I just returned from the American Society of Cataract and Refractive Surgeons Annual Meeting. It is a wonderful opportunity to meet with colleagues and leaders in my profession. This month I will be sharing exciting data presented by the US Navy which showed that modern LASIK is extremely safe with excellent visual results.
Patient Satisfaction Following LASIK – Update on the PROWL 1 & 2 Studies
LASIK is one of the most common elective surgeries in the USA with approximately 700,000 procedures performed annually. It is designed to correct nearsightedness, farsightedness and astigmatism. A rigorous 2 hour screening examination is performed in our office to determine whether a patient is a good candidate for the procedure. Despite it’s overall safety, many patients still fear the side effects of LASIK.
The PROWL studies used anonymous online patient questionnaires to collect data on patients’ visual and dry eye symptoms as well as their satisfaction with their LASIK results. PROWL 1 studied active duty sailors, and PROWL 2 a civilian population.
Both studies found patients reported improvement in both dry eyes and night vision symptoms such as halos compared to before their LASIK. PROWL 1 vision data showed 99% of patients were 20/20 or better at 6 months following surgery. The majority of patients (>96%) were extremely satisfied with their vision after LASIK.
In summary, the PROWL studies demonstrated that the vast majority of patients have excellent vision and satisfaction with their procedure following LASIK. Many of the symptoms patients are concerned about, including dry eyes and glare and haloing at night, are in fact improved compared to before LASIK in the majority of patients at 3-6 months following their procedure.
Source: Presentation of Dr. Elizabeth Hofmeister, US Naval Medical Center, ASCRS Annual Symposium and Congress, New Orleans LA May 2016
Michelle Akler, MD Akler Eye Center Sterling Heights & Dearborn
This is a very special edition of Akler Eye Center news. We are celebrating our 5th anniversary this month. It is hard to believe how quickly the years have flown by! I want to think everyone for their support and for the privilege of taking care of your most precious organ – your eyes!!
Cataracts are the commonest cause of worldwide blindness, affecting tens of millions of people. Cataracts are caused when the normally clear crystalline proteins in the lens begin to clump together, causing the lens to become cloudy, blurring of the vision. Currently the only treatment for cataracts is cataract surgery, where the cloudy lens is replaced by an artificial lens.
Dr. Zhang and colleagues studied a family with congenital cataracts (where cataracts are inherited and develop early in a family) and discovered that this family did not synthesize a compound called lanosterol, hence causing early cataract formation. Further, he gave eye drops containing lanosterol to 7 dogs with cataracts for 6 weeks, and all the dogs showed either partial or complete resolution of the cataracts.
This is very interesting early research on alternate cataract treatments. Future directions will focus on preparing for trials in humans with the hope that this type of treatment may be useful to prevent cataracts from forming.
Myopia, commonly known as nearsightedness, is the commonest reason children require eyeglasses, and it tends to progress rapidly in childhood. In the United States, 42% of the population is myopic, compared with 25% in the 1970’s. People with severe nearsightness (high myopia) are at higher risk for serious eye problems such as retinal detachment, macular degeneration, premature cataracts and glaucoma. Researchers in Singapore posed a question: what if there is a way to slow down the progression of myopia in children?
Dr. Tan’s group used several different concentrations of the eye drop atropine in children over a period of 5 years and analyzed the progression of myopia in these children. They found that the lowest dose of atropine (0.01%) resulted in the lowest level of nearsightedness over time with few to no side effects. The pupil dilation was less than 1 mm and there was no impairment of the near vision (a common side effect of higher doses of atropine).
This interesting study showed that low doses of atropine in children resulted in up to a 50% reduction in the progression of myopia. More studies will be needed to determine when it is safe to begin the treatment and for how long it is needed. Further, the exact mechanism by which atropine affects the progression of nearsightedness is not known.
Source: American Academy of Ophthalmology Annual Meeting, November 2015
I was contacted last month by Yahoo news regarding a new technology that allows patients to take a vision test and check for glasses via their home computer. The company, Opternative, was designed to create an easier way to obtain a prescription. The website asks several questions of the user, including age and general health questions, then asks you to measure 10 feet from the computer, which is where you stand when the vision exam is administered. Within 24 hours a licensed optometrist in your state dispenses a digital prescription for glasses.
The questions posed to me were: can a computer evaluate your eyes as well as a real doctor?
My answer – it depends.
The refraction exam when well performed detects nuances in the speed the patient answers and adjusts for squinting and lighting conditions, which the computer cannot do. Of course, the computer cannot administer a medical eye examination which screens for conditions such as glaucoma, dry eyes and diabetic eye disease.
At this point, while the concept is interesting and innovative, I still recommend having your eye examinations done by an eye care professional. A computer is simply not a substitute for a doctor.
Glaucoma is a condition in which the optic nerve is progressively damaged by elevated eye pressure and/or reduced blood flow to the optic nerve. It is a leading cause of blindness worldwide. One of the major risk factors for glaucoma development is advancing age – or as I like to tell patients – the longer you are alive the more likely it is to develop.
Metformin is a medication that is commonly used to treat diabetes. It is a drug that mimics caloric restriction; this class of drugs has been shown to reduce risk of other diseases associated with advancing age. A research team based at the University of Michigan decided to investigate whether patients on metformin have a reduced risk of developing glaucoma.
Over 150,000 diabetic patients over age 40 years with no history of glaucoma were studied. After 10 years, 4% of the patients developed glaucoma. The patients who were taking the highest dose of meformin had a 25% reduced risk of developing glaucoma compared to those who did not take metformin. The research team estimated that taking a standard dose of metformin (2 grams per day) for 2 years would reduced the risk of developing glaucoma by 21%.
This data applies only to diabetics as this was the population studied. Taking metformin to prevent glaucoma if you are not diabetic can cause complications such as low blood sugar. Further studies are planned to see if this result can be extended to non-diabetics and if oral metformin can prevent glaucoma progression in those with the disease.
Source: JAMA Ophthalmology, Association of Geroprotective Effects of Metformin and Risk of Open-Angle Glaucoma in Persons with Diabetes Mellitus. August 2015 pp 915-23
Recently, I was contacted by Health Magazine to comment on the safety of extended wear contact lenses. The trending story that prompted the interview was regarding a 39 year old man who wore extended wear contact lenses and woke one morning with eye pain and very blurry vision. He was seen by an eyeMD and was diagnosed with an infection of the cornea caused by Pseudomonas aeruginosa. This organism causes a severe, rapidly progressive ulcer in the cornea, the clear window on the front of the eye. Corneal scarring and reduced vision is the usual result despite treatment with antibiotics. The patient in question will likely require a corneal transplant to regain his sight.
The American Academy of Ophthalmology released a statement regarding extended wear contact lenses in 2013. Although the lenses are FDA approved for overnight use, studies have shown a 10-15% increase in corneal infection in these lenses compared to daily use lenses. Further, patients who wear these contact lenses are more likely to not properly take care of the lenses or remove them at the recommended intervals. Patients who choose these lenses must be properly educated about the importance of good hygiene and proper cleaning methods. Overnight lenses should be removed and not worn overnight once weekly. When I encounter patients who have been less than perfect with their contact lens regimen, I remind them that LASIK vision correction is safer than their current contact lens habits.
To read the full article in Health Magazine, visit this link.
Simplifying our patient’s postoperative cataract regimen with “Near Dropless” cataract surgery
When discussing cataract surgery with patients, I used to counsel that taking all of the eyedrops afterwards was the hardest part of the procedure. The eye drop regimen was confusing and expensive, requiring 3 different drops be taken four times daily for up to 4 weeks after cataract surgery. I am pleased to report that a new technique has allowed us to dramatically reduce the number of drops used after surgery.
TriMoxi is a combination of antibiotic (moxifloxacin) and steroid (triamcinolone) that is injected into the eye at the conclusion of the cataract surgery. Delivering this medication into the back part of the eye (vitreous body) allows prevention of both infection and inflammation after cataract surgery without the use of multiple eye drops.
This technique has been safe and effective for our patients. Our current regimen is to use only one non-steroidal anti-inflammatory drop for 3 days prior to surgery and 2 weeks after surgery. This has been especially well-received in our elderly population who previously would have had to rely on family members to administer their drops multiple times daily. Of course, inflammation may still develop in a small percentage of patients who would then require additional drops.
How Diet Can Prevent Age-Related Macular Degeneration
The National Institute of Health (NIH) conducted a landmark study called the Age-Related Eye Disease Study (AREDS) that followed nearly 5,000 patients for more than a decade. The patients’ dietary habits were examined as part of the research. Patients eating the highest amounts of leafy greens such as kale, collard greens and spinach had a 40% reduction in the likelihood of developing age-related macular degeneration (ARMD). Further, the same risk reduction was found in those patients eating fish high in omega-3 fatty acids such as salmon at least twice a week.
Lutein and zeaxanthin are members of the carotenoid family and are present in large amounts in leafy greens. These compounds are concentrated in the macula, the part of the retina needed for sharp central vision. Omega-3 fatty acids are present in the macula as well. Interestingly, for those of you wondering about carrots and eye health, no beta-carotene was found in the retina, debunking the myth that eating carrots is good for your eyesight.
In patients with macular degeneration, taking a supplement that contains lutein and zeaxanthin (AREDS-2 formula vitamins) reduces the risk of the macular degeneration progressing. There has not been a study that shows that omega-3 supplements prevent macular degeneration, although eating fish can.
In those patients without macular degeneration wanting to keep their eyes healthy, a diet rich in leafy vegetables and fish containing omega-3 fatty acids is recommended.
Source: The Relationship of Major American Dietary Patterns to Age-Related Macular Degeneration, American Journal of Ophthalmology, July 2014.
Akler Eye Center, Michelle Akler, M.D.
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I just returned from the annual meeting of the American Society of Cataract and Refractive Surgeons (ASCRS). One of my favorite parts of the meeting is the Innovator Session, where cutting edge research from around the world is presented. In this issue, I will share some of these exciting developments with you.
An Update From ASCRS
The Charles D. Kelman Innovator’s Lecture is named for the physician who created the original phacoemulsification machine; this device is the basis of modern cataract surgery. This year the lecture was given by an outstanding Japanese ophthalmologist, Shigeru Kinoshita, MD, PhD. The talk was titled “Novel Treatment Dimensions for Corneal Endothelial Dysfunction”.
The cornea is the clear window on the front of the eye. The light must pass through the cornea and the lens before focusing on the retina in the back of the eye. On the back layer of the cornea there are endothelial cells. The job of these cells is to pump water out of the cornea, thus maintaining its clarity. If there are not enough cells, the cornea becomes cloudy. Currently, the only way to replace corneal endothelial cells is with a surgery called a corneal transplant.
Dr. Kinoshita has developed a growth media for corneal endothelial cells in the lab that allows him to reproduce these cells. He has injected these reproduced cells into the eyes of human subjects, and the cloudy corneas became completely clear. He can reproduce enough cells from one donor cornea to treat 199 patients with cloudy corneas who would otherwise require a corneal transplant.
This represents an amazing development in the treatment of patients with Fuch’s Dystrophy and other conditions causing corneal blindness. I look forward to the technology being introduced in the US. Source: ASCRS Innovator’s Session, April 20, 2015
Akler Eye Center and the Community Dearborn Heights Spirit Festival Join Us June 10th, 10am – 2pm Canfield Community Center
Learn about your options for presbyopia treatments at our Detroit area eye surgery centers
When it comes to reading glasses, you do have options in Michigan with Akler Eye Center
Welcome spring! I hope the weather soon catches up with what the calendar is telling us! I did see a crocus on a walk the other day – always welcome after all that cold and snow! This month I’ll be sharing information about a new treatment for presbyopia – the loss the ability of our eyes to focus up close as we age.
One of the commonest eye conditions I discuss in the office is the blurry near vision that all of us experience at some point after age 40. This condition, known as presbyopia, is caused by the lens inside the eye becoming less flexible as we age. This creates difficulty seeing up close for near tasks including reading, using cell phones, and seeing computer screens clearly without reading glasses.
A thin ring-like device known as a corneal inlay is being investigated in the United States to reduce the dependence on reading glasses in presbyopic patients. The ring is called a KAMRA inlay and is 3 mm in diameter with a 1.6 mm hole in the middle. The device is implanted in the cornea, the clear tissue on the front of the eye in a 10 minute outpatient procedure. The inlay acts like a camera aperture, adjusting the depth of field so both near and far can be seen without wearing reading glasses.
KAMRA corneal inlay next to a contact lens
In a study of 507 patients with presbyopia, the ring was implanted and the patients were followed for 3 years. In 83 percent of eyes the patients were able to see 20/40 or better both at distance and reading. This is considered the standard for being able to read a newspaper and drive a vehicle without glasses. The device can be removed should complications occur.
The KAMRA and several similar devices are available in other countries such as Europe and Asia but are not yet FDA approved for use in the US.
Source: American Academy of Ophthalmology 118th Annual Meeting, October 2014
Michelle Akler, MD Detroit Area Presbyopia Surgeon