When Henry Ford’s model T rolled out of the factory the thought that one day cars would have tinted windows was not even a consideration. Beyond the windshield, there were no other windows on that model. Over time, cars and their windows have evolved to meet the demands of the driver. Tinted car windows had traditionally been used in police vehicles and limos to conceal their occupants. Eventually tinted windows were embraced by average drivers as fashionable, and cool. We see them on most SUVs and small cars owned by teenagers.

September 11, 2001 changed all of that. In order for law enforcement officials to be able to see into motor vehicles as they drove by, the tinted window had to go. Consequently, in many states car windows must have at least a 70% light transmission rate to be legal. As with most laws, medical conditions generally supersede the laws requirements. In this case there is one, and only one condition that permits car windows to be tinted beyond 70%. Individuals with this disorder are required to have a doctor’s note with them all the time while driving in case they are stopped by law enforcement.

The medical condition that permits tinted windows is called Xeroderma Pigmentosum (XP). It is a very rare, recessive, inherited disease that significantly increases an individual’s sensitivity to sun light. It results in premature skin aging, and most often skin cancers. Even a small amount of UV light will cause severe sun burns that have a very high rate of malignancy.

The physiology of the disease is quite simple. Our skin is constantly being damaged by sun exposure, and needs to be repaired. Individuals with XP have a defect in their DNA repair system. Nucleotide excision enzymes that are needed to fix the sun damage are mutated, and unable to repair the damaged skin. As a result there is an alteration of the DNA in the damaged cells leading to mutations. This in turn results in the formation of cancerous cells.

The disease generally has 3 stages. The first appears about 6 months after birth. While the skin looks normal, exposed areas to the sun will get very red and become scaly with irregular spots and freckles. These changes will spread to the neck and legs even if they are not exposed to the sun. The spots may go away in the winter, but will reappear in the spring. The second stage is characterized by Poikiloderma. This level demonstrates thinning of the skin, light and dark patches and irregular web like blood spots and vessels that can be seen under the skin. The third stage is Solar Keratoses, and skin cancers. This stage may occur as early as 5-6 years old if there is sun exposure. The most common cancers seen are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Ocular problems will occur in approximately 80% of these patients. There is extreme photosensitivity, and irritated, blood shot and cloudy eyes. Frequently, conjunctivitis occurs. In addition, lesions on their eye lids and surrounding ocular areas have been noted.

The need for dark, tinted windows is clearly justified in this case. The flexibility in this law allows individuals who otherwise would be unable to drive, to drive.

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Rosacea is a chronic dermatologic disease that most often affects the face and surrounding ocular tissues. It is characterized by facial flushing (erythema), telangiectasia, roughening of the skin, and inflammatory pustules on the skin surface. The differential diagnosis for Rosacea includes acne vulgaris, contact dermatitis, seborrheic dermatitis, eczema, sarcoidosis, lupus, perioral dermatitis, and some drug induced photoreactions.

There are 4 types of Rosacea including Erythematotelangiectatic Rosacea which is characterized by dilation of multiple blood vessels and telangiectasia. Papulopustular Rosacea demonstrates with skin pimples and plaques and Phymatous Rosacea which presents with phymas and tissue hyperplasia. The final types and most frequently seen is Ocular Rosacea. This type is characterized by multiple ocular signs and always exhibits exacerbations and remissions.

Ocular signs for Ocular Rosacea present prior to skin manifestations in as many as 20% of the cases. The cause of the inflammation is most often Staphylococcus exotoxins and ocular surface inflammation is the most common complication . Signs include dry eyes, telangiectasia of the lid margins, conjunctivitis, blepharitis, Chalazia, Hordeola, Meibomianitis and Keratitis. The glands of Zeiss and Moll may also be affected and complicate tear production.

Rosacea occurs in 4 distinct stages and starts with Prerosacea which includes skin flushing and recurrent episodes of facial redness. Triggers such as sunlight, alcohol, tobacco, spicy foods and stress will exacerbate the condition. Stage 1 includes the prerosacea signs plus telangiectasia which is permanent blood vessel dilation, and prominent sebaceous glands resulting in oily skin. Stage 2 adds on swelling of the skin tissue, papules, pustules, and enlarged pores. Stage 3 results in tissue hyperplasia, rhinophyma and enlargement of the sebaceous glands on the nose.

Initial treatment includes warm compresses to the lids, non-preserved artificial tears and oral doxycyclines for 6 weeks. In addition, patients are advised to avoid the previously mentioned triggers. The incidence of this disorder is approximately 1 in every 20 Americans or about 14 million individuals.

Treatment of Ocular Rosacea will depend on the types and severity of the condition. Therapy includes lid hygiene with warm compresses and lid scrubs. Artificial non preserved tears must be employed as are soft topical steroid eye drops. Restasis in often used to increase tear production and now topical antibiotics such as Azasite are frequently used. Oral antibiotics like Doxycycline have always been a standard treatment and co management with the patient’s primary care physician or dermatologist is recommended. In severe cases surgical intervention is required to treat lid and corneal disease.

In short, Ocular Rosacea is a common disorder that can affect the health of the eye and therefore the vision. Aggressive therapy must be administered and managed to ensure life long vision.

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Contact lens comfort has always been of paramount importance, and manufacturers have spent a great deal of time and money to continually improve it. Problems such as dry eyes have frequently been a challenge to eye care practitioners, but with new developments the trend seems to be developing better alternatives.

The laws of nature dictate that water goes from where it is to where it is not. As such, most soft contact lenses will dry out with dry eyes because they are made of approximately 50% water. In contrast, Rigid Gas Permeable contacts are made with a fraction of that and accordingly will dry out much less. This results in much better, and longer lasting comfort. However, there are still issues that must be considered. The first is edge design. By redesigning the peripheral curves of the lens to better increase tear flow and exchange under the lens as well as the bearing on the cornea, greater comfort can be achieved. The second is the surface of the lens. Different materials have been used to better decrease the wetting angle and thus improve the wettability of the lens. This in turn will improve oxygen permeability and therefore comfort and ocular health.

To that end, RGP Plasma treatment has been developed. Plasma treatment alters the surface properties of the lens making it more water loving, and more oxygen permeable. The process involves placing the lens in a vacuum chamber, and exposing it to highly pressurized ionized cold gasses that remove all contaminants and chemical residues from the lens surface. This process lowers the wetting angle increasing the wettability of the lens. Patient comfort and ocular health dramatically improve as well.

This improved contact lens state does not last for ever and will vary depending on handling of the lens, and solutions used. The process can be repeated as needed as long as the lens is in good condition. This treatment in addition to the newer gas permeable materials has proven to be a huge step forward in contact lens technology.

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Americans have pursued a never ending search for nutrients, and supplements in an effort to improve ocular health and prevent eye diseases. While many advertized items have little or no actual benefit, there are some that have been shown to be helpful, and efficacious. Over the last half century research has started to embrace these supplements as beneficial to our health, and their impact on one’s general well being.

Understanding the aging, and physiological processes offers a pathway to the benefits of these nutrients. Cataracts, Macular Degeneration, dry eyes and other age related disorders are but a few of the considerations that these neutricuticals are targeted to address. A study conducted by West and associates concluded that there are some supplements that are very helpful and when taken properly will prevent damage and even do some repair.

Research conducted by the Age Related Eye Disease Study ( AREDS) found that individuals who took antioxidant combinations of 500 IU Vit C, 400 IU Vit E, 15 mg of beta carotene and Zinc for approximately 6 years had a 17%-21% lower rate of Age Related Macular Degeneration(ARMD) progression as compared to individuals in the placebo group. Patients who took Zinc or antioxidants alone also showed a decrease in the progression of ARMD, but not to the extend as the first group. No benefit was shown with the folks who took Vit E alone. In addition, participants who took Lutein for 18-20 weeks demonstrated higher plasma levels, and increased macular pigment density. This would counter the ARMD damage and improve visual quality.

The West and associate study found no benefit at all in preventing, improving or reversing the damage caused by Cataracts or Diabetic Retinopathy. Herbal remedies, antioxidants, and all vitamins were found to be useless with regard to these two conditions.

Unlike cataracts, Glaucoma has been shown to be aided by the use of supplements. Cannabinoids have demonstrated an ability to lower the intraocular pressure, thereby lowering the visual devastations of Glaucoma. The problem with this supplement is obtaining an accepted method of administration that is regulated, dose reproducible and legal. Additional studies have shown that Ginkgo Biloba has improved the visual fields of normal tension glaucoma patients with as little as four weeks of use. The reason is believed to be the vasodilating affect of this supplement. Bringing more blood, and oxygen to the starved retinal tissue. Bilberry has not been clinically demonstrated to aid glaucoma patients in any way.

While additional studies must be conducted to asses all the benefits of these, and other nutritional supplements, it is clear that some do help. Furthermore, of equal importance is the drug interaction of supplements with both each other and prescription medicines. Many herbs, drugs and supplements can and do increase/ decrease the affect of other substances when present at the same time. Care must always be taken and warnings displayed. In all cases, one must consult with their health care professionals as to what supplements can be safely used.

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