Allergies are caused by chemicals called antigens that create a physiological reaction resulting in symptoms. These are usually ocular redness, tearing and most often itchiness. The best way to decrease allergic reactions is to avoid the antigen. Environmentally, this becomes quite difficult unless one stays in side all the time with the air conditioner on. The other alternative is the reduce the offending agent, interfere with the physiological reaction and treat the symptoms.

Soft contact lenses absorb matter and act as a reservoir for the antigens, slowly releasing them into the eye. Therefore, the type of lens and cleaning methods play a major role in step number one. In very bad allergies, daily disposable contact lenses work well since they are replaced with out any secondary contact with the eye.The other alternative is to wear a very good quality lens that sheds there deposits. Gas permeable lenses work the best in this regard.

Cleaning the lenses is part two. Since allergies trigger certain reactions, and most people with an allergy to one thing will frequently be allergic to other things as well, the best solution for cleaning lenses in allergic folks is a hydrogen peroxide system. Solutions such as AOSept, Oxysept and clear care are the most commonly used for this purpose.

Treatment pharmacologically is the third and most physically rewarding of these steps. In bad allergies, the first step is often with a mild topical steroid eye drop. These can be used for several days to 1-2 weeks depending on the severity of the case. This will bring relief to the patient while reducing or eliminating contact lens wear concomitally. The next step is to begin a long term therapy to maintain comfort and reduce the allergixc symptoms. This is best done with a drop like Patanol or Pataday. These drups reduce the symptoms while blocking the chemical reaction. These drops can be used for prolonged periods of time.

In short, when allergies strike, stop contact lens wear and see your eye doctor as soon as possible. Enjoy your summer!!

The answer that we are being told is that the early and frequent procedures, which was detecting issues and leading to early treatment, may have also resulted in too many and in some cases unnecessary therapies. While I can understand not wanting treatments that are not required if the alternative is deaths because of undiagnosed cancer, most people will chose the procedures.

I believe that this has been pushed not by the medical needs of the patients, but by the insurance industry wanting to reduce its’ cash outlay. By pushing screenings back 10 years it would be able to substantially cut back on office visits, testing and surgeries that they now pay for. Even self breast exams that have no downside, can lead to a greater insurance pay out and thus they want to advise against them.

My suggestion is to always advise early detection, but be more careful on the therapy end. Perhaps follow cases more closely if there is a question whether treatment is needed, but always be ready to treat when needed. The alternative seems to be throwing the baby out with the bath water. It is despicable that the very lives of our loved ones are being sacrificed for the saving of money by insurance companies. The time has come for us to think with our heads not our wallets, and start using common sense which seems to be lacking in the insurance industry and many layers of government.

These RK patients do have corneal issues 10 plus years later. Their corneas often display a brownish line in the bottom half indicating iron left behind when the endothelial pump removes fluid from the cornea. In addition, most of these patients are far sighted with astigmatism and their prescription gets stronger later in the day. This makes it difficult to have an accurate eye glass prescription. Weakness of the cornea also increases the risk of corneal rupture when exposed to trauma.

LASIK and PRK do not flatten out the entire width of the cornea thus leaving the endothelial layer intact. This does not affect the pump or the functioning of the physiology of the corneal tissue. Therefore negative corneal changes that are displayed in RK patients should not occur in the LASIK and PRK patients.

According to an article published in the November issue of the Archives of Ophthalmology, there are no long term destructive corneal effects following LASIK and PRK. The study examined 29 myopic LASIK and PRK patients 9 years after the surgery and found them to display no abnormal changes. There was a 5.3% decrease in the endothelial cell density which corresponds to a normal cell decrease in individuals that never had the refractive procedure.

While the study did not examine far sighted post operative patients, they concluded that the results would be similar to the near sighted patients. Whereas post operative RK patients displayed corneal changes after 5 years, the LASIK and PRK patients did not show any signs after 9 years. Further studies must be conducted at longer post op intervals to fully examine the long term effects, but this initial study is very encouraging.

The question then comes up as to what type of sunglasses are the best. I generally go by the rule that if a pair of sunglasses tells you how good they are, then they are not. The best pairs are those of the quality sunglass manufacturers. The good quality sunglasses are those that serve two functions. The first is to filter out all the high energy UV light of all wavelengths. This removes the catalyst that creates the ocular damage on and in the eye.

The second is providing good quality optics. The lesser expensive sunglasses usually sacrifice optical quality which decreases one’s vision and increases glare and distortion. Comparing the good and bad sunglasses is dramatic.

The better quality sunglasses permit perfectly clear, sharp vision while giving 100% protection. The least expensive of the good quality glasses are the Ray Ban collection. The two best quality and most expensive lines are Maui Jim and Oakley. Frame style frequently determines which line a patient will wear and that is fine as long as the quality of the sunglasses is good. Serengeti, Revo, Bolle and Nikes are also among the lines that are good for ocular protection.

Have a happy healthy holiday season and a happy new year. AND WEAR YOUR SUNGLASSES.

Zinc is an essential cofactor that is required in more then 300 enzymatic reactions. It is important in cellular ATP production, as well as brain and retinal growth and function. While Zinc binds to DNA aiding in gene expression, it also plays a role in cell death.

Good sources of Zinc are meats, eggs, many seafood, some peas and wheat germ. The recommended dosage (RDA) is 11 mg per day, but more may be recommended for ocular conditions such as Macular Degeneration. Larger dosages can interfere with copper bioavailability.

Unlike most nutrients, the average diet does not provide the RDA for zinc, especially with vegetarians. Zinc deficiencies are common in alcoholics, chronic kidney disease sickle cell anemia and all malabsorption patients. It is related to decreased vision, poor wound healing and an increased susceptibility to infections. In addition, poor night vision has been linked to low levels of zinc.

More then 50 mg of zinc per day are reserved for macular degeneration patients and must be closely followed by an eye doctor. Levels exceeding 300 mg will cause a decrease in the immune system, blood formation and copper deficiency anemia.

All nutritional supplements must be monitored and interactions between then regulated. The thought that if some is good, more is better does not work with anything ingested.

Research being conducted at the Universities of Washington and Florida have reached a possible cure for color blindness in squirrel monkeys. Through the use of a gene transfer technique that added a third cone pigment replacing the one missing from their retinas. Over a period of 5 weeks these monkeys had acquired full color vision. The color identification was measured using the Cambridge color tests.

This gene transfer technique adds the missing color sensitivity to the retinas that were deficient at birth. The researchers employed human DNA which means when the procedure is used on humans no changes in the clinical therapy would be needed.

This revolutionary technique is the first step in curing color blindness and may mean and end to this common condition.

Zeaxanthin is a strong antioxidant that minimizes phototoxic stress. Systemic use of Zeaxanthin helps protect against dementia, skin conditions and certain cancers. With regard to the eyes, it is present in the natural lens. Oxidative stress causes cataracts and increases the likelihood of macular degeneration. Zeaxanthin is involved along with Lutein in increasing the density of macular pigment especially in the central fovea.

Macular pigment absorbs excess light and reduces free radicals that are responsible for oxidative stress. By absorbing the light the pigment protects the outer layer of the retina from this potential damage. Thus, Zeaxanthins’ ability to increase retinal pigment directly results in a protective action that will reduce the likelihood of macular degeneration. Epidemiological studies have supported this fact demonstrating an inverse relationship between AMD and macular pigment.

Obviously, a Zeazanthin deficiency will lead to a decreased retinal pigment concentration which can lead to more oxidative stress and therefore macular degeneration. This deprivation can also result in cataractogenesis in susceptible individuals. No studies have been conducted as to the potential affects of Zeaxanthin excess, but there have been no reported reactions in patients who have taken this supplement in large quantities. It is therefore considered relatively safe.

While Zeaxanthin does not satisfy current criteria as a essential nutrient, it may be used to fulfill the need for this category.

One problem with such devices has been the patient’s ability to actually wear and use this complex instrument. They are unsightly and cumbersome to use and frequently result in lack of use. Thus the need to better deliver this optical aid became a priority within the low vision field of practitioners.

A new procedure called Osteo-odonto-keratoprosthesis was performed on a Mississippi woman to help her see after losing sight due to Stevens Johnson Syndrome. Dr Victor Perez of the Bascom Palmer Eye Institute employed an extracted tooth from the patient, shaved, sculptured and modified it to hold and optical cylinder with a telescope. This tooth/telescope unit was then implanted under the patient’s skin so it could bond and give time for the body’s immune system to get used to. It was left there for 1 month during which time the eye was prepared for its’ surgical insertion.

This unit was then implanted in the eye at the iris plain. Two weeks post op, the patient was able to read 20/70, and Dr Perez expected her vision to further improve as the swelling decreased.

This patient used her own tooth as prosthesis in her eye and may serve as a model for further such procedures. She has a gap in her smile, but can finally see again.

This practice subjects the rabbits to pain and suffering and treats them like disposable tissues. It is a terrible, heartless method that demonstrates a total lack of respect for other living creatures that feel pain and fear as much as we do. Fortunately, there is an alternative method utilizing cow and chicken corneas from dead animals. This procedure has been approved by both the US and Europe. The dead tissues are exposed to the same irritants and studies instead of the live subjects. There is NO pain and NO suffering!

According to Thomas Hartung who is director of the Center for Alternatives to Animal Testing at John’s Hopkins University, the Draize eye test should become history as this and other alternative become available. The germ killing cleaning products no longer have to be tested on live rabbit eyes to see if they are safe.

We as humans have an obligation to safeguard the safety of animals. They are at our mercy and using them for this kind of testing shows a lack of respect for other life. We must employ methods that do not put animals at risk and expose them to pain. Only lab tests should be permitted and when safety and efficacy have been determined then human volunteers can be used. Animal testing never gives us the actual response anyway, so why torture these poor living creatures.

According to the July 2nd issue of The New England Journal of Medicine, antihypertensive medications can slow the progress of diabetic retinopathy. A clinical study was performed on type 1 diabetics receiving either Cozaar 100mg 4 times per day, Vasotec 20 mg once per day or a placebo all for a period of 5 years.

The results were outstanding and demonstrated a definite link between these medications and reduction in diabetic retinopathy. The group taking Cozaar demonstrated a 70% reduction in retinopathy while the Vasotec group showed a 65% decrease in the progression of the disease. These results were compared to the placebo group that should no change in the expected retinopathy changes.

Research has shown that patients with moderate to severe diabetic retinopathy present with high levels of angiotensin conversion factor and angiotensin II in their vitreous and retina. Therefore, it makes sense that blocking these factors with anti hypertension medications would reduce the progression of diabetic retinopathy.

More studies must be conducted to determine the dosage and best medication for this therapy, but it certainly shows that there are other treatments in the future to preserve sight in the always difficult to treat diabetic patient.