Houston Dry Eye Clinic

Unmet needs-By Kelly Nichols, O.D.

2012-01-22T09:04:00.000-08:00

Unmet Need in Dry Eye

A recent "Industry News" article in the AOA News (http://newsfromaoa.org/2011/11/06/new-allergan-survey-shows-48-have-dry-eye-symptoms/) caught my attention and continues to intrigue me. The article reports several very interesting facts indicating unmet dry eye need including: 1) Nearly half of all U.S. adults (48%) experience one or more dry eye symptom(s) regularly; 2) 19% of women age 55 and older have experienced dry eye symptoms for more than 10 years, 3) 69% who experience one or more dry eye symptom(s) have not visited a eye care professional to treat symptoms; and 4) of those who visited an eye care professional to treat their dry eye symptoms, 19% visited more than once before finding relief, and 22% reported that they still have not found relief.

My bottom line summary of this market research indicates that there is more unmet need in dry eye disease than likely any other ocular condition. Potential patients self-treat (with or without clinician), experience significant visual and quality of life issues due to dry eye, and have not found substantial relief from the condition. Therefore, ask about symptoms, examine for dry eye, actively manage dry eye and lid disease, and hopefully make a difference.

Chromagen Eyeglass Lenses

2012-01-10T20:44:00.000-08:00

In all my years of being an optometrist I have never given much thought to vision therapy. Many years ago at several meetings I saw a device known as a colorymeter. Kind of a funny looking device it was a plywood box with a light inside and several knobs outside.The premise was that as the patient looked into the box the doctor changed the color of the light shining on the reading material. I could not figure out how I would decide which lens to use. After many years, I once again came across the company. This time the promise was that the doctor would introduce each lens in front of the patient's eye demonstrating two choices and narrowing the possibilities from 16 to 8 to 4 to 2 to one. This lens was placed into a trial frame and the process is repeated in the other eye. Finally with the two lenses in place the patient reads with and without the glasses to see if there is any improvement. I have been amazed! Many individuals increased 50%.

For more information please look at the website:http://www.ireadbetternow.com/

3 D Movie Problems

2011-11-12T05:36:00.000-08:00

The Wall Street Journal (5/18, Valentino-DeVries) “Digits” blog reported that, according to the American Optometric Association, an estimated three million to nine million Americans suffer from vision issues which make it difficult or even impossible for them to view 3-D television shows and movies. While some people get eyestrainfrom watching 3-D films, others become dizzy, nauseated, and experience headaches. The AOA suggests that people having difficulty with 3-D films should see their optometrist for evaluation of possible dysfunction in their binocular vision.

Dry Eye...its complicated

2011-11-06T20:35:00.000-08:00

I have recently installed a device called a Tear Lab. I have the first unit in Houston and I intend to use it to monitor the success or failure of treatment for dry eye.

Here is a video. Not for the typical patient, but one that will educate you on the complexities of dry eye.

http://www.trbchemedica.com/index.php?option=com_content&task=view&id=100&Itemid=61

Benefits of Being Vegetarian

2011-08-19T04:45:00.001-07:00

FROM CATARACT & REFRACTIVE SURGERY TODAY — 8/12/2011
MEDICAL STUDIES

Vegetarians may have a reduced risk of developing cataracts, according to a study in the American Journal of Clinical Nutrition.[1] Researchers at the University of Oxford in England studied the lifestyle characteristics of 27,670 self-reported nondiabetic participants aged 40 and older by using data from the Hospital Episode Statistics in England and Scottish Morbidity Records.

Participants were asked to fill out dietary surveys between 1993 and 1999, then their medical records between 2008 and 2009 were monitored to see if they developed cataracts. Almost 1,500 had cataracts during the follow-up period. The data showed that vegetarians and vegans were 30 to 40 percent less likely to develop cataracts than high meat eaters.

“There are many good reasons to follow a healthy diet and our study
suggests that lowering your risk of cataract can now be added to these,” lead author Paul Appleby, Senior Statistician, Cancer Epidemiology Unit at the University of Oxford, said in an email to Cataract & Refractive Surgery Today. “How far individuals move along the path towards a plant-based diet is a matter of personal choice.”

There was a strong relation between cataract risk and diet group, with a progressive decrease in risk of cataract in high meat eaters – those who ate 100 grams (3.5 or more ounces) daily -- to moderate meat eaters (1.7 to 3.4 ounces), low meat eaters (less than 1.7 ounces), fish eaters (participants who ate fish but not meat), vegetarians, and vegans, with risk ratios of 0.96, 0.85, 0.79, 0.70 and 0.60, respectively.

The study authors point out that eating meat does not necessarily promote cataract formation, rather it is vegetables that may have protective nutrients that lower cataract risk; and vegetarians may practice other healthy lifestyle behaviors that can contribute to a lower risk for cataracts.

“There was no obvious explanation of our findings in terms of specific nutrients. It may be that diet group is simply a better marker of a healthy diet than the intake of any given nutrient,” Mr. Appleby said.

1. Appleby PN, Allen NE, Key TJ. Diet, vegetarianism, and cataract risk. Am J Clin Nutr. 2011;93(5):1128-35.

2011-07-25T21:42:00.000-07:00

• Remura (Ista Pharmaceuticals, Irvine, Calif.) Remura is lowdose bromfenac, a non-steroidal anti-inflammatory drug; it’s currently available in Xibrom ophthalmic solution as a treatment for postoperative inflammation following cataract surgery. (Twice-daily Xibrom will be replaced by the newly approved oncea- day bromfenac product Bromday during the next few months.) Phase III trials of low-dose bromfenac as a treatment for dry eye are under way as of September 2010. Ista plans to conduct four randomized, doublemasked, placebo-controlled studies under a special protocol assessment agreed upon with the Food and Drug Administration; the studies will involve more than 30 sites in the United States. Two concentrations of bromfenac will be tested (both lower than Xibrom’s 0.09% concentration). To meet FDA guidance on drugs for chronic dosing, the company expects to conduct both a six-month and a 12-month safety study. According to the Ista website, the company hopes to report efficacy results by mid-2011.

Latest on Dry Eye

2011-07-22T22:57:00.000-07:00

I have always been interested in the treatment of dry eye. Over the years I have tried pretty much everything that has come along. I have tried artificial tears, steroids, Restasis, Azasite, Lacriserts. Lately I have been using some non-steroidal anti-inflammatory medications topically.

Actually getting excellent results. Hope to continue to help patients feel better with this really common condition.

Review of Ophthalmology > Targeting AMD with a Critical Carotenoid

2011-04-14T04:26:00.000-07:00

Review of Ophthalmology > Targeting AMD with a Critical Carotenoid

'Nutritional Boot Camp' more than weightloss program

2010-09-30T05:19:00.000-07:00

'Nutritional Boot Camp' more than weightloss program

Bifocals modestly effective in slowing myopic progression.

2010-01-19T21:26:00.001-08:00

January 11, 2010 — Bifocal lenses can moderately slow myopic progression in children with high rates of myopic progression after 24 months, according to new research published in the January issue of the Archives of Ophthalmology.

"Myopia is a common refractive problem, particularly in East Asia, where reported prevalence values in children can be as high as 50% to 60% by the age of 12 years. Prevalence of myopia is also high among Asian children living in Western countries," write Desmond Cheng, OD, MSc, PhD, formerly from Queensland University of Technology, Brisbane, Australia, and currently from Hong Kong Polytechnic University, Hong Kong, and colleagues.

"A number of well-designed prospective studies have investigated the effect of positive lenses, in bifocal or multifocal form, on myopic progression in children. However, bifocals and multifocals have proven to be relatively ineffective myopia-control treatments in children," the authors write.

Myopic progression rate appears to be an important factor in determining the effectiveness of multifocal lens treatment, the authors point out.

The aim of this study was to determine whether bifocal and prismatic bifocal spectacles could control myopia in children with high rates of myopic progression, defined as 0.5 diopters or more in the preceding year.

The study randomly assigned 135 Chinese Canadian children (73 girls and 62 boys) with myopia of at least 1.00 diopter to receive single-vision lenses (n = 41), +1.50-diopter executive bifocals (n = 48), or +1.50-diopter executive bifocals with a 3-prism diopter base-in prism in the near segment of each lens (n = 46).

The authors explain that their randomization was done by putting subjects' file numbers on slips of paper and drawing them from a container at random. In addition, subjects and the investigator were aware of the treatment assignments, as blinding was difficult to achieve because the lens treatments were visually very different.

The mean age of the children was 10.3 years (standard error [SE], 0.15 years), and their mean visual acuity was −3.08 diopter (SE, 0.10 diopter).

Myopic progression was measured by an automated refractor under cycloplegia, and increase in axial length was measured by A-scan ultrasonography at 6-month intervals for 24 months.

Of the original 135 children, 131 (97%) completed the trial at 24 months.

The results showed that myopic progression averaged −1.55 diopter (SE, 0.12 diopter) for children who wore single-vision lenses, −0.96 diopter (SE, 0.09 diopter) for those who wore bifocals, and −0.70 diopter (SE, 0.10 diopter) for those who wore prismatic bifocals.

Significant Effect of Lens Design

There was a significant effect of lens design on the degree of myopic progression (P < .001), the authors report. Compared with the single-vision lens group, the magnitude of mean myopic progression was −0.59 diopter (P < .001) in the bifocal lens group and −0.85 diopter (P < .001) less in the prismatic bifocal lens group.

The study also found that axial length increased an average of 0.62 mm (SE, 0.04 mm), 0.41 mm (SE, 0.04 mm), and 0.41 mm (SE, 0.05 mm) in the single-vision lens, bifocal lens, and prismatic bifocal lens groups, respectively.

The treatment effect of bifocals (0.59 diopter) and prismatic bifocals (0.85 diopter) was significant, with a P value less than .001, and both bifocal groups had less axial elongation than the single-vision lens group (0.21 mm; P < .001), the authors report.

The findings of this study could be generalized to children with rapidly progressing myopia, irrespective of ethnicity, although this clearly needs to be tested, the authors state.

Limitations of the study include the use of an atypical randomization scheme to assign subjects to treatment groups and potential bias because the investigator was not masked.

The authors concede that the treatment effect of bifocal and prismatic bifocal lenses of 38% and 55%, respectively, that they found in their study — although greater than those in other studies — is still modest.

"Whether or not the effect tapers off will decide clinical significance," they write. "If the treatment effects continued over time, then the treatment could have a significant role in preventing the development of very high pathologic myopia."

For now, they conclude, bifocals should be offered to myopic children "with caution" in clinical practice.

Dr. Cheng has reported no relevant financial relationships.

Arch Ophthalmol. 2010;128:12-19.

Male Myopes HIgher Retinal Detachment Risk

2010-01-14T08:25:00.001-08:00

TOP STORIES 1/13/2010Younger male myopes have higher retinal detachment risk 4 years after cataract surgeryAm J Ophthalmol. 2009;149(1):113-119.
Younger age, male gender and increased axial length were associated with an elevated risk of retinal detachment 4 years after cataract removal and IOL implantation, according to a study.
Myopic eyes are especially prone to various ocular pathologies and postoperative complications. The prevalence of myopia among young people has increased to about 10% to 25% in Western nations and 60% to 80% in Eastern nations, the study authors said.
"Inasmuch as the World Health Organization reports myopia as the leading cause of visual impairment, myopia-related complications remain an important concern for ophthalmologists," they said. "Myopia is a proven significant risk factor for [retinal detachment] after cataract extraction."
The prospective cohort study included 9,388 patients who underwent extracapsular cataract extraction with phacoemulsification and IOL implantation in Taiwan between August 1999 and December 2001. Mean patient age was 65.96 years. Mean follow-up was 79.21 months.
Axial length was less than 23 mm in 4,445 eyes (47.34%), 23 mm to 26 mm in 4,394 eyes (46.8%), and 26 mm or more in 549 eyes (5.85%).
Study data showed an overall cumulative 8-year retinal detachment rate of 2.31%. The mean length of time between cataract removal and retinal detachment diagnosis was 40.6 months. Male gender, age younger than 50 years, history of retinal detachment in the contralateral eye and phacoemulsification correlated with retinal detachment risk; the associations were statistically significant (P = .01, P = .002, P = .005 and P = .013, respectively).
In addition, eyes with axial length of more than 26 mm had a significantly higher risk of pseudophakic retinal detachment than eyes with axial length of 23 mm to 26 mm (P = .0003). A late increase in the risk of retinal detachment was highest among male patients with high myopia.
"Although we did not have data about the characteristics of [retinal detachment] in our study, we speculate that anomalous posterior vitreous detachment developed years after cataract extraction and caused the late wave of increased risk for pseudophakic [retinal detachment] in our results," the authors wrote. "However, this speculation could not explain the lack of late increase in females."
Patient education and prophylactic treatment are critical for managing risk factors, they said.

Resveratrol may assist those with Macular Degeneration

2009-12-12T06:20:00.000-08:00

Photos: For The First Time Researchers Show Reversal Of Earliest Sign Of Retinal Aging, Using A Resveratrol-Based Nutriceutical Matrix (Longevinex®)

The Office of Stuart Richer OD, PhD

11 / 30 / 2009

NORTH CHICAGO, Ill., Nov. 30 /PRNewswire/ -- Using a high-output camera to film the back of the human eye, for the first time researchers have shown that a resveratrol-based (rez-vair-ah-trawl) nutriceutical matrix can effectively remove cellular debris from the human eye that accumulates with advancing age and correlated this with significant improvement in visual acuity and night vision in an 80-year old man. Resveratrol is widely known as a red wine molecule.

To view the Multimedia News Release, go to: http://multivu.prnewswire.com/mnr/longevinex/41407/

The accumulation of cellular debris in the retina is believed to be the first detectable sign of retinal aging.

Dr. Stuart Richer OD, PhD, Chief, Optometry Section at the Veterans Medical Center in North Chicago, in a report entitled "Molecular Medicine in Opthalmic Care," published in the December 2009 issue of the journal Optometry, says this may be the first time an intervention has been documented to reverse aging changes in a human retina.

The patient, an 80-year old male, came to the eye clinic complaining of loss of night vision. Commonly prescribed nutriceuticals, such as lutein, vitamin E and fish oil were employed with no positive result.

After 5 months on the dietary supplement regimen, five measurable parameters of vision improved to varying but significant degrees including night (contrast) vision, visual acuity, color and side vision. Upon testing, it was also found the patient also experienced improvement on a survey of mental tasks. The patient said, "My night vision and thinking have gotten much better."

The underlying cause

A broad body of evidence exists to assert the claim that the human eye and all other organs in the human body "rust and calcify" with advancing age. Dr. Richer prescribed a nutriceutical matrix (Longevinex® -pronounced long-jev-in-ex) designed to remove excess intra-cellular minerals by a process called chelation (key-lay-shun), particularly calcium, iron and copper, that build up in retinal tissues over time.

About lipofuscin

Dr. Richer explains that the retina of the eye begins to show signs of retinal aging, usually beginning in the third decade of life, with the progressive accumulation of lipofuscin, the medical term for cellular "garbage" that pollutes cells as they age. Researchers believe lipofuscin is not an innocent bystander -- that it generates free radicals, gene mutations and even cell death.

Molecular medicine

The use of natural iron-chelating polyphenolic molecules, such as resveratrol, quercetin and rice bran employed in this case, has been proposed as an intervention that addresses a wide range of age-related changes in the brain, eye and blood vessels. These molecules work by their mineral chelating (key-lay-ting) properties.

Older patients can't wait for a cure

Dr. Richer says this case may serve as an early example of the potential for molecular medicine to make an impact in eye care. "While only one case, these patients do not have time to wait for controlled long-term studies and 'best available evidence' needs to be employed, given there are no foreseeable side effects or undue cost."

While Dr. Richer says this is not a proven cure yet, he thinks modern medicine may soon be able to prevent the onset of aging changes in the retina decades before vision is lost. He says prevention is the best approach.

The future

If this paper foretells what is to come, young adults may soon be able to obtain a non-invasive retinal/lipofuscin assessment many decades prior to the development of aging changes in the retina and then later utilize oral mineral chelators to promote a healthy retina.

Furthermore, it becomes evident that by measuring lipofuscin deposits, that not only the biological age of the human eye can be assessed apart from its chronological (calendar) age, but that lipofuscin measurement may serve to help determine the biological age and the "speed of aging" of the entire body.

Lipofuscin accumulates in all tissues of the body with advancing age. System-wide, age-reversing effects could also be estimated in this non-invasive manner. With this discovery optometry offices may soon become anti-aging centers.

Dr. Richer has no financial interest in the product. Resveratrol Partners LLC, makers of patent-pending Longevinex®, provided the nutriceuticals for this patient. To learn more, visit www.eyedoctorricher.com.

Pycnogenol improves acuity in Diabetics

2009-12-12T05:55:00.000-08:00

Study Shows Pine Bark Improves Circulation, Swelling And Visual Acuity In Early Diabetic Retinopathy

MWW Group

12 / 02 / 2009

Research reveals Pycnogenol is effective in visual improvement in subjects

(Dec. 2, 2009) – HOBOKEN, NJ – According to the National Institute of Health, 40 percent to 45 percent of Americans diagnosed with diabetes already have some stage of diabetic retinopathy. Diabetic retinopathy, damage to the retina caused by leaky blood vessels, is a major cause of blindness in people with diabetes and is one of the most feared diabetic complications. In fact, up to 80 percent of all patients who've had diabetes for 10 years or more will experience some form of diabetic retinopathy.

A recent study published in the Journal of Ocular Pharmacology and Therapeutics reveals Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, can improve microcirculation, retinal edema and visual acuity in the early stages of diabetic retinopathy.

"Previous research has shown that Pycnogenol® may reduce the progressing advanced stages of diabetic retinopathy," said Dr. Robert Steigerwalt, a lead researcher of the study. "While previous studies focused on the latent stages of diabetic retinopathy, the aim of this new study was to show the protective effects of Pycnogenol® in the early stages of this growing diabetic complication."

The randomized controlled study, conducted by G D'Annunzio University in Italy, investigated a total of 46 diabetic patients over a period of three months. The Pycnogenol® treatment group consisted of 24 patients, with 22 patients placed in a placebo treatment group. Each of the patients had been previously diagnosed with diabetes for at least four years prior to participating in the study and their blood glucose was well controlled by diet and oral anti-diabetic medication. Patients had early stage retinopathy characterized by capillaries in the eye leaking fluid into the retina causing swellings. At this stage only minor bleedings into the retina occur and damage to light-sensing cells may still remain largely reversible.

Subjects were treated with three 50 mg Pycnogenol® tablets (total 150 mg. of Pycnogenol®) or placebo tablets in the morning after breakfast over a period of three months. Following treatment with Pycnogenol®, the major positive observation of this study was visual improvement, which was subjectively perceived by 18 out of 24 patients in the Pycnogenol® group. Testing of visual acuity using the Snellen Chart (the standard eye chart used by eye care professionals to measure visual acuity) showed a significant improvement from baseline 14/20 to 17/20 after two months of treatment with Pycnogenol®. There were no improvements found in the control group.

The retina is considered swollen when the diameter of the macula exceeds 500 micro meters and treatment with Pycnogenol® significantly decreased the swellings below that level, as judged by the high resolution ultrasound imaging used in the study. Furthermore, the blood flow velocity in capillaries nourishing the light sensing cells improved. The authors suggest that both effects account for the improved vision of patients. In the control group, retinal edema was not relieved, blood flow velocity remained unaffected and no visual improvements occurred.

In contrast, all 22 subjects in the control group maintained the same diabetic macular swellings as they were diagnosed with at the beginning of the study.

"Pycnogenol® has been intensively investigated for decades to stop the progression of diabetic retinopathy and help patients to maintain their remaining eye sight," said Dr. Steigerwalt. "Our study suggests that Pycnogenol® taken in the early stages of retinopathy may enhance retinal blood circulation accompanied by a regression of edema, which favorably improves vision of patients. Pycnogenol® may be particularly beneficial for preventing this complication in diabetic patients, based on the large number of individuals who were diagnosed when the disease had already significantly progressed."

Over the past decade, numerous studies have been published on Pycnogenol's® health benefits for people living with diabetes. Most notably, research results on five clinical studies with over 1,000 diabetes patients showed that Pycnogenol® has the ability to seal leaky capillaries in the eye. This capability impedes the progression of vision loss in patients suffering from diabetic retinopathy.

###

About Pycnogenol®

Pycnogenol® is a natural plant extract originating from the bark of the maritime pine that grows along the coast of southwest France and is found to contain a unique combination of procyanidins, bioflavonoids and organic acids, which offer extensive natural health benefits. The extract has been widely studied for the past 40 years and has more than 220 published studies and review articles ensuring safety and efficacy as an ingredient. Today, Pycnogenol® is available in more than 700 dietary supplements, multi-vitamins and health products worldwide. For more information, visit www.pycnogenol.com.

Natural Health Science Inc. (NHS), based in Hoboken, New Jersey, is the North American distributor for Pycnogenol® (pic-noj-en-all) brand French maritime pine bark extract on behalf of Horphag Research. Pycnogenol® is a registered trademark of Horphag Research Ltd., Guernsey, and its applications are protected by U.S. patents #5,720,956 / #6,372,266 and other international patents. Horphag Research Ltd. Is the recipient of the 2008 Frost & Sullivan North American Health Ingredients Excellence in Research Award. NHS has the exclusive rights to market and sell Pycnogenol® in North America and benefits from more than 35 years of scientific research assuring the safety and efficacy of Pycnogenol® as a dietary supplement. For more information about Pycnogenol® visit our Web site at www.pycnogenol.com.

Skipping Sentences While Reading

2009-12-12T05:09:00.000-08:00

Many of my patients report that while reading they have to follow along with their finger or they will find that they are skipping lines. Usually they have had many eye examinations during their lifetime. Seldom has any doctor asked this question. They are almost universally surprised that something can be done to assist them in this problem. We test all of our patients for a condition called a vertical phoria. In this condition we find a clear misalignment of the eyes. Almost every patient has a small degree of misalignment in a horizontal plane. Those who have a misalignment in the vertical plane will complain that they have difficulty following along a line and moving to the next line. There is of course an underlying problem which is patient posture. Patients with this problem often lean to one side while sitting in the exam chair. I point this out to my patients, but I also point out that I am not a chiropractor or alignment specialist. What I can offer the patient is a special lens which allows the image to focus on corresponding points in the eye. There is no visible difference in this lens which is known as a vertical prism, but the patient usually notices an immediate improvement in the clarity of reading material and an improvement in their ability to read along without skipping lines. It would of course be in the patients best interest to improve their actual posture, but as this is not my specialty, I am limited to assisting them in simply seeing better. There is real help utilizing postural therapy, but I will not go into that in this blog. If you or someone you know suffers from the inability to follow along a line I would be pleased to have you contact me with your questions or comments.

Treatment for Red Eyes

2009-12-09T06:06:00.000-08:00

Do you have a red eye? Have you been told that its just "pink eye" and that nothing can be done about it. I hear this comment every day in my office. "I thought if I left it alone, it would get better." "Its just my allergies." All of these comments may be correct, but in some cases a red eye can linger for weeks or months. In my office, I am proactive in treating red eyes. Whether they are caused by bacteria, virus, dry eye or even allergies, I feel it is important to assist patients in achieving a satisfactory outcome.

Houston Dry Eye Clinic

Unmet needs-By Kelly Nichols, O.D.

Chromagen Eyeglass Lenses

3 D Movie Problems

Dry Eye...its complicated

Benefits of Being Vegetarian

FROM CATARACT & REFRACTIVE SURGERY TODAY — 8/12/2011 MEDICAL STUDIES

Latest on Dry Eye

Review of Ophthalmology > Targeting AMD with a Critical Carotenoid

'Nutritional Boot Camp' more than weightloss program

Bifocals modestly effective in slowing myopic progression.

Male Myopes HIgher Retinal Detachment Risk

Resveratrol may assist those with Macular Degeneration

Photos: For The First Time Researchers Show Reversal Of Earliest Sign Of Retinal Aging, Using A Resveratrol-Based Nutriceutical Matrix (Longevinex®)

The Office of Stuart Richer OD, PhD

Pycnogenol improves acuity in Diabetics

Study Shows Pine Bark Improves Circulation, Swelling And Visual Acuity In Early Diabetic Retinopathy

MWW Group

Skipping Sentences While Reading

Treatment for Red Eyes

FROM CATARACT & REFRACTIVE SURGERY TODAY — 8/12/2011
MEDICAL STUDIES