Eye Didn't Know!

Health Care Reform?

John Stossel interviews John Mackey, of Whole Foods Market, who provides a tested alternative to the  health care "reform" making its way through Congress. 

Unlike Congress's "reform", which, of course, will do nothing of the sort, John Mackey's Health Savings Accounts have been enthusiastically endorsed by his employees, have provided them with control over their health care spending, and have lowered costs.

The following video is part one of seven, which are all available by clicking on the You Tube logo in the corner of the screen.

How To Fix Health Care

Do you think more government is the solution to health care costs? 

Think about the cost of education, military, highways, and health care, which are all virtual government monopolies. Costs which have skyrocketed, with questionable quality. 

Now think about the rest of the economy. Computers, televisions, clothing, and for-profit medicine, such as lasik eye surgery. Costs have plummeted, and quality has increased exponentially. 

This is what happens when people are free to buy and sell as they please. Natural incentives encourage innovation, price-shopping, increasing quality, and lower costs. 

The following video explains succinctly, and clearly, how our government has mandated perverse incentives into the tax code and insurance laws which have created the monster which is today's health care, and three simple, common-sense solutions. 

Are these solutions discussed ANYWHERE in the proposed healthcare overhaul? Fat chance. 

Thanks to Dr. Maloney for contributing to this fine video.

 

Diabetic Eye Exams

This is a superb video from the American Academy of Ophthalmology. You should pass it along (by clicking the share button) to anyone with diabetes or anyone with a family member with diabetes.

Why do you dilate my pupils?

Did you know? Patients frequently ask why it's necessary to dilate the pupils during a complete eye examination. It's simple, really. Imagine the difference between looking into a room through a keyhole, and looking in through a large window. If you really want to get a good view inside the room, the large window gives a much more complete view.

Similarly, dilating the pupil enables the ophthalmologist to view the entire back of the eye. What are we looking for? There are hundreds of things that can go wrong inside the eye, (many of which have no symptoms). We're checking to see if everything is normal. We look at the optic nerve, the blood vessels, and the retina, including the central retina, called the macula. If you have a specific complaint, like floaters, or a family history of glaucoma, or blurred central vision, obviously we will pay particular attention to the part of the eye which is most likely involved.

Here is a diagram which shows the advantage of a dilated pupil. The diagram is incorrect, though. With a dilated pupil, and the proper equipment and technique, the entire back of the eye can be examined (including the periphery), not just the part shown in the diagram.

 

(courtesy of the National Eye Institute) 

Did you also know? In 1823, a Dr. Purkinje was the first to ever look inside a living human eye, when he devised the optics to do so. It was not until 1850 that another ophthalmologist, Hermann von Helmholtz, invented the ophthalmoscope independently and publicized his device that other doctors finally were able to look inside the eye and more accurately diagnose its conditions. Read more about the history of the ophthalmoscope here.

How the Eye Works

Did you know?  The average person has almost no idea how the eye works! When educating patients about their eye conditions, I routinely start from square one, and give them a quick overview of how the eye works. The simplest and most accurate explanation is that the eye is like a camera.

Light enters the camera through its lens, is inverted, and lands on the film (or digital sensor), where it can be processed into a picture.

Similarly, light enter the eye through the cornea (the clear window) and passes through the lens, where it is inverted. The light then lands on the retina, which is like the film in the camera. The signals from the retina travel through the optic nerve to the brain, where they are processed into a picture.

(image courtesy of the American Academy of Ophthalmology, with permission)

Did you also know? The pupil of the eye is like the aperture of the lens. In dim light, a photographer opens the aperture wider, letting more light in. Similarly, the pupil enlarges in dim light, letting more light in. In dim light, the photographer will choose a more sensitive film (or increase the sensitivity of the sensor). Similarly, the retina gradually adapts to dim light by becoming more sensitive to light (think of walking into a dim movie theater.)

So, are your eyes Nikon or Canon?

Using Eyedrops

Did you know? Patients are routinely prescribed eyedrops for a variety of conditions, including dry eye, infections, glaucoma, and for post-operative care. Few patients, however, are given instructions on how to instill their eyedrops. When asked to demonstrate how they instill their drops, few patients are able to perform drop administration reliably, which means that they may be receiving inadequate medicine, or may be spending too much on drops because the drops don't enter the eye on first attempt.

The sketch below shows proper technique. One stands in front of the mirror, pulls the lower lid down, and places one drop into the pocket formed. The drop does not need to be placed on the eyeball, and one drop is all that is necessary.

That's all there is to it!

(image courtesy of American Academy of Ophthalmology)

Did you also know? Closing the eyes gently for a minute or two after drop instillation may help increase its absorption into the eyes and keeping the medication out of the bloodstream.

Health Care Costs

Did you know? Imagine a restaurant where you don't pay for your food. Everyone else in the restaurant pays your bill. Imagine that none of the other diners pay for their food. You, and everyone else pay for their meal. Do a thought experiment as to what would happen to expenses at this restaurant. 

With everyone else paying for your food, you would likely indulge in the finest, most expensive food on the menu. As would everyone else at the restaurant. The restaurant would keep raising prices, as demand would keep rising. If all restaurants were forced to operate in this way, costs would explode, and dining would assume a greater and greater share of the nation's economy.

Do the same thought experiment with haircuts. Housing. Automobiles. Computers. Televisions. It is obvious that costs would rise in each situation.

Medical Care.

Oops, that situation today exists for most medical care.

Two historical events provided the incentives for this situation. In World War II, wage and price controls (never a good idea) were imposed. Employers wanted to reward their employees in other ways, so the government mandated that health insurance could be provided tax-free. Thus began the link between employment and insurance, and the incentive for insurance to become bloated, providing for more than just catastrophic illnesses and accidents, like insurance was designed to do.

Second, Medicare and Medicaid were started in the 1960s to provide "free" health care for seniors and the poor, thus creating the situation like the restaurant above. 

John Stossel, as usual, hits the nail on the head in this excellent video:

For a way out of this mess, John Mackey, president of Whole Foods Markets, provides these clear, economically sound solutions.

More Allergy Relief!

Did you know? In the past few months, more allergy relief eyedrops have appeared on the over-the-counter shelf. Previously, I wrote about Zaditor eyedrops, then Alaway. Both of these drops are formulations of ketotifen, a compound with anti-itch and anti-allergy properties, which actually works, has few side-effects, and no rebound redness or itching when it wears off.

Since then, four competitors have introduced their own brand: Refresh Eye Itch Relief, Visine All Day Eye Itch Relief, and more recently, Claritin Eye, and Zyrtec Itchy Eye Drops.

It is obvious that many of these drops are hoping to build on the brand-name recognition of their allergy pills. (the eyedrops are not the same ingredient as the antihistamine pills!)

All of these drops contain the same concentration of the same active ingredient, (ketotifen 0.025%) and as far as I can tell, the same inactive ingredients. Consider them identical, and shop by price.

In my comparison shopping, the Bausch and Lomb product, Alaway, is by far the least expensive. It comes in a 10 cc bottle, while all of the others come in 5 cc bottles.

All of these drops work much better than any previous over-the-counter allergy eyedrop, without the side effects like rebound redness. Please buy these products before buying any product which "gets the red out." (Those products can have rebound redness and irritation)

These drops were prescription-only until recently. I always recommend these before the prescription-only drops (like Patanol) because they work and are much, much less expensive (at least in the case of Alaway).

Did you also know?  One of the most effective treatments for itchy eyes is completely free! A washcloth with cold water is very effective at decreasing the itching of allergic eye problems.

Happy Birthday, Mary Cassatt

Did you know? Today is the birthday of one of my favorite artists, Mary Cassatt (1844-1926), an American Impressionist who exhibited in Paris at the original Impressionist shows, and was a close friend of Edgar Degas. She influenced many prominent American Industrialists to collect Impressionist art, which is one reason Impressionism is well represented in American museums today. Cassatt suffered from cataracts, and probably diabetic eye disease, and stopped painting entirely during the later years of her life. If you compare her later paintings with her earlier ones, the later ones suffer greatly from coarseness and lack of detail, which is why she stopped painting.

(self-portrait, courtesy of Wikipedia Commons and Metropolitan Museum of Art)

Did you also know? The San Diego Museum of Art has a lovely Cassatt work, Simone in a Blue Bonnett.

Longer, Thicker, Darker Eyelashes With Latisse®

Did you know? Latisse® is the new prescription medicine for growing longer, thicker eyelashes. Patients are already coming to my office and asking for it. The aesthetician in my office has been using it for a number of weeks and already reports a noticeable difference in her eyelashes.

Latisse® was developed because of a side-effect of a commonly used eyedrop for glaucoma. I can always tell if these patients are using their drops because their lashes are thicker and longer! Allergan decided to reformulate this medicine into a liquid which can be applied to the base of the upper eyelashes. In their clinical trial of 278 patients, 79% of patients noted thicker, longer and darker lashes at week 20 compared to 20% using a placebo. The majority noted improvement after two months. 

The eyelashes gradually return to their baseline appearance after discontinuing the medicine.

There is a theoretical side-effect of permanent darkening of the iris (the eye color), though this did not happen in the clinical trial, and is unlikely to occur if the medicine does not enter the eye. There is also the theoretical side-effect of reversible skin darkening, but this did not occur in the trial either.

Did you also know? Allergan, the makers of Latisse®, also make BOTOX® and Juvederm®. I enjoy using all of these products in my practice, and my patients enjoy looking younger, with a natural appearance.