Refractive surgery, PRK and LASIK, have evolved and become more common place over the last 10 years. As more of these procedures are performed, the scope of their goals appears to be increasing as well. Initially, patient’s desires were to reduce or eliminate their need for eye glasses, but now a new therapeutic approach appears to be on the horizon.

Amblyopia is reduced vision in an eye for a non pathological reason. Among the reasons for amblyopia are an eye turn called strabismus, high prescriptions, and large differences in powers between the two eyes. Any situation that will result in one eye seeing much better then the other can cause amblyopia. Therapy for this condition has always been to blur the vision in the good eye forcing the weaker eye to work harder and stimulate the visual cortex. During the developmental years, birth to 7-8 years of age, the brain is establishing its connections, and once completed amblyopia is much more difficult to treat. The results are much more moderate at best.

Conventional modalities have included patching the good eye or blurring the vision with dilating drops such as atropine. In addition, the weaker eye must wear either a contact lens or thick eye glasses in order to focus light on to the retina permitting the best possible vision. Eye exercises are also required to maximize the stimulation of the weaker eye. Compliance is a major factor for success of this treatment. Since most of these patients are children, parental supervision, and enthusiasm is required. As a result, in many instances the therapeutic outcome is not as successful as desired because either the child is non compliant or the parent is not as diligent. In addition, because of contact lens intolerance or an inability to wear glasses where one lens is much thicker then the other, lack of proper stimulation results in a bad therapeutic outcome.

According to an article published in the July issue of Ocular Surgery News, amblyopia resulting from differences in powers of the eyes affects about 1-2% of the population. Approximately 40% of children 2 years of age with anisometropia (big differences in powers between the two eyes) suffer from amblyopia, while 76% of 5 year olds with the same condition will be amblyopic. The higher the level of the anisometropia; the greater the likelihood and severity of the condition.

Dr. Evelyn Paysse has been conducting a study to determine if PRK would be a better alternative to balancing the refractive differences and thus eliminating the cause of the amblyopia. By having the two eyes the same power it would be much easier for the child to function in his/her daily activities and it would also make the amblyopia treatment easier to perform. Amblyopia therapy must still be done because the PRK does not eliminate the amblyopia, just the difference in power between the eyes. As an alternative to contact lenses or thick eye glasses, PRK would be a permanent solution to equalize the powers in both eyes.

This situation would be of even greater benefit among special needs children suffering from conditions such as Down’s Syndrome, cerebral palsy, developmental disorders and other neurobehavioral conditions. The improved visual function would have a positive behavioral impact in these children since they would no longer be living in an isolated visual world.

In summary, while elective surgery should always been minimized in children, it should be considered when the end result can have a life long benefit and result in better vision. When contact lens intolerance exists, and eye glasses can not be worn comfortably, then refractive surgery may be a great alternative. Of course, patient and parent compliance must be present for the best therapeutic results.

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Stem cells have proven themselves to be the next great healer in treating deadly and debilitating diseases. While research has been restricted, their efficacy is well known. The concept that one’s own body, through the use of stem cells, can cure and heal damage to the tissues; and therefore improve function is a medical breakthrough of monumental proportion.

Delivery of these stem cells to the affected organs is always an issue that must be considered as much as the selection of the cells themselves. There must be an effective method to deposit these stem cells in the least invasive maner; thus minimizing damage to the body, target organ and the stem cells themselves.

While the eye, and the cornea in particular, are external, there still must be a method to introduce the cells in such a way as to minimize any structural alteration to the eye. Researchers at the University of New South Wales have done just that. They used a standard soft contact lens to culture a patient’s stem cells. This contact lens was then placed directly on to the individual’s eye permitting the stem cells to migrate directly on to the eye. The contact lens was left on the eye for 10 days which was the time required for the stem cells to repair the damage to the corneal tissue. This technique is unique in that it does not require foreign human or animal products and is totally non invasive. It is inexpensive and requires only a small amount of the patient’s own ocular surface tissue.

Delivery systems such as this may prove to be the best way to heal damaged tissue and reduce the high cost of this method of therapy.

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Vitamin E is an important component of good general health. It has many benefits and is one of the fat soluble vitamins along with A, D and K. It exists in 8 different forms and the most active form in humans is alpha-tocopherol.

Taking the correct amount of Vitamin E is as important as a deficiency. Over dosing can result in hemorrhages and lead to stroke. Some of the more common sources of it are nuts, sunflower seeds, oils, green leafy vegetables, and some grain products. The normally recommended intake of Vitamin E is 22.4 IU or 15 mg for an average male adult. Lactating women should take about 19 mg.

Vitamin E is important in maintaining cell membrane integrity and also helps in producing Vitamin A from oxidation. It also is a key part in the proper functioning of the circulatory system and red blood cell production. In addition, it is key in the body’s use of Vitamin K with regard to the clotting factor.

With regard to the eyes since it limits the production of free radicals, it can delay and even prevent development of chronic diseases such as age related macular degeneration and cataracts. Furthermore, in combination with Vitamin A it promotes corneal healing with trauma and refractive surgery. It also helps maintain a stable tear film reducing dry eyes and its’ symptoms.

Vitamin E is in high concentrations in the photoreceptors in the back of the eye and further helps protect them from oxidative damage. It must be noted that Vitamin E supplements should be avoided in Retinitis Pigmentosa patients as there is some evidence that it actually may reduce vision at a faster rate then in patients that did not take additional Vitamin E. There is no solid evidence to support this claim, but clinical findings suggest that avoidance is recommended. Vitamin E has been suggested in the treatment of macular edema and certain cases as well.

Vitamin E deficiency is rare in adults, but can be found in individuals with protein transfer disorders, fat metabolism and mal-absorption diseases, as well as Crohn’s Disease, Ulcerative Colitis and cystic fibrosis. It’s deficiency will affect the retina by decreasing nerve fiber impulse transmission causing muscle weakness. Excessive intake can result in death due to hemorrhages and stroke.

A well balanced diet should give most adults enough Vitamin E, but if one does not eat well then a vitamin E supplement is important in maintaining good over all and ocular health.

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