Dr. Jay's blog

Strokes On The Rise Among Young, Middle-Aged.

2012-01-31T05:14:00.000-08:00

Strokes On The Rise Among Young, Middle-Aged.

The AP (1/31) reports that strokes "can happen at any age, even to children -- and they're on the rise among the young and middle-aged." Government data indicate that "nationwide, hospitalization rates for ischemic strokes have jumped by about a third among people ages 15 to 44 over the past decade."

Group Calls For Halt To Insurance Codes Switch

2012-01-27T06:48:00.000-08:00

Group Calls For Halt To Insurance Codes Switch.

The Hill (1/27, Pecquet) reports in its "Healthwatch" blog that the American Medical Association "has sent House Speaker John Boehner (R-Ohio) a letter urging him to halt a federal requirement forcing doctors to switch to new insurance codes in 2013," as it "will require doctors' offices to deal with some 68,000 codes, more than five times the current 13,000," and "cost medical practices anywhere between $83,290 and more than $2.7 million, depending on size." AMA CEO James Madara writes that the move will "create significant burdens on the practice of medicine with no direct benefit to individual patient care."

Modern Healthcare (1/27, Conn, Subscription Publication) reports that in Madara's letter , he said that "the timing of the transition 'could not be worse as many physicians are currently spending significant time and resources implementing electronic health records (EHR) into their practices.'" In addition, he "said more needs to be done to synchronize three key federal health information technology programs: those pertaining to electronic prescribing, the meaningful use of EHR systems and the physician quality reporting system."

Embryonic Stem Cell Treatment May Help Patients With Macular Degeneration

2012-01-24T05:42:00.000-08:00

Embryonic Stem Cell Treatment May Help Patients With Macular Degeneration.

The CBS Evening News (1/23, story 6, 3:00, Pelley) reported, "There is a new treatment for the leading cause of blindness in older people. The treatment uses embryonic stem cells and a study says that it shows promising results."

The Washington Post (1/24, Stein, Brown) reports that the treatment has "apparently" restored "some vision for at least one and possibly two women losing their sight to incurable forms of progressive blindness." Being that "the women were the first to volunteer for an experiment designed primarily to test the safety of injecting an embryonic stem cell therapy into people, scientists are being cautious."

The Los Angeles Times (1/24, Kaplan) "Booster Shots" blog reports that "the patients -- one with dry age-related macular degeneration and the other with a pediatric version of the disease called Stargardt's macular dystrophy -- were treated at UCLA over the summer. The therapy was developed by Advanced Cell Technology Inc., and the company funded the study."

USA Today (1/24, Vergano) reports that "surgeons...injected 50,000 cells each into one eye of" the "two women." The researchers found that, "four months after the injections, neither study patient had lost vision, as usually happens in progressive blindness, or showed signs of abnormal growth in their eyes, quelling fears associated with the cells that they could give rise to tumors." The "patient with Stargardt's macular dystrophy...saw demonstrably improved vision, while the other patient's improvement looked more ambiguous."

However, the Time (1/24, Szalavitz) "Heathland" blog reports that "experts said the improvement of the macular degeneration patient might be mostly psychological, because the vision in her untreated eye appeared to get better too."

The New York Times (1/24, B7, Pollack, Subscription Publication) reports, "The paper," published in the Lancet, "comes two months after the Geron Corporation cast a pall over the field by abruptly halting the world's first clinical trial based on embryonic stem cells - one aimed at treating spinal cord injury. Geron, which has not published results from the aborted trial, also said it would abandon the entire stem cell field." However, "the results reported Monday could help lift some of that pall."

CNN (1/24, Cohen) notes that the patients "had to take anti-rejection drugs for a short period so their eyes wouldn't reject the foreign tissue."

The Boston Globe (1/24, Conaboy) reports, "The patients were the first in trials that will study the use of the cells in 24 people. The researchers injected the first patient in a separate trial in Europe on Friday."

Bloomberg News (1/24, Frier) reports that "both patients have requested treatment in their other eye," according to Advanced Cell Chief Scientific Officer Robert Lanza.

According to MedPage Today (1/24, Smith), the researchers "reported that controlled differentiation of the cells resulted in a culture of retinal pigment epithelium cells that was 99% pure and, in animals, injection of the retinal cells was not associated with tumor formation or with any other safety issues." Also covering the story are the Wall Street Journal (1/24, Hobson) "Health Blog," the UK's DailyMail (1/24, Hope), BBC News (1/24, Roberts), the UK's Press Association (1/24), the National Journal (1/24, Fox, Subscription Publication), Reuters (1/24, Begley), the Financial Times (1/24, Cookson, Subscription Publication), WebMD (1/24, DeNoon), and HealthDay (1/24, Preidt).

Paperwork causes unintended distractions for physicians and nurses

2012-01-21T08:40:00.000-08:00

Paperwork causes

unintended distractions for

physicians and nurses

I admittedly snorted out loud when I read a New York Times article recently regarding
increased physician distraction due to electronic devices, especially with the advent of the
smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout
a typical work day.

There is no question that electronic devices distract physicians as the article pointed out. But that’s like complaining about a leaky faucet when there’s a flooded basement and a hole in the roof.

The bigger problem that should be mentioned is hospital bureaucracy which probably creates just as much if not more unintended distractions for physicians and nurses.

What many patients and lay public may not realize is that there is a ton of paperwork that goes into the care of a patient. Regulatory bodies like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that accredits hospitals have made it mandatory in many cases though I suspect hospital administration often carries it a step above and beyond what is truly necessary.

What all this “mandatory” paperwork means is that nurses are calling physicians all the time just so they can check a box on a form, and there are a lot of boxes to check.

Take a simple ear tube placement. A procedure that takes about 1-2 minutes to perform under sedation in the pediatric population.

It takes about 15-20 minutes to fill out all the nursing and physician forms (whether paper or electronic medical records). When the surgery actually begins, the nurse is too busy filling out even more forms rather than paying attention to the surgery. And when the surgery is already over, the nurse is still busy filling out forms.

Talk about distraction — a registered nurse has been relegated to being a mere secretary rather than helping (or paying attention) in the care of a patient.

I recently asked a nurse how much time they spent on actual patient care versus how much time filling out forms during a typical shift.

It saddened my heart when I was told 60-70% of a nurse’s time is spent on filling out forms and only 30-40% on actual patient care. This time disparity was not always true in years past.

Ask any physician how many times they get called during a typical day because some form or paperwork was not completed or needs completion or just remind to get it completed by nurses who themselves are the main individuals who suffer under the crush of mandatory documentation in a hospital setting.

It is irritating to say the least to get a phone call during the middle of an operation, say, dissecting a tumor off the facial nerve during a parotid cancer resection, by someone who wanted to remind me to sign off on a medication list on a patient I’ve already provided prescriptions for.

Another classic experience of mine was when the anesthesiologist had trouble intubating a patient who started to suffer a severe lack of oxygen. I was immediately called to the bedside and performed an emergency tracheostomy.

Of course, the nurse involved in the case immediately instructed me to stop performing the trach and to get consent as per the regulations. Heaven forbid we now can’t check that little box that states “consent obtained prior to surgery.” But in the interest of patient care, I did suggest that it would be better if the patient lived with an unconsented trach rather than die due to time spent obtaining consent.

Though electronic devices may be considered a “distraction” analogous to a mosquito buzz that comes and goes, one must not forget the avalanche of paperwork which is a much more pervasive and insidious distraction that deliberately takes attention away from the care of the patient. I understand the need for documentation, but at some point when the documentation itself dominates the majority of heathcare rather than the actual administration of care, there’s something fundamentally wrong going on.

It’s probably why medical missions are so gratifying to participating nurses and physicians, where 90%+ of the time is in actual patient care.

Christopher Chang is an otolaryngologist who blogs at Fauquier ENT Consultants blog.

Paperwork causes unintended distractions for physicians and nurses

2012-01-21T08:38:00.000-08:00

Paperwork causes unintended distractions for physicians and nurses

I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.

The bigger problem that should be mentioned is hospital bureaucracy which probably creates just as much if not more unintended distractions for physicians and nurses.

What all this “mandatory” paperwork means is that nurses are calling physicians all the time just so they can check a box on a form, and there are a lot of boxes to check.

Take a simple ear tube placement. A procedure that takes about 1-2 minutes to perform under sedation in the pediatric population.

Talk about distraction — a registered nurse has been relegated to being a mere secretary rather than helping (or paying attention) in the care of a patient.

I recently asked a nurse how much time they spent on actual patient care versus how much time filling out forms during a typical shift.

It saddened my heart when I was told 60-70% of a nurse’s time is spent on filling out forms and only 30-40% on actual patient care. This time disparity was not always true in years past.

It’s probably why medical missions are so gratifying to participating nurses and physicians, where 90%+ of the time is in actual patient care.

Christopher Chang is an otolaryngologist who blogs at Fauquier ENT Consultants blog.

Daily Aspirin Use May Double Seniors' Risk Of Wet AMD.

2012-01-06T05:54:00.000-08:00

Daily Aspirin Use May Double Seniors' Risk Of Wet AMD.

HealthDay (1/6, Mozes) reports, "Daily aspirin use among seniors may double their risk of developing" the "wet" form of "age-related macular degeneration (AMD), a significant cause of blindness in seniors," according to a study published in the January issue of the journal Ophthalmology. In fact, "daily aspirin use was associated with the onset of late-stage" wet AMD, "and to a lesser degree, the onset of early 'dry' AMD -- even after the researchers took into account age and a history of heart disease, which in itself is a risk factor for AMD."

Specifically, "late-stage 'wet' AMD was 2.22 times more likely among daily aspirin users (95% CI 1.61 to 3.05) in a" study population of 4,691 European seniors, MedPage Today (1/6, Phend) reports.

Medscape (1/6, Keller) explains, "More frequent aspirin use was associated with higher grades of AMD. One third of the individuals with wet AMD consumed aspirin daily compared with only 16% of control participants." Medscape adds, "Limitations of the study include its cross-sectional and retrospective nature, with the possibility of recall error about aspirin use and possible confounders," such as the fact that aspirin is found in many over-the-counter drugs that study participants might not have recognized as containing it. "In addition, there were no data on the doses of aspirin or the use of other antiplatelet or anticoagulant drugs" taken by study participants.

Studies Find Placebo Effect Works In Various Conditions.

2012-01-03T06:28:00.000-08:00

On the front of its Personal Journal section, the Wall Street Journal (1/3, D1, Wang, Subscription Publication) "In The Lab" reports a variety of research studies have shown that giving patients placebo, a sugar pill, seems to show a response in patients with conditions such as depression, fertility, asthma, and irritable bowel syndrome and may even be more effective than the actual treatment. The piece also notes that whether people know that they are receiving placebo or the drug does not seem to make a difference in response either, according to a study. Several studies have shown that a certain mind-set or belief concerning a person's body or health may influence improvements in their disease symptoms, which shows the relationship between mind and body.

Happy New Year

2011-12-29T05:19:00.000-08:00

Happy New Year from Drs. Miller and Miller.
Wishing all health and prosperity in 2012.
Please be safe.

Sodium-Potassium Ratio May Be More Important Than Total Sodium Intake

2011-12-29T05:17:00.001-08:00

Sodium-Potassium Ratio May Be More Important Than Total Sodium Intake.

The New York Times (12/26, D7, Brody, Subscription Publication) reported in "Personal Health" that research published in the Archives of Internal Medicine "found that while a diet high in sodium -- salt is the main source -- increases your risk" of heart disease, "even more important is the ratio of sodium (harmful) to potassium (protective) in one's diet." One of the study's authors, Dr. Elena V. Kuklina, a nutritional epidemiologist at the Centers for Disease Control and Prevention, said, "We controlled for all the major cardiovascular risk factors and still found an association between the sodium-potassium ratio and deaths from heart disease." The Times points out that "according to an Institute of Medicine report on sodium released last year, 'No one is immune to the adverse health effects of excessive sodium intake.'"

Merry Christmas

2011-12-22T11:28:00.003-08:00

Merry Christmas and happy holidays from Drs. Miller and Miller.
Please be safe.

Clinical Trial for Glaucoma Patients

2011-12-21T08:17:00.000-08:00

I am currently enrolling patients in a glaucoma treatment trial. Any patient treated for glaucoma, by meds - surgery - or both - is eligible.

If you or someone you know is interested, please call my office at 337-457-5277 and speak to Amy or Kelsey.

Drs. Miller and Miller

350 Moosa Blvd

Eunice, LA 70535

335-457-5277

Dirty Little Secret: Almost Nobody Cleans Contacts Properly

2011-12-14T12:42:00.001-08:00

People who wear contact lenses say they're diligent about keeping them clean. But press them for details, and it turns out that hardly anyone is doing it the right way.

"It's horrible," says Dwight Cavanagh, a clinical professor of ophthalmology at UT Southwestern Medical Center who surveyed contact wearers' hygiene habits. "It was like, 'Mom, I cleaned up my room.' If you go up on the second floor and open the door and look under the bed, what are you going to find?"

In a survey of more than 400 contact lens wearers, Cavanagh found that just 2 percent of them are following the rules for safe contact lens use. Chief among the sins is showering or swimming while wearing contacts, sleeping in them and using them longer than recommended before throwing them out.

People also commit "solution misuse," topping off the disinfectant solution in the case rather than starting afresh, and 47 percent of the people asked said they never replace their lens case, or only do so when the eye doctor gives them a new one at the annual visit. The research was published in the December issue of Optometry and Vision Science.

A separate new survey found that people have turned to beer, baby oil, Coke, petroleum jelly, lemonade, fruit juice, and butter as oh-so-wrong alternatives to contact lens solution. That was from an August 2011 survey in the United Kingdom by Bausch + Lomb, a lens solution manufacturer.

"Do you want to be one of those people who is going blind and it hurts like hell and you can't work for three months?" Cavanagh asked Shots. "Once you've got a serious eye infection going in your cornea, you're in trouble."

Eye infections caused by contact lenses are relatively rare; the risk ranges from 1 in 7,500 for hard-lens wearers to 1 in 500 for people who sleep in daily wear lenses. But multiply that by the 40 million people who put lenses in their eyes every day, and you can see why Cavanagh, a corneal surgeon who has to try to fix the damage, gets agitated.

"We see patients all the time with pseudomonas ulcers, gray green pus, they go blind," he continues. "We see amoeba infections from people showering in their contacts, going swimming in lakes. These infections are horrible."

OK, OK, you got our attention. Shots promises to no longer lick a contact lens before inserting. And showering or swimming with contacts is clearly a big no-no. That exposes eyes to Acanthamoeba, an organism that commonly lives in tap water and lakes. Some infections have involved contaminated contact lens solution, but other people have been infected by showering or swimming.

Medication For Ocular Hypertension May Reduce Glaucoma Risk.

2011-12-13T05:19:00.001-08:00

The Los Angeles Times (12/13, Stein) "Booster Shots" blog reports, "Medication to treat ocular hypertension may drastically cut the frequency of developing a common form of glaucoma," according to a study published in the Archives of Ophthalmology. Researchers randomized "1,636 people...to a group that received medical treatment for ocular hypertension or to a group that was observed. After following up with the groups for an average 7.5 years, the observation group was offered medication, and both groups were followed again for an average 5.5 years." Notably, the study authors "found that taking a topical medication to treat ocular hypertension for 10 years decreased the occurrence of primary open angle glaucoma by about 50% among all those at risk, including African Americans, who have a higher incidence of the disease than do whites."

Medicare To Pay For Obesity Counseling.

2011-12-01T09:00:00.000-08:00

USA Today (11/30, Kennedy, Hellmich) reports that yesterday, the Centers for Medicare and Medicaid Services (CMS) announced (pdf) that Medicare "will pay for screenings and preventive services to help recipients curb obesity and the medical ailments associated with it, primarily heart disease, strokes and diabetes." Specifically, the new "benefits will include face-to-face counseling every week for one month, then one counseling appointment every other week for the following five months for people who screen positive for obesity."

"Those who lose at least 6.6 pounds during the first six months will be eligible for once-a-month visits for another six months," CQ (11/30, Subscription Publication) reports. "The obesity service will be added to other preventive services offered without cost sharing under the health care law."

Reuters (11/30, Berkrot) quotes CMS Administrator Donald Berwick, MD, who said, "Prevention is crucial for the management and elimination of obesity in our country."

According to MedPage Today (11/30, Gever), "CMS, which first floated the obesity coverage plan last September, said it expects more than 30% of the Medicare population to qualify for the new benefit." However, "counseling must take place in a primary care setting such as a physician's office. It will not be covered when provided in skilled nursing facilities, hospitals, emergency departments, outpatient surgery centers, or hospices."

Higher, Lower HbA1c Levels Associated With Worse Outcomes In CKD With Diabetes.

2011-11-29T06:50:00.000-08:00

Higher, Lower HbA1c Levels Associated With Worse Outcomes In CKD With Diabetes.

MedPage Today (11/29, Neale) reports, "Among patients with diabetes and stage 3 or 4 chronic kidney disease, glycated hemoglobin levels that are too low are associated with worse clinical outcomes, just as are levels that are too high," according to a study in the Nov. 28 issue of Archives of Internal Medicine. "Higher glycated hemoglobin (HbA1c) levels at baseline were associated with greater risks of death, progression of kidney disease, new end-stage renal disease, cardiovascular events, and all-cause hospitalization (P<0.001 for all trends)." However, "for mortality in particular, an HbA1c level that was too low -- less than 6.5% -- also was associated with an elevated risk." An accompanying editorial "called for randomized controlled trials to better inform the discussion about the best approaches for managing risk factors in patients with advanced kidney disease."

Four Medications Linked To Most Emergency Hospitalizations For Older Americans.

2011-11-28T10:19:00.001-08:00

The New York Times (11/24, O'Connor, Subscription Publication) "Well" blog reported, "Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States," according to a study published in The New England Journal of Medicine. Researchers found that "just four medications or medication groups -- used alone or together -- were responsible for two-thirds of emergency hospitalizations among older Americans." The investigators looked at data from 58 "hospitals...participating in a surveillance project run by the C.D.C. that looks at adverse drug events."

The National Journal (11/24, Quinton, Subscription Publication) reported that the researchers found that "forty-six percent of hospitalizations involved medicines used to prevent blood clots; a single anticoagulant, warfarin, was responsible for one-third of hospitalizations, the report found. Another 25 percent involved diabetes medications, either insulin injections or medicines taken by mouth."

WebMD (11/24, Doheny) reported, "The researchers estimated that 265,802 visits to emergency departments for adverse drug events occurred from 2007 to 2009 for adults 65 or older." More than "a third of these visits, or nearly 100,000, required hospitalization." The investigators found that "unintentional overdose of medication was the most common reason, accounting for nearly two-thirds of hospitalizations."

Also covering the story were the Wall Street Journal (11/24, Martin, Subscription Publication) "Health Blog," Modern Healthcare (11/24, McKinney, Subscription Publication), HealthDay (11/24, Goodwin), MedPage Today (11/24, Smith), and Medscape (11/24, Lowes).

New Contact Lenses Under Development Stream Real-Time Images

2011-11-22T05:36:00.000-08:00

BBC News (11/22, Roberts) reports that according to research published in the Journal of Micromechanics and Microengineering, "a new generation of contact lenses that project images in front of the eyes is a step closer after successful animal trials." The new "technology could allow wearers to read floating texts and emails or augment their sight with computer-generated images, Terminator-style." However, the "crude prototype device can only work if it is within centimetres of the wireless battery," and "its microcircuitry is only enough for one light-emitting diode," BBC News explains.

Census Report: Nearly Two Million People In US At Least 90 Years Old.

2011-11-18T05:27:00.000-08:00

News that more Americans are living to be 90 years old was covered on all three network news broadcasts, as well as by several other print and online sources.

The CBS Evening News (11/17, story 7, 2:15, Pelley) reported, "The Census Bureau reported today that there are now nearly two million people in this country in their 90s."

NBC Nightly News (11/17, story 8, 0:45, Williams) reported that "the number of Americans aged 90 and older nearly tripled in the last three decades." ABC World News (11/17, story 7, 2:45, Muir) also noted the increase on its broadcast.

USA Today (11/18, El Nasser) reports, "The number of people living to age 90 and beyond...is likely to quadruple by 2050." However, "This burst in the number of oldest old puts extra pressure on elderly care programs, health care costs, retirement savings and Baby Boomers with the dual responsibility of caring for aging parents and unemployed adult children."

Also covering the story are the Los Angeles Times (11/18, Kaplan) "Booster Shots" blog, CQ (11/18, Adams, Subscription Publication), the National Journal (11/18, Quinton, Subscription Publication), the AP (11/18), HealthDay (11/18, Reinberg), the Milwaukee (WI) Journal Sentinel (11/18, Glauber), Reuters (11/18, Keiper), and the NPR (11/18, Memmott) "The Two-Way" blog.

Statistics Reveal Trends In US Birth Rates.

VA Reinstates Bevacizumab As Off-Label Treatment For AMD.

2011-11-10T05:33:00.001-08:00

Medscape (11/9, Waknine) reports, "The US Department of Veterans Affairs (VA) has announced the reinstatement of bevacizumab (Avastin, Genentech unit of Roche AG) as an option for the off-label treatment of wet age-related macular degeneration (AMD)." Going forward, "the VA will now allow one patient dose per manufacturer's vial of bevacizumab, with the caveat that patients be carefully screened before receiving treatment and be fully informed of the health risks associated with off-label therapy." Medscape points out that even though "ranibizumab (Lucentis) is specifically approved to treat AMD, bevacizumab has a similar method of action and has been employed by the VA to cut costs (at $50 vs. $2,000 per dose), despite concerns regarding the compounding of intravitreal injections from an intravenous product."

Studies: Increased Fluid Intake May Protect Kidneys.

2011-11-08T08:27:00.001-08:00

The New York Times (11/8, O'Connor, Subscription Publication) "Well" blog reports that "two large studies found a lower risk of long-term kidney problems among people who drink more water and other fluids daily." In the first study, published last March in the journal Nephrology, researchers found that among 2,400 people over the age of 50, "those who drank the most fluids, about three liters daily, had a 'significantly lower risk' of chronic kidney disease (CKD) than those who drank the least." In a second "study published last month in the Clinical Journal of the American Society of Nephrology, Canadian scientists followed 2,148 healthy men and women, average age 46, for seven years" and found that "those who had the highest urine volume -- in other words, those who drank the most fluids -- were least susceptible to declines in kidney function."

AOA: Nearly One In Four School-Aged Kids May Have Vision Problems.

2011-11-04T05:13:00.001-07:00

The Milwaukee (WI) Journal Sentinel (11/3, Ong) reports that in 66 students in a Milwaukee school "received free glasses Wednesday as a result of a partnership between Milwaukee Public Schools, the optical company Wisconsin Vision and Prevent Blindness Wisconsin, a nonprofit organization dedicated to ensuring healthy vision in schoolchildren statewide." Darren Horndasch, CEO of Wisconsin Vision, explained that "vision problems can hinder the development of reading and other visual skills, because 80% of a child's learning is related to sight." And, "according to the American Optometric Association, nearly 25% of all school-age children have vision problems, resulting in the inability to achieve their full potential if undetected."

CDC: Most Americans Exceed Dietary Guidelines For Salt.

2011-10-31T12:40:00.000-07:00

Bloomberg News (10/21, Lopatto) reports, "Almost all US citizens, including children, exceed the dietary guidelines for salt, putting them at risk for hypertension and heart disease, according to a report by the Centers for Disease Control and Prevention."

The National Journal (10/21, Fox, Subscription Publication) reports that approximately "half the population should limit salt to very low levels -- 1,500 milligrams a day or less. But virtually none of those who should limit salt are doing so, the CDC said in" its Morbidity and Mortality Weekly Report.

The CNN (10/21) "The Chart" blog reports, "The new report is based on a nationally representative survey conducted by the CDC between 2005 and 2008, which included a detailed diet questionnaire."

Forbes (10/21, Husten) reports, "In a statement issued by the AHA [American Heart Association], however, the president of the AHA, Gordon Tomoselli, says the CDC report is 'too conservative, in its suggestion that only 47.6 percent of American adults fit into the population group that should be consuming no more than 1500 mg a day of sodium.'"

HeartWire (10/21, Stiles) reports that Tomoselli added, "This suggestion doesn't go far enough to address either the human or economic burden that our excessive intake of salt costs."

Also covering the story were the Chicago Tribune (10/21, Eng), HealthDay (10/21, Preidt), and WebMD (10/21, Hendrick).

Car Windows Do Not Filter Out UVA Rays.

2011-10-31T12:37:00.000-07:00

The Boston Globe (10/13, DeMarco) reports, "Car windows -- and those in your home -- are good at filtering out ultraviolet B rays, which cause sunburns. But car and home windows generally don't filter out ultraviolet A rays, which penetrate deeper into the skin" and "can interfere with your body's ability to protect against skin cancer," explained dermatologist Paul Lizzul, MD, PhD, MPH, MBA, associate director of clinical research in dermatology at Tufts Medical Center. According to the American Academy of Dermatology's website , sunscreen should be worn "on exposed areas whenever we go outside," and that includes inside the car.

Study Examines Role Vitamin D Plays In Immunity

FDA Warns Against Decorative Contact Lenses Without A Prescripti

2011-10-27T13:13:00.000-07:00

on.

KCRG-TV Cedar Rapids (10/26, Yeung) reports, "Dr. Rachel Bishop from the National Eye Institute says that people should not get decorative contacts until they've seen an eye specialist, gotten a prescription, and learned how to care for them." Otherwise, "taking shortcuts and buying these without getting an eye exam" could put "a person at significant risk," ranging from "irritated eyes to permanent vision loss." The FDA said "even decorative lenses are prescription, so over-the-counter sales are illegal."

The Star-Ledger (10/26, Baxter) reports the FDA has "received reports of the lenses causing corneal ulcers, eye infections and vision loss because of people not using them properly, or because they were not designed properly for someone's eyes," according to the FDA.

Eye Disease, Vision Loss Cost US About $68B Annually.

2011-10-25T06:01:00.001-07:00

The Helena Independent Record (10/19, Reynolds) reported, "From a public health perspective, blindness and vision loss put serious social and economic burdens on both individuals and society," causing "suffering, disability and loss of productivity, and they diminish quality of life. According to the National Eye Institute (NEI), eye disease and vision loss cost the United States about $68 billion a year."

Time Spent Outdoors Associated With Reduced Myopia Risk.

2011-10-25T05:58:00.001-07:00

BBC News (10/25) reports, "The time children spend outdoors could be linked to a reduced risk of being short-sighted," according to research presented at an ophthalmology meeting. "An analysis of eight previous studies by University of Cambridge researchers found that for each additional hour spent outside per week, the risk of myopia" was decreased by two percent. "Exposure to natural light and time spent looking at distant objects could be key factors, they said." The study authors "concluded that short-sighted children spent on average 3.7 fewer hours per week outdoors than those who either had normal vision or were long-sighted."

Vitamins Associated With Increased Risk Of Death In Older Women.

2011-10-11T05:20:00.001-07:00

The CBS Evening News (10/10, story 8, 0:30, O'Donnell) reported, "More than half of American adults take dietary supplements."

ABC World News (10/10, lead story, 2:40, Sawyer) added, "A major new study in an important medical journal finds in some cases the supplements either do no good or could increase the risk of dying from cancer or heart disease."

NBC Nightly News (10/10, lead story, 2:40, Williams) reported that the study published in the Archives of Internal medicine found that "women who take supplements, including multivitamins, appear to have slightly higher death rates." NBC chief science correspondent Robert Bazell explained, "Researchers followed more than 38,000 women average age 61 for 19 years. They found higher death rates in those taking multivitamins, vitamin B-6, folic acid, zinc, magnesium, copper and iron."

In a follow-on analysis piece, NBC Nightly News (10/10, story 2, 1:20, Williams) discussed the story with NBC medical director Dr. Tanya Benenson, who told viewers, "I think a multivitamin for anybody is fine. ... It's when we get into excessive mega doses of things when you're not deficient, that's where the problem starts." She added, "Just because a little bit is good for you doesn't mean more is better."

On the front of its Personal Journal section, the Wall Street Journal (10/11, D1, Dooren, Subscription Publication) points out that investigators followed some 39,000 women for approximately 19 years.

The New York Times (10/10, D6, Bakalar, Subscription Publication) reports in "Vital Signs" that "some supplements, like iron, were associated with a substantial increase in the risk of death, while others -- vitamin A and vitamin D, for example -- had no effect." Overall, "multivitamin use was linked to a 2.4 percent increase in the absolute risk of death, but calcium supplements appeared to decrease the risk."

"As in the broader population, women in the study who took supplements tended to be healthier -- with lower rates of diabetes and high blood pressure, and lower body mass index -- than women who didn't," the Los Angeles Times (10/10, Brown) reports. Still, "with the exception of the women taking calcium, they died at slightly higher rates." The Times points out, however, that researchers "did not explore whether supplements contributed to the causes of death among the women."

Still, USA Today (10/11, Lloyd) reports, "the study highlights concerns about the long-term use of supplements and vitamins in people who do not have severe nutritional deficiencies," the investigators said. "An accompanying editorial notes that [the] findings 'add to the growing evidence demonstrating that certain supplements can be harmful.'"

"A 2007 study published in the Journal of the American Medical Association linked vitamin E, vitamin A and beta- carotene to higher death rates," Bloomberg News (10/11, Lopatto) notes. "Another, published in the same year in the Journal of the National Cancer Institute, linked multivitamins to an increase in prostate cancer."

Also covering the story are MSNBC /Reuters (10/11), the Huffington Post /AARP (10/11), HealthDay (10/11, Reinberg), MedPage Today (10/11, Neale), WebMD (10/11, Mann), Medscape (10/11, Hitt), BBC News (10/11, Roberts), and the UK's Telegraph (10/11, Beckford).

Studies: Diabetes Education, Behavioral Interventions May

Studies: Refractive Errors Most Common Vision Problems In Children.

2011-10-11T05:19:00.000-07:00

Medscape (10/11, Waknine) reports, "About 4% of preschoolers have myopia, 21% have hyperopia, and 10% have astigmatism, according to data from two studies supported by the National Institutes of Health and published in the October issue of Ophthalmology." According to the studies, "refractive errors, such as myopia, hyperopia, and astigmatism, are the most common vision problems in children and are correctable with eyeglasses." The first study was performed by researchers from the Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California-Los Angeles, and the Division of Ophthalmology, Children's Hospital Los Angeles. The second study was conducted by investigators from the Doheny Eye Institute.

Aspirin Use In Seniors Associated With Increased Wet AMD Risk.

2011-10-03T08:36:00.000-07:00

Reuters (10/3, Grens) reports that according to a study published in the journal Ophthalmology, people over the age of 65 who take aspirin twice a day may be twice as likely to suffer from late-stage wet age-related macular degeneration (wet AMD) than seniors who do not take aspirin so often or at all. After examining data on some 4,700 seniors from all over Europe, researchers found that approximately four of every 100 people who used aspirin each day had wet AMD, compared to just two out of every 100 people who took aspirin much less frequently.

Experimental Eye Drop May Prevent Spread Of Viral Conjunctivitis

2011-10-03T08:34:00.000-07:00

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WebMD (10/1, Boyles) reported that according to a study published in the Journal of Medicinal Chemistry, "an experimental eye drop might stop viral pinkeye in its tracks and keep family members, schoolmates, coworkers, and other close contacts of patients from becoming infected." While "the drops have not been studied in humans...researchers say they are optimistic the treatment will prevent infection by tricking the virus into binding to artificial surfaces in the drops designed to mimic key cells in the eye." The study's author pointed out that at that point, "the entrapped virus should be easily washed from the eye in tears," thereby preventing the spread of viral conjunctivitis.

Fall-Prone Older Adults With Impaired Vision May Not Alter Walking Speed.

2011-09-19T13:36:00.000-07:00

Fall-Prone Older Adults With Impaired Vision May Not Alter Walking Speed.

HealthDay (9/17, Preidt) reported that according to a study published in the journal Insight: Research and Practice in Visual Impairment and Blindness, "fall-prone older adults may be more at risk for taking a tumble because they don't slow their walking speed when their vision is impaired." Researchers arrived at that conclusion after examining "five older adults who had fallen at least once in the past year, six older adults who had not fallen, and six younger adults," all of whose "walking was monitored under normal conditions and again when they wore goggles that caused blurred vision."

[Patients tend to underestimate the relationship between cataracts and "falls". This increases the risk of a broken hip, which is a very serious issue with senior citizens. -- Dr. J.D. Miller, Jr.]

Xanthelasmata May Be An Independent Risk Factor For Heart Disease.

2011-09-16T05:16:00.001-07:00

Xanthelasmata May Be An Independent Risk Factor For Heart Disease.

Forbes (9/16, Husten) reports that research published in BMJ suggests "that xanthelasmata (raised yellow patches around the eyelids) but not arcus cornae (white or grey rings around the cornea) is an independent risk factor for cardiovascular disease."

HealthDay (9/16, Mozes) reports, "The link between the skin condition and heart disease, however, is characterized as an association, rather than a clear case of 'cause and effect.'"

MedPage Today (9/16, Walsh) reports that "during a mean follow-up of 22 years, adults participating in a long-term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for myocardial infarction of 1.48 (95% CI 1.23 to 1.79)." The investigators reported that "participants with these plaques also were at increased risk of ischemic heart disease (HR 1.39, 95% CI 1.20 to 1.60) and death (HR 1.14, 95% CI 1.04 to 1.26)."

BBC News (9/16, Gallagher) reports that "the authors believe patients with xanthelasmata may be more likely to deposit cholesterol around the body."

Requiring a prescription for OTC products is a waste of physician time

2011-09-12T10:42:00.000-07:00

Requiring a prescription for OTC products is a waste of physician time

Most OTC products, excepting some medical equipment like crutches and diabetic supplies, now cannot be purchased with flexible spending account dollars without a physician prescription.

by EDWARD PULLEN, MD

One of my partners asked last week how I am dealing with this issue. He has had several patients ask for a long list of prescriptions for OTC products so that they can use their FSP to pay for these things with pre-tax dollars. This puts us in a no-win situation. Either we spend the time to write several prescriptions for whatever the patient asks for or spend a similar amount of time explaining why we decline to write the prescriptions.

It is very likely that this is a great example of the law of unintended consequences. The law was clearly written to increase tax revenue. The unintended consequence is that patients are now asking for a prescription for things like aspirin, Tylenol, body lotion, dandruff shampoo, shoe inserts and nearly anything else you can imagine. Here are some of the issues I have with this situation:

Even in the highest tax brackets the savings for some of these items just are not worth my time to write and document a prescription: Aspirin cost $2. Tax savings potential $0.66
This is one more task added to the primary care physicians to do list after patients are seen to accomplish before we can go home. It takes at least 30 seconds to open a patient’s chart, write a prescription, and get the Rx to a patient’s pharmacy or to leave at the front desk for them to pick up. Patients often ask for prescriptions for multiple items, some requiring more time than just writing a prescription.
These requests use up minutes in a patient visit that can be better used for other care. Do I want to spend my time gathering enough information to help a patient adjust their insulin and eating to control their blood sugar, or writing prescriptions for their corn pads, aspirin, body lotion and anti-perspirant.
Once a physician writes a prescription they incur some liability for the product used. Let’s say a patient uses a product that they ask me to prescribe. If they then have a problem in any way related to that product you can bet my name will be added to the list of defendants in the product liability lawsuit.
I really don’t know about much about many of the OTC products patients use. Some of the herbal and supplement products used have labeling that is nearly indecipherable, and certainly nothing I would ever recommend. Should I now be writing a prescription for these as a money saving service to patients? I think I’ll say no to these requests.

Really this new law is a good example of a decision made with one intended consequence that leads to another unintended consequence. In this case the government is responding to concerns about the cost of health care, so they have tried to save costs to the government by eliminating the pre-tax status of some OTC products. By doing so they have increased primary care physician overhead costs. This is likely a false savings. It is certainly poor use of primary care physician’s time and is unlikely to be an incentive for new medical school graduates to choose primary care over higher paying specialty care where few of these prescription requests will be seen.

Edward Pullen is a family physician who blogs at DrPullen.com.

2011-09-10T10:26:00.000-07:00

Patients often think doctors do nothing, but they’re wrongby ER STORIES, MDVery often I ask patients about their recent visits to other doctors. While I am taking a history, it’s important for me to know if you’ve recently been seen by another provider for the same or similar complaints and what they did, what they diagnosed you with, what they prescribed, etc. I often get a kind of irritated response such as “Oh, he didn’t do anything” or “he said it was nothing” or “he didn’t say anything to me.” Although I know my share of lazy doctors, I bet the vast majority of times, the doctor did do something and did say something.Just not what the patient either wanted to hear or that their perception or comprehension was wrong. See, I can often tell that a patient has “nothing” by just reading their triage note and taking a look at them. Nothing serious or something self-limited that gets better with no treatment or testing that is. Guess what, your doctor can do that too. Certainly after a directed history and exam, a doctor can usually tell if an otherwise healthy, young(ish) patient has something very minor. In other words, he (or she) doesn’t have to order tests or give you a prescription because you have a virus. What did he really do for you? He used his brain, experience, and training to ask the right questions and his skills at knowing what to look for on examination. He did this to reassure you that you have “nothing.”Now, maybe he is not a good communicator. Maybe he doesn’t have the time to sit there and explain the pathophysiology of viruses or something like benign peripheral vertigo – and thus you feel short changed. After all he “just asked me a few questions, listened to my lungs and told me to go home and rest.”Anyway, my point is that ask questions if you feel like you don’t understand what your doctors is thinking – but rest assured, most probably, he really didn’t just “Do nothing.” If you do this, perhaps you won’t be back in the ER with the same complaints and me having to “Do nothing” all over again.http://www.kevinmd.com/blog/2011/09/patients-doctors-wrong.html

Five Lifestyle Factors May Help Reduce Risk For Type 2 Diabetes.

2011-09-06T07:17:00.000-07:00

Five Lifestyle Factors May Help Reduce Risk For Type 2 Diabetes.
The Wall Street Journal (9/6, D2, Dooren, Subscription Publication) reports that according to a study published in the Sept. 6 issue of the Annals of Internal Medicine, adherence to five lifestyle factors may reduce the chance of developing type 2 diabetes.
CNN /Health.com (9/6, MacMillan) reports, "Meeting just one of five key health goals reduces your odds of developing diabetes in middle age by roughly one-third...and the more goals you meet, the lower your risk falls, even if you have a family history of diabetes," according to a study published in the Sept. 6 issue of the Annals of Internal Medicine. CNN quotes study lead author and epidemiologist Jared Reis, PhD, of the National Heart, Lung, and Blood Institute, as saying, "The question we were trying to raise is whether there are added benefits to each individual lifestyle improvement you make, and it looks like that answer is definitely yes."
HealthDay (9/6, Reinberg) reports, "For the study, Reis' team collected data on 114,996 men and 92,483 women 50 to 71 years of age who took part in the National Institutes of Health--AARP Diet and Health Study," then followed these individuals, none of whom had diabetes at study start, for over 10 years.
WebMD (9/6, Hendrick) reports, "Lifestyle factors that can influence the risk of developing type 2 diabetes include diet, weight, physical activity, smoking, and alcohol use." However, the investigators said that "diabetes risk can be reduced by 31% for men and 39% for women for each positive lifestyle change, such as quitting smoking or regularly exercising. Also, alcohol use should not exceed one drink daily for women and two drinks daily for men." Reuters (9/6, Pittman) also covers the story.

NRC Seeks Comments on Revised Dose Limits to Lens of the Eye

2011-09-02T05:35:00.001-07:00

The agency says the international radiation protection community may follow the International Commission on Radiological Protection's recommended limit of of 20 mSv (2 rem) per year, versus the current U.S. limit of 150 mSv (15 rem) per year.

Sep 01, 2011
The Nuclear Regulatory Commission has asked for comments from stakeholders about possibly lowering the current U.S. occupational exposure limit for radiation to the lens of the eye. NRC hasn't begun rulemaking on the issue, but its notices said the international radiation protection community may follow the International Commission on Radiological Protection's recent recommended limit of of 20 mSv (2 rem) per year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv (5 rem). The current U.S. limit is seven times higher: 150 mSv (15 rem) per year.

"In particular, the International Atomic Energy Agency has specifically considered and is now incorporating, the new limits into the revision of the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources," NRC's notice stated.

Protecting the eyes against the effects of ionizing radiation is designed primarily to prevent the formation of cataracts, and the sensitive part of the eye for this health effect is the lens. it noted. The radiation dose to the eye is defined by 10 CFR 20.1003 as the lens dose equivalent (LDE) at a tissue depth of 0.3 centimeters. Cataract formation falls under the class of radiation effects referred to as deterministic (tissue reactions, in current ICRP terminology). "At doses above the threshold, the severity of cataract formation increases with dose, but the radiation-induced incidence below the threshold dose is believed to be essentially zero. Currently, 10 CFR part 20 limits annual occupational exposures to the lens of the eye to 150 mSv (15 rem) per year (10 CFR 20.1201)," the notice said.

NRC asked for comments on the ICRP recommendations by Oct. 31. The commission said it seeks early input before making any decision about whether to consider this issue for future rulemaking.

To submit a comment, visit www.regulations.gov and search Docket ID NRC-2009-0279.

Your Child Needs A Comprehensive Eye Exam

2011-08-31T09:36:00.000-07:00

Your Child Needs A Comprehensive Eye Exam
Val Jones, M.D.

August 31st, 2011 by Dr. Val Jones in Expert Interviews with Dori Carlson, O.D.

In a recent interview with the president of the American Optometric Association (AOA), Dr. Dori Carlson, I learned the surprising statistic that about 1 in 4 school age children have an undetected or undiagnosed vision problem. School vision screenings, while helpful, still miss more than 75% of these problems. And for those kids who are discovered to have a vision problem during a school screening, upwards of 40% receive no follow up after the diagnosis. Clearly, we need to do better at diagnosing and treating childhood visual deficits. My full conversation with Dr. Carlson can be listened to below:

Dr. Carlson told me that the solution involves comprehensive eye exams – a full medical eye exam performed by an eye doctor. During a comprehensive eye exam, the optometrist will check the health of the eye tissues, including the eye muscles, cornea, conjunctiva, tear ducts, pupils, lens, and retina, as well as the patient’s ability to track objects, to see at different distances, and to focus adequately.

Vision correction is important at the youngest age possible because learning is greatly impacted by vision. Children who can’t see the chalk board, or who can’t read a computer screen or book, may lag behind in school or have attention challenges. In fact, it’s likely that some visually impaired children are misdiagnosed with ADHD (Attention Deficit Hyperactivity Disorder) as their interest in lessons fade since they can’t participate well without seeing what’s going on.

Dr. Carlson told me that parents sometimes erroneously believe that they’d be able to tell if their child has a visual deficit. In her experience, some children have been misdiagnosed with balance and hearing problems when they actually had a strong visual deficit in one eye. In one case, a 7 year old boy learned to ride his bicycle so that he turned right three times in order to go in a leftward direction because his left eye had poor vision.

So why are vision problems so common among children? According to Dr. Carlson, babies are all born far-sighted, and they begin to gain near vision when they’re 6 months old. However, many babies and young children lose their farsightedness at different rates in each eye. If the rates vary by quite a bit, vision can be greatly impacted, and early interventions with corrective lenses and/or eye patches can be critical in heading off long term problems. The best way to assess a baby or young child for such problems is to have a comprehensive eye exam by an eye care professional. It is recommended that children have exams beginning at age 6 months to 1 year and then every 2 years or so thereafter.

Dr. Carlson and the AOA are so committed to making comprehensive eye exams available to all Americans that they have founded the InfantSEE program. The InfantSEE website (www.infantSEE.org) provides a nation-wide list of optometrists who offer free exams to infants, regardless of the parents’ health insurance or ability to pay.

So there you have it, parents – please make sure that your child is set for success this school year by taking him or her to an eye care professional for a comprehensive exam. School vision checks are not designed to assess the whole eye and all the possible vision problems that occur. Remember that you can’t tell if your child has a vision problem just by looking at them!

***

Val Jones, M.D.

The Case For Annual Eye Exams: Normal Vision Doesn’t Guarantee Healthy Eyes

2011-08-31T09:34:00.001-07:00

The Case For Annual Eye Exams: Normal Vision Doesn’t Guarantee Healthy Eyes

June 13th, 2011 by Dr. Val Jones in Announcements, Health Tips

You probably see your primary care physician once a year, and your dentist twice a year. But how often do you see your eye doctor? Vision is the most valued of the 5 senses, and yet Americans don’t seem to be making regular eye exams a priority. A recent CDC survey suggests that as many as 34.6% of adults over the age of 40 (with moderate to severe visual impairment) believe that they don’t need regular eye exams. About 39.8% of the respondents said that they didn’t get regular exams because they were too costly, or because their health insurance didn’t cover the expense.

Although cost may play a role in peoples’ thinking, a comprehensive eye exam costs as little as $45-50 at retail outlets. I suspect that the real reason why people don’t get regular eye exams is because they incorrectly believe that if their vision is stable, their eyes are healthy.

A comprehensive eye exam is a type of medical check up – it is not just a vision assessment. Eye care professionals can diagnose everything from glaucoma and cataracts to high cholesterol, diabetes, high blood pressure, and even neurologic conditions such as brain tumors and multiple sclerosis. The eyes are more than a “window to the soul” but a window to general physical health. And the good news is that exams are relatively inexpensive and painless – so please consider making them part of your yearly health maintenance routine.

And to my primary care friends – don’t forget to encourage your patients to get annual eye exams. As the CDC notes:

Recommendations from primary-care providers can influence patients to receive eye-care services; persons who had visual screening during routine physical examinations had better eye health because of reminders to visit eye specialists. Public health interventions aimed at heightening awareness among both adults aged ≥65 years and health-care providers might increase utilization rates among persons with age-related eye diseases or chronic diseases that affect vision such as diabetes.

I myself have had an unexpected diagnosis during an eye exam, and feel passionate about the importance of preventive screening.

US Doctors Spend More Time Dealing With Insurers.

2011-08-26T05:15:00.000-07:00

US Doctors Spend More Time Dealing With Insurers.
In continuing coverage, Pauline W. Chen, MD, writes in the New York Times (8/26, Subscription Publication) "Well" blog that in a study published in the August issue of Health Affairs, "researchers asked hundreds of physicians and administrators in private practices across the United States and Canada how much time they spent each day with insurers and other third-party payers." Notably, US physicians spent significantly more time than their Canadian peers "dealing with multiple health plans: more than $80,000 per year per physician, or roughly four times as much as their northern counterparts. And their offices spent as many as 21 hours per week with payers, nearly 10 times as much as the Canadian offices." Chen points out how all this time spent dealing with insurers "inevitably gets in the way of patient care."

Anti-Reflective Coating

2011-08-24T05:30:00.001-07:00

Anti-Reflective Coating

By Gary Heiting, OD

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Anti-reflective coating (also called AR coating or anti-glare coating) improves both your vision through your lenses and the appearance of your eyeglasses.

Both benefits are due to AR coating's ability to eliminate reflections of light from the front and back surface of eyeglass lenses.

AR coating is especially beneficial when used on high-index lenses, which reflect more light than regular plastic lenses. Generally, the higher the index of refraction of the lens material, the more light that will be reflected from the surface of the lenses.

For example, regular plastic lenses reflect roughly 8 percent of light hitting the lenses, so only 92 percent of available light enters the eye for vision. High index plastic lenses can reflect up to 50 percent more light than regular plastic lenses (approximately 12 percent of available light), so even less light is available to the eye for vision. This can be particularly troublesome in low-light conditions, such as when driving at night.

Today's modern anti-reflective coatings can virtually eliminate the reflection of light from eyeglass lenses, allowing 99.5 percent of available light to pass through the lenses and enter the eye for good vision.

Anti-reflective coating reduces the glare that you see, as well as the glare that others can see on your lenses.
By eliminating reflections, AR coating also makes your eyeglass lenses look nearly invisible so people can see your eyes and facial expressions more clearly. Anti-reflective glasses also are more attractive, so you can look your best in all lighting conditions.

The visual benefits of lenses with anti-reflective coating include sharper vision with less glare when driving at night and greater comfort during prolonged computer use (compared with wearing eyeglass lenses without AR coating).

Anti-reflective coating also is beneficial when applied to the back surface of lenses in sunglasses, because it eliminates reflections of sunlight into your eyes from the lenses when the sun is behind you.

Since the purpose of sunglasses is to reduce how much light enters your eyes and because you aren't concerned about making eye contact with others when wearing shades, there is no benefit to having AR coating applied to the front surface of sunglass lenses.

Most premium anti-reflective coatings include a "hydrophobic" surface layer that prevents water spots from forming and makes the lenses easier to clean. Some AR coatings also include an "oleophobic" surface layer that repels skin oils and makes it easier to remove smudges from the lenses.

Some eyeglass lenses have factory-applied AR coating on both lens surfaces. Other lenses, particularly progressive lenses and other multifocal lenses (i.e., bifocals and trifocals), have the coating applied after the lenses have been customized to your eyeglass prescription by an optical lab.

How Anti-Reflective Coating Is Applied

Applying anti-reflective coating to eyeglass lenses is a highly technical process involving vacuum deposition technology.

The first step in the AR coating process is to meticulously clean the lens surface and to inspect the lens for even microscopic surface defects. Even a tiny smudge or piece of lint or hairline scratch on the lens surface during the coating process can cause a defective coating.

Typically, a production line includes multiple washing and rinsing baths, including ultrasonic cleaning to remove any traces of surface contaminants. This is followed by air drying and heating of the lenses in special ovens to further remove unwanted moisture and gases from the lens surface.

Modern vacuum coating machine for applying AR coating to eyeglass lenses (Image: SatisLoh.)
The lenses are then loaded into special metal racks with spring-loaded openings so the lenses are held securely but with virtually all lens surfaces exposed for the coating application. The racks are then loaded into the coating chamber. The door of the chamber is sealed, and the air is pumped out of the chamber to create a vacuum.

While the lens racks are rotating in the coating chamber, a power source within the machine focuses a beam of electrons onto a small crucible that contains a series of metal oxides in separate compartments. When bombarded by the beam of this electron "gun" in succession, the metal oxides are transformed into vapors that fill the coating chamber and adhere to the lenses in a specific order to form a precise multilayer AR coating.

Each AR coating manufacturer has its own proprietary formula, but generally all anti-reflective coatings consist of multiple microscopic layers of metallic oxides of alternating high and low index of refraction. Depending on the AR coating formula, most lenses with anti-reflective coating have a very faint residual color, usually green or blue, that is characteristic of that particular brand of coating.

Anti-reflective coatings are incredibly thin. The entire multilayer AR coating stack generally is only about 0.2 to 0.3 microns thick, or about 0.02 percent (two one-hundredths of 1 percent) of the thickness of a standard eyeglass lens.

Caring for Glasses With Anti-Reflective Lenses

When cleaning AR-coated lenses, use only products that your optician recommends. Lens cleaners with harsh chemicals may damage the anti-reflective coating.

Also, don't ever attempt to clean AR-coated lenses without wetting them first. Using a dry cloth on a dry lens can cause lens scratches. And because anti-reflective coating eliminates light reflections that can mask lens surface defects, fine scratches often are more visible on AR-coated lenses than on uncoated lenses.

Diet Rich In Nuts, Soy May Help Reduce LDL Cholesterol.

2011-08-24T05:27:00.001-07:00

Diet Rich In Nuts, Soy May Help Reduce LDL Cholesterol.
USA Today (8/24, Hellmich) reports that while "nutrition experts have known for years that some foods, such as oatmeal, nuts and soy products, lower cholesterol," but new research "shows that a diet with several of these foods can decrease LDL (bad) cholesterol significantly."
The Wall Street Journal (8/24, Wang, Subscription Publication) reports that the study , published in the Journal of the American Medical Association, provides more proof that simply reducing dietary fat may not be the best way to boost one's heart health.
The Los Angeles Times (8/24, Healy) reports that for the "study tested a diet that contained a portfolio of cholesterol-fighting foods such as soy protein, nuts, 'sticky' fiber such as that found in oats and barley, and plant sterols." The 345 participants, all of whom had high cholesterol, "each followed one of three diets: an 'intensive portfolio' diet, a 'routine portfolio' diet, or a high-fiber, low-saturated-fat diet rich in produce and whole grains." Of "the 267 subjects who completed the trial, all three groups lost roughly an equal amount of weight," but participants "on one of the portfolio diets - intensive or routine - saw their LDL cholesterol levels decline between 13.1% and 13.8% after six months," compared to the 3% decline in LDL levels seen in those on the high-fiber, low-saturated-fat diet.
Also covering the story were the CNN (8/24) "The Chart" blog, Reuters (8/24, Pittman), the NPR (8/23, Aubrey) "Shots" blog, MedPage Today (8/23, Fiore), HealthDay (8/23, Gordon), WebMD (8/23, Warner), and HeartWire (8/23, O'Riordan).

Patients need to contribute to help their doctors

2011-08-23T06:17:00.001-07:00

Patients need to contribute to help their doctors
by MAURICE BERNSTEIN, MD

“Be a fountain not a drain,” an expression used by baseball announcer Rex Hudler, is one that has motivational content particularly in terms of an individual included as part of a team.

I would suggest that this expression would be appropriate when considering a basic team in medical practice: the doctor-patient relationship. It is critical in most clinical situations that both the doctor and the patient assume responsibility for making progress toward the goal of diagnosis and therapy and hopefully a cure. The doctor-patient relationship is not one of the patients simply “taking” or “draining” the knowledge and skills of the physician or one of the doctor simply “spouting” those capacities to the patient.

Each member of this team has a responsibility to contribute and not just “take.” That means that the patient must realize that the doctor can usually fail to make a diagnosis without a full history provided by the patient. It also means that to examine the patient, a certain degree of patient cooperation is required for the exam to be of value. And when it comes to treatment, patient compliance is also essential.

On the other hand, the physician should understand that looking at the patient simply as an “object” of a disease and a resource to demonstrate one’s skills for an income is not what the doctor-patient relationship is all about. It is not about “taking” but is about considering the patient as a “subject” of physical and mental concerns giving the patient not only a chance to be physically healthy but also a feeling of comfort in the relationship and support of the patient’s emotional health.

Now, one may argue that the doctor-patient relationship is not really a equally balanced one in that it is the patient who is sick and may be ignorant of the facts of the illness and treatment whereas the doctor is not. Therefore, it should be only the doctor who should be required to be the “fountain” and, well, the patient receiving and taking the results, the “drain.”

Which view do you hold?

Maurice Bernstein is a physician who blogs at Bioethics Discussion Blog.

Touch humanizes the doctor patient relationship

2011-08-23T06:15:00.000-07:00

Touch humanizes the doctor patient relationship
by KEVIN PHO, MD

I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically advanced, and expensive, tests.

In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.”

In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured:

Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.

Great point. She continues, saying that,

touch [is] inherently humanizing, and for a doctor-patient relationship to have meaning beyond that of a business interaction, there needs to be trust — on both ends. As has been proved in newborn nurseries, and intuited by most doctors, nurses and patients, one of the most basic ways to establish trust is to touch.

Although some doctors — myself included, at times — may dismiss the much of the physical exam as data-bereft relics of the past, listening to a patient’s heart and lungs, palpating the abdomen, and looking into the eyes and ears, is in part what separates physicians from being test-ordering, guideline-following automatons.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.

CDC: Four Healthy Behaviors May Prolong Lifespan.

2011-08-22T05:48:00.000-07:00

CDC: Four Healthy Behaviors May Prolong Lifespan.
HealthDay (8/19, Preidt) reports that four healthy behaviors may confer longer life according to a study in the American Journal of Public Health. CDC researchers analyzed long-term data from the National Health and Nutrition Examination Survey III Mortality study and found that individuals who refrained from smoking, ate a "healthy diet," participated regularly in "physical activity," and avoided "excessive alcohol use -- were 63 percent less likely to die early from any cause than those with none of those healthy habits."

Diabetic Who Hacked His Own Insulin Pump Shares Findings At Conference.

2011-08-11T05:54:00.001-07:00

Diabetic Who Hacked His Own Insulin Pump Shares Findings At Conference.
The AP (8/11, Robertson) reports that "a security researcher who is diabetic has identified flaws that could allow an attacker to remotely control insulin pumps and alter the readouts of blood-sugar monitors," leaving diabetics vulnerable to receiving inaccurate dosing of insulin. Diabetic Jay Radcliffe used his own equipment for the experiment and "shared his findings with The Associated Press before releasing them Thursday at the Black Hat computer security conference in Las Vegas." The AP points out that "the hacking fears come on top of human errors and technical glitches tied to medical devices. The US Food and Drug Administration has identified software and design errors as critical concerns in investigating hundreds of deaths potentially linked to drug pumps." The FDA also has warned "device makers that they are responsible for making sure they can update equipment after it's sold."

Vision Problems Affect Millions Of American Children.

2011-08-11T05:23:00.001-07:00

Vision Problems Affect Millions Of American Children.
In an op-ed in the Worthington (MN) Daily Globe (8/11), Cliff Carmody, executive director of the SW/WC Service Cooperative of Marshall, MN, writes, "Current research shows that vision problems affect millions of American children and thereby impact their ability to learn. ... The American Optometric Association notes that when vision problems go undetected, children almost invariably have trouble reading and doing their schoolwork. They often display fatigue, fidgeting, and frustrations in the classroom -- traits that can lead to a misdiagnosis of dyslexia or other learning disabilities." Because August is National Children's Vision and Learning Month, Carmody urges parents to make sure their children undergo a thorough eye examination before the start of the new school year.

Early Morning Smoking May Be Linked To Increased Risk Of Certain Cancers.

2011-08-08T05:19:00.001-07:00

Early Morning Smoking May Be Linked To Increased Risk Of Certain Cancers.
The CNN (8/8, Tinker) "The Chart" blog reports that "smokers who indulge in their first cigarette shortly after waking up have an increased risk of developing lung and head and neck cancers, according to two new studies published in Cancer, a journal of the American Cancer Society." Researchers found that individuals "who smoked their first cigarette between 31 and 60 minutes after waking up were more than 30% more likely to develop lung cancer; the odds increased to nearly 80% for those who smoked in their first half-hour awake." Meanwhile, "for head and neck cancers, subjects were more than 40% more likely if they indulged in the 31-60 minute window, and nearly 60% more likely for those who smoked in their first half-hour awake."
MedPage Today (8/8, Phend) reports that although "any smoking boosts cancer risks, an early start in the day might be particularly risky because it signals stronger nicotine dependence, the researchers suggested." BBC News (8/8) also covers the story.

Study: Health Insurance Paperwork Costs US Doctors $83,000 Annually.

2011-08-05T05:15:00.001-07:00

Study: Health Insurance Paperwork Costs US Doctors $83,000 Annually.
The National Journal (8/4, Fung, Subscription Publication) reported, "Researchers at the University of Toronto said the United States could save about $27.6 billion each year if it followed in Canada's footsteps by implementing a single-payer health care system, which would cut down on the amount of time and money doctors spend on dealing with multiple insurance companies," according to a study published online Aug. 3 in the journal Health Affairs. The study found that "doctors spend about $22,000 per physician per year in Ontario," whereas "doctors in the United States spend almost four times as much -- $83,000 -- because they must deal with a range of insurance plans, frequently employing an administrator dedicated to sorting out the paperwork."
The Orlando Sentinel (8/5, Doughman) reports that American physicians "must spend time obtaining authorization for certain medical procedures, which, the authors said, can ultimately save money and prevent doctors from giving inappropriate care." The study authors also "concluded that American physicians and insurance companies could interact 'much more efficiently' if claims were filed electronically rather than via mail or fax."
What's more, "medical practices in the US spend nearly four times as many hours a week dealing with insurers than do practices in Canada, at nearly four times the cost," MedPage Today (8/4, Walker) reported. "US doctors spend only about one hour more each week interacting personally with health plans than their neighbors to the north (3.4 hours versus 2.5), but practice staffers in the US spend nearly 10 times more hours dealing with insurance companies than do the staff of Canadian practices," the study found.
Medscape (8/4, Crane) reported that the study authors cited "recommendations from the Institute of Medicine and others that include 'creating common, possibly mandatory standards for billing, claims payment, prior authorization, etc.; making all standard interactions electronic; using a single credentialing process; using a single quality measurement process; and using automated verification at the point of care of patient eligibility for health insurance benefits.'" In addition, they noted that "Section 1104 of the Affordable Care Act of 2010 instructs the Secretary of Health and Human Services to take steps to simplify interactions between providers and health plans." Finally, "the reform law's emphasis on new payment methods, such as bundled payments and pay-for-performance, and new ways of organizing healthcare delivery, such as accountable care organizations, could move US health care away from fee-for-service payment," thereby reducing administrative costs. HealthDay (8/4, Preidt) also covered the story.

NEI Recommends Eye Protection To Prevent Sports-Related Eye Injuries.

2011-08-04T05:16:00.000-07:00

NEI Recommends Eye Protection To Prevent Sports-Related Eye Injuries.
The Seattle Times (8/3, Kelly) reports the National Eye Institute (NEI) says that "more than 600,000 Americans will suffer an eye injury while playing a sport this year." Of these injuries, 42,000 cases will have to be treated in a hospital emergency room. The institute "and the national associations of ophthalmologists and optometrists" point out that more than 90% of the injuries could have been prevented if the athletes had been wearing some kind of eye protection. According to the NEI, children 14 and under are most likely to receive an eye injury playing baseball or softball while for children 15 and older, basketball is the leading source of eye injuries.

Report: Optometrists Have Shortest Waiting Times.

2011-08-02T05:27:00.001-07:00

Report: Optometrists Have Shortest Waiting Times.
The New York Times (8/2, D6, Alderman, Subscription Publication) reports in "The Consumer" that "no one likes to be kept waiting" to see their healthcare professional. Across the US, "the average wait time to see a doctor last year was 23 minutes, according to the health care consultants Press Ganey. Neurosurgeons have the longest wait times (30 minutes) and optometrists the shortest (17 minutes), according to the report." The article suggests strategies people can use to avoid waiting, such as getting the first appointment of the day, checking before leaving home to make sure the doctor is running on time, finding a new healthcare provider, or signing up with a concierge practice. The disadvantage of the latter, however, is that a concierge practice does not take insurance.

FDA Recommends Sunglasses With 100% UVA/UVB Rating.

2011-07-29T05:15:00.001-07:00

FDA Recommends Sunglasses With 100% UVA/UVB Rating.
The Louisville (KY) Courier-Journal (7/28, Carter) reported that the Food and Drug Administration "recommends selecting sunglasses that are labeled with a UVA/UVB rating of 100 percent to get the most protection" from the sun's harmful rays. The agency said consumers should also "try to find a wraparound style" that covers the eye socket completely. Children also need sunglasses; and parents should "check the label, remembering that toy sunglasses may not have any UV protection," according to the FDA.

Optometrist: "No Better Time" To Implement Kentucky's Eye Care Law.

2011-07-28T05:18:00.001-07:00

Optometrist: "No Better Time" To Implement Kentucky's Eye Care Law.
In an op-ed in the Lexington (KY) Herald-Leader (7/27), optometrist Ben Gaddie, OD, president of the Kentucky Optometric Association and education chairman of the American Optometric Association, wrote, that in Kentucky, new "legislation allows optometrists who become trained and credentialed to provide additional treatments using the latest technology." Dr. Gaddie asserted, "History has shown that every time optometrists have been allowed to expand their scope of practice, it has resulted in more Kentuckians receiving safe, quality eye services -- further demonstrating that the scare tactics used by a few have no basis in reality." Dr. Gaddie concluded, "When Kentucky is facing critical health-care provider shortages, citizens who are disproportionately affected by disease, an aging population and budget shortfalls, there is no better time to implement the Better Access to Quality Eye Care Law."

Eating Fish May Help Men Reduce Risk For Type 2 Diabetes.

2011-07-26T07:55:00.001-07:00

Eating Fish May Help Men Reduce Risk For Type 2 Diabetes.
MedWire (7/25, Albert) reported that, according to a study published online July 20 in the American Journal of Clinical Nutrition, "eating fish can help men reduce their risk for type 2 diabetes." After analyzing data on 22,921 men and 29,759 women without a history of diabetes who ranged in age from 45 to 75 and who were followed for about five years, researchers "found that when compared with men in the lowest quartile for overall fish consumption, those in the highest quartile for consumption had a significant 27% reduced risk for developing type 2 diabetes."
Notably, "fish consumption in women was not significantly related to a risk for type 2 diabetes," Medscape (7/25, Barclay) reported.

Optometrists Detect Early Vision Problems Though InfantSEE Program.

2011-07-26T05:31:00.001-07:00

Optometrists Detect Early Vision Problems Though InfantSEE Program.
The South Bend (IN) Tribune (7/25, Dukes) reported that the InfantSEE program helps optometrists detect vision problems early in small children. The program, which was begun by the American Optometric Association's charity, the AOA Foundation, "provides free comprehensive eye and vision assessments to infants between the ages of six...and 12 months." The program provides babies with a thorough, in-depth evaluation designed to catch problems with refractive error and eye motility.

Parents should also include a visit to an optometrist among their baby’s first-year medical visits.

2011-07-25T11:18:00.000-07:00

By HOWARD DUKES
South Bend Tribune Staff Writer
7:29 p.m. EDT, July 24, 2011

Ask parents if they took their infants to the doctor, and the doctor who comes to mind is a pediatrician.

Courtney Koszyk said parents should also include a visit to an optometrist among their baby’s first-year medical visits.

Koszyk is the mother of Jordan Koszyk. Jordan, who will be a first-grader at Bittersweet Elementary School in the fall, has a condition known as refractive amblyopia. The condition, also known as lazy eye, is caused when one eye is more nearsighted or farsighted than the other.

Dr. Linnea Robbins-Winters, the optometrist who discovered and treated Jordan’s refractive amblyopia, said that one in 10 children is at risk for having an unknown eye and vision problem.

These problems can go undiscovered until the child enters school, according to Robbins-Winters, an optometrist at Eye Care Associates of Michiana.

The condition is harder to correct when a child is older.

Jordan’s condition was discovered because of the InfantSEE program.

InfantSEE was started by the American Optometric Association’s charity, the AOA Foundation. The program is also supported by the Vision Care Institute and Johnson & Johnson.

The InfantSEE program provides free comprehensive eye and vision assessments to infants between the ages of 6 months and 12 months. Robbins-Winters has been a participant in InfantSEE since the program started in 2005.

Robbins-Winters said the infants receive an in-depth assessment.

“We’re checking eye motility - movement of the eye,” Robbins-Winters said. “We’re looking for signs of lazy eye and we’re looking for refractive error, which would be nearsightedness, farsightedness or astigmatism.”

Robbins-Winters also said optometrists check how well the eyes work together and they also look for potential problems.

Koszyk said Jordan was 10 months old when Winters-Robbins did the assessment.

“At that time, I could tell that one eye was significantly weaker than the other eye,” Robbins-Winters said. “If she hadn’t been diagnosed at that early point, she would not have nearly the visual acuity that she does right now.”

Jordan’s treatment involved wearing glasses and patching therapy, according to Robbins-Winters.

Patching therapy involves wearing a patch over the stronger eye to force the weaker eye to work.

Eventually, the weaker eye becomes stronger, and doctors will be able to reduce and eventually end the patching therapy, according to Robbins-Winters.

“Most children are actually done patching by the age of 8,” Robbins-Winters said. “But if (the condition) is caught late, we may have to patch quite a bit longer.”

Jordan is right on schedule, according to her mother and Robbins-Winters.

The doctor ended the patching therapy and is monitoring the strength of the eye to ensure that Jordan maintains the improvement in her vision.

Children with lazy eye receive prescriptions for glasses at a very young age. How do children who are 2 or 3 years old deal with wearing glasses? How does an active toddler manage to keep the glasses on without breaking or losing them? Are they reluctant to wear glasses? That is often a problem with school-aged children.

Children such as Jordan handle wearing glasses quite well, Robbins-Winters said. They associate the glasses with being able to see, and are often motivated to take care of them, the doctor said.

“That toddler knows that when they put those glasses on that their world is clearer,” Robbins-Winters said. “They didn’t know that it was supposed to be clear so they’re not going to complain.

“But once you give them the tools they need to see better, they will accept them and wear them.”

Eye Experts Say Reading On Smartphones May Strain Eyes.

2011-07-25T10:01:00.001-07:00

Eye Experts Say Reading On Smartphones May Strain Eyes.
HealthDay (7/21, Gardner) reports that, according to a study published in Optometry and Vision Science, "people reading text messages or browsing the Internet on their smartphones tend to hold the devices closer than they would a book or newspaper." This, combined with the often small font sizes, "could put added strain on people who already wear glasses or contact lenses." Eye surgeon Dr. Scott MacRae suggests increasing font size on smartphones, e-readers, and using "Verdana 12-point font, the only font designed specifically for computers."

Younger Children May Respond Better To Amblyopia Treatment.

2011-07-12T05:18:00.001-07:00

Younger Children May Respond Better To Amblyopia Treatment.
MedPage Today (7/11, Walsh) reported, "Younger children with amblyopia respond better to treatment than do their older peers," according to a meta-analysis published online July 11 in the Archives of Ophthalmology. After examining data on some 996 children, researchers found that youngsters "younger than seven had significantly greater improvements for both moderate (P<0.04) and severe (P<0.001) amblyopia than did those seven to 13." And, "among the younger children, there were no significant differences in response between those ages three to five and those in the five and seven group for either moderate (P=0.67) or severe (P=0.09) amblyopia." Medscape (7/11, Barclay) also covered the story.

Genetics, Lifestyle May Contribute To AMD Progression.

2011-07-11T05:38:00.001-07:00

Genetics, Lifestyle May Contribute To AMD Progression.
The Boston Globe (7/8, Satija) reported that a study published in the July issue of Ophthalmology detailed the influence of genetics and environment on the development of age-related macular degeneration (AMD). Researchers "looked at over 200 male pairs of identical twins" in which some twins both had the disease but at different stages, or only one twin did. The study found that heavy smoking was correlated with more advanced AMD, whereas eating foods high in betaine and methionine correlates with slower development of disease. "A previous study of identical and fraternal twins...found that genetics explained between 46 and 71 percent of the severity of the disease, while environmental factors explained between 19 and 37 percent."

Sunglasses Necessary To Prevent Eyes From UV Damage.

2011-07-05T07:50:00.001-07:00

Sunglasses Necessary To Prevent Eyes From UV Damage.
The Washington Post (7/4, Butler) reported that wearing sunglasses is necessary to protect the eyes from damage from ultraviolet (UV) rays. Optometrist Michael Rosenblatt, OD, pointed out that "certain people run an elevated risk for UV damage," particularly people "with light-colored irises." He explained, "If you easily burn in the sun, you should think of yourself as a person who suffers greater damage from UV light in all areas, including your eyes." For that reason, he recommended sunglasses that "extend from the eyebrow to the cheek and wrap around the contour of face, along with lenses that have 100 percent UVA and UVB protection."
Optometrist Describes

Visual Recovery Reported In Patient With Longstanding Retinal Detachment.

2011-06-20T05:58:00.001-07:00

Visual Recovery Reported In Patient With Longstanding Retinal Detachment.
BBC News (6/17) reports, "A man in the US, who was blinded in one eye 55 years ago, has had his sight restored, according to the Journal of Medical Case Reports." The man "was eight when his retina was detached after he was hit in the right eye with a stone." However, at the age of 63, after undergoing treatment to reduce pressure and swelling within the eye, the man was able to see bright light again. This led doctors to attempt an operation to reattach the retina. Amazingly, following surgery, sight was restored. Physicians "believe it was successful because of the low 'height' of the retinal detachment."
The UK's Telegraph (6/17, Adams), "When a retina has been detached for so long, degenerative changes usually occur that make restoring sight impossible." The author of the case report explained that the patient's visual recovery after so long a time "has implications for restoring eyesight in other patients."

Zeaxanthin, Lutein May Help Protect Eyes Against UV Light Damage.

2011-05-31T06:06:00.001-07:00

Zeaxanthin, Lutein May Help Protect Eyes Against UV Light Damage.
The Calgary Herald /Monterey County Herald (5/26, Quinn) reported that, according to the National Eye Institute, eyesight is "all about light" entering the eye and hitting the retina. That body "contains 'photoreceptors' that convert light to electrical signals that travel to the brain and figure out what we 'see.'" Unfortunately, ultraviolet (UV) light may damage eyes, much like it does skin. Fortunately, "specific nutrients and other substances in foods can help to absorb dangerous light and act as a shield." The article went on to explain that vegetables and fruits containing zeaxanthin and lutein may help protect the eye against damage caused by ultraviolet light.

Nearly 20% Of Young Adults In US May Have High Blood Pressure.

2011-05-31T05:46:00.001-07:00

Nearly 20% Of Young Adults In US May Have High Blood Pressure.
ABC World News (5/25, story 6, 0:25, Sawyer) reported that research published online in Epidemiology indicates that nearly one-fifth "of Americans who are 24 to 32 years old have high blood pressure."
USA Today (5/26, Marcus) reports, "For the National Longitudinal Study of Adolescent Health, dubbed Add Health, funded by the National Institutes of Health, researchers from the University of North Carolina-Chapel Hill asked 14,000 men and women between the ages of 24 and 32 about their high blood pressure history and then took blood pressure readings of participants." The investigators "found that 19% of participants had high blood pressure." These "findings...are significantly higher than other recent research from another large, ongoing health study, the National Health and Nutrition Examination Survey (NHANES), which found only 4% of adults 20 to 39 have high blood pressure."
The CNN (5/25) "The Chart" blog reported that lead study author Kathleen Mullan Harris said that "among those measured with high blood pressure, only 25% had been told previously that they had high blood pressure."
Also covering the story were Reuters (5/26, Steenhuysen), the PBS News Hour (5/26, Clune, Kane) "The Rundown" blog, the Raleigh News & Observer (5/26, Price), WebMD (5/25, Mann), HealthDay (5/25, Dallas), and MedPage Today (5/25, Neale).
Masked Hypertension May Be Prevalent In 45% Of African Americans. HeartWire (5/25, O'Riordan) reported that research "presented this week" at the American Society of Hypertension 2011 Scientific Meeting "confirm the high prevalence of masked hypertension in African Americans, with investigators reporting that masked hypertension is prevalent in 45% of African Americans during any single office visit." The findings "suggest that blood-pressure monitoring in the office might not be sufficient to assess cardiovascular-risk exposure in this population and that out-of-office blood pressure monitoring might be needed to expose underlying hypertension."
Single-Pill Combinations May Achieve Better Blood Pressure Control Than Other Regimens. MedPage Today (5/25, Neale) reported that "initiating antihypertensive treatment with single-pill combinations achieves better blood pressure control rates within a year than either free-dose combinations or monotherapy outside of the clinical trial setting," according to a study presented at the American Society of Hypertension meeting. Investigators found, "after adjustment for several factors," that "use of a single-pill combination to start therapy was the strongest predictor of blood pressure control (HR 1.21, 95% CI 1.18 to 1.25) compared with monotherapy." Although "the use of a free-dose combination also was significantly better than monotherapy...the magnitude of the association was smaller (HR 1.08, 95% CI 1.06 to 1.10)."

'Problem' Patients: Dealing with Angry, Edgy Patients

2011-05-25T06:14:00.001-07:00

'Problem' Patients: Dealing with Angry, Edgy Patients
By Trisha Torrey | May 25, 2011
This is the last in a four-part series exploring better communications with your patients to enhance their visits to your practice.

Perhaps one of the biggest complaints I’ve heard from doctors is that they are seeing an increasing number of angry patients. Appointments are clouded by a tension that used to be rare. It’s difficult to get these patients to open up. Little or no conversation takes place.

“Good to see you today, Mr. Lee. How does your shoulder feel?”
“It still hurts.”
“I’m sorry to hear that. Have you been taking that prescription I wrote for you?”
“Sometimes.”
“Has your therapy helped at all?”
“Therapy was a waste of time.”
Not only can’t you get your patient to open up, but it’s clear that there is something else besides his shoulder pain getting in the way of the conversation.
You’re wondering what Mr. Lee expects from you if he won’t be more helpful. You’re ready to finish up the appointment as quickly as you can and move on. But if you do that, Mr. Lee will just return next time with even more of a chip on his painful shoulder.
What makes Mr. Lee behave this way?
As we’ve highlighted in previous parts of this series, the basis for the anger is history, Mr. Lee’s ability to trust the care he will receive, and your ability to deliver it by managing his expectations. Mr. Lee is refusing to cooperate because for some reason, he feels his trust has been violated.
Trust is built when patients feel respected. Lack of respect creates lack of trust. Maybe Mr. Lee was left too long in the waiting room. Some older patients don’t like the 20-something medical assistant calling them by their first names. Other patients are frustrated because you won’t discuss the information they found on the Internet. Still others have modesty issues and may be embarrassed.
Another reason patients get angry is because their expectations have not been met. Mr. Lee didn’t realize that his last prescription would require two weeks before his shoulder pain began to subside. No one explained he would need to take his pain meds with food or he would suffer nausea. When the nurse took his vitals and he mentioned he had begun eating cherries because he read somewhere that they would ease his pain, she laughed at him. In all cases, Mr. Lee expected one reaction but got another.
There are extremes, too. These descriptions probably don’t fit you, but may describe your colleagues: doctors who are arrogant, or belittle their patients, use words their patients don’t understand, or who are dismissive. Your patient may be angry because he has dealt previously with a colleague who behaves in these ways. Not your fault – but you’re paying the price.
Is there any way to improve Mr. Lee’s disposition and behavior? For most angry patients there is.

The best approach is to be direct — face it head on. When Mr. Lee puts up those seemingly impenetrable walls, pause, look him directly in the eye, and ask him, “Mr. Lee. I sense an unspoken problem here and it strikes me that you are frustrated or angry. What can I do to help?”
Yes, he may clam up, and you may not get any further information. But most patients, when provided with an open door, will walk right through it. They’ll tell you what’s going on.
Know that whatever is bothering one patient is bothering many others as well. If you listen carefully, you’ll know what adjustments will need to be made across the board. He’ll tell you, “I didn’t know that….,” or “You didn’t tell me ….” It may be “You told me…. But it didn’t work.” Or “How was I supposed to know that….”
You may need to hear between the lines of his answers. “I didn’t know…” means he feels like you didn’t explain it to him, and he thinks you should have. “It didn’t work” means he expected it would, and you didn’t help him understand that it might not.
Your tendency may be to defend yourself. For example, you may remember telling him that it would take a few weeks before his pain pills would work. Or you know that it says right on the bottle that the medicine should be taken with food.
The problem is, even if you are right, your patient’s perception is that you are wrong — and that’s why he is angry. You are the professional, and you are responsible for making Mr. Lee feel better about it.
What is required here is good, solid, memorable communication. If he complains about the waiting room — look into the delays. If he is embarrassed or feels disrespected, figure out why and make adjustments. When your patient describes something to you, relate his story back to him, telling him you want to be sure you understand. When you give him instructions, ask him to repeat them back in his own words. Be sure you manage his expectations by describing the benefits of adherence, or the consequences of bad choices. Be clear about side-effects and which ones require immediate follow up.
A good relationship with your patient is like a good marriage. It requires that solid, useful, fair, two-way conversation. When you respect your patients, and model good communication, you’ll find their demeanors improve — a benefit to everyone.
Trisha Torrey is "Every Patient’s Advocate," the About.com Guide to Patient Empowerment, and author of "You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Health Care You Deserve)." She focuses on helping patients and doctors work more collaboratively to improve outcomes for all.

Self-Reflection May Help More Doctors Show Compassion.

2011-05-24T07:06:00.000-07:00

Self-Reflection May Help More Doctors Show Compassion.
In a Washington Post (5/16) op-ed, Manoj Jain, of the Rollins School of Public Health at Emory University, wrote that many "say our healthcare system lacks compassion. I too at times feel that pills and surgeries, CT scans and radiation therapies, biopsies and blood tests have become a priority in medicine and that compassion -- the 'touchy-feely' part of medicine -- has become an afterthought in patient care." However, because few patients "confront doctors about their behavior," the burden of "self-reflection on issues of compassion often remains" with the physicians themselves or a training program. Overall, "I believe that doctors and other healthcare providers are genuinely compassionate and that this is often what steered them toward medicine [and healthcare] in the first place."

Diabetic Retinopathy May Predict All-Cause Mortality, Cardiovascular Disease In Type 1 And Type 2 Diabetes.

2011-05-09T07:01:00.001-07:00

MedWire (5/6, Albert) reported that, according to a meta-analysis published April 27 in the journal Diabetes Care, "diabetic retinopathy (DR) is a predictor for all-cause mortality and cardiovascular disease (CVD) in patients with both type 1 and type 2 diabetes." The meta-analysis, which encompassed 20 studies including 19,234 participants, found that, "compared with patients with type 2 diabetes and no DR, those with any degree of DR had a significant 2.34-fold increased risk for the combined endpoint of all-cause mortality and/or CVD (myocardial infarction, angina pectoris, coronary artery bypass graft, ischemic changes on electrocardiography, stroke, or lower leg amputation)."

Significantly Less Costly Treatment's Efficacy Same As Pricier One For AMD, Study Confirms.

2011-04-29T07:33:00.000-07:00

In continuing coverage, the New York Times (4/29, B4, Pollack, Subscription Publication) reports, "A drug that costs about $50 a dose is just as effective at preserving and improving vision in elderly people" with the wet form of age-related macular degeneration (AMD) as a drug that costs "$2,000 a dose," according to a study sponsored by the National Eye Institute, part of the National Institutes of Health.
The Wall Street Journal (4/29, Dooren, Whalen, Subscription Publication) reports that the findings, which were published online in the New England Journal of Medicine Thursday, showed that Genentech's significantly less costly drug Avastin (bevacizumab injection) works just as well as the company's costly Lucentis (ranibizumab injection) at treating AMD. The findings will also be presented at the Association for Research in Vision and Ophthalmology meeting on Sunday, May 1.
According to the AP (4/29), the study also shows that patients with AMD, which "can lead to blindness," can be treated "less often" with Avastin, "sparing them a lot of pain" as well as expense. "Anyone wanting to use Lucentis now will have to justify its cost to insurers and policymakers," wrote Dr. Philip Rosenfeld of Bascom Palmer Eye Institute at the University of Miami wrote in an accompanying editorial .
MedPage Today (4/28, Phend) pointed out that those in the 1,161-patient clinical trial who received "monthly intravitreal injections of bevacizumab gained 8.0 letters of visual acuity after one year, compared with an 8.5-letter gain for those receiving ranibizumab," according to the study. Notably, monthly costs "averaged $595 for bevacizumab and $23,400 for ranibizumab."
The Los Angeles Times (4/29, Cevallos) "Booster Shots" blog notes that the two drugs "might pose slightly different" side-effects. "Serious adverse events, largely hospitalizations, were seen in 24% of Avastin patients compared with 19% of Lucentis" patients. Although, the study authors said that many "factors could explain the difference in rates," considering that "earlier Avastin studies have suggested potential risks as well, the side-effects issue is one to watch."
The study is also covered by the Boston Globe (4/29, Kotz), the Cleveland (OH) Plain Dealer (4/29, Tribble), the Fox News (4/29) "Body & Mind" column, Reuters (4/29, Steenhuysen), and the Financial Times (4/29, Jack, Subscription Publication).

Fewer Americans Have AMD

2011-04-27T15:54:00.000-07:00

Fewer Americans Have AMD
Less Smoking, Healthier Lifestyles May Be Warding Off Vision-Robbing Eye Disease in Older Adults, Researchers Say

Fewer adults in the U.S. are developing age-related macular degeneration (AMD), possibly because of healthier lifestyles, researchers report in this month's Archives of Ophthalmology.

AMD is an eye disease that gradually makes it difficult to see fine details, such as numbers on a watch or letters on a street sign. It is a leading cause of vision loss among people aged 60 and older, according to the National Eye Institute. Smoking, obesity, high blood pressure, and a family history of AMD increase your chances of developing the disease.

Ronald Klein, MD, MPH, of the University of Wisconsin School of Medicine and Public Health, Madison, and colleagues reviewed data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) to determine the overall number of Americans with AMD. More than 7,000 patients aged 40 and older participated in the survey and underwent digital eye imaging, which reveals changes in the eye's retina.

The Study

The new report finds that 6.5% of middle-aged and older adults in the U.S. had signs of the eye disease in 2005-2008. Non-Hispanic blacks aged 60 and older had lower rates of AMD than non-Hispanic whites of the same age.

The findings are a stark contrast to an earlier NHANES analysis from 1998 to1994, which estimated that AMD developed in 9.4% of Americans.

Study authors say lower rates of smoking, improved blood pressure management, and an increase in healthier diets and exercise programs may have contributed to the decline in AMD among older adults.

Vitamin D May Help Protect Women Against Age-Related Macular Degeneration.

2011-04-12T05:05:00.001-07:00

ABC World News (4/11, story 8, 1:55, Stephanopoulos) reported that vitamin D may help protect women against age-related macular degeneration (AMD), according to a new study .
MedPage Today (4/11, Neale) reported that "looked at data from the Carotenoids in Age-Related Eye Disease Study (CAREDS), which was conducted under the umbrella of the Women's Health Initiative Observational Study. In CAREDS, age-related macular degeneration status was assessed an average of six years after serum samples were analyzed for 25(OH)D status." The new analysis, published in the Archives of Ophthalmology, "included 1,313 women ages 50 to 79."
WebMD (4/11, Hendrick) reported that "in the study, researchers say women under 75 who got the most vitamin D had a 59% decreased risk of developing age-related macular degeneration, compared to women with the lowest vitamin D intake." The "researchers also found that the women who had a blood vitamin D level higher than 38 nmol/L had a 48% decreased risk of early" AMD. "A blood level of 50 nmol/L is considered sufficient, according to the Institute of Medicine."
The UK's Daily Mail (4/12) reports that "these results did not apply to vitamin D absorbed via sunlight -- the association was only seen with women who consumed the vitamin in foods and supplements." The "researchers found that time spent in the sun did not affect risk levels, even though the most important source of vitamin D is it generation in the skin as a reaction to sunlight." The UK's Telegraph (4/12, Beckford) also covers the story.

Vegetable-Rich Diet Associated With Decreased Risk For Cataracts.

2011-04-11T09:36:00.001-07:00

Reuters (4/9, Boerner) reported that, according to a study published online March 23 in the American Journal of Clinical Nutrition, people who are vegans or vegetarians appear to have a 30% to 40% reduced risk for cataracts. In a study involving some 27,600 people over the age of 40, some of which were followed for about 15 years, researchers also found that people who ate more than 3.5 ounces or more of meat each day had the highest risk for developing cataracts.
Some Vegetarians May Face Increased Risk Of Heart Problems From Nutritional Deficiencies. WebMD (4/8, Doheny) reported that research published in the Journal of Agricultural and Food Chemistry suggests that "some vegetarians may be increasing their risk of heart problems from nutritional deficiencies in their diets." In a "review of published articles from medical journals," researchers "found that vegetarian diets are often lacking in some key nutrients. These include vitamin B12 and omega-3 fatty acids."

Current Methods May Detect Just 10 Percent Of Medical Errors.

2011-04-08T04:44:00.001-07:00

ABC World News (4/7, lead story, 2:45, Sawyer) reported that there is "stunning medical news tonight about how many Americans have something go wrong when they go to the hospital. ... One in three patients will face a mistake during a hospital stay. Far worse than we've ever been told."
The Los Angeles Times (4/7, Brown) "Booster Shots" blog reported, "In the April issue of the journal Health Affairs, which focuses on medical error[s], a team of researchers affiliated with the Institute for Healthcare Improvement, a think tank in Cambridge, Mass., report that the number of 'adverse events' in hospitals -- injuries caused by medical error rather than patients' underlying conditions -- might be 10 times greater than previously measured." Researchers "used a new method to look for bad outcomes, reviewing medical records for 795 patients at three large US hospitals that had 'well-established operational patient safety programs.'" They "detected 354 adverse events among the patients -- 10 times more than other methods in use." The researchers concluded that in all, "adverse events occurred in 33.2% of admissions."
"Trigger Tool" May Help To Better Detect Adverse Events in Hospitals. MedPage Today (4/7, Walsh) reported that "commonly used methods of measuring inpatient safety and adverse events fall far short of the detection rates seen with a 'trigger' tool developed by the Institute for Healthcare Improvement," according to a study published online in Health Affairs. Researchers found, "in a review of 795 patient records," that "local hospital reporting systems detected only four adverse events (1%), while the Agency for Health Care Research and Quality's Patient Safety Indicators identified 35 events (8.99%)."

Bacteria, Fungi In Old Makeup May Cause Eye, Skin Infections.

2011-03-15T05:40:00.000-07:00

MSNBC (3/14, Dahl) reported that for "many women who cling to their makeup, it's hard to toss it before reaching the bottom of the container," particularly when some makeup products are on the pricey side. But not doing so just makes it easier "for bacteria or fungi to get into your makeup, potentially causing eye or skin infections, health experts warn." For example, "Dr. Andrea Thau, a New York optometrist and a spokesperson for the American Optometric Association, says she treats one or two women each month for cosmetic-related infections." The Food and Drug Administration points out that eye makeup should be replaced about every three months, particularly creams and liquids.

Researchers Identify US Diabetes Belt.

2011-03-08T05:49:00.001-08:00

The CNN (3/7, Willingham) "The Chart" blog reported that "in April's issue of the American Journal of Preventive Medicine, researchers have been able to identify a 'diabetes belt' of 644 counties in 15 US states. Located primarily in the southeastern part of the country, the belt defines where diabetes care and prevention are most needed." The blog entry noted that the "belt includes portions of the states of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia, as well as the entire state of Mississippi."
Focusing on the demographics involved, WebMD (3/7, Hendrick) reported that "researchers identified four factors that distinguished the diabetes belt from the rest of the US." Notably, "the population of the diabetes belt counties contained substantially more non-Hispanic African-Americans than the rest of the country," nearly a third of the people in the diabetes belt were considered to be obese, just over 30% of people in "diabetes belt counties were judged to lead sedentary lifestyles," and only about a quarter of the people there had a college degree, compared to just over a third in the remaining portion of the US. Reuters (3/8, Pittman) also covers the story.

Screening For Retinopathy Of Prematurity May Safely Start At 31 Weeks.

2011-03-01T09:34:00.001-08:00

Medscape (2/28, Barclay) reported, "Screening for retinopathy of prematurity (ROP) may safely start at 31 weeks of postmenstrual age (PMA)," according to a study published in the February issue of the Archives of Ophthalmology. After examining data on 506 infants, the study authors wrote, "In our population of infants born before 27 weeks' gestation, the first examination could safely be postponed until PMA of 31 weeks because the onset of ROP stage 3 did not occur before then and criteria for treatment were not reached before PMA of 32 weeks." They added, "Gestational age at birth and PMA at the time of examination should be considered when deciding when and where the next examination should be performed."

Diabetic 3 month average glucose may have (A1c) shows additional value.

2011-02-14T06:10:00.000-08:00

HbA1c Value Above 8% May Increase Risk For Sight-Threatening Retinopathy In Diabetes.
MedWire (2/9, Albert) reported that, according to a study published online Feb. 8 in the journal Diabetes Research and Clinical Practice, "having a glycated hemoglobin (HbA1c) value above 8.0% significantly increases the risk for sight-threatening retinopathy (STDR) in patients with diabetes." After evaluating "the HbA1c level and retinopathy status of 1,414 individuals with diabetes," 255 of whom had retinopathy, researchers "found that a cut-off value of 8.0% for HbA1c was most predictive for both non-STDR and STDR."

Small Study Supports Vision Test's Accuracy For Detecting Concussions.

2011-02-08T05:43:00.000-08:00

USA Today (2/8, Lloyd) reports, "A vision test that can be administered in a minute on the sidelines could be an effective tool to detect concussions," according to a study in Neurology. The "King-Devick (K-D) test, involves the athlete reading single digit numbers displayed on index-sized cards." Although other sideline exams "test cognitive or memory skills and rely on the administrator to make subjective decisions, the K-D test is objective," researchers say. It reveals "impairments of eye movement, attention, language and other symptoms of impaired brain function. It looks at rapid eye movements and other signs that are frequently abnormal following a concussion." The initial "research was a small study limited to 39 boxers and MMA fighters."

Sunglasses Not Just For Summer Anymore, Article Explains.

2011-01-18T06:10:00.001-08:00

The New York Times (1/15, B6, Alderman) reported in "Patient Money" that "sunglasses are not just for summer." That is because "skiing on fresh snow, skating on reflective ice or hiking at high altitudes can be harder on your eyes than a day at the beach." In fact, "snow...reflects nearly 80 percent of the sun's rays," while beach sand reflects merely 15 percent. What's more, the sun's ultraviolet rays can damage eyes, leading to cataracts and possibly age-related macular degeneration and even cancer of the eyelids. The New York Times (1/14, Barrow) "Well" blog also covered the story.

Devices, Programs May Benefit People With Low Vision.

2010-12-28T08:47:00.001-08:00

The New York Times (12/28, D2, Brody) reports in "Personal Health" that many devices and programs can now help people with low vision "live more fulfilling, independent, and productive lives," such as specially modified computer screens and keyboards, specialized eyeglasses, talking watches, and audio book players. The National Federal of the Blind offers a newsline accessible by telephone touch pad to provide daily access to US newspaper articles. Meanwhile, the VA offers "rehabilitation programs...meant to help blind and low-vision veterans and active service members regain their independence and quality of life and to function as full members of their communities and families."
The New York Times (12/27, Bilanow) "Well" blog highlighted the experiences of Jim Vlock, an 84-year-old veteran with macular degeneration, who uses a variety of programs and devices to maintain his independence.

Fully 86% Of Those With An Existing Eye Disease Do Not Get Yearly Eye Exams.

2010-12-21T06:25:00.000-08:00

In the first of two columns devoted to vision loss, the New York Times (12/21, D2, Brody) reports in "Personal Health" that a "nationwide survey (conducted Sept. 8 through 12 by Harris Interactive) showed that only a small minority of those most at risk get the yearly eye exams that could detect loss of vision and prevent, delay or even reverse its progression." Amazingly, "fully 86 percent of those who already have an eye disease do not get recommended exams, the telephone survey of 1,004 adults revealed." The Times notes that "the survey was commissioned by Lighthouse International, the world-renowned nonprofit organization in New York that seeks to prevent vision loss and treats those affected."
According to the New York Times (12/20, Barrow) "Well" blog, "Poor vision can lead to job loss, social difficulties, and the pain and cost of falls and accidents." The blog entry quoted Mark G. Ackermann, Lighthouse's president, who "emphasized that our rapidly aging population predicts a rising prevalence of sight-robbing diseases like age-related macular degeneration and diabetic retinopathy that will leave 'some 61 million Americans at high risk of serious vision loss.'"

Healthy Lifestyle Habits May Cut Risk For Developing AMD

2010-12-15T11:50:00.001-08:00

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MedPage Today (12/14, Gever) reported that, according to a study published online Dec. 13 in the Archives of Ophthalmology, "women who exercise, eat right, and don't smoke could cut their risk of developing age-related macular degeneration (AMD) by more than two-thirds." In a study encompassing "1,313 women ages 55 to 74 at baseline," researchers found that, "compared with sedentary smokers who ate lots of fatty processed foods, participants...who had healthy lifestyle habits were found to have an adjusted odds ratio of 0.29 for developing AMD over a six-year span."

Acupuncture May Help Improve Vision In Children With Amblyopia.

2010-12-14T06:56:00.001-08:00

The CNN (12/13, Curley) "The Chart" blog reported, "Acupuncture is helping to improve vision in children with lazy eye, according to a study published online Dec. 13 in the Archives of Ophthalmology." For the study, "researchers compared the effectiveness of two hours of daily patching therapy with acupuncture for treating lazy eye in 88 children aged seven to 12," all of whom "had already worn glasses for at least 16 weeks."
HealthDay (12/13, Mozes) reported, "About half the children were treated five times a week with acupuncture, targeting five specific acupuncture needle insertion points (located at the top of the head and the eyebrow region, as well as the legs and hands)." Meanwhile, "the other half were given two hours a day of patch therapy, combined with a minimum of one hour per day of near-vision exercises, such as reading." Then, "after about four months of treatment, the research team found that overall visual acuity improved markedly more among the acupuncture group relative to the patch group."
Focusing on specific points of improvement, WebMD (12/13, Doheny) reported, "At 15 weeks, visual acuity with eyeglasses improved by about 1.8 lines on the vision chart in the patched eyes and 2.3 lines in those who had acupuncture." Notably, "an improvement of two lines or more occurred in nearly 67% of those in the patching group, but nearly 76% of those in the acupuncture group," while "amblyopia was evaluated as resolved in nearly 17% of patched eyes but nearly 42% of the acupuncture group."
MedPage Today (12/13, Fiore) reported, "The mechanism" why acupuncture works "remains unclear, but researchers say that acupuncture at vision-related acupoints may modulate the activity of the visual cortex." What's more, "acupuncture has also been shown to be effective in increasing blood flow to the cerebral and ocular vasculatures, stimulating the expression or retinal nerve growth factors and leading to metabolic changes in the central nervous system." The study authors "called for further study of the value of acupuncture in treating amblyopia." Reuters (12/13) also covered the study.

Diets Rich In Omega 3-Fatty Acids May Reduce Risk Of AMD.

2010-12-02T08:59:00.001-08:00

USA Today (12/2, Marcus) reports, "Eating more seafood rich in omega-3 fatty acids, such as oysters, crabs and tuna, appears to slow advanced" age-related "macular degeneration (AMD), a common cause of age-related blindness," according to a study published in the December issue of the journal Ophthalmology. "The findings are consistent with previous research suggesting omega-3 supplements and omega-rich diets protect vision in some people, says study author Bonnielin Swenor of the Wilmer Eye Institute at Johns Hopkins School of Medicine."
MedPage Today (12/1, Neale) reported that in a study of 2,391 "Medicare beneficiaries living in Maryland, patients with advanced AMD were significantly less likely to eat at least one serving of seafood high in omega-3 fatty acids a week than healthy controls (OR 0.4, 95% CI 0.2 to 0.8)."
According to WebMD (12/1, Hendrick), the investigators also "examined whether dietary zinc from crab and oyster consumption had an impact on advanced macular degeneration risk, but no significant relationship was found. Zinc also is considered protective against the disorder," but one of the study authors speculated "that her study found no effect, because the zinc levels obtain from fish and seafood were low, compared to supplement levels."
HealthDay (12/1, Mozes) quoted Anand Swaroop, PhD, chief of the neurobiology, neuro-degeneration, and repair laboratory at the US National Eye Institute, who "interpreted the findings with caution." Swaroop stated, "I wouldn't want people to start taking grams of omega-3 to protect against AMD based on this finding, because I'm not really sure that this study has sufficient power to draw any conclusions." He called for "larger studies with longer term follow-up before being able to properly assess the impact." The UK's Daily Mail (12/2, Borland) also covers the story.

Amblyopia Treatable Even After Child's Eyes Are Developed.

2010-11-17T05:05:00.001-08:00

The UK's Daily Mail (11/16, Farmer) reported, "Historically, it's been thought that little can be done to treat amblyopia once a child's eyes are developed, between the ages of seven and eight." However, that is not the case. Pediatric eye expert Ashwin Reddy, of London's Moorfields Eye Hospital, treated an eight-year-old boy diagnosed with amblyopia by putting "the youngster on a regimen which involved wearing a patch over his good right eye for two hours a day for a total of 400 hours, to train the brain to use the weak eye," and prescribed eyeglasses with a strong lens for the boy's lazy eye. Two years after starting treatment, the child's eyesight has improved "dramatically," and he now enjoys perfect sight as well as 3D vision when he wears his glasses.

Fenretinide May Benefit Patients With Dry AMD.

2010-10-18T06:53:00.000-07:00

The UK's Daily Mail (10/18, Macrae) reports that fenretinide, "a drug based on vitamin A, could prevent millions from going blind" due to dry age-related macular degeneration (AMD), according to research presented at an ophthalmology conference. In a study of nearly 250 patients with dry AMD who were randomized to fenretinide or to placebo, researchers found that "in the highest dose, the drug halted visual deterioration after a year. This suggests that while it was unable to do anything to stop cells that were already damaged from dying, it protected healthy cells."
Bloomberg News (10/17, Olmos) reported, "The drug is believed to slow the progression of macular degeneration by reducing inflammation, inhibiting abnormal growth of blood vessels, and reducing levels of vitamin A in the retina, which can cause the formation of lesions that impair vision in people with the disease."

Deaf People May Develop "Super Vision" To Compensate For Hearing Loss.

2010-10-14T05:41:00.001-07:00

The UK's Telegraph (10/11, Smith) reports, "Scientists believe the brain adapts to the loss of hearing by rewiring itself to enhance sight," according to findings reported online Monday in the journal Nature Neuroscience. Parts "of the brain that normally locate sound can learn to do the same job using vision instead." Researchers "made the discovery by studying cats -- the only animal besides humans that can be born congenitally deaf."
BBC News (10/11) quotes study author Dr. Stephen Lomber, who said, "The brain is very efficient, and doesn't let unused space go to waste." He added, "The brain wants to compensate for the lost sense with enhancements that are beneficial." For example, "if you're deaf, you would benefit by seeing a car coming far off in your peripheral vision, because you can't hear that car approaching from the side -- the same with being to more accurately detect how fast something is moving," he noted. The UK's Press Association (10/10) also covered the story.

Blind People Use Visual Cortex To Heighten Senses Of Touch, Hearing.

2010-10-07T06:57:00.001-07:00

HealthDay (10/6, Preidt) reported, "Blind people use the visual part of their brain to heighten their senses of touch and hearing," according to a study published in the Oct. 6 issue of the journal Neuron. In the study, "researchers used functional MRI to observe brain activity in 12 people who were blind from birth and 12 sighted people as they performed a set of tasks involving hearing and feeling." The investigators found that "the visual cortex in the blind takes on these functions and processes sound and tactile information, which it doesn't do in the sighted. The neural cells and fibers are still there and still functioning, processing spatial attributes of stimuli, driven not by sight but by hearing and touch," the study's lead author explained.

New Implantable Telescope May Help People With AMD.

2010-09-13T08:23:00.001-07:00

The Chicago Tribune /McClatchy (9/11, Chan) reported that a "tiny implantable telescope has been developed to help people with" age-related macular degeneration (AMD). "The telescope, smaller than a pea, works by allowing light to be focused on working parts of the retina," thus helping "restore the ability to see what had been previously lost." CMS has yet to approve the device for Medicare patients, however.

Experimental Synthetic Cornea May Provide Alternative To Cadaver Corneas.

2010-08-26T11:45:00.001-07:00

The Los Angeles Times (8/26, Maugh) reports that, according to a study published in the Aug. 25 issue of Science Translational Medicine, "an experimental synthetic cornea implanted in 10 patients may be a potential alternative to cadaver corneas for curing vision loss due to corneal inflammation and scarring." The Times explains that "the new artificial corneas use collagen produced in yeast as a scaffolding that allows cells from the recipient to grow into the graft so that it mimics the original tissue." Notably, "the two-year preliminary test showed that the biosynthetic corneas restored vision as effectively as cadaver corneas, did not require anti-rejection drugs, and allowed normal tears to form."
The Washington Post /AP (8/26, Neergaard) reports that "in 10 patients with severe vision loss from damage to a corneal layer," researchers removed "damaged tissue in one eye," then implanted "the new biosynthetic cornea.... Soon, cells that line a healthy cornea started growing in the collagen." Remarkably, "two years later, six of the patients had significantly improved vision with glasses and two were no worse."
"The researchers went one step further and gave contact lenses to the patients," HealthDay (8/25, Dotinga) reported. "With the lenses in place, they all had improved vision," a study author said.
WebMD (8/25, Boyles) explained the overall importance of the study, noting that "worldwide, more than 10 million people have impaired vision or blindness as a result of corneal damage, but only a small fraction ever receive transplants from cadaver donors." This "shortage of human donor tissue, coupled with the threat of graft rejection from donor corneal transplants, has driven the search for other ways of treating corneal damage." And, even though "synthetic corneal replacements made from plastic are available, they have many drawbacks and are considered an option for only a small percentage of people."
BBC News (8/26, Rutherford) points out that "prosthetic corneas made from synthetic plastic are already used for patients who have previously had unsuccessful donor grafts but these can be difficult to implant and can cause infection, glaucoma and detachment of the retina."
The UK's Daily Mail (8/26), the UK's Telegraph (8/26), the UK's Press Association (8/26), and Reuters (8/26, Kelland) also cover the story.

Mid-Range Vision Poses Problems For Many Computer Users.

2010-08-17T05:43:00.001-07:00

Writing in the Wall Street Journal (8/17, D1) "Health Journal" on the front of the Personal Journal section, Melinda Beck points out that many people have difficulty seeing objects in the mid-range of their vision, particularly computer screens. Not only do those who wear glasses to correct either distance or close vision have difficulty, but also those who wear progressive lenses, too, unless they look at the screen exactly in the right spot. According to the American Optometric Association, approximately 40% of Americans spend three or more hours daily focusing on an electronic device with a screen. For some nearsighted middle-aged people, removing their distance glasses might be enough to help them read their computer screen for a while until they lose their close vision.

Green Laser Pointers May Emit High Levels Of Invisible, Potentially Dangerous Infrared Light.

2010-08-09T06:32:00.001-07:00

WebMD (8/6, Hendrick) reported that, according to research detailed in the National Institute of Standards and Technology's (NIST) Technical Note 1668, "green laser pointers may emit high levels of invisible and potentially dangerous infrared light." Researchers "bought three low-cost green laser pointers that had been advertised to have a power output of 10 milliwatts," but found that one particular laser "delivered infrared levels of nearly 20 milliwatts," enough light to cause retinal damage. The investigators pointed out that inadequate testing during manufacturing may account for the intense infrared emissions found in some laser pointers.

Young Children Who Suffer Head Trauma Should Have An Ophthalmologic Exam, Report Says.

2010-07-27T05:46:00.000-07:00

MedPage Today (7/26, Walsh) reported that, according to a clinical report from the American Academy of Pediatrics published online July 26 in the journal Pediatrics, "children younger than five who suffer head trauma or an unexplained life-threatening event should have an ophthalmologic evaluation, particularly if there is suspicion of abuse." The report suggested that "this ophthalmologic exam should be done, whenever possible, with indirect ophthalmoscopy and pupil dilation, preferably within the first 24 hours of injury, because the ocular findings may be transient." The report noted that "the range of retinal abnormalities associated with head trauma is wide and can include small, intraretinal hemorrhages confined to the posterior pole to numerous, multilayered hemorrhages extending to the edge of the retina."

Two New Treatments May Help Slow Retinopathy In Patients With Type 2 Diabetes.

2010-07-26T07:48:00.001-07:00

The CNN (7/23, Young) "Paging Dr. Gupta" blog reported, "Researchers have found two new treatments that could slow" diabetic retinopathy in patients with type 2 diabetes. In a study of 2,865 patients with type 2 diabetes, researchers found that "intensive blood sugar control and the combination therapy" of blood pressure medicine and "a combination of lipid and fenofibrate therapy" worked to decrease "the progression of vision loss by one-third." However, "patients in the intensive blood sugar control arm of the study had a higher risk of severe low blood sugar and death. The National Eye Institute says doctors need to consider these risks when discussing a treatment plan with their patients."

Eye Tests May Not Reliably Detect Hyperopia, Astigmatism In Adolescents.

2010-07-13T06:39:00.001-07:00

HealthDay (7/12, Preidt) reported that, according to a study published in the July issue of the journal Archives of Ophthalmology, "eye chart tests reliably detect nearsightedness in adolescents, but not farsightedness or astigmatism." In fact, "when Australian researchers assessed almost 2,400 students, with an average age of just under 13 years, they found that the average visual acuity score was 54 letters." While "the cutoff point of 45 letters reliably spotted participants with nearsightedness (myopia)...no reliable cutoff was found for either farsightedness (hyperopia) or astigmatism."
Patients With Diabetes Mellitus Who Drink Moderate Amounts Of Alcohol At Increased

FDA Approves Implantable Telescope To Help Patients With Age-Related Macular Degeneration.

2010-07-08T10:26:00.000-07:00

The AP (7/7, Neergaard) reports that the FDA has "approved a first-of-its-kind technology to counter a leading cause of blindness in older adults -- a tiny telescope implanted inside the eye." The Implantable Miniature Telescope "aims to help in the end stages of incurable age-related macular degeneration," although the FDA "warned Tuesday that patients need post-surgery rehabilitation to make it work." Dr. Malvina Eydelman, FDA's ophthalmic devices chief, said the device can improve the quality of life for those who are 75 and older, have a certain degree of vision loss and who also need a cataract removed. In addition, "the FDA took the highly unusual step of requiring that patients and their surgeons sign a detailed 'acceptance of risk agreement' before surgery, acknowledging potential side effects -- including corneal damage and worsened vision -- and the need for lots of testing to determine who's a candidate."
The San Jose Mercury News (7/7, Johnson) notes, "In a study involving more than 200 patients implanted with the device, the FDA said, 75 percent 'improved their level of vision from severe or profound impairment to moderate impairment.'" NPR's (7/6, James) "Two-Way" blog also covered the story.

SSRI Antidepressants May Increase Risk Of Developing Cataracts.

2010-06-03T05:40:00.001-07:00

The Los Angeles Times (6/1, Maugh) "Booster Shots" blog reported that, according to a study published in the June issue of the journal Ophthalmology, "the family of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, increases the risk of developing cataracts by about 15%, but some members of the family produce a higher risk." Researchers, in a study of "18,784 cataract patients and 187,840 healthy controls over the age of 65," found that "fluvoxamine (Luvox) increases the risk by 39%, venlafaxine (Effexor) increases the risk by 33%, and paroxetine (Paxil) increases the risk by 23%."
HealthDay (6/1, Mozes) reported that "rising risk was only associated with the current use of such medications, not prior use, the authors noted." Moreover, the investigators "observed that not all antidepressants appeared to be linked to an increased risk for cataracts, although they noted that the lack of an association was not definitive proof that there is in fact no risk." The study's lead author explained, "The eye's lens has serotonin receptors, and animal studies have shown that excess serotonin can make the lens opaque and lead to cataract formation."

Latino Americans Have Higher Rates Of Blindness, Diabetic Eye Disease, Cataracts.

2010-05-03T05:58:00.001-07:00

HealthDay (5/1, Preidt) reported that, according to four papers published in the May issue of the American Journal of Ophthalmology, "Latino Americans have higher rates of visual impairment, blindness, diabetic eye disease, and cataracts than whites in the United States." In analyzing data "from more than 4,600 participants in the Los Angeles Latino Eye Study (LALES)," researchers found that "the Latinos' rates of visual impairment and blindness were the highest of any ethnic group in the country, compared to other US studies of different populations."

Doctors May Be Able To Postpone Treatment In Some Glaucoma Patients.

2010-03-09T09:05:00.001-08:00

HealthDay (3/8, Dotinga) reported that, according to a study published in the March issue of the Archives of Ophthalmology, eye doctors "can sometimes wait before treating those at risk of developing" glaucoma. After tracking "1,636 people with higher than normal eye pressure" and randomizing them either to observation or to medication, the researchers discovered that the "risk of developing glaucoma was 16 percent" in the group receiving medication and 22 percent in group under observation. An accompanying editorial suggested that patients "with high eye pressure should ask their doctor whether they're at high risk or if they can just be monitored."
However, those "patients at high risk for glaucoma because of ocular hypertension appeared to benefit from early drug treatment," MedPage Today (3/8, Gever) reported. In fact, "among patients in the highest tertile of risk scores...28% of those started on topical medication for ocular hypertension developed primary open-angle glaucoma (95% CI 22% to 34%), compared with 40% of those who went untreated for eight years before beginning medication (95% CI 33% to 46%)."

Patients taking glaucoma medications regularly may have reduced risk for early death

2010-02-09T06:32:00.001-08:00

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HealthDay (2/8, Edelson) reported, "People who take medication to treat glaucoma appear to outlive those who don't treat the eye disease," according to a study published in the February issue of the Archives of Ophthalmology. In a study of "21,506 people with glaucoma or suspected glaucoma," researchers found that patients "who regularly took glaucoma medications had a 74 percent reduced risk for early death, compared with those who didn't take the drugs." One study author theorized that "the medications are beneficial, acting to boost kidney function, lower blood pressure, or otherwise improve general health." Reuters (2/9, Allen) also covers the story.

Prismatic bifocals may reduce myopia progression in children.

2010-01-12T05:58:00.001-08:00

The Los Angeles Times (1/12, Roan) reports that, according to a study published Jan. 12 in the Archives of Ophthalmology, "treating nearsightedness early in its course with bifocal lenses instead of single-vision lenses may reduce the ultimate severity of the condition." In a study of "135 Chinese Canadian children who were diagnosed with progressive myopia," researchers assigned "the children...to wear either single-vision lenses, bifocals, or bifocals with prism, a type of correction that is ground into lenses to help the eyes work together and enhance near vision." Two years later, "the slowest rate of progression was among children who wore prismatic bifocals; a 58% difference in the rate of progression compared to children wearing single-vision lenses."
MedPage Today (1/11, Phend) reported that while "a prescription for regular bifocals reduced progression to -0.96 D, compared with the -1.55 D seen with single-vision glasses over a 24-month period," the prismatic bifocals proved "to be more effective, with a drop of only 0.70 D over the same period." Medscape (1/11, Lowry) also covered the story.

Researchers explain how light may exacerbate migraine pain.

2010-01-11T07:25:00.001-08:00

The Boston Herald (1/11, McConville) reports that "researchers at Beth Israel Deaconess Medical Center say they've figured out why light makes migraines worse," according to a study published in the Jan. 10 online issue of Nature Neuroscience. The investigators "found that a group of recently discovered retinal cells that travel along the optic nerve to the brain contain neurons that become electrically charged during a migraine." So, "when light is introduced, the activity increases, and the pain is intensified," the study found.
"The team studied 20 blind individuals, all of whom suffered from migraines," HealthDay (1/10, Gardner) reported. Six of the "participants had no light perception at all...no functioning optic nerve," and therefore "experienced no photophobia." Because the other "14 people could sense light and dark and also experienced photophobia," the study authors theorized that the "optic nerve is critically needed in order to produce photophobia or exacerbation of the headache by light."
AFP (1/10), BBC News (1/11), the UK's Press Association (1/10), the UK's Independent (1/11, Connor), the UK's Telegraph (1/11, Devlin), and the UK's Daily Mail (1/11, Macrae) also covered the story.