Conductive Keratoplasty is a procedure whereby radio waves are introduced into the peripheral cornea in an attempt to steepen the corneal curve. This will increase the power of the cornea effectively making that eye nearsighted. In doing so, the eye will be able to read things up close more easily. This is accomplished because the radio waves emit energy that is absorbed by the surrounding tissue. The protein in the tissue then contracts pulling the surrounding areas inward. When done in a specific, calculated fashion the cornea changes shape to get the desired result.

This procedure is performed on individuals that see well in the distance, but do not want to wear reading glasses. When one eye sees near and the other distance, that is called Monovision. It used to be done a lot with contact lenses until multifocal contacts took over as a better alternative. The problem with employing mono vision is that one eye is always blurry. If looking far then the near eye is out of focus, and the opposite applies when reading up close. This new visual environment takes time to get used to, and some folks never adjust to it. The success rate depends on what your visual demand is, and what one’s personality is. For example, I am way to neurotic to get used to it. A smudge on my reading glasses upsets me. I would be a terrible candidate for this surgery. On the other hand my business partner is always happy with everything, and would therefore be a great candidate. That is how he has gotten along with me for 14 years! So the first thing one needs to determine is what the expectations are and how you as a person deals with change.

The next consideration is what the uncorrected distance vision is. The best candidate is one who has no distance prescription at all. I have found that the 2 biggest factors that determine success with this procedure is
1) realistic expectation
2) good distance uncorrected vision.

The first seems silly, but actually is the most important. If one expects to be perfect all the time with out any sacrifice then they should not have the surgery. The fact is that there will be poor binocular vision and thus bad depth perception. The will affect the tennis and golf game as well as judging distance when driving. Glare will also result when driving at night. I have had patients that were happy as clams despite less then perfect vision and the side effects that I mentioned because they expected as much. Others saw great and had very few side effects,but complained bitterly since they wanted perfection.

Distance vision plays a big role in success. If the non operative eye is farsighted the success rate goes down significantly. That eye will see blurrier after surgery, and will try to focus which will make the distance vision even worse. This accommodation with make the near vision worse since eyes focus together and will move the focal point in closer then the person wants to read. Therefore, only those individuals that have NO distance prescription at all should have CK.

I am fortunate to work with some of the best eye surgeons in the US and all these factors are carefully evaluated prior to making a decision. As they say,” go into surgery with both eyes open.”

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Beauty is in the eye of the beholder, or so we are told. Unfortunately, the eye of the beholder may have had Botox injections which resulted in very negative results affecting the eyes.

Botulism toxin is a toxic chemical that is produced by a Bacteria. Its purpose is to paralyze the prey thus making it easier to attack, kill and eat it. Before long man in his infinite wisdom came to understand this fact and successfully refined this substance. Early uses included paralyzing ones enemy making it easier to kill him. Poisoning has been a favorite method of treating foes over time and as technology has improved so has Botulism toxin. Medicine has long used herbs and various chemicals to treat disorders and more recently for cosmetic purposes.

The first ocular use for Botulism toxin was to temporarily cure Blepharospasms. These are when the eye lid muscles spasm to the point that the eyes are either constantly blinking or closed due to muscular contractions. The lid injection of the toxin paralyzes the muscles reducing or eliminating the spasms. It lasted approximately 4-6 months at which time another injection was required. In the hands of a highly trained doctor the results are excellent.

The 90′s brought the age of cosmetic surgery and procedures to the forefront. If Botulism toxin stops eye lid spasms why not wrinkles as well. Thus began the ” age of Botox!” The name had to be changed since no normal person would agree to have ” Botulism TOXIN” injected into their face, so BOTOX was born. Essentially it is the same chemical compound that is injected into the facial tissue with the purpose of paralyzing the surrounding area. By relaxing the tissue, wrinkles flatten out and a youthful appearance can be restored. For the most part it is very effective. Unfortunately, where there is money to be made many people perform procedures that they are not well trained in and bad things happen.

When Botox is done by a physician who is familiar with the physiology of the area that is being worked on extra care can be employed to avoid muscle and nerve tissue that may have negative results. For example, if an injection is given too close to the eye itself extra ocular muscles may be affected resulting in eye movement paralysis. This will result in an inability to move the eyes and will cause double vision. In addition, if the injection site is near the eye lids Ptosis or lid droop will result causing one or both eye lids to stay closed all the time. It may also precipitate the lower lid to droop pulling away from the eye. This will permit tears to flow out of the eye and the eyes will be constantly red and very dry. An injection near the Lacrimal Gland will paralyze the tear making gland and extreme dry eyes will result. The good news is that it will wear off in about 6 months. The bad news is that it will wear off in about 6 months. Thus, frequently adjunct medical treatment must be administered to prevent damage to the eye and increase comfort until the affect of the toxin wears off.

Highly trained and experienced Dermatologists and some Ophthalmologists are the best doctors for this procedure. Avoid the doctor who does it as a side line just to make more money. Also ask how many of these procedures the doctor has done and try to find out if there have been any complications resulting from the injection in that office. Always go into this procedure “with both eyes open” and try to keep them that way.

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I have been in practice for over 23 years and am still amazed and astonished at the number of people that don’t listen to my professional eye care advise and recommendations. People come to me with eye problems and ask me to solve them as well as make recommendations as to what the BEST solution would be for them. As such, based on my many years of experience, lectures, literature review etc, I advise them as to what I know is the correct answer to their problem.

If it is a medical issue requiring medication, I will prescribe the best pharmaceutical agent to get the fastest remediation of symptoms and at the same time be as safe as possible. As medications change so must my prescribing taking into account the patient’s medical history. Thus, I often laugh to myself when a patient calls me from the drug store asking if there is a “cheaper” medication that will be “just as good.” If there was, wouldn’t I have given that drug to them instead of the one that I did? When I explain that there is “no generic version” or any substitute for that drug I still get comments like ” well how about anything else? or do I really need it anyway?” If some one comes to me and has an infection requiring treatment, the answer is the drug that I prescribed, not ” nothing” or “the drops that her sister once used for a cold sore!” People want my advise so long as it is what they wanted, not what they may need.
I even get patients that feel because they went on line once and read about certain medications that they are now qualified to prescribe drugs for everything from bed sores to HIV. As the saying goes, ” a little knowledge is very dangerous.”

Another favorite of mine is when a patient comes to me with vision or contact lens related complaints asking me to solve their problems. After a comprehensive eye exam I advise them as to what the options are and the best solution for them. Often they can not see well with their contacts or they hurt when they wear them. The simple answer is frequently a better fitting or quality lens. Thus I laugh when I tell them the lens that would solve their problems, but they don’t want to wear that one. They would prefer wearing the one advertised on TV or the lens that their sister in law wore in Tibet!! I like asking them why they came to me if they did not want to follow my advise. Any fool on the street can tell them what they want to hear. If they want an educated, experienced, professional, answer they should be willing to listen and realize that the person they came to knows more then they do about the eyes. I love telling people that they are free to do what they want since it is the American way, and that they can go back “on line” when their eye get worse for the answer.

I am often reminded of the patient who came to me about 10 years ago with a raging eye infection wearing his wife’s 3 year old soft contact lenses. He had a sexually transmitted disease called Chlamydia that caused a massive eye infection. Wearing the contact lenses was like throwing gas on a fire. I told him he needed to throw away that contaminated OLD contacts and start antibiotic treatment right away. He looked at me as though I was telling him to jump off a bridge. He then told me that he did not want to discard the contacts because they were his wife’s and she would be angry with him. Forget about the fact that he contacted a sexually transmitted disease by sleeping with another woman and probably then gave it to his wife. He also refused to take any medication since he only believed in “self” treatment. He then went on to explain that self treatment meant using his own urine that he purified by straining it through his wife’s nylon stockings as an eye drop…..need I say more!!

I made him sign a waiver that I did not condone his treatment and had advised him of a more scientifically tested treatment. I never did find out how he did or if he then gave the disgusting contact lenses back to his wife, but I always use him as a joke when ever I lecture to young doctors.

The point is, that we all seek professional advise from people that are better trained then we are for matters beyond our ability. We should listen to them and while asking questions is a good thing we must remember that we went to them for THEIR opinion. If we are not going to listen to them or go on line while we are still in their office for a different answer or cheaper lens, then don’t waste any one’s time. Doing the right thing often involves taking the advise of people that know more then we do about a condition. Use the Internet as a reference tool not a FREE doctor.

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While LASIK usually heals very well with out incident there are situations that may complicate the process resulting in serious issues that may alter the final results. To best illustrate this I have 2 case histories that will explain different problems. The first is caused buy the patient, the second in no one’s fault.

A 25 year old man had LASIK with out incident on a Friday and came in for his first post op visit on Saturday. All was normal as his vision was 20/20 in each eye and aside from a little redness he was fine. He was advised to avoid situations that may result in ocular trauma, rubbing of the eyes or any place that may have windy conditions. He was of course also told to wear his sunglasses outside and sleep with his shield at night.

On Sunday he went to the beach to play in a Volleyball tournament. After fighting off multiple spike attempts, one of them did manage to hit him square in the face resulting in eye trauma. He then fell to the ground landing face first in the sand. On Monday he came in with red, painful eyes and blurry vision. Examination revealed that the flap on the cornea had shifted out of place and there was sand under it. Both of those are emergencies and required bringing him back into surgery to lift the flap and clean under it. He was seen on Tuesday and he was not as happy as the first post op visit. He had more redness, discomfort and his vision was only 20/40. He had to use the steroid drops for 2 weeks until the swelling resolved and his vision returned to 20/20. He was very fortunate that the problem that he caused was able to be corrected. Had the flap been completely taken off during the volley ball game or a lot of sand got under the flap, the results could have been devastating. He ultimately did achieve 20/20 in each eye and was happy with the results. He did have more glare then the average patient because the juncture where the flap was made scarred a little resulting in diffraction of light. It will fade over time, but may not completely resolve itself.

The second patient was 100% compliant, but had bad luck. She was a 38 year old woman who underwent LASIK and was perfect for the first week following surgery. She returned 10 days after the procedure complaining of pain, decreased vision and redness in both eyes. An examination revealed both flaps were milky white and the edges were slightly lifted up.
She stated that she was avoiding all the things that she was supposed to and even visited her ailing friend in the hospital. The significance of the hospital visit is that she had apparently been exposed to an infectious agent that was attacking the corneal flaps. There was no additional surgery required, but aggressive medical treatment was needed. She was put on several very strong antibiotic eye drops, steroids and even an oral antibiotic to kill the infectious agent. She was followed up on a daily basis and after 1 week she began to show signs of improvement. The corneal flaps did reattach at the edges and became almost perfectly clear. Her best vision was 20/25- in each eye and her eyes were healthy.

The first patient was foolish and caused his problem, the second did nothing wrong, but had bad luck. The bottom line is that when undergoing refractive surgery one must always do as instructed, and hope for the best with factors that can not be controlled.

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Macular Degeneration is an ocular condition whereby the central part of the retina called the Macula, breaks down resulting in decreased vision. Usually a genetic predisposition is required for the condition to occur and the severity will depend on both genetics and environmental factors. Studies have long concluded that factors such as drug use and smoking will precipitate the disease to occur at earlier ages and will substantially make the vision worse. Smoking will increase the likelihood of the condition occurring 300% and will also make it much worse then in an individual that never smoked.

Recent studies have concluded that other factors never before associated with the condition may also be contributing causes to the disease. Certain types of carbohydrates have conclusively been associated with the condition. Specifically, foods rich in carbohydrates that have a high glycemic index have been linked to Macular Degeneration. This factor raises the blood glucose level and is a measure of how fast the carbohydrates are metabolized. The faster the food is broken down the higher the glycemic index.

Foods made from simple carbohydrates like cake and white bread or ones that are sweetened with sugar or corn syrup metabolize very quickly pouring glucose into the system. Complex carbohydrates like fruits and vegetables break down more slowly and result in a steadier release of glucose into the system. Complex carbs are much better for timed release of energy for active people since it keeps fueling the system. It also uses the glucose as it is released thus decreasing the likelihood of having to store it in cells. This of course results in an increase in fatty tissue.

Intake of foods with a high glycemic index causes conditions such as diabetes, hypertension, vascular disease and certain types of cancers. The American Journal of Clinical Nutrition has published studies correlating these foods and conditions. One such study stated that individuals that ate a lot of high glycemic index carbohydrates had as much as a 40 times greater chance of developing macular degeneration and that the severity of the condition would be worse then those that did not eat that class of food.

The theory behind the correlation between the high glycemic index carbohydrates and macular degeneration stems from it’s impact on the smaller blood vessels. High blood glucose like in diabetes weakens the cellular bonds in the blood vessel walls. This in turn weakens the vessel’s ability to maintain good blood flow thought the vessels. As a result the blood leaks out of the blood vessels resulting in damage to the surrounding tissue. In addition, the end organs are not going to get the full supply of blood. It can be compared to a garden hose that leaks water all along the hose. As a result the sprinkler will not get enough water and the grass at the end will turn brown. Also, the areas along the hose will flood damaging those parts as well.

In summation, there are many factors that can contribute to macular degeneration, but recent studies show that simple carbohydrates increase the likelihood of contracting and the severity of the condition. As with most disorders, eating the proper food will keep you healthier and prevent some conditions.

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