Category Archives: Cornea

Ocular Manifestations of Ehlers-Danlos Syndrome

It’s hard to find a comprehensive source for the ocular problems experienced by patients with Ehlers-Danlos Syndrome.

Our practice continues to be sought out by patients for help in their quest for answers to the potential ocular complications related to Ehlers-Danlos Syndrome, such as dry eye syndrome and keratoconus, as a result, the number of patients we see with EDS grows rapidly.

Good Morning America Investigates LASIK Complications

Good Morning America reports that the American Academy of Ophthalmology states 90% of patients achieve 20/20 vision following laser vision correction.  What the AAO report does not address is that 20/20 does not mean that the patients have a good quality of visual acuity.  The Good Morning America Video (video at the end) interviews both satisfied and unsatisfied patients.  Some patients complain of a worsening of their dry eye symptoms, halos or shadows, glare or starbursting, poor night vision, reduced contrast or simply uncorrectable blurry vision.  The vast majority of the patients that have had LASIK or PRK are happy with the result.   However, laser vision correction is not reversible and some of the resultant problems from refractive surgery are not resolvable.

Options available to patients that are not happy with their surgical result, of course depend on the symptom.  Some of the options available to patients are:

Post Surgical Contact Lenses

These special contact lenses are available as soft contacts, as gas permeable lenses and as a combination soft/gas permeable.  Post refractive surgery contact lenses are usually used when a patients vision can not be corrected by additional surgery, glasses or regular contact lenses because their corneal surface has become slightly irregular or distorted.  The symptoms may include, blurry vision, halos and shadows.

Dry Eye Syndrome

The most common complaint following refractive surgery is dry eyes.  Most often the dryness improves two to six months following surgery.  Ocular dryness can also cause blurry vision.  Should the dryness not improve there are numerous solutions to improve patient comfort and it is worth seeking help from an eye doctor that is familiar with treating dry eye syndrome.

Glare and Poor Night Vision

Often glare, halos and night vision problems are due to large pupils and/or uncorrected refractive error.  Night driving glasses will usually help patients that are still a little nearsighted following refractive surgery.  Treating the glare is little more difficult.  Glare often improves with time, however a medication called Alphagan has been known to improve night glare symptoms by causing the pupil to constrict slightly.  Alphagan may contribute to the ocular dryness, however.

Know Your Vision Correction Options

LASIK and PRK are good procedures and can greatly improve one’s quality of life.  Prior to taking the refractive surgery plunge patients should thoroughly research their options.  In an upcoming article I’ll cover the alternatives to refractive surgery.

At Total Eye Care we offer all of the refractive surgery and non surgical vision correction options available and we pride ourselves on giving our patients an objective opinion of all of their choices.  It is important for our patients to be well educated on the pros and cons of each option so that they can make an informed decision.

Check out the video below from the Good Morning America’s investigation on LASIK, it offers a balanced report on refractive surgery.

LACRISERT® – an Option for Patients with Severe Dry Eye Syndrome

We now have LACRISERT® available in the office for the treatment of dry eye syndrome.  So far the results have been promising.  LACRISERT® is inserted inside your lower lid once or twice a day.  Lacrisert slowly releases supplemental tears to your eyes throughout the day.

Most patients have found that using the LACRISERT® once a day provides sufficient relief for most of the workday.  When the LACRISERT® has almost completely dissolved it tends to not stay trapped inside the lower lid, causing intermittent blurred vision.  A drop of artificial tears flushes out the last remnant restoring vision.

Please feel free to call the office to see if LACRISERT® may be an option for your dry eyes.

Another Possible Dry Eye Medication

In each of the previous two months I’ve written about new dry eye medications, Prolacria and RX-10045, that may receive approval in late 2010, thus I was not looking to write about another dry eye medication, however I write about new developments as I come across them so here it is .  In a recent study naltrexone hydrochloride, as an eye drop, restored corneal sensitivity and normalized tear production in diabetic rats.  Interestingly, the effect occured within an hour of administration and lasted for days.

Naltrexone hydrochloride or NTX, as it is known, is currently used in treating alcohol dependence. Low dose naltrexone (LDN) has some popular off label uses as well for auto immune diseases such as multiple sclerosis and fibromyalgia to name a few.

Studies using NTX to treat dry eye syndrome in humans can not be far behind.  It is also expect that NTX will also be studied to see if it can reverse the effects of diabetic retinopathy.

New Dry Eye Medication in Late Clinical Trials

Dry eyeInspire Pharmaceuticals announced that it has enrolled 450 patients in phase 3 of a clinical study that will compare the effectiveness of a new prescription medication in the treatment of dry eye syndrome.  At this time it is expected that the new medication, diquafosol tetrasodium ophthalmic solution 2%, will be marketed under the trade name, Prolacria.  Now that enrollment for phase three of the clinical trials has completed Inspire Pharmaceuticals expects to have results available in the first quarter of 2010.  The clinical trial will compare Prolacria with a placebo over a 6 week period.

This is great news for our patients that suffer from dry eye syndrome.  Rest assured that as soon as it is available we will let all of our readers know.

This great image of the dry eye is courtesy of Flicker user Sadisto’s, CC.

Study Shows UV Absorbing Contact Lenses Really Work.

Johnson & Johnson conducted a study using rabbits and concluded that UV absorbing contact lenses significantly reduced the UV induced changes in the cornea, aqueous humor (fluid in the eye) and the lens.  The study authors concluded that UV absorbent contact lenses were capable of protecting the cornea and crystalline lens of rabbit eyes from UV induced changes.

So the question is how does this affect humans?  There are a number of contact lenses on the market today that block most of the UV rays.  While we can’t guarantee that the results of the study would apply to humans we can generally infer that wearing this type of contact lens is beneficial for patients that spend a lot of time outdoors and do not wear sunglasses.

UV absorbent lenses do not protect our conjunctiva. The conjunctiva is the clear membrane that covers the blood vessels over the white part of the eye.  This is an important reason as to why UV absorbent contact lenses are not a replacement for quality sunglasses.  Excessive exposure to UV light on the conjunctiva is a leading cause for pterygia and pinguecula.  A pterygium is the fleshy growth that grows over the colored part of the eye, usually located at 3:00 or 9:00.  A pinguecula is the yellow bump on the white part of the eye, which is also located at 3:00 or 9:00.

While not a replacement for good sunglasses, using UV absorbent contact lenses, especially in children, is a good practice.

A New Dry Eye Medication Under Development

Resolvyx Pharmaceuticals announced promising results for patients that suffer from dry eye syndrome during Phase 2 of a new class of anti-inflammatory medications.  RX-10045, as it is now called, is a resolvin compound administered as an eye drop. In a 28 day study patients reported improved symptoms and the doctors reported a statistically significant improvement in the patients dry eyes.  The entire press release is available on the Resolvyx Pharmaceuticals website.  This is great news for patients that suffer from dry eyes.  This is one of many medications on the horizon for the pharmaceutical treatment of dry eyes.

FDA Promotes Proper Contact Lens Care

FDA Taking Steps to Improve Contact Lens Safety

The U.S. Food and Drug Administration is taking steps to improve contact lens safety by reminding consumers of the importance of following proper cleaning and storing procedures. Consumers who do not follow instructions for contact lens care and use increase their risk of serious eye infections that can lead to blindness.

To support proper cleaning and storage, the FDA has developed a new video on contact lens safety.  The video stresses the importance of emptying the solution out of the contact lens case after each use and using the rub-and-rinse method for added effectiveness.

Other important lens care tips include:

• Do not top off or reuse lens cleaning solution;
• Use a contact lens solution to clean, rinse, and then air dry contact lens cases after each use;
• Do not expose contact lenses or lens storage cases to any type of water or other non-sterile solutions.
• Replace your contact lens case at least every three (3) months

In early 2009, the FDA convened a workshop called “Microbiological Testing of Contact Lens Care Products,” in collaboration with several eye care professional groups, to develop consensus on test methods for evaluating contact lens solutions. Based on discussions from this workshop and from a 2008 meeting of the agency’s advisory panel for ophthalmic devices, the FDA is developing manufacturer guidance on potential labeling improvements for these products.

In its June 2008 meeting, the advisory panel for ophthalmic devices made specific recommendations for contact lens product labeling and directions for use, including adding a discard date on their products, in addition to the usual expiration date. The discard date is the date the solution should be thrown out after opening.

On May 19, 2009, the FDA’s Center for Devices and Radiological Health issued a letter to manufacturers of contact lens multipurpose solution products that include an option for cleaning without a step for rubbing the lenses. This letter informed these manufacturers of the panel’s conclusion that there is improvement in lens care when using a rub-and-rinse regimen as compared to a rinse-alone regimen, which omits the rubbing step. The direction to rub and rinse lenses, based on the advice of an eye care professional, has always been part of the labeling for multipurpose contact lens care products. More information on contact lens safety is available in a PDF.

Cool Technology – Stem Cell Treated Contact Lens Reduces Blindness

This is great stuff.  A contact lens was applied to a patient’s eye to treat a corneal problem, reducing the patient’s blindness.  Contact lenses will soon be used to administer allergy and glaucoma medications.  Our state legislature, here in Texas, last month approved eye doctors to fit the medication delivery contact lenses.  Optometrists and ophthalmologists will be able to begin fitting them when the FDA gives the new drug delivery contact lenses their final approval.  Check out the stem cell video below.   A medical school in Australia is pioneering this important technology.

Patients and Doctors at Total Eye Care Discuss Dry Eye Syndrome

Seeing patients with complications related to dry eye syndrome are a very common occurrence at Total Eye Care.  Last month we made this video about dry eye syndrome.  The video discusses how silicone punctal plugs are used to treat dry eye syndrome.  It ties in well with this post on the Eye Doc Blog a few months ago about what causes  dry eye syndrome.  Check it out and let us know what you think.