Treating infections with Betadine

PRACTICE PEARLS From Ophthalmology 2008, presented by the University of California, San Francisco, School of Medicine, Beckman Vision Center, Department of Ophthalmology Educational Objectives The goal of this program is to improve the practice of ophthalmology. After hearing and assimilating this program, the participant will be better able to: 1. Recognize the causes of potentially treatable blindness in children and discuss the effectiveness of povidone iodine in its prevention. 2. Identify common ocular viral infections and manage them with appropriate diagnostic and therapeutic agents. 3. Summarize the recent trends in litigation involving refractive surgeries and employ actions and behaviors to avoid legal claims. 4. Implement effective strategies to manage the potential for itraoperative floppy iris syndrome in patients receiving medications such as selective α blockers. 5. Choose the appropriate treatment and duration of treatment for amblyopia. Faculty Disclosure In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, Dr. Abbott reported serving on the Board of Directors of OMIC, and Dr. Chang reported a consulting agreement with Advanced Medical Optics, Inc. Drs. Rutar, Margolis, and Horton, and the planning committee reported nothing to disclose. Acknowledgements Lectures for this program were recorded at Ophthalmology 2008, held December 12㪥, 2008, in San Francisco, CA, and presented by the University of California, San Francisco, School of Medicine, Department of Ophthalmology, Beckman Vision Center, San Francisco, CA. The Audio-Digest Foundation thanks the speakers and UCSF School of Medicine, Beckman Vision Center for their cooperation in the production of this program. Povidone Iodine for the Treatment of Bacterial Keratitis in Children  Tina Rutar, MD, Assistant Professor, Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California, San Francisco, School of Medicine  Epidemiology of childhood blindness: blindness occurs in 1.4 million children worldwide; untreatable in approximately one million (eg, retinal dystrophy, microphthalmus, cerebral visual impairment, optic atrophy or optic nerve hypoplasia); potentially treatable in 0.4 million (eg, corneal scarring, cataract, retinopathy of prematurity); regional and socioeconomic differences—primary causes in developed countries include retinal (retinopathy of prematurity), optic nerve (hypoplasia), and disorders of higher visual pathway (cerebral visual impairment); worldwide, bacterial corneal ulcers and scarring cause most avoidable childhood blindness (eg, 260,000 cases of blindness caused by scarring); predisposing conditions include trachoma, vitamin A deficiency, and ocular trauma; bacterial keratitis leads to corneal scarring and perforation Strategies to decrease blindness caused by corneal scarring: eliminate predisposing conditions; vaccinate against measles; encourage use of protective eyewear; educate to reduce use of harmful traditional medications; provide prophylaxis for ophthalmia neonatorum to all newborns Povidone iodine treatment for infectious keratitis: effective in preoperative preparation; in ophthalmology, also effective for postoperative prophylaxis, prevention of ophthalmia neonatorum, and treatment of bacterial conjunctivitis Clinical study: randomized double-blind controlled trial conducted in India and Philippines of 1.25% solution of povidone iodine vs ciprofloxacin or neomycin, polymyxin, and gramicidin (Neosporin); 172 patients (156 adults and 16 children) enrolled Pediatric participants: 7 randomized to povidone iodine and 9 to antibiotic arms; nurses administered drops every hour for first 3 days; later, medications tapered according to protocol Primary outcome measure: probability of cure depended on rate of cure (closed epithelial defect with minimal conjunctival injection) and time to cure; other measures included rates of improvement, worsening, and failure Results: 71% of children treated with povidone iodine achieved cure (vs 44% with antibiotics); cure or improvement seen in 82% of children treated with povidone iodine, compared to 89% with antibiotics; cure achieved in 6 days with povidone iodine vs 7 days with antibiotics; worsening on treatment observed in 1 child who received povidone iodine; 1 child failed treatment with ciprofloxacin Outcome: in study including all 172 participants, patients treated with povidone iodine did as well as those treated with antibiotics Other differences between children and adults: order of prevalence of bacterial species (ie, Pseudomonas, Streptococcus pneumoniae, and Moraxella in pediatric patients; Moraxella, Pseudomonas, and Streptococcus in adults); ulcer characteristics—pediatric patients had smaller stromal defects and hypopions than adults I have long treated my patient's eye infections with Betadine. It speeds up the treatment. I recommend this to all of my patients.

Increased tear osmolarity (salt concentration) causes eye surface inflammation

Increased tear osmolarity (salt concentration) causes eye surface inflammation

New research confirms elevated tear osmolarity (increased salt in the tears) causes dry-eye surface disease. In an article published this month in Eye & Contact Lens Luo, Li, Corrales and Pflugfelder demonstrate that ocular surface inflammation in dry eye is caused by elevated tear film osmolarity. Click HERE to read this important article.

Some had believed that there was a direct inflammatory attack on the eye surface independent of the decrease in tear production or increase in tear film evaporation that is characteristic of dry-eye disease. We now know this is untrue.

I had the opportunity to write an editorial on this paper that highlights the important treatment ramifications of this research. Click HERE to read this editorial.

New Dry Eye Treatment

Recently I have added a new device to my office. Its called the TearLab. http://www.tearlab.com/

So, I procured this item and thought to myself, of what use is such an item?

First I want to tell you that a great many patients who clearly suffer from symptoms of dry eye do not truly have dry eye. The tear lab clearly shows what patients have a lack of tears and what patients do not.

The only benefit I can see from the product would be if once measured, I could prescribe a new treatment and see a change. The change would need to be shown in a numeric fashion.

This device clearly does that. It is repeatable. I have also added a new drug to my formulary. It seems to clearly make a difference in dry eye patients. I will not go into what the drug is, but suffice it to say that it is much better than any other on the market. I hope to explore these novel treatments in greater detail in the future.

New Toyos Dry Eye Treatment Film

Unmet needs-By Kelly Nichols, O.D.

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

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

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.