Toxicologist John Draize, 65 years ago, invented the “rabbit test” as a standard for measuring eye damage when exposed to chemical agents. The rabbits are held in a brace preventing them from moving their bodies or heads for 21 days or longer after the chemical has been introduced into their eyes. The eyes are then evaluated for redness, corneal damage, structural changes and alterations in the anterior section of the eyes. The animals are then useless to the researchers since the eyes have been compromised.

This practice subjects the rabbits to pain and suffering and treats them like disposable tissues. It is a terrible, heartless method that demonstrates a total lack of respect for other living creatures that feel pain and fear as much as we do. Fortunately, there is an alternative method utilizing cow and chicken corneas from dead animals. This procedure has been approved by both the US and Europe. The dead tissues are exposed to the same irritants and studies instead of the live subjects. There is NO pain and NO suffering!

According to Thomas Hartung who is director of the Center for Alternatives to Animal Testing at John’s Hopkins University, the Draize eye test should become history as this and other alternative become available. The germ killing cleaning products no longer have to be tested on live rabbit eyes to see if they are safe.

We as humans have an obligation to safeguard the safety of animals. They are at our mercy and using them for this kind of testing shows a lack of respect for other life. We must employ methods that do not put animals at risk and expose them to pain. Only lab tests should be permitted and when safety and efficacy have been determined then human volunteers can be used. Animal testing never gives us the actual response anyway, so why torture these poor living creatures.

Drugs are manufactured for treating specific conditions and the FDA tests and approve them for that use. Frequently, during the use of a medicine other benefits are discovered by accident. For example, the new class of glaucoma drugs have been shown to increase eye lash growth. Thus the manufacture now makes a separate form of the drug called Latisse to apply directly on to the lashes.

According to the July 2nd issue of The New England Journal of Medicine, antihypertensive medications can slow the progress of diabetic retinopathy. A clinical study was performed on type 1 diabetics receiving either Cozaar 100mg 4 times per day, Vasotec 20 mg once per day or a placebo all for a period of 5 years.

The results were outstanding and demonstrated a definite link between these medications and reduction in diabetic retinopathy. The group taking Cozaar demonstrated a 70% reduction in retinopathy while the Vasotec group showed a 65% decrease in the progression of the disease. These results were compared to the placebo group that should no change in the expected retinopathy changes.

Research has shown that patients with moderate to severe diabetic retinopathy present with high levels of angiotensin conversion factor and angiotensin II in their vitreous and retina. Therefore, it makes sense that blocking these factors with anti hypertension medications would reduce the progression of diabetic retinopathy.

More studies must be conducted to determine the dosage and best medication for this therapy, but it certainly shows that there are other treatments in the future to preserve sight in the always difficult to treat diabetic patient.

Decreased tear production is a common occurrence as we all age and may occur secondary to many ocular surgeries. The symptoms may include but are not limited to a dry burning feeling, red eyes, and a sandy, gritty sensation. When patients enter our offices we usually categorize their disorders based on a variety of factors including age. Dry eye patients are not usually children and as a result this very common condition may go undiagnosed.

When a child rubs his/her eyes there may be a number of reasons, but while dry eyes are not often included in the differential diagnosis, it should be. The underlying causes of their symptoms and thus eye rubbing may be dry eyes caused by several anomalies. Inflammatory disease caused by such conditions as Sjogren’s, juvenile rheumatoid arthritis and viral disease may be just a few causes. Congenital disorders and poor nutrition including vitamin deficiencies can also cause dry eyes in the young. More serious diseases like diabetes and other vascular conditions may also be the reason.

In short, we must always consider dry eyes when a child enters our office with ocular symptoms. Excluding this common condition simply because of age will result in a misdiagnosis and very unhappy child and parent.

Patients’ complaints of burning, dry and red eyes are often passed off as either nothing significant or a side bar of dry eyes. Many eye doctors simply recommend artificial tears and hope for the best. When these same individuals return with contact lens discomfort and related symptoms, they are more difficult to deal with.

While dry eyes are in many cases the etiology of the symptoms, the cure is more complex. The underlying reason for the dry eye condition must be determined in order to fully correct the problem. An often overlooked cause is Meibomian Gland Dysfunction (MGD). The Meibomian gland is responsible for secreting a very important component of the human tear, the oil component. Oil protects the tears from immediately evaporating. Without this important component, the tears would evaporate immediately, and the eye would be painfully dry. Therefore, in order to relieve an individual’s symptoms and, in some cases increase contact lens comfort and wear, this lid condition must be remediated.

The first step is to clean off the lids. This is best done by aggressive lid hygiene using diluted baby shampoo and a Q tip to perform lids scrubs on a regular basis. This should be followed by warm compresses and lid massage to express collected and trapped mucous and debris in the glands. Following the lids scrubs Azasite, a prescription medication, should be instilled as this new antibiotic performs two functions. The first is bactericidal and the second is anti-inflammatory. It rehabilitates the lid margins. Additionally, omega III supplements should be taken as they will increase tear production. The patient must be told that this effect will take 2-3 months to begin and they must take the omega III regularly. Artificial tears should also be used on a regular basis as these will bridge the gap until the other therapies take hold. Finally, Restasis can be prescribed in certain cases to further increase the tear production. As with other medications, proper instructions must be given.

Avoiding contact lens wear during the initial phases of this therapy is recommended and can be modified on case by case basis. Of course, proper lens fit, hygiene and wearing schedules are a must.

Since MGD is a chronic condition, regular follow ups are recommended and regimen modification may occur.

Exercise and good dietary habits have long been used as a way to improve health, lose weight and even reduce or eliminate certain medical conditions. Adult onset diabetes and hypertension are two conditions that significantly improve through exercise.

A recent article published in the BioMed Central Ophthalmology journal concluded that moderate aerobic exercise, such as running or cycling will temporarily reduce intraocular pressure (pressure in the eye). The study followed 7 groups of individuals including non medicated patients with normal intraocular pressures, patients with normal pressures taking Timolol Maleate (Timoptic; glaucoma medication), people with normal pressures taking Latanoprost (Xalatan; glaucoma medication), folks with normal pressures taking Brimonidine Tartrate (Alphagan; glaucoma medication), glaucoma patients taking Timoptic, glaucoma patients Xalatan, and glaucoma patients taking all three glaucoma medications.

The study concluded that all individuals demonstrated statistically lower intraocular pressures during and immediately following moderate aerobic exercise. The result was only temporary and therefore can not be used as a therapeutic modality, but does open the door to a multi-plan approach to treating glaucoma and bears further investigation. Exercise alone should not be the only method employed to lower the pressure, but as an adjunct to glaucoma therapy, all patients are advised to exercise at least 30 minutes per day.

Seasonal allergies are a constant companion for many individuals and represent a major health factor for millions of Americans. Symptoms include sneezing, coughing, red itchy eyes, sore throat and even dark circles under the eyes.

Hay fever is often caused by pollens which are at the highest counts in higher heats, humidity and carbon dioxide concentration. Ragweed is the most common allergen in the fall which causes our immune system to release histamines and other inflammatory mediators. The spring is dominated by tree contributions, followed by flowers, weeds and molds. These all cause the same immune system response. In the United States about 75% of allergy sufferers are to ragweed and 10% are to trees.

Since we can not cure allergies, we must change our environment to best deal with them. When the outdoor allergens are high, try and stay indoors keeping the humidity below 50%. Change the filters on the air conditioners at least once a month and wear a mask outside when working in the garden. Be sure to wash hands immediately after out door activities, shower and change clothes often.

Contact lens wearers should consider reducing their wear during high allergen times and while working out doors. If contacts are worn then rub and rinse them frequently and use hydrogen peroxide systems like AOSept or OXYSept.

Medications can also be very helpful. Eye allergy drops like Patanol or Pataday are great at relieving the symptoms, and severe allergy suffers can benefit from mild topical steroid drops as well such as Lotemax or FML. Systemic antihistamines that can be purchased over the counter are useful as well, Claritin, Allegra, Benadryl etc.

Always inform your health care provider and eye doctor of all the medications that you are taking even the OTCs. They can interact with prescriptions that may be detrimental, or antagonize conditions such as glaucoma.

Lid twitching, also known as Myokymia, is the spontaneous contracting of the eye lid muscles around the eyes. It involves, but may not be limited to, the obicularis oculi muscle. Most often it is caused by stress, fatigue, caffeine or alcohol intake and on rare occasions neurological anomalies. The majority of cases are benign and self limiting.

The oldest and most recommended treatment had been over the counter quinine. The efficacy of the therapy involved increasing the refractory period and therefore decreasing the excitability of the obicularis muscles. In December of 2006, the FDA removed quinine from the OTC ranks due to potentially dangerous side effects including leg cramps, cardiac arrhythmia, renal failure, thrombotic issues and decreases in vision and hearing. The FDA reacted as a result of 655 reported cases of such conditions. Quinine is now used mainly for the treatment of Malaria and is closely regulated.

Topical antihistamines have been used as a very effective treatment, but the actual results have never been studied. We have used them with excellent results. Additionally, betaxolol, a glaucoma drug, used twice per day has also been effective in stopping the twitches. Finally, the use of Botulinum toxins in severe cases works well, but is accompanied by potential side effects as well.

The simplest therapy is to attempt to reduce the stress, use cool compresses and when needed use the topical antihistamine. In all cases, see your eye doctor if the symptoms do not go away within a few days.

Nature has designed us for efficiency and effectiveness. We have body hair to keep us warm, nose hair to filter out debris and eye lashes for protection. The lashes have become more then just feelers and filters for many folks. There are those that apply false eyelashes, some use mascara and others make up to extend and fill them out.

Recently there is a topical glaucoma medication that has been ‘off-labeled’ approved to enhance eyelash growth and thickness, Latisse. While Latisse can improve the appearance of one’s lashes, a change in their growth pattern or in them turning inward can result. Trichiasis is a condition whereby the eyelashes grow inward toward the cornea. When this occurs there is an increased predilection for them to rub against the eye resulting in scratches on the cornea, pain and even scarring if left untreated.

Regardless of how eyelashes are managed, occasional discomfort upon blinking is a result of these lashes rubbing against the cornea. Careful examination is required to determine if this is the case. The most often employed treatment is called Epilation. This is simply plucking out the offending lashes so they do not damage the cornea. Frequently, the patient must return every several months for additional Epilation, to eliminate the offending source. In some cases when there are many lashes growing in, a bandage contact lens must be worn in addition to the lash removal.

In short, if you feel a foreign body sensation upon blinking, see your eye doctor because some lashes may have to be epilated.

Nutritional supplements are plentiful in the local vitamin store and which one is best for you will vary depending on age, medical condition and dietary habits. Lutein is a water soluble carotenoid that possesses anti-oxidant properties. Age related macular degeneration (ARMD) patients are particularly helped by the intake of additional anti-oxidants like Lutein. It is ingested orally and reached the target organs like the retina via the blood stream. The immediate benefit of Lutein is seen in the increase of macular pigment optical density. This improves visual function.

In addition, Lutein aids in the absorption of high energy, short wavelength light that has been shown to act as a catalyst to Macular Degeneration and cataracts. Since both the retina and the crystalline lens are vulnerable to oxidative damage, Lutein an anti-oxidant, is of particular benefit in preserving these structures and thus maintaining better ocular health and vision. The two foods that have the highest quantity of Lutein in them are spinach and kale.

Individuals who have deficiencies in the amount of macular pigment are especially helped by Lutein supplements. Patients with poor dietary habits are likewise encouraged to take Lutein. Visual function is improved rapidly upon consumption depending on the blood level of Lutein. Furthermore, since filtering high energy blue light increases contrast sensitivity, one can also expect an improvement there with additional levels of Lutein.

In short, young healthy individuals who eat well will probably not see many benefits with Lutein supplements. Since it is water soluble excess amounts will be excreted so there is no harm to taking extra amount. In patients who suffer from ARMD, cataracts and other ocular conditions who are older and eat poorly, Lutein supplements are of particular benefit. As always, consult your physician when taking any medications and supplements.

Contact lenses have been worn for many decades and have improved substantially over the years. Along with this change in lens technology has been a dramatic improvement testing and diagnostic capabilities. While many contact lens wearers do so with out incident, there are many perils that may inflict damage to the eyes that can result in devastating complications.

Proper contact lens fitting and follow ups should include not only the basic refraction, cornea readings and corneal health evaluation, but also corneal topography and endothelial cell count measurements. The topography examines the outer most layer of the cornea for irregularities, curves and pathology. The Endothelial cell count measures the actual cells in the inner most layer of the cornea. This layer is one cell layer thick and when damaged does NOT regenerate. Thus, proper care must be taken when considering both contact lens wear and any ocular surgery. The ECC evaluates the number of cells per unit area and the quality of the cells. In an otherwise healthy normal individual one would expect to see about 2400 cells per unit area and the actual cells should be uniform, regimented, equal in size and shape and similar in color. Any alteration in their appearance could indicate a negative change resulting in death to the cells and a gap in this cell layer. The endothelium has the responsibility of pumping water out of the cornea. Any damage to it will result in increased corneal swelling, thickness, glare and a decrease in correctable vision.

An ECC should be performed on all contact lens patients to make sure that this very important tissue component is functioning properly. Certain changes in the endothelium should result in major changes in contact lens wearing.

Polymegathism is a change in the cell size and appearance within the endothelial layer. Studies have suggested that Polymegathism demonstrates a compromise in the endothelial cell’s ability to pump water out of the cornea. This can, and often does result in corneal opacification (cloudy cornea). The etiology of the change is the increase of lactate in the cells, changes in PH, and an elevation in CO2. As a result, there is a decrease in cellular ATP and an increase in endothelial hypoxia.

The reason for these changes is often contact lens over wear, poor fitting contact lenses, and poor contact lens compliance. The resultant changes occur because the endothelium is over worked and breaks down under the stress. These cells appear as huge irregular cells and may number as few as several hundred per unit area in severe cases.

In patients with moderate to severe Polymegathism contact lens wear must either be completely terminated or substantially reduced to less then 10 hours per day. In addition, the only lens that would permit enough oxygen through to the cornea would be a high DK (allowing a good deal of oxygen) rigid gas permeable contact.

With regard to refractive surgery, this condition is a contra-indication. During the normal course of any corneal procedure there is a possibility of endothelial cell loss. Therefore, any corneal surgery that is not required must be avoided. In addition, future cataract surgery may pose a problem since there is always loss of endothelial cells during that procedure.

In summary, before wearing contact lenses a complete exam should be performed including an ECC to make sure that the entire cornea is healthy and that it is not being put at risk by wearing the lens. Of course the same rules apply prior to LASIK.