Diabetes is reaching epidemic proportions in the United States with more then 26 million Americans currently suffering with this serious disease. The most common of the eye complications are bleeding in the retina and macular swelling. Diabetic retinopathy is the leading cause of blindness in young Americans, and the swelling of the retina is due to chronic, long term retinal inflammation.

In an attempt to treat this very serious inflammatory condition, steroid injections have been given directly into the affected eye. It should be noted that this therapeutic modality in not FDA approved, but doctors have continued to employ it since it has been effective in reducing the swelling. The problem has long been that this treatment has substantially increased risk of ocular complications. In addition, frequent injections every few months are required in order for the therapy to be effective.

The steroid injections reduce retinal thickness thus improving vision. The steroids inhibit this inflammation by suppressing the endothelial growth factor. This in turn decreases the vascular damage. These beneficial results only last about 3 months, but the potential side effects include cataracts, increased pressure in the eye, endophthalmitis (severe inflammation) and uveitis.

The goal is to increase the effectiveness of the steroid without increasing the negative side effects. Intraocular implants have been employed near the front of the eye, behind the natural lens, for treating multiple retinal conditions. These include cytomegalovirus (CMV) and posterior retinitis. These implants require sutures and thus have an increased risk of infection when used.

Iluvien is an injectable steroid that is currently under FDA investigation for Diabetic Macular Edema and will last up to 3 years after injection. It is injected with a 25 gauge needle which seals itself; not requiring any sutures. It can also be placed more posterior in the eye for higher effectively and thus better results; this will also decrease the chances of bad side effects so common with the other steroid injections.

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New drug developments are exciting; they cure disease and often alleviate difficult problems. Such was the case when Viagra and Cialis were created to cure erectile dysfunction. For a little longer than forever, men who have suffered this personal and embarrassing disorder have had to either avoid sexual encounters or employ less then pleasant alternatives.

This innovation allowed men to engage, and enjoy sexual relations. However, with every advance, potential side effects can occur. Men with cardiovascular disease or who take certain medicines are at risk for serious systemic complications, with these medications.

This class of drugs is called selective phodiesterase type 5 inhibitors because they treat the erectile dysfunction by interfering with the action of this compound on the vasculature in the penis. The problem that arose was this same reaction takes place in the retina. Mild but transient blurry vision, altered light perception, and a blue hue in one’s vision are common complaints in men taking this class of drug. Long term use has resulted, in some cases, in non-arteritic anterior ischemic neuropathy, central serous chorioretinopathy, and other vascular related changes. Scientists have concluded that these side affects result from off target inhibition of PDE6 which is very similar to PDE5 and is involved in regulation of photo transduction.

The good news is that according to a study published in the April issue of Archives of Ophthalmology, conducted by Eli Lily Research Labs, these changes are temporary and transient. They stated that there is no long term damage to the retina or visual system when using this class of medication. It should be noted that the study only followed these men for a period of 6 months. As with all medications, follow the doctor’s instructions and guidelines, stop taking it if there are any problems and seek medical help if any symptom does not resolve in a reasonable period of time.

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While all men are created equal, our corneas are not. Presurgical testing for refractive surgery must include corneal topographies, Orbscans and Pachometry to determine corneal thickness. Examination of these results must be done carefully to first; determine the correct measurements of the cornea second; evaluate corneal health, and third; differentiate between corneal disease and unusual but healthy corneas.

One such finding of an unusual but healthy cornea, is called Displaced Apex syndrome. Many eye care practitioners assume that a patient’s line of site, pupillary center and corneal apex are all in a straight line. This however, is not always the case. The importance of these findings can not be over emphasized. Each one must be determined and the surgical procedure must take them all into account in order to have a successful outcome.

Common mistakes include false positives for Keratoconus or irregular astigmatism. In order to properly evaluate the cornea its thickness must be determined, anterior and posterior elevations as well as anterior and posterior sagital curvatures are required. Comparison of elevation and curvature maps will permit the doctor to accurately differentiate true pathology from false positives.

Simply looking at the front surface of a cornea can lead one to falsely diagnose Keratoconus because of an irregular appearance and an inferior “conic appearance.” However, examining the posterior elevation maps will allow the practitioner to rule out a false positive. If the front surface shows this irregularity, then a true Keratoconus patient will demonstrate the same result on the back surface. However, if the posterior corneal surface is completely normal while demonstrating the steepening anterior surface then a true diagnosis of Displaced Apex Syndrome must be made. This is significant because there is no pathology, refractive surgery can be performed and the calculations must be made in order to account for the different shaped cornea.

Displaced Apex Syndrome results in the apex of the cornea not aligning with the line of sight and/or pupillary axis. Once the correct diagnosis is made; all the rest of the answers fall into place. Missing this very important anatomical characteristic will cause the patient to have terrible refractive surgical results. Most of the surgeons that I have spoken with will chose PRK for these patients as the best procedure.

As always, before having surgery make sure the doctor is very experienced and is familiar with all forms of testing AND knows how to read these results.

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Science has known for a long time how important nutrition is to one’s general health. Recent studies have been more specific as to which foods may help and which may hurt various parts of our bodies. A recent study published in The American Journal of Epidemiology concluded that eating red meat increases an individual’s chances of contracting Age Related Macular Degeneration 50%. It also stated that eating chicken would decrease that same likelihood by 50%.

The research was conducted in Australia following over 6700 people and found that people that at red meat at least 10 times per week were 50% more likely to contract AMD then those who did not eat the red meat. By contracts it also found that folks that ate chicken at least 3 times per week were 50% less likely to contract AMD as compared to people who did not eat any chicken.

Red meat is known to be high in saturated fats that negatively affect the vascular system. These fats will cause blockages, obstructions and therefore decrease blood flow to all organs. While the researchers could not conclusively determine the exact reason for the correlation between red meat and AMD, they did conclude that it had to do with the saturated fats in the meat. They felt that the decreased blood flow to the macula would result in the increased incidence of the AMD in these patients. However, these same researchers did not have an answer as to why there was a decreased incidence in those chicken eaters. That finding will require further research.

In summary, eating red meat does introduce protein into our systems and does have positive effects on us. However, as with most things we must remember to moderate our intake. It is harder to digest then other sources of protein and can have negative affects on us as well. Sources like chicken and fish are healthier then red meat and as studies such as this one have shown can prevent certain serious ocular conditions.

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