Newest Glaucoma Surgery

As the U.S. population ages we are seeing more and more cases of Glaucoma, damage to the optic nerve usually associated with high pressure inside the eye. In America the treatment strategy usually involves eyedrops and lasers with surgeries reserved for the most advanced cases. This is not the case in the United Kingdom where surgery is most frequently used if a single eyedrop is not effective enough to control the eye pressure. The surgery most often used in both the U.S. and the U.K. is a trabeculectomy, but newer surgeries now available will probably be used instead of the trabeculectomy. Glaucoma is very likely to become a surgical rather than a medical disease.

The company Glaukos very recently had approval granted for a unique and exciting glaucoma implant called the micro-bypass iStent. This tiny instrument is inserted into the eye's natural drainage system called the trabecular meshwork. It functions as an enhanced drain to decrease eye pressure. Usually inserted along with cataract surgery, it can also be used in stand-alone glaucoma surgery.

The studies that were used to prove that the iStent is effective have shown that a single shunt will decrease pressure to the point where pressure is very often controlled with one or no eyedrops! In addition, two or more iSent devices can be implanted at the same time to give a greater decrease in eye pressure. You don't have to use them during cataract surgery; the iStent can be implanted in a stand-alone procedure for Glaucoma only.

Research into new medicines and surgeries for Glaucoma continues. At SkyVision Centers we pledge to remain on the front line in fighting this disease.

Glaucoma 201: Side Vision Loss

Why is Glaucoma such a devastating disease? Well, two reasons. The first, of course, is that it robs you of your vision. The second is that this "thief" steals your vision slowly and painlessly, and you may not even know you have glaucoma until it's too late!

Your peripheral, or side vision is the first part of your vision to be lost in glaucoma. This is one of the reasons it's so hard to know that you have the disease, because your central vision, the vision you read and drive with, is preserved until very late in the disease.

We measure your side vision with a test called a "Visual Field" or Perimetry test. Modern testing is computerized. You place your chin on a chin rest and look into a dim, white bowl. When you see a light come into view you press a button. The readout looks like this: 

   

In the early stages you might only lose a very small portion of your vision.

In very late stages much of your side vision is gone; it can be like looking through a tunnel.

Don't let glaucoma steal your vision!                  

Glaucoma 101

Glaucoma is one of the "silent blindness" disease of older folks all over the world. Most glaucoma has no symptoms at all, no warning that there is a problem. The only way to know that you have glaucoma is to have a complete eye examination performed by an eye doctor. Even then addtional testing might be necessary.

Glaucoma is damage to the optic nerve, the nerve that carries "light" from the eye to the brain. It usually comes with high eye pressure, but not always. There are lots of people who have glaucoma who have eye pressure that seems normal, and there are even more people who have high pressure who will never get glaucoma. The "normal" pressure in the eye is 11-21. Most people who get glaucoma are older, usually older than 60.

There are several ways to measure pressure in the eye. The two most common methods are Non-Contact Tonometry--the air puff-- and Contact Tonometry--the blue light. The "blue light" technique is much more accurate and is necessary to treat glaucoma. The "air puff" is a great screening test for glaucoma because it's easy to do, and easy to have done.

There's lots to talk about with Glaucoma so we'll try to teach you as much as we can here on the Skyvision Blog. All of our Doctors, Dr. White, Dr. Kaye, and Dr. Schlegel have lots of experience in treating people with glaucoma here in Cleveland. Stay tuned!

Cataract Rates Rising In U.S.

Here's some more information for you during Cataract Awareness Month. It appears that the rate of cataract diagnosis has risen ~19% in the U.S. since the year 2000. Remember our post from the other day about cataracts? Everyone who lives long enough will develop a cataract! At least 50% of those people who develop cataracts will go on to have surgery, and it's probably also true that if you live long enough you will need your cataract out!

There are some risk factors for cataract growth, especially for early onset of cataracts. Family history is important as is your medical history. Diabetes is a very strong risk factor for the development of cataracts. Exposure to ultraviolet light can also increase not only your risk for developing a cataract, but also the speed with which that cataract may get worse.

Thankfully, cataract surgery is one of the most frequently performed, successful, and safest surgery in the United States. Not only is it possible to improve your vision once the cataract has caused it to decrease, but there are also implant options that you can choose that will reduce your need to wear glasses after your cataract surgery like the Crystalens from Bausch & Lomb.

Here's the link for the recent story with info from the AAO. Give us a call at SkyVision Centers if you have any questions about cataracts!

Plaquenil and Retinal Toxicity

There are many medicines that have side effects that can affect the eye. Most of them are minor and little more than a bit of an inconvenience. Some of them can cause vision loss, and for those it is sometimes necessary to visit an eye doctor to rule out and problems.

One of these medicines is Plaquenil, also known by its chemical name hydroxychloroquine. Plaquenil is a medicine which was developed from chloroquine, one of the original medicines used to treat malaria. Doctors discovered that a beneficial side effect of these medicines was a decrease in joint inflammation and pain in people who suffer from rheumatoid arthritis and other inflammatory diseases. Unfortunately there is also a risk for toxic side effects from these medicines. In the 1960's ophthalmic reseachers at NYU (Dr. White's alma mater) demonstrated that chloroquine has an irreversible toxicity that causes blindness once you take a certain amount.

Thankfully, the development of hydroxychloroquine or Plaquenil has allowed people to obtain the pain relief with a much lower incidence of toxicity, and the toxic effects can be stopped and often reversed if the medicine is no longer taken. Approximately 8 patients out of every 1000 are diagnoses with toxicity each year. In order to prevent this some screening guidelines have been developed which were recently updated.

If you take Plaquenil you should see an eye doctor trained to rule out toxicity. 200 mg (1 pill) each day means an annual exam, and 400 mg (2 pills) each day requires a follow-up exam every 6 months. At least once each year a central visual field (VF) should be performed. The most recent recommendations say that an OCT should be done as well. We expect that additional testing will be requested as more information about this medicine continues to become available. Check back here for periodic  updates.

August Is Cataract Awareness Month!

Did you know that August is Cataract Awareness Month?! Just what is a cataract anyway? A cataract is a clouding of the natural, crystalline lens inside the eye. The lens sits just in back of our pupil in front of the retina. It helps to focus light on the retina, and helps us to change our focus when we look at things up close.

Everyone who lives long enough will get a cataract! Some people get them much younger than other people, and the amount of trouble the cataract causes you and your vision is what determines when you need to have surgery. The only way to treat a cataract is to remove it surgically. As of this time in history there isn't any way to really prevent a cataract from ever growing in your eye. It seems as if the only way to slow cataract growth is to protect your eyes from UV light when you are young, and to not smoke.

Our cataract surgeon is Dr. Darrell White. Dr. White is one of the most experienced cataract surgeons in all or Northeast Ohio. Our Advanced Lifestyle Lens Implant program is the leader in the use of lens implants to reduce your need to wear glasses after having your cataracts out. In face, Dr. White was the first surgeon in Ohio to implant the Crystalens, the first of the new wave of implants designed to correct not only distance vision, but also reading vision, without wearing glasses!

Once your cataract is removed it will never come back! Cataracts are a very treatable cause of decreased vision as we get older. If you or a family member have been told that you have a cataract, it's a very treatable problem with very good results! Here in Northeast Ohio we are blessed to have many very fine cataract surgeons, including our own Dr. White!

Eye Doc Education 3.0!

This evening the doctors of SkyVision Centers will be hosting their 3rd educational seminar for local eye doctors. The first two seminars were rousing successes and we expect nothing less tonight. Each session has included two talks by either our very own SkyVision docs or invited guests. The topics covered have included the new Tear Osmolarity technology and Cataract Implants for Astigmatism among others. In addition, the two meetings have included very interesting dinner fare!

Attendees at 1.0 were treated to an Italian feast with accompanying Italian wines, while 2.0 featured artisinal pizza and Brew Kettle beer brewed especially for the meeting!

Tonight the speakers will be Dr. Darrell White and Dr. Scott Schlegel. Dr. White will introduce the concept of "service lines" in the development of protocols to diagnose, treat, and follow specific diseases in "Glaucoma Protocol Development I". Dr. Schlegel will be tackling the subject of introducing a patient with cataracts to the choices they will face when then are trying to decide what type of Intra-Ocular lens to use for their surgery.

What about dinner? Well, tonight we will be serving Mexican! Their will be a fajita bar with all of the fixin's, traditional Mexican cookies, and of course something interesting to wash it all down! We are all looking forward to seeing our friends in the eye care community as we gather to improve our collective understanding of how best to treat our patients.

Woman Arrested For Poisoning With Eyedrops!*

A 33-year-old Pennsylvania woman could spend the rest of her life in prison after admitting to police that she repeatedly poisoned her boyfriend with Visine eye drops for more than three years in a bid for his attention.


Vickie Jo Mills of Ayr Township, Pa., was arrested Thursday and charged with 10 counts of aggravated assault, 10 counts of simple assault and 10 counts of reckless endangerment after she told authorities she slipped Visine eye drops into the drinking water of her boyfriend, 45-year-old Thurman Edgar Nesbitt III.

Mills, who has a child with Nesbitt, told Pennsylvania State Police she put Visine drops, medicinally used to "get the red out" of eyes, into his drinking water 10 to 12 times since June 2009.

Nesbitt had been sick for years with symptoms such as nausea, vomiting and blood pressure and breathing problems, according to police. His doctor, Dr. Harry Johnston, alerted authorities in after detecting traces of tetrahydrozoline, a chemical found in eye drops, in Nesbitt's blood tests.

A follow up test at the police station showed Nesbitt had 49 nanograms per milliliter of tetrahydrozoline in his system, categorized by medical experts as "an extremely high level, according to the Record Herald newspaper.

Mills, according to an affidavit, "never meant to kill him [Nesbitt], only wanted him to pay more attention to her."

Mills is currently free on $75,000 bail. She appeared in Fulton County Court on Monday but was granted a continuance request made by her defense team. She will next appear in court on Sept. 17.

The 30 charges filed against her carry a maximum combined sentence of 240 years in jail and more than $300,000 in fines, according to the judge in the case, Magisterial District Judge Wendy Mellott.


*From Yahoo news.

High Tech Dry Eye Care

Dry Eye Syndrome is the cause of more visits to the eye doctor than anything except routine vision exams. People with dry eye may have symptoms like burning, redness and blurring, to feeling like there’s something in their eye. They can even have tearing caused by dryness! Dry Eye Syndrome is so common that it is the most frequently searched eye problem on the Internet—10 times more common than LASIK!

Tear Osmolarity is the measurement of the saltiness of your tears. This test is an important measurement of the health of your tears and your eye lubrication. Tears are a complex combination of salt water, mucin, and special oil called mebum. All three of these elements are mixed, kind of like Italian salad dressing, and they form the tears that coat the surface of our eyes every minute of every day.

The measurement of your tear osmolarity is a rather new test. It's fully FDA approved. When your tear saltiness is high this is an indication that your tears are not normal. At Skyvision Centers we use the most modern instrument available, made by the TearLab Corporation, to do your test.

Why is this an important measurement? The most common cause of Dry Eye is a problem in the production of the saltwater part of your tears. This will give you a HIGH Tear Osmolarity. You can learn more about Dry Eye and Tear Osmolarity at Skyvision Centers, Northeast Ohio’s leading Dry Eye Center.   

Eyedrops For Cataract Surgery

Dr. White is our cataract surgeon at Skyvision Centers. He is one of the most experienced cataract surgeons in Cleveland, and indeed in all of the Midwest. He, along with Drs. Schlegel and Kaye, form our cataract team of doctors. They choose which eyedrops are the best available for use before and after cataract surgery. In addition the doctors have chosen a group of medicines that are easier to take (you only need to use the drops twice per day), and eyedrops that are comfortable so you don't avoid using them!

There are typically three types of eyedrops used around the time of your cataract surgery. An antibiotic is prescribed which is to be used starting 5 days BEFORE cataract surgery. The antibiotic typically is continued for a week after the surgery. The doctors have chosen an antibiotic drop from the strongest class of atibiotics now in existence in order to prevent infections. There are three choices in this class of medicines, two of which can be used twice per day.

A non-steroidal anti-inflammatory drop (NSAID), kind of like Motrin in a drop form, is also prescribed to start 5 days prior to the surgery. This medicine is then continued for 4 weeks after the surgery. It is used to prevent a type of swelling in the back of the eye. The doctors have chosen a medicine that is easy to take (twice per day), doesn't hurt when you put it in, and doesn't have any dangerous side effects. There are NO TRUE GENERIC EQUIVALENTS for this medicine. The generic medicines on the market must be used 4 times per day. They can be very uncomfortable; most people complain bitterly that they sting. Most importantly, the generic option has a 30% complication rate. That's right, 3 out of 10 people have swelling and inflammation in their cornea caused by this drop and this causes pain and a big drop in vision.

Finally, a steroid eyedrop is prescribed to be used after the surgery, beginning on the 1st day after the surgery. This drop treats the normal post-op inflammation in the eye. Like the other eyedrops it is used twice per day, and you continue to use it for 4 weeks after the surgery. There are NO TRUE GENERIC EQUIVALENTS for this medicine. The generic medicines must all be used at least 4 times per day and they are not as strong or as effective.

We understand that medicines can be expensive, especially when an important medicine is not fully covered by your health insurance. But we are talking about YOUR EYES and eye surgery. Your Skyvision doctors have chosen what they feel are the best medicines possible to do every thing possible for you to have a great surgical result.

What could be more important?!

Good News On Omega-3 Fatty Acid Supplements

Do you take an Omega-3 Fatty Acid supplement like fish oil or flaxseed oil? If not are you thinking about taking one? Our doctors at SkyVision Centers keep coming up with more and more reasons you should!

Omega-3 Fatty Acids are building blocks for the oil secretion from the Meibomian glands in your eyelids. This oil is what stabilizes the front of your tear film and keeps your tears from evaporating before your next blink. We've lost count on the number of articles in the eye literature that have shown this. Whether you have Dry Eye or not, taking a supplement will improve the quality of your tears in most cases.

The Nurses Health Study which has followed thousands of nurses for decades published a very telling study on Omega-3 Fatty Acid content in diets and vision loss from Macular Degeneration. In short, those nurses who had the highest weekly intake of Omega-3 Fatty Acid in the DHA and EPA forms (see below) had a 1/3 lower incidence of lost vision.

Data continues to accumulate on the benefits of taking an Omega-3 Fatty Acid supplement as a way to decrease your risk of heart disease. This is especially true in men who have other cardiac risk factors. Once again, Fish Oil high in DHA and EPA has an anti-inflammatory effect that seems to work against the type of inflammation that attacks the coronary arteries. This is the same anti-inflammatory effect in your muscles and joints that CrossFitters have found, which is why using Fish Oil is a very common standard in the CrossFit community of athletes.

So what kind of Omega-3 supplement should you take. Dr. White likes to tell his patients that women can take either Fish Oil or Flaxseed Oil, but that men probably should NOT take Flaxseed Oil because of a potential danger to the prostate gland. Flaxseed Oil comes in 1000mg capsules and the best results come from taking 2 or 3 each day.

Fish Oil in capsule form (de-odorized to prevent "fish burps"!) is a little more complex. There are all kinds of levels of quality. You should look for ultra-filtered (to remove mercury), and you want to have the Omega-3 in the DHA/EPA (triglyceride) form. Look on the ingredients and buy the supplement that has the highest percentage of Omega-3 in the DHA/EPA form. Our Doctor's Advantage Omega Shield supplement (that Dr. White takes) has ALL 1200mg in the DHA/EPA form. In general, 1200mg pills have a higher concentration than 1000mg pills, and once again you should try to take 2 or 3 each day if you can.

Cataract Surgery and Falls

You will often hear a SkyVision Centers doctor talk about the benefits of having both eyes treated surgically to remove cataracts when they have each reached a point where removing them would be considered medically necessary. Many years ago a young researcher from Dr. White's training program, Jonathan Javitt, did landmark research that showed a clear safety benefit and improved health measures in older women who had their second eye surgery done compared with those who only had one cataract removed. It turns out that people really DO see better when both of their eyes have the best possible vision.

A new, equally important study has just been published in the Journal of the American Medical Society that shows a decrease in the frequency that older individuals have hip fractures if they have had cataract surgery. This makes a lot of sense if you think about it: our most important sensory cues about balance come from our eyes. If we do not see well we then become more sensitive to other problems with balance like poor circulation to the balance centers of the brain, or aging changes in the inner ear.

This large retrospective review evaluated the incidence of hip fractures within a year of cataract surgery in a random sample of Medicare beneficiaries age 65 and older diagnosed with a cataract from 2002 to 2009. Overall, those who had cataracts removed had 16 percent fewer hip fractures than those who declined surgery. Older patients (aged 80 to 84) and those with significant comorbidities (other diseases) experienced the most significant benefit, with 28 percent fewer hip fractures compared to equally sick patients who did not have surgery. And those who had severe cataracts removed had 23 percent fewer hip fractures than those with severe cataracts who declined surgery.