DR. JOSEPH DELLO RUSSO

According to an article from the July 2008 issue of Ophthalmology Times, Google has launched a new health site www.google.com/health designed to allow for patients to create pesonal online profiles, import medical records, learn more about health issues, search for doctors and hospitals. The Cleveland Clinic is a partner in this venture.

Marissa Mayer, Vice President of Search Product and User Experience at Google, said that “through our health offering patients will be empowered to manage their own records”.

After a health risk warning from Canadian authorities, Sandoz Canada (Quebec) has recalled its prescription timolol eye drop, regulatory agency Health Canada said on its Web site. The agency has warned consumers not to use Sandoz timolol ophthalmic solution in 0.25% and 0.5% strengths, noting some bottles may contain greater quantities of the active ingredient than is represented on the label. According to a local news report, potential adverse events include red eye, eye irritation, inflammation of the eyelids and/or cornea, drooping of the upper eyelid, double vision, dizziness, headache, abnormally slow heartbeat, abnormally low blood pressure, shortness of breath, difficulty breathing, and cardiac failure. Health Canada will continue to monitor the effectiveness of the recall being implemented by Sandoz, which plans to send a separate notification to doctors regarding the recall. To date, no adverse events have been recorded in Canada in association with Sandoz timolol, according to the news report.

Editor’s note: Timolol has been the most popular drop for glaucoma fro about 30 years. This notice does not state whether this alert restricts usage in the US. It will certainly be available again, since a simple adjustment of the concentration would seem easy to correct.

A new survey conducted by the New England Eye Institute (Boston) and Transitions Optical (Pinellas Park, Fla.) has found that only 5% of consumers are aware that ultraviolet (UV) exposure can cause damage to their eyes, the two organizations reported jointly in a press release. The study also found that more than half (57%) of respondents said they do not wear protective eyewear when in the sun for extended periods. Those surveyed said they spend about 3.5 hours outdoors daily, which represents an average of 1,000 of unprotected UV exposure per year. A total of 80% of respondents were aware of the risk of skin cancer associated with UV exposure, the organizations said.

President Bush vetoed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, last week. The House and Senate immediately voted to override the veto. The legislation provides for an 18 month “fix” by stopping the 10.6% reduction that was effective on July 1, 2008 and the 5.4% cut scheduled to take effect on January 1, 2009. It extends the June 2008 rates through December 31, 2008 and provides for an additional 1.1% update in 2009.

Editor’s note: A welcome relief for doctors and hospitals who find it difficult as of now to even meet their overhead. Cutting doctor fees will effect patient care, except congress does not realize this.

LASIK monovision is a viable and increasingly accepted method for correcting presbyopic and pre-presbyopic refractive surgery candidates, according to results from a recent study. In addition, crossed monovision, in which the dominant eye is corrected for near vision, may be applied successfully in suitable candidates.

“Although the overall success of monovision was good, patient selection is extremely important, as not every patient can adapt to monovision,” the study authors said. “Patients selecting monovision should also be aware that the reliance on one eye for distance vision makes an enhancement procedure more likely than if bilateral distance vision is chosen.”

Roger F. Steinert, MD, and colleagues retrospectively analyzed the preoperative characteristics and postoperative outcomes of 284 patients 45 years or older who elected to undergo LASIK to correct myopia or hyperopia. Subsequently, refractive success, functional success and patient enhancement rates were evaluated for patients treated with monovision correction. Of 284 total LASIK patients, 188 (67%) elected to undergo monovision correction and 96 (34%) chose bilateral distance correction.Editor’s note by Dr. Dello Russo: Monovision is the preferred choice if one can get adjusted. The only way to determine this before lasik is a trial with lenses prior to lasik. People with certain personalities, occupations and lifestyles are better candidates than others. If you see ads for “getting rid of reading glasses”, monovision is what it’s all about. I have mono myself.

Allergan will seek approval from the FDA to market an ointment that claims will lengthen eyelashes. Allergan announced on ASCRS Eyeworld’s website on June 16, 2008, that its use produced “significant growth” in recent trials.

Editor’s note: the first hurdle will be to prove to the FDA that this product does not harm the eye. The FDA will not easily approve its use since it’s simply for cosmetic use. It first must be shown to “do no harm”.

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.

“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.

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.

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.

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.

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.  

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.

As reported in the January journal of Ophthalmology Times by Dr. Talamo, a noted Boston Lasik surgeon, the no-blade or Intralase method of creating the flap in the first step of the lasik procedure is now becoming the standard of care in the industry.

Editor’s note: Dr. Dello Russo was the first Lasik surgeon to introduce the Intralase laser to the nation and beyond in February of 2002. It has been his “standard of care”.

As reported in the December edition of Ophthalmology Times and by Dr. Talamo of Boston, patients now have choices in the type of lens implant that they can choose to replace their clowded lens (cataract).

They used to have no choice. Surgeons had only a choice between brand names, not types of implants. Over the past few years there is a whole stream of implants that have emerged on the market, designed to not only give good distance vision but some near vision ability as well. Every lens supplier has its own patented “multifocal” implant. Now the doctor can adjust the choice according to a person’s individual needs.

Editor’s note: expect new varieties to not only address far and near vision, but also astigmatism.

As reported in the December edition of Ophthalmology Times, there is a general consensus that the incidence of dry eye following Lasik is decreasing, according to Dr. Maldonado, since surgeons are eliminating candidates who demonstrate some degree of dryness during Lasik evaluation.

Editor’s note: it is necessary to treat any dryness that a potential Lasik patient may have before Lasik. Many techniques exist, such as lacrymal plugs, drops (both lubricating and curative), ointments, etc…

As reported in the December edition of Ophthalmology Times, refractive companies are merging and/or being engulfed by giant companies, as for example Bausch and Loumb, Advanced Medical Optics, Wavelight, Alcon, and Allergan.

Editor’s note: We may be headed for a total of only three major companies in the refractive (Lasik) industry. Some feel that this will discourage the small start-ups that often introduce new technology. I personally do not agree. The ability of a start-up to eventually be bought up is encouraging to the small company, often strapped for cash to push a new technology all the way through R&D.

EyeWorld Week February 27, 2008

A study reported on the online web site of Eyeworld Educational Symposium, preschoolers with poorer unaided vision perform lower on developmental tests.

According to the study performed at Shiley Eye Center these same poorer-scoring children experienced an improvement when retested six weeks after being prescribed glasses.

These developmental tests are thought to be indicative of success in school. 

From a study that appeared in the Review of Optometry, February 15th, 2008.

Wine helps prevent cataracts? That is what a study by Dr.Paul Kopecki concluded after a five year study at Rekjavk Eye Center.
 
Researchers believe that regular consumption of red wine in moderation allows the French to counter-balance their fatty diets and live healthier lives, possibly living as much as ten years longer than others. The Rekjavk Study also indicated that moderate drinkers of red wine seem to be less prone to developing cataracts as well as retinal degeneration, which are both aging problems. Researchers believe that red wine contain antioxidents that are beneficial to a healthy diet.

One of the most discussed topics at the Eyeworld meeting in Mexico (February 2008) was presented by Drs. D. Koch, H. Wu, T. O’Brien and Robert Osher who explained that cataract surgeons now have greater choices when performing a cataract surgery. They can often customize lenses for the needs of the individual patient.

Not long ago the cataract (cloudy normal lens of the eye) was removed and replaced with a lens or an implant powered to focus for distance alone. Reading glasses were required for nearsightedness. New implants are now available, providing not only give distance vision but also some degree of reading ability. Also available are implants corrected for astigmatism, that would be left after conventional cataract surgery.

Editor’s note: as exciting as these new implants are, recently developed lenses have been used on people without cataracts but who have a prescription that is beyond the treatment range of Lasik. These “phakic” lenses are implanted in front of the normal lens. People who have had this lens implanted have been exceedingly happy within our practice, but this technology is still young.