As reported in EYENET journal of the AAO, March 2008, the wearing of seatbelts dramatically lowers the risk of injuries in a car accident. Conversely airbags reduce total body injuries but a higher frequency of eye injuries with the impact of the airbag to the facial region.
Author Archives: Dr. Joseph Dello Russo
DO GLASSES MAKE OUR EYES WEAKER?
“EVER SINCE I STARTED TO WEAR GLASSES MY EYES GOT WORSE” – does not it sound familiar?
As Barbara Wright reported in Ophthalmology Times, May 15, 2008, people seem to think that wearing glasses when you are young makes your eyes worse, having to get stronger glasses from then on.
Dr. Dello Russo explains that nearsightedness is a progressive process. The average person who’s DNA determines that they are destined to become nearsighted will start to need them at around 8-9 years old. As the child grows so does the myopia which gets worse and hence the increasing need for ever-stronger glasses. This will continue until about the age of 20 when the prescription settles and becomes “stable.”
So, it is not the wearing of the glasses that makes one’s eyesight worse, but getting stronger glasses is just keeping up with the normal worsening of their myopic condition.
NEW TREATMENT FOR DRY EYES
As reported in Ocular Surgery News, Dr. Rapuano pointed out that a form of anti-microbial known generically as cyclosporine is a weapon in the long-term treatment of dry eyes. The brand name is RESTASIS. It is the only treatment available that actually results in the increase of volume of tears. It does not work right away – it takes about a few weeks and may to be used for months or longer in severe cases. The downside of Restasis is the delay in stimulating tears and the fact that it an expensive choice.
Editor’s note: Restasis has become a staple of long-term use against dry eye.
ISN’T LASIK SAFE?
This question was asked by the FDA Eye Panel which approved laser eye correction in 1996 following an extensive six year research.
In 1996 the FDA approved laser surgery as being both “safe and effective”. I was one of the FDA researchers who performed these very controlled studies for the FDA between 1990 until 2000.
When we started with the research the FDA’s definition of “effective” was that 80% of patients treated during the six year study had to achieve 20/40 vision. Our results were better than what the FDA required from us.
Like any new technology Lasik continued to get better with time and man’s ingenuity. Over the past 18 years Lasik evolved into an ever more successful and safer treatment. See the article “Lasik surpasses contact lenses in safety”. Well performed Lasik by an experienced surgeon on a good candidate is very safe, probably the safest surgery done today. These are undisputed facts in 2008.
A couple of months ago the FDA held hearings on the psychological complaints made by a few patients after undergoing Lasik. These effects were brought to the attention of the FDA by 141 persons who have had surgery in the distant past, in the early days of Lasik. Although the FDA is not accustomed to revisiting an already approved treatment, the FDA accommodated these unhappy people by setting up a meeting and listening to their complaints.
It turns out that there have been 10 million Americans and 16 million people worldwide who have had Lasik and so far only 141 people complained to the FDA, some claiming suicidal tendencies , obviously unrelated to Lasik. 141 out of 16 million people.
Although the FDA panel was impressed by the safety of present-day Lasik the FDA Panel listened to these complaints and recommended that further consideration is ought to be given concerning the quality of life after Lasik. The study which will hopefully reassure the public is to be held in 2009 by the august ASCRS and AAO, the two most prestigious ocular societies.
EDITOR’S NOTE: I see no harm in performing these studies which although are truly unnecessary may will help to reassure the public about the safety of Lasik. 141 out of 16 million lasiks? Pretty safe when done well in my opinion.
Since Lasik is not a product but rather a surgical service the quality of Lasik will vary with the surgeon, the Lasik center and lasers used. So there are degrees of safety and effectiveness. So a statement by me that “Lasik is safe” does not account for poorly done Lasik.
As a general rule, well done Lasik by a skilled Lasik surgeon an a good candidate is quite safe. Statistics show that only one in 10,000 lasiks will have significant a side effect. That is a startling statistic.
FDA PANEL SCRUTINIZES LASIK SAFETY DATA
Ocular Surgery News recently published an article covering an FDA panel which was held in Gaithersberg, MD to evaluate the safety of lasik – read it here: http://www.osnsupersite.com/view.asp?rid=28435. During the discussion, Dr. Donnenfeld said that Lasik is the “safest elective procedure”. I will follow up soon with additional information on Lasik safety.
CONTACT LENS WEARERS FACE A “GATHERING STORM” WITH THE RISE OF LENS-RELATED INFECTIONS
As reported at the ACVO annual meeting in Waikoloa, Hawaii, there has been an alarming rise in fungal infections among lens wearers. Causes may be related in part to lens solutions as well as poor hygienic care by patients. There is a large percentage of patients who suffer some loss of vision, nearly one third requiring a corneal replacement to restore sight.
The rise in fungus infections was noted first in 2005 by the CDC, and it is often associated with loss of sight.
Editor’s note: this report is consistent with a report issued by Dr Dello Russo in 2007.
ABOUT THE RISK OF KERECTASIA
At a recent meeting of the Council on Refractive Technology, Dr. Michael Twa discussed the most significant risk of Lasik, kerectasia.
Kerectasia was a little-known corneal disease, most often an inherited tendency which as one ages into their twenties and thirties leads to poor vision by a progressive worsening of the shape of the cornea, becoming thinner and malformed. It was a disease only rarely seen by cornea specialists.
We now know that with the blossoming of lasik some of these genetically predisposed patients can be made worse if they undergo Lasik. Lasik became very popular from about 1997-2004 with significant kerectasia patients made worse, speeding up the natural worsening that would normally only occur with age.
Since the average Lasik surgeon never saw kerectasia before, they were not aware that Lasik could speed up the genetic process, therefore a surprising number of Lasik people developed kerectasia, not right away but within 24 months.
The Lasik community did not become aware of this effect until about 2003. This has lead many surgeons to abandon Lasik and select PRK for patients.
The most important way of preventing Lasik patients from developing kerectasia is to identify those with a genetic tendency for kerectasia. Instruments in the 1990’s and early 2000’s simply were not sophisticated enough to identify all potential cases before surgery.
Editor’s note: Current instruments are able to identify abnormal corneas most of the time, but the surgeon must use his/her experience and judgment to interpret these tests.