The refractive surgical procedure, PRK involves debrading, or scraping the top layer of the cornea, thereby exposing the inner layers which are then treated with a laser. In doing so, the cornea can be reshaped, and this will improve the vision of the patient. Ideally, the patient will wear a bandage contact lens for several days post operatively while taking anti inflammatory and antibiotic eye drops. Most often the patient’s cornea will heal properly and the corrected vision will be stable, and good.

On occasion, the corneal tissue does not grow back at the desired rate, and nearsighted patients may become farsighted post operatively. In these cases, the outer layer of the cornea may not have fully regenerated resulting in an overcorrection. This condition is called Epithelial Hypoplasia, and is a thinner then required corneal outer layer. The cornea may be as thin as 50-60 microns, 560 microns for a normal cornea, and has difficulty growing back.

Fortunately, there is a procedure to help the epithelium regenerate correctly, and it is called CLAKIS. It is a contact lens assisted procedure, and effectively makes the cornea grow back. The treatment involves placing a soft contact lens on the eye, and wearing it for a week at a time while taking Non Steroidal Anti Inflammatory drops, Voltarin, concurrently. The contact lens creates an inflammatory response in the post operative eye while the Voltarin prevents scarring during the regrowth period. The increased inflammation causes an increase in cell growth, increasing the outer layer and thereby decreasing the hypoplasia. In doing so, the hyperopia (farsightedness) is eliminated.

This procedure is not a well known, or a widely employed therapy. However, it is a very effective solution for the surgical over correction of nearsighted patients. In short, it is very important to always be in the care of a very experienced surgeon so he/she can properly deal with all potential surgical complications, and respond in an efficacious way.

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Reduced vision, or even blindness my exist for an individual for a number of reasons. Treatment will depend on what the cause is, and how effective the treatment will be. Conventional, non invasive treatment has always been eye glasses, or contact lenses to correct visual problems. Over time, improved eye glass lenses and contacts have evolved that reduce glare, eliminate unwanted wavelengths of light, improve depth perception, and address many environmental issues.

More recently, there have been new developments in the medical treatment for visual impairments. For example, Avastin a drug that was originally intended to treat Colo-rectal cancer has been found to improve the vision in patients with Macular Degeneration, Diabetic Retinopathy and other vascular related retinal diseases. Non steroidal anti inflammatory drugs can reduce retinal inflammation, and cyst formations. New drugs have been developed to treat infections more affectively.

A major challenge has been therapeutic alternatives for genetic and congenital disorders. These diseases arise from within the patient, and therefore pose limited treatment options. The future appears to be gene therapy. Recent clinical trials performed at the Scheie Eye Institute in Philadelphia using gene therapy have dramatically improved patient’s vision from detecting hand motion to reading letters on an eye chart. These tests were performed on individuals suffering from a congenital disease called Leber’s Congenital Amaurosis. The study was then published in the New England Journal of Medicine. This particular eye disease results from a mutation in the RPE 65 gene. This mutation prevents the gene from producing a protein required in the manufacturing of the retinal pigment epithelium. This protein is required for the retinal tissue to absorb and process the light into vision.

The treatment included injecting a normal RPE 65 gene directly into the retina. Two weeks following the injection, all the patients demonstrated improved vision. In addition, all participants became more sensitive to light. As a result of the increase in acuity, there was a concomitant decrease in abnormal eye movements which further increased the eye’s ability to see.

While these clinical investigations were performed on individuals with a certain congenital disorder, it gives hope to other people with genetic conditions that help is on the way. With any luck, retinal disease will be a thing of the past as these treatment modalities improve.

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Amblyopia, or lazy eye is reduced vision in one eye as a result of a sustained period of visual neglect in childhood, resulting in neither eye glasses nor medical treatment improving the vision in that Amblyopic eye. During infancy, an infant’s neurological system is very flexible, and can easily adapt to changing environmental stimuli. As such, during these formative years our visual systems learn how to function. If during that time one eye does not get adequate visual stimuli it will not develop to the same level as the other eye.

As an individual gets older, the flexibility of the system decreases, and after the age of 7-10 years old, much less can be done to improve vision in an Amblyopic eye. The best treatments to date for improving vision in one of these patients has been patching the better eye, forcing the weaker eye to work harder. In doing do, vision improves in that eye. The younger the patient, the better the results can be obtained. In addition, Vision Therapy(VT) should be part of the therapeutic plan as it retrains the visual system to function correctly. VT has a very high rate of success when done properly.

The problem has long been that after a certain age, due to the lack of plasticity of the aging visual system, an Amblyopic eye was not able to regain adequate vision. New research appears to have changed Amblyopia treatment.

The antidepressant medication Prozac, has been shown with continuous administration to reinstate ocular dominance plasticity in adulthood. This can promote improved visual function in older individuals. In early childhood the neuronal connections are very plastic, but as the critical period closes, this flexibility is greatly reduced. According to research published in an issue of Science Magazine, treatment with Prozac reopens the critical period of plasticity in the visual cortex, and Lateral Geniculate Body parts of the brain. These studies were done in rats only. In order for this flexibility to be reopened, the good eye must still be patched for a minimum of several hours per day.

The researchers concluded that the restored plasticity with the use of Prozac was as a result of a reorganization of neuronal connections in the cortex. Furthermore, maximum visual improvement was achieved when Vision Therapy was also administered. The only concern that the researchers revealed was what side affects would be with long term use of the drug. To date, known affects include but are not limited to suicide, severe anxiety, glaucoma, and visual filed defects. Future, long term research needs to be done to determine the risk/benefits of such treatment.

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Over the counter remedies are all thought to be very safe; since a doctor’s prescription is unnecessary. That however, is not true. All medications, whether they are prescribed or not, have side effects, and can react with other pharmacological entities. In some cases, these effects could have very detrimental consequences. As an example, drinking grapefruit juice when taking cholesterol lowering medication affects the metabolism of the medication, and can create a toxic environment. Further, milk neutralizes the antioxidant affect of tea, and facial creams can raise eye pressure.

The blood supply of the scalp is shared with that of the forehead, and eye lids. Any products applied to the head, or scalp can be absorbed into the blood stream, and ultimately get introduced into the eye. One such potential complication is hair coloring chemicals. We have seen on numerous patients, eye irritations, and allergies on women who have had their hair colored. The chemicals travel from the scalp to the eye lids into the eyes causing a negative reaction.

A much more serious issue is the use of steroid cream frequently used by Dermatologists. Most of the time, this cream used for the treatment of allergies, dermatitis, and even to reduce wrinkles. However, a recent study conducted in Concord, North Carolina concluded that ” ….although secondary ocular hypertension from topical steroid eye lid cream is unlikely, it is possible that enough of the drug is absorbed into the eye in sufficient quantities to raise the intraocular pressure in a steroid responder.” What this study found was that in certain individuals, the steroid cream can cause the pressure in the eye to rise, and ultimately cause damage to the eye if left untreated.

Steroids have long been used in the eye to treat inflammation, but only when carefully monitored. When such medications are employed near the eye, but are not carefully followed, can raise the pressure and cause Glaucoma. A similar study described a 29 year old woman being treated for Eczema for many years who ultimately went to her eye doctor with glaucoma in both eyes, and irreversible vision loss attributed to the steroid creams used around her eyes.

In short, it is very important for patients to realize that all medications may have secondary affects, and can cause disorders not related to the conditions they are being treated for. It is vital to understand any potential side affects, and follow up with related health care professionals to be sure the medications being taken are not creating collateral disorders.

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As we age, there is an increase in many disorders, and the physiological changes that make those diseases worse. Like wise, there is an increase in frequency and severity of neurological conditions affecting the brain with age. One such condition is Lewy Body Disease. This is of particular interest to me because of 2 reasons. The first is obvious. My name is attached to the disorder. While I have a rare name it is shared with a famous researcher of the early 1900s. The second is that my wife is convinced that I either have dementia or just do not listen to her.

While most doctors are not familiar with a condition called Lewy Body Disease, it is the second most common cause of dementia resulting in as much as 20% of all cases. This is according to the Lewy Body Disease Association. There is no cure for this condition and does worsen with time.

Lewy Body Disease is comprised of a spectrum of symptoms involving dementia and motor abnormalities. Diagnosis is difficult because the dementia is similar to Alzheimer’s or Parkinson’s but differs in that LBD does demonstrate strong psychotic hallucinations, extreme sensitivity to antipsychotic medications and the disease varies from day to day. Furthermore, LBD is twice as likely to occur in men as women unlike Alzheimer’s which is equal in both sexes. There is also no genetic link.

Lewy Body’s are abnormal microscopic protein deposits located in the mid brain and found in nerve cells that disrupt the brain’s normal function. This results in the deterioration of the brain over time. It was first discovered by Frederick Lewy in 1912 a colleague of Alois Alzheimer. It has long been known that the presence of Lewy bodies is a hallmark of Parkinson’s; they were discovered in the cortex in the 1960s and affiliated with dementia. People with LBD have the protein bodies in both the mid brain and the cortex which severely impairs the functioning of the brain.

Signs of LBD include mental decline, recurrent visual hallucinations, poor response to antipsychotic medications, difficulty with daily living activities, sleep disturbances and fluctuations in autonomic processes like blood pressure, temperatures swallowing and bowel movements.

Diagnosis is difficult; it requires an autopsy which makes it more difficult in the living patient, but a well trained physician can differentiate this disease from Parkinson’s and Alzheimer’s.

Sincere there is no treatment for this disease, diagnosis does not really help the patient cope with the eventual symptoms, but at least knowing what is happening may help in future cures. The visual disturbances, and hallucinations are the links to my series of articles. Many patients will come in saying that they see things. Knowing that there is another possible diagnosis is helpful to at least the patient’s family.

As for me, I can at least tell my wife that I have a reason for acting strange and blame it on my name sake of 1912.

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