Exposing the LASIK Scam

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 Post subject: contacts and dry eye
PostPosted: Mon Jul 03, 2006 1:01 am 
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Previously intolerant of contacts, they are now a necessity. I don't want to wear them without educating myself as to the long term risks.
I trusted what the doctors told me regarding Lasik - the reason I have to wear uncomfortable and potentially dangerous contacts now.
Eyes wide open.

Quote:
http://www.richmondeye.com/eyehealth_contacts.asp

A successfully treated corneal ulcer may still leave a scar which could affect the vision. It is important to avoid situations which can lead to corneal ulcer, such as overwear of lenses, poor disinfection techniques, swimming with contact lenses in, and ignoring symptoms of pain or redness.
Often, there will be a history of contact lens wear, which is the most common precipitating condition. ....
Corneal Swelling (edema)
Corneal edema, or swelling, occurs when there is an inadequate supply of oxygen reaching the cornea due to contact lens wear. Essentially, the cornea becomes smothered by the lens. Sleeping in contact lenses, as with extended wear lenses, greatly increases the risk of corneal edema. In this situation, even less oxygen reaches the cornea because the eyelid is closed over it. Also, the normal blinking of the eye is not present, which helps tears and oxygen to circulate under the lens.

Symptoms of corneal edema included blurred or foggy vision, seeing rainbows around lights, redness, and possibly irritation or pain. Complications of corneal edema include corneal abrasion, a tight lens syndrome (see above), and corneal ulcer or infection. Generally, a lens should not be worn if symptoms of corneal edema are occurring.

Phlyctenulosis
Phlyctenulosis (flick-ten-u-low-sis) is a blepharitis related complication of the cornea and conjunctiva. Bacteria at the edge of the eyelids (blepharitis) liberate toxins which get into the tears and irritate the eyes. In this complication, a hypersensitivity reaction, or allergic reaction develops on the cornea or conjunctiva.


Quote:
BACTERIAL KERATITIS
Signs and Symptoms

The patient with bacterial keratitis will generally present with a unilateral, acutely painful, photophobic, intensely injected eye. Visual acuity is usually reduced, and profuse tearing is common. There will be a focal stromal infiltrate with an overlying area of epithelial excavation. Often, there will be a history of contact lens wear, which is the most common precipitating condition. Corneal trauma or pre-existing keratopathy are also common precipitating conditions.1

Pathophysiology
Once the corneal defenses are breached, the cornea is prone to colonization and infection by pathogenic bacteria. Factors known to compromise corneal defenses include direct corneal trauma, chronic eyelid disease, systemic immune disease, tear film abnormalities affecting the ocular surface and hypoxic trauma from contact lens wear.
2
The collagen of the corneal stroma is poorly tolerant of the bacterial and leukocytic enzymes, and undergoes degradation, necrosis and thinning. This leads to scarring of the cornea. As thinning advances, the cornea may perforate, thus introducing bacteria into the eye with ensuing endophthalmitis.

Pasted from <http://www.revoptom.com/handbook/March_2004/sec3_1.htm>


Can't find studies regarding this combination as most dry eyes would AVOID contacts.

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 Post subject: A good relationship with a local Optometrist
PostPosted: Tue Jul 04, 2006 1:24 am 
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Sixeyes,

You need to have a really good relationship with your Optometrist and have your ocular surface health evaluated regularly! Keeping tabs on your ocular surface will take a lot of worry away.

The dry eye patients who wear lenses in my acquaintance are careful with their eyes... they use drops regularly, rinse with cold saline, get plenty of sleep etc.

I'm not sure where exactly you live... but Dr. Tseng is a dry eye specialist in Miami and Dr. Maskin is a dry eye specialist in Tampa. You may consider seeing one of these doctors even if you have to travel to do so.


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 Post subject:
PostPosted: Tue Jul 04, 2006 2:20 am 
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I had a contact lens specialist recently tell me not to worry about the dryness. He said ''thats what drops are for''. Is it really safe for a person with dry eyes to wear lenses all day as long as they keep their eyes moist with rewetting drops. Sounds fishy to me.


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 Post subject: Contact and interruption of tear layers
PostPosted: Tue Jul 04, 2006 3:36 pm 
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Your tear quality is paramont in eye health and in tolerating contacts- the balance of the 3 layers. My contact doc said some of my problem might result from the interruption of those layers by the contact. Makes sense.
I'm using Restasis (it's ok), given Lotemax but I can't find info on combining the two.
I'm trying massive anti-inflammatory supplements, anti-oxidants, etc. I believe the problem is systemic. Maybe my immune system? An allergic reaction is swelling glands/ ducts in my eyelids?
I do lid-scrubs for blepheritis, saline flush to get rid of accumulated histamines, digital massage for meibomian gland function, flax, fish oil, lutein, curcumin, L-Carnosine, now some drink from berries from the Amazon. I'll try anything once.
Obviously this is something I have to learn to live with.
Having had compromised vision for 1 1/2 yrs. until they found the right combination of contacts and glasses I am desperate not to lose any more vision.

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 Post subject:
PostPosted: Tue Jul 04, 2006 6:18 pm 
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I may be wrong but isn't Lotemax a low dose steroid like FML. Why have you been put on this stuff along with restasis. There are serious risks associated with long term steroid use and the two medications would be doing essentially the same thing to treat your dry eye. I have tried just about everything and I have had the best result with the following: Two tablespoons of flax oil with a full dose of Complete Omega each morning. Restasis morning and night and Refresh Endura as needed. I also gently scrub my eye lids and lashes (eyes closed!) in the shower with Dove soap and then rinse them thoroughly. I sleep with a humidifier as well.

I have not tried any of the following things you mentioned...saline flush to get rid of accumulated histamines, digital massage for meibomian gland function, lutein, curcumin, and L-Carnosine. Could you tell me more about them.


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 Post subject:
PostPosted: Mon Jul 17, 2006 1:47 am 
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I hope this information is helpful. Everything I read regarding dry eye is linked to inflammation. All the suggested medicinal therapies target inflammation -Restasis, Lotemax. Even Endura's effectiveness is a result of it's use of the same main ingredient as Restasis minus the medicine. And dry eye seems to be closely related to arthritis and allergies, both forms of inflammation. Flax seed oil is excellent - also anti-inflammatory.
Eye Health: (from Life Extension site)
Since the cornea helps focus images into our eye, maintaining clarity is essential. Both infection and injury can produce scars that leave the cornea cloudy. Clouded corneas reduce the amount of light that enters the eye, resulting in decreasing stimulation of the photoreceptors and dim vision. Scarring can also affect the shape of the cornea, producing astigmatism. Severe corneal scarring, or keratoconus, is one of the reasons for a corneal transplant operation.
If the tear system is not functioning properly, dry eye may develop. In some instances, it can be debilitating. Dry eye can be caused by numerous rheumatologic and auto-immune diseases, such as Sj?gren?s syndrome, rheumatoid arthritis, and systemic lupus erythematosus. It has also been linked to many medications. Dry eye can even occur without an obvious cause. Rarely, ocular dryness is severe enough to cause permanent damage to the cornea. Dry eyes can be treated with artificial tear drops or prescription medications such as Restasis? or by unplugging of the tear drainage system.
Oxidative stress has also been implicated in the development of cataracts (Zoric L et al 2005). A cataract occurs when the lens become cloudy as a result of normal aging. The only cure for cataracts is surgery, although one study has suggested that antioxidant therapy may help reduce the risk of developing them (Zoric L et al 2005).
Inflammation has also been identified as a possible aggravating factor in the development of macular degeneration. These findings suggest the possibility of preventing macular degeneration by reducing oxidative stress by using antioxidants and reducing inflammation.

Pasted from <http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=366&query=corneal&hiword=CORNEA%20CORNEAS%20corneal%20>

Glycation's Role in Inflammation

Pasted from <http://www.lef.org/protocols/prtcl-146.shtml>

Glycation can be described as the binding of a protein molecule to a glucose molecule resulting in the formation of damaged protein structures. Many age-related diseases such as arterial stiffening, cataract and neurological impairment are at least partially attributable to glycation. These destructive glycation reactions render proteins in the body cross-linked and barely functional. As these degraded proteins accumulate, they cause cells to emit signals that induce the production of inflammatory cytokines.

Pasted from <http://www.lef.org/protocols/prtcl-146.shtml>

Carnosine;
Glycation is also an underlying cause of age-related catastrophes including the neurologic, vascular, and eye problems. Carnosine is a unique dipeptide that interferes with the glycation process.

Pasted from <http://www.lef.org/newshop/items/item00787.html>

Carnosine's ability to rejuvenate connective tissue cells may explain its beneficial effects on wound healing. In addition, skin aging is bound up with protein modification. Damaged proteins accumulate and cross-link in the skin, causing wrinkles and loss of elasticity. In the lens of the eye, protein cross-linking is part of cataract formation.

Pasted from <http://www.lef.org/magazine/mag2001/jan2001_report_carnosine_1.html>

N-acetyl-carnosine. This supplement has also been shown to support healthy eyes. When administered topically in the form of N-acetyl-L-carnosine, this nutrient can move easily into both the water-soluble and lipid-containing parts of the eye. Once there, it helps prevent DNA strand breaks induced by UV radiation and enhances DNA repair. In the lipid areas of the eye, N-acetyl-L-carnosine partially breaks down and becomes L-carnosine. In a 1999 study of 96 patients aged 60 years or older with cataracts, one to two drops of a carnosine-containing solution was administered three to four times each day for three to six months. At the end of the study, the level of eyesight improved, and the lens became more transparent. For primary senile cataracts, the effective rate was 100 percent; for mature senile cataracts, the effective rate was 80 percent (Wang AM et al 2000).

Pasted from <http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=366&query=corneal&hiword=CORNEA%20CORNEAS%20corneal%20>

Lutein;
Pasted from <http://www.lef.org/magazine/mag2001/jan2001_report_carnosine_1.html>
Researchers have also found that lutein and zeaxanthin are more highly concentrated in the center of the macula. There, the amounts of lutein and zeaxanthin are much greater than their concentrations in the peripheral region. At the Baylor College of Medicine in Houston, scientific investigators demonstrated, using retinas from human donor eyes, that the concentration of lutein and zeaxanthin was 70% higher in rod outer segment (ROS) membranes where the concentration of long-chain polyunsaturated fatty acids and susceptibility to oxidation is highest, than in residual membranes (Rapp et al. 2000). The fact that lutein and zeaxanthin are particularly concentrated in these parts of the eye suggests that they may act as a shield or filter that helps to absorb harmful UVB light and dangerous free-radical molecules, both of which threaten the retinal tissue (Moeller et al. 2000; Bernstein et al. 2001).

Pasted from <http://www.lef.org/protocols/prtcl-097.shtml>

Meibomian Gland digital message:
The front of each eye is covered by an eyelid, which blinks periodically to spread tears over the eye surface and remove unwanted material. The eyelids also have glands that secrete oil onto the cornea, forming a portion of the tear film of the eye.

Pasted from <http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=366&query=corneal&hiword=CORNEA%20CORNEAS%20corneal%20>

Saline rinse for histamine accumulation;
Suggested by a doctor - dry eye indicating an 'allergic' reaction which causes an increase of histamines to the area? I'm not sure if this helps but it feels good. After approximately 5 hrs. of contact wear my eyes feel as though they are bulging. Maybe swelling is involved, of ducts, glands, or the cornea?

I wish I could find more information regarding the LONG TERM effects of gas perm contacts on eyes with inadequate tear production and poor quality tears. Thanks to Lasik I have been sentenced to a life of contact lense wear together with bifocal glasses.

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 Post subject: Ask Dr. Minarik
PostPosted: Thu Jul 20, 2006 8:34 pm 
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Sixeyes,

If your post falls under Dr. Minarik's radar here you can find him at:
http://doctormyeye.com. Dr. Minarik has been fitting damaged LASIK patients with RGPs for a long time and he would know if your concerns about long-term wear are an issue. I will bet you a cold beer that he says they are NOT an isssue.

You have done a great deal of dry eye research and your links are valuable... I recall a study demonstrating that antioxidant vitamins do have benefit in the prevention of macular degeneration in the elderly. I should dig that up...

Hope you are well (as can be expected...) :)

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We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. -Plato


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 Post subject: ...Burp....
PostPosted: Thu Jul 20, 2006 9:47 pm 
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Location: Rockford, IL
Ahh....the promise of free beer brings me back out of hibernation. First, lets look at the Lotemax long term issue. The bottom line is that the long term use of steroids in dry eye patients has been studied extensively, but the most work has been done with Alrex. Alrex is a 0.2% concentration of loteprednol, while Lotemax is 0.5% (150% stronger). It is a commonly accepted practice to put a patient on Alrex for the long term, but Lotemax is a "silver bullet" for occasional bursts of immunosuppression. So, you should consider using the lower dose (Alrex) because it has a much better safety profile.

Restasis is the first prescription medicine for dry eyes. It is alone in the marketplace in the US, but the next wave of medications seem to have a better chance to truly help dry eye patients. I just spent a few hours at a conference that really went into the future of dry eye therapy, and the results of some of the clinical trials are just stunning. Chronic dry eyes is looking more and more like an inflammatory cascade that starts when the dry eye sloshes off dead cells and then the patient becomes allergic to those dead cells and the inflammatory process begins. Restasis attacks that inflammatory process very late in the sequence of biochemical events. In essence, Restasis helps after you have sloshed off, attacked and become inflamed. Stopping the inflammatory process before it happens is the "holy grail" of dry eye research, and it seems as though the "chase" for that holy grail is taking us all the way back to the hormone androgen, which is the precursor of both estrogen and testosterone. Hence, dry eyed women have a different inflammation than men because the cascade starts all the way back at androgen and then takes a diverse path from the estrogen/testasterone split.

On the long term contact lens front, there are always "ifs".
If you are fit well, and your lenses are kept clean and maintained well, and you replace them often, then the long term use of contact lenses is well documented as safe and effective. Long term patients who become non-compliant because they take their lenses for granted are often the ones who get into trouble.

For example....patients who are not contact lens wearers who get a bacterial conjunctivitis ("pink eye") virtually always get a corneal infection from normal bacteria found on the face and lashes. Contact lens wearers are more likely to get bacterial infections in their eyes that come from the rectum. Yeah, I know...yuck. Contact lens wearers forget to wash their hands every time they touch their rear ends and it comes back to get them. Sigh.

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For resources, check www.doctormyeye.com


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 Post subject: Those bacteria come from WHERE?????
PostPosted: Sat Jul 22, 2006 6:27 pm 
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Yuck is right. A friend of mine told me today that he recently had a pinkeye infection. So glad he is NOT a contact lens wearer.

What do you think about hand disinfectant use before using lenses? Is regular handwashing enough?

Should we all invest in some avant-garde plumbing that does all the washing and drying in hands-free manner?


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 Post subject: Inflammatory cascade
PostPosted: Mon Jul 24, 2006 12:18 am 
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[quote="DrMinarik"]
Stopping the inflammatory process before it happens is the "holy grail" of dry eye research, and it seems as though the "chase" for that holy grail is taking us all the way back to the hormone androgen, which is the precursor of both estrogen and testosterone.
So what do we study now? I'm ready. I've learned so much about eyes these past several years. Who would have thought?
I have had some good result with a 'super-food' supplement which is very high in anti-inflammatory factors. Am I being deluded? My eyes occasionally have moisture now but it's still intermittent. My joints don't hurt anymore either - in spite of squats at the gym! My doctor has pointed out that the eyeball is a joint - a ball and socket. Hmmm.

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