2008年5月23日星期五

The eye and vision errors

The parts of the eye. Indicated are the conjunctiva, sclera, choroid, optic nerve, retina, chamber angle, lens, cilary body, vitreous humor, aqueous humor, iris, pupil, cornea. The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye's imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In LASIK surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

(See the animation of the LASIK procedure and what should I expect before, during, and after surgery.)

Other types of refractive surgery
Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser. Later, LASIK was developed. The same type of laser is used for LASIK and PRK. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Another type of refractive surgery is thermokeratoplasty in which heat is used to reshape the cornea. The source of the heat can be a laser, but it is a different kind of laser than is used for LASIK and PRK. Other refractive devices include corneal ring segments that are inserted into the stroma and special contact lenses that temporarily reshape the cornea (orthokeratology).

What the FDA regulates
In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices such as the lasers used for LASIK. Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once the FDA has approved a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved device for other than its FDA-approved indication is called "off-label use." The FDA does not regulate off-label use or the practice of medicine.

The FDA does not have the authority to:

* Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
* Set the amount a doctor can charge for LASIK eye surgery.
* "Insist" the patient information booklet from the laser manufacturer be provided to the potential patient.
* Make recommendations for individual doctors, clinics, or eye centers. FDA does not maintain nor have access to any such list of doctors performing LASIK eye surgery.
* Conduct or provide a rating system on any medical device it regulates.

The first refractive laser systems approved by FDA were excimer lasers for use in PRK to treat myopia and later to treat astigmatism. However, doctors began using these lasers for LASIK (not just PRK), and to treat other refractive errors (not just myopia). Over the last several years, LASIK has become the main surgery doctors use to treat myopia in the United States. More recently, some laser manufacturers have gained FDA approval for laser systems for LASIK to treat myopia, hyperopia and astigmatism and for PRK to treat hyperopia and astigmatism.

Who Should Not Wear Contact Lenses?

Some of the conditions that may keep you from using contact lenses include

* frequent eye infections
* severe allergies
* dry eye
* a work environment that is very dusty or dirty
* inability to handle and care for the lenses properly

Most people who need vision correction can wear contact lenses. If you think they might be for you, talk to your ophthalmologist.

2008年5月16日星期五

Tips To Prevent Eye Infection

As tips to avoid eye infections, the doctors in Baharin, strongly suggested to avoid use of public swimming pools as they are a very common source to spread eye infections like eye flu or conjunctivitis. Also, they advise not to share the same face towels or flannels with the patients of the infected diseases.

However they assure the problem do not stay for long. As a suggestion to the affected people, doctors say the infected eyes should be washed with a warm solution of salt water and cotton wool, and one should remember to wipe the eyes from the bridge of the nose to the outer corner of the eye, and not the other way around. Doctors also suggest to use disposable paper handkerchiefs to wipe the eyes.
The tips from the doctors came as a response to the increasing number of eye infection cases in the country. Health Education director Dr Amal Al Jowder, says they receive many such cases these days. As suggestion to infected one, she said any antibiotic eye drops or creams, which are left over after the infection has cleared up, should be disposed off properly. Dr Al Jowder further said viral conjunctivitis is usually associated with the common cold and can spread rapidly between people. She also informs viral conjunctivitis, if not taken care of immediately, can affect the cornea, giving rise to a condition known as keratitis, and it can persist for several weeks. To conclude, she stressed the necessity to consult doctors for appropriate use of eye drop and to avoid any further problems.

Cataracts to be Treated Very Carefully

What are cataracts, and how are they diagnosed and treated, especially non-surgically?

A cataract is a clouding of the lens of the eye. To fully understand cataracts, it is important to understand the eye's anatomy.

The eye has several major structures: The outermost structure is the cornea, which is like the crystal on a watch. It is clear and protects the inner structures of the eye.

The iris, which is behind the cornea, is the colored part of the eye, and it regulates the amount of light getting into the eye. Just behind the iris is the lens. This is like the lens on a camera, helping to focus the light entering the eye onto the retina.

The retina lines the inside of the eye like film in a camera.

For a person to see well, all of these structures must be healthy.

Symptoms :

The symptoms of cataracts include blurry vision, difficulty seeing well enough to read and drive, seeing a great deal of glare and halos.

An ophthalmologist can diagnose cataracts during an eye examination.

Factors that increase a person's risk for developing cataracts include :

Age, a family history, smoking, diabetes mellitus, injury to the eye, chronic steroid use, radiation therapy near the eye and certain eye diseases.

Lens Implant :

One way to understand exactly what cataracts are is to compare the lens of the eye to a camera lens. If a camera lens were dirty or hazy, it would not take a clear a picture. The camera repair shop would remove the lens and put a new one in its place. This is similar to how cataracts are repaired. The eye's lens is surgically removed and replaced with a new, clear lens, called a lens implant.

Cataract Surgery :

In the early stages of cataract development, vision may not suffer significantly and cataract surgery is not necessary. Often as cataracts develop, changing the person's glasses prescription is all that is needed for good vision.

Cataract surgery is indicated only when the lens clouds so much that a person has difficulty reading or driving.

If you are told that you need cataract surgery but your vision is fine, be a little cautious and, perhaps, seek a second opinion.

Additionally, there is no such thing as emergency or urgent cataract surgery, so if a doctor tells you that you need surgery at once, you may want to get a second opinion, as well.

Surgery is the treatment for cataracts when they become significant. Maximizing glasses can help in the early stages; however, the use of vitamin and nutritional supplements and "cataract eye drops" has not been thoroughly studied, and none of those treatments seem to help very much.

The surgery has come a long way from the days when a patient was hospitalized for as long as two weeks. Today, it is performed on an outpatient basis, in an ambulatory surgery center. Preparing for the surgery takes most of the time. The patient receives multiple sets of eye drops, the eye is cleansed and the patient is given an IV.

The surgery is done while the patient is awake, but he or she may be mildly sedated with what is known as "twilight anesthesia." There should be no pain, and the operation takes about ten minutes. Shortly after the operation, the patient is able to go home.

2008年5月15日星期四

chind eye safety

In the 5- to 14-year-old age group, baseball is the number one cause of sports-related injuries.

Be aware of potentially dangerous situations at home and in school. Insist that children use protective eyewear when participating in sports or other hazardous activities.

Provide adequate supervision and instruction when your children handle potentially dangerous items, such as pencils, scissors, forks and penknives.

Be aware that even common household items such as paper clips, bungee cords, wire coat hangers, rubber bands and fishhooks can cause serious eye injury.

Avoid projectile toys such as darts, bows and arrows, and missile-firing toys.

Do not allow your children to play with non-powder rifles, pellet guns or BB guns. They are extremely dangerous and have been reclassified as firearms and removed from toy departments.

Keep all chemicals and sprays, such as sink cleaners or oven cleaners, out of reach of small children.

10 Most Essential Advices Your Eye Doctor Won’t Tell You

1. "I use my eye chart as a crutch."

Many optometrists (who provide primary eye care) and ophthalmologists (M.D.s who can perform surgery) are adapting shrewder business tactics to keep costs down and patient traffic brisk. For instance: Walk into any eye doctor's office and you're likely to see the trademark pyramid of letters that's at the heart of every eye exam. But some doctors use the eye chart as the main — or worse, only — component of an eye exam. Everyone raises their hand. But vision is more than reading the 20/20 line. It shouldn't be confused with healthy eyes. A full checkup should include a glaucoma test, a check for near vision (in which you look at a target within reading distance) and dilation of the pupil, so that the doctor can look at the back of the eye to detect cataracts or age-related diseases.

2. "Glasses are my cash cow…"

Since optometrists and ophthalmologists rarely hand over eyeglass prescriptions without prompting, most people don't know that federal regulation requires eye doctors to release them so that patients can comparison-shop for glasses. And why would they? In order to offset the high overhead of managing a practice, doctors and optical retailers may jack up the prices of glasses they sell from 50% to 80%, estimates Harold Koller, an ophthalmologist in Meadowbrook, Pa. "Some of my friends say the annual profit of having a dispenser in their office is between $25,000 and $50,000.

3. "…and contact-lens discounters are my enemy."

Contact lenses are another area where you can save a lot of money, given the chance. Mail-order distributors, discount chains and online retailers offer discounts of about 20%. And while some doctors will hand over the prescription if you ask, many don't have to: There is no federal law requiring doctors to release contact-lens prescriptions.

In this case, the concern isn't completely about profits. Contact lenses can be more problematic — poorly fitting or irritating — for patients than glasses; once a doctor hands over that paper, he loses not only a potential sale, but also control, says Peter Ferguson, a spokesman for the New York State Board for Optometry. "What if something goes wrong? Could this somehow be turned around [to blame the doctor] if the contacts are defective?"

4. "Your kid may not even need glasses."
In school yards across the country, "four eyes" is no longer an insult. Glasses are hot, and eye doctors are ready to cash in on the trend. According to Koller, outgoing chairman of the American Academy of Pediatrics' section on ophthalmology, children are more likely than adults to want glasses they don't need because "the people they idolize often wear glasses." (Blame that Potter kid.) But kids' glasses can run upwards of $300.

5. "I blur the truth about laser surgery."

Lasik — the procedure that uses a laser to correct vision by reshaping the cornea — is all the rage with patients and ophthalmologists alike, and it's easy to see why. In the 15 minutes it takes your doctor to zap a laser in both of your eyes, he earns enough to buy a ticket to Honolulu. According to John Pinto, president of an ophthalmic management-consulting firm in San Diego, the typical Lasik practice earns a 30% margin on a procedure that costs the consumer, on average, $1,200 per eye. Furthermore, he says, in any given market of 1 million people, there will typically be about five doctors dividing up an annual $8 million pie.

6. "I learned Lasik in four days."

Is four days enough time to learn how to operate on a patient's eyes? At least one Lasik course director thinks so. The following advertisement was found on EyeWorld.org, an online publication for ophthalmologists: "SUMMER SPECIAL!! Obtain Lasik skills in a four-day, complete training course and avoid the awful 'learning curve.'" Gabriel Child, director of the course in question, The Real Lasik Course, defends his program by saying that he has found no significant difference in complications between the procedures performed by newbies and those done by the teaching ophthalmologists.

7. "Surgery's wrong for you? Don't expect me to stop you."

To Erik Petersen, a 25-year-old artist from Prescott, Ariz., laser surgery seemed like the perfect solution: He had never liked glasses, and his persistent dry eyes made it hard to wear contacts. Surgery, however, did little to fix his vision. As the doctor worked on his left eye, Petersen felt a sharp pain "that freaked me out" so much that the doctor couldn't operate on the other eye. It was a blessing in disguise. With his left eye, he now sees massive halos over objects, and every morning it "feels like it's glued shut." And since his vision in each eye is now so different, contacts are his only option. Other patients who should think twice about Lasik: anyone who's had a herpes infection, a lazy eye, or severe myopia or astigmatism.

8. "Sterile equipment? Nope. But hey, we washed it."

Peter Brett, a 42-year-old oncologist in California, was horrified back in 2001 when he read an article from the San Francisco Chronicle about the eye center where he and his wife had both had laser surgery; supposedly, instead of sterilizing the surgical microkeratome blades, the clinic rinsed and reused them. Brett was so concerned that he and his wife were tested for Hepatitis B and C, as well as HIV. (All tests were negative.) In a settlement to an investigation brought by the Medical Board of California, the doctors in question admitted that the protocol was to rinse and reuse a blade on up to four eyes; the board concluded that the doctors departed from the standard of care and placed them on probation.

9. "Open your eyes and I'll be gone."

Ever heard of "co-management"? It's a controversial trend in eye care in which an eye surgeon can share postoperative checkups with an optometrist — who, in turn, gets a cut of the surgery fee. This arrangement sometimes makes sense for patients, especially those who live in rural areas and have had surgery far from home.

But it can also be disastrous, since the risk of complications — bleeding, infection or retinal detachment — are much greater in the first 10 days after surgery, says Alan Mendelsohn, president of Florida's Broward County Medical Association. "There's no other specialty in medicine," he says, "where a surgeon doesn't see his patients postoperatively."

10. "You're a guinea pig."

Eye care is one of the most rapidly advancing areas of science, and the benefits to patients can be life-changing. In fact, it's quite easy to find an eye doctor conducting a clinical trial of some new, experimental treatment. Devices that aren't approved by the FDA for any use, however, require informed consent from all patients. Unfortunately, when it comes to fully understanding the risks, patients are often in the dark.

Eye diseases-Cataracts

What is a cataract?

A cataract is a clouding of the normally clear lens of the eye. It can be compared to a window that is frosted or yellowed.


are you at risk
The most common type of cataract is related to aging of the eye. By age 80, more than half of all Americans either have a cataract or have had cataract surgery (per NEI). All persons 65 and over should be evaluated for cataracts through a comprehensive eye exam every one to two years.

Age is the most common risk factor. You may be at a higher risk of developing cataracts if you:

* Smoke
* Use steroid medications
* Suffered an eye injury
* Have diabetes
* Have had prolonged exposure to sunlight
* Are obese
* Are an alcoholic
* Have a family history of cataracts

If you have any of these risk factors, you should schedule an appointment with your ophthalmologists for an exam.

Cataracts are a common cause of decreased vision, particularly for seniors, but they are treatable. Your ophthalmologist can tell you whether cataract or some other problem is the cause of your vision loss and can help you decide if cataract surgery is appropriate for you.

LASIK eye surgery

LASIK eye surgery has become hugely popular in the last decade as a surefire way to get rid of glasses. However by middle age (soon after 40) most people (including LASIK treated patients) develops presbyopia, the inability to read or see things up close. In middle ages, even LASIK treated patients have to go looking for reading glasses.

Refractec Inc. is studying whether conductive keratoplasty, a radio wave treatment for presbyopia, can be used on people who have had Lasik so people never have to wear contacts or glasses.

A preliminary study presented last month at the annual meeting of the American Academy of Ophthalmology in Chicago showed no safety problems and satisfactory outcomes for near and far vision.

"There were no patients who were dissatisfied. There was a significant improvement in near vision, and their distance vision was unaffected," said Dr. Daniel S. Durrie, lead investigator of the study and an ophthalmologist in Kansas City.

Source: The Detroit News

Conductive keratoplasty is a very simple procedure that doesn't cut or remove anything unlike LASIK.