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Entries tagged as ‘LASIK’

Dr. Diana Driscoll Speaks at the Ehlers-Danlos National Foundation Meeting

August 11, 2008 · 6 Comments

Dr. Diana Driscoll spoke to doctors and patients at the Ehlers-Danlos National Foundation Meeting (EDNF) in Houston, Texas August 1st and 2nd.  Her topic was “Your Eyes and Ehlers-Danlos Syndrome”.  Dr. Driscoll, herself is an Ehlers-Danlos Patient, therefore her lecture extended beyond the ocular effects of Ehlers-Danlos Syndrome (EDS) and included some of the treatments and techniques that she has found to have increased her functionality.

The National EDNF Meeting is held every other year and is presented as an opportunity for patients with EDS, doctors and researchers to unite in their quest for answers to this debilitating condition.

Ehlers-Danlos affects multiple body systems requiring a multidisciplinary team of doctors to assist patients.  Physicians of many specialties were present as speakers, patients and attendees.

About Ehlers-Danlos Syndrome

Ehlers-Danlos Syndrome is an inherited connective tissue disorder affecting our body’s production of collagen used to make connective tissue.   Connective tissue is the glue that holds our body together making up approximately 80% of our body weight.  The most common symptoms of EDS affect the joints and skin.

Skin symptoms are characterized by thin, soft, velvety skin that bruises easily and stretches.  Tearing of the skin is common along with slow wound healing.  Scars are often look like “cigarette paper”.

Joint symptoms include hyperextensible joints (joints that extend beyond their normal range of motion). People with hyperextensible joints have often been called “double jointed”.  Because the ligaments and tendons are “stretchy” the joints dislocate or become subluxated easily.  The premature onset of osteoarthritis is common and is often difficult to identify in an X-ray.

Some of the more common ocular symptoms of EDS are keratoconus, angioid streaks, and myopia.  EDS patients are not candidates for LASIK.  At Total Eye Care we are keenly aware of the potential complication that can result from any corneal surgeries performed on Ehlers-Danlos patients.

One of the most debilitating complications of EDS is a type of dysautonomia called Postural Orthostatic Tachycardia Syndrome or POTS.  Dysautonomia is the result of our autonomic nervous system ceasing to function properly.  Our autonomic nervous system regulates functions that our body does automatically such as digestion, breathing, heart rate, blood pressure, body temperature, blood sugar regulation, hormonal/endocrine imbalances and our  sleep cycle.

Postural Orthostatic Tachycardia causes a person’s heart to race when they stand still.  When a normal person stands, their heart rate may go up a few beats per minute and stabilize. A POTS patient’s heart rate will go up over 30 beats per minute.  If their body can not compensate, a POTS patient will often faint or shake uncontrollably.  A tilt table is used to test for POTS.

It is estimated that 40% to 70% of EDS patients suffer from POTS.  Many patients with POTS don’t know that they have EDS and are often mis-diagnosed with fibromyalgia or chronic fatigue syndrome.  It is thought that autonomic dysfunction is caused by instability of the cervical spine thus interfering with the brain stem’s ability to regulate our bodies.

The classification system for Ehlers-Danlos Syndrome consists of 6 types; Classical, Hypermobile, Vascular, Kyphoscoliosis, Arthrochalasia, Dermatosparaxis.  The prevalence of EDS is approximately 1 in 3000.  EDS affects both males and females and is not specific regarding race or ethnicity.

Ehlers-Danlos Syndrome is a genetic disorder, however many patients, such as Dr. Driscoll, are unaffected until the symptoms are triggered by a virus.

A copy of the lecture slides for Your Eyes and Ehlers-Danlos Syndrome is available in PDF form as is a handout for patients to give to their eye doctor before their eye exam.

This entry has been cross posted on The Total Eye Care Website.

Categories: Ehlers-Danlos · LASIK · examinations · eyecare
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FDA Listens to LASIK Patients

April 28, 2008 · No Comments

On Friday, the Food and Drug Administration heard testimony from LASIK patients dissatisfied with the outcome of their surgeries. The ophthalmic devices panel heard testimony that approximately 1/4 of all patients that wished to have LASIK were poor candidates and 95% of LASIK patients were satisfied with the outcome of their surgery. Expert testimony before the panel concluded that the FDA should provide clearer warnings about the risks and possible complications of LASIK. Next year the FDA and the National Eye Institute will begin a landmark study to better identify which patients are more likely to encounter post surgical LASIK complications and how those complications affect quality of life. We compared the incidence of complications for patients having LASIK vs contact lens related complications in a prior blog entry.

I find that the FDA is not the only one that could improve their modus operandi here but that some of the marketing/advertising for refractive surgery is irresponsible. This over promise of results does not apply to just refractive surgery but also the bifocal lens implants promising to give your back your ability to see near and far without bifocals.

At Total Eye Care our role as optometrists is to provide the patient with an objective assessment, finding the best method of vision correction available for each patients situation. Today there are many refractive options available such as contact lenses, glasses, orthokeratology, PRK, LASIK and refractive lensectomies just to name a few. If a refractive option is selected it is our job to work with the patient to find the best surgeon and procedure for each patient to get the best, safest result. The Associated Press had good coverage regarding the ophthalmic devices hearing, if you would like to read it it’s available here.

Categories: Cornea · FAQ · LASIK · Refractive issues
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LASIK - Is It Safer Than Contact Lenses?

March 31, 2008 · 1 Comment

It’s all over the radio these days a LASIK surgeon touts “some experts believe LASIK is safer than contact lenses”. In reality this is a difficult statement to backup properly, given that we are really comparing apples to oranges. Why is this comparison difficult? Comparing LASIK to another refractive surgery procedure, such as PRK, is rather straight forward because the complications are similar for both procedures and the opportunity for complications is essentially nil after the patient is stable, typically 6 months to a year after surgery. A contact lens wearer, on the other hand, has a lower complication rate. When compared to LASIK or PRK contact lens complications are less severe and less frequent, however, a contact lens wearer’s potential for complications will last as long as the patient is wearing their lenses, often for decades.

Both LASIK and contact lenses are safe and in our office we utilize both techniques, choosing which is best for the patient. It is our practice to discuss all of the refractive options with our patients. We weigh the risks and benefits of each option before proceeding.

As a practical matter the incidence of vision threatening problems in compliant contact lens wearers is very small. When a patient does have a problem, it typically manifests itself as a red eye usually resulting from poor care or not replacing their contacts as often as recommended. It is exceedingly rare for a contact lens related red eye to cause a patient to require surgery to resolve the problem.

This prompts me to ask “what does the research say”. In my mind that’s what matters. Let the studies show us which is safer. The most important contact lens and LASIK complications are those that have resulted in a loss of vision and therefore that is the best criteria to compare LASIK versus extended wear contact lenses. A 2005 study including almost 5,000 patients followed over a 1 year period showed that 30 day Ciba Night & Day contact lens wearers, experienced an overall rate of presumed infiltrative keratitis (a type of corneal ulcer) of 0.18%. Of those experiencing keratitis 0.036% resulted in a loss of vision and 0.144% experienced keratitis without vision loss.

Numerous studies published in 2005 and 2006 indicated a complication rate for LASIK, resulting in a loss of best corrected vision, ranging from 0.6% to 7.0%.

Given the facts outlined above, I feel it is doing patients a disservice to state or imply that refractive surgery is as safe or safer than silicone hydrogel contact lenses. Both LASIK/PRK and silicone hydrogel contact lenses have come a long way in reducing both the rate and severity of complications and in looking at the numbers both are safe.

I still believe LASIK and PRK are good options for patients. I, in fact, have had LASIK and at our office it is still one of the refractive options we present to our patients. However, the research does not support the statement that refractive surgery is as safe as contact lens wear nor should it be promoted as such.

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Categories: Cornea · Eye Care · FAQ · LASIK · Refractive issues · Vision · contact lens · examinations · eye
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