nobody wants surprises, especially after an eye operation. If you or a loved one is anticipating eye surgery make sure you clearly understand what to expect after the procedure. What are the most commonly encountered postoperative symptoms and how should they be managed? Inquire about what to do if a problem is suspected. In other words, when should the doctor be called?

Finally, and this is really important, make sure you have accurate phone numbers that will give you emergency access to your doctor during off-hours.

Related Topics:

• Activity After Eye Surgery
• Precautions to Take After Laser Eye Surgery

Why Some Glaucoma Patients Are Miserable

Glaucoma patients have a lot on their minds.

First, they are coping with the potential for irreversible vision loss.

Next, they often have to take pressure-lowering eyedrops several times a day. This can become a complicated routine, especially for older adults.

Of course, these folks have to find a way to pay for their medications.

Besides that, many glaucoma patients experience chronic eye discomfort. New research implicates a preservative in the eyedrops as the culprit.

Benzalkonium chloride (BAK) has been used for decades to keep eyedrop medications sterile. Most bottles of eyedrops are intended to be used for a month or more. These bottles are stored in pockets and purses, atop desks and bathroom sinks. They are opened and handled by humans several times a day and, guess what, humans are inadvertently unsanitary at times. BAK keeps the medication safe and germ-free.

Good protection, however, comes at a price.

Glaucoma researchers writing in the August 2008 issue of Journal of Glaucoma identify BAK as a leading contributor to ocular surface abnormalities. By ocular surface we mean the multilayered tear film that coats the eyeball: a water layer, a mucus layer, and an outer oily layer that prevents tear evaporation. If you have a unbalanced tear film your eyes will feel bad and look bad.

The doctors studied 109 adults taking anti-glaucoma eyedrops. Each patient completed an Ocular Surface Disease Index questionnaire and underwent evaluation by Schirmer test, corneal and conjunctival lissamine green staining, and tear break-up time. It turns out that 65% of subjects had tear film abnormalities and prescription eyedrops with BAK twice as often generated chronic eye discomfort.

The researchers concluded that a large proportion of patients with open-angle glaucoma or ocular hypertension had signs and/or symptoms of ocular surface disease in at least 1 eye. The coexistence of ocular surface disease and the use of BAK-containing medications may impact vision-related quality of life in this patient population.

Bottom line: If you take eyedrops for glaucoma and your eyes feel irritated or look irritated ask your doctor if your eyedrops contain BAK and if an alternative BAK-free eyedrop can be substituted.

REFERENCE: Journal of Glaucoma, August 2008, pages: 350-355

Related Topics:

• WebMD Video: Living with Glaucoma
• WebMD Video: Tailoring Glaucoma Treatment to Patient Lifestyle

LASIK: Visible Proof

A recent visitor to our WebMD Vision & Eye Disorders message board asked a very interesting question:

4 years after uncomplicated LASIK can an examiner tell whether or not an eye has had previous LASIK?

That's a very interesting question and it immediately prompts me to think:

Why would you want to know?

First things first, since LASIK surgery includes creation of a superficial flap of corneal tissue the edges of the flap are usually visible for years afterwards. Sometimes the edges heal extremely well, making it nearly imperceptible, but a careful magnified examination using the slit lamp biomicroscope will expose the flap incision.

Besides the flap edges there are other visible clues to alert the examiner to the presence of earlier LASIK. Clumps of migrating surface cells and grey-white patches of scar tissue can accumulate underneath the flap. These features jump out right away.

Now, about my question. Who would want to know if somebody had undergone previous LASIK?

Many careers require excellent eyesight without refractive correction. It goes beyond aviators. Many law enforcement jobs, security jobs, and other occupations demand crystal clear vision. Folks eager to qualify for a dream job will do what they feel is necessary to get hired. Such enthusiasm is honorable but it can backfire. Perfect LASIK may still leave you needing spectacles for residual error. Moreover, refractive surgery may affect your near vision and force you to obtain (disqualifying) reading eyeglasses. Finally, some employers exclude candidates with a history of prior eye surgery.

Here's some good advice. Invest wisely and make sure you fully understand all of the hiring criteria before paying for expensive refractive surgery.

Related Topics:

• Your Guide to LASIK
• Vision Tests for Your Next Checkup