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Gene Therapy and Eye Disease:

 

One of the biggest frustrations I have had as an eye doctor is that often once we diagnose a disease there is very little we can do to cure or alter the course of that disease.    This is especially true with some of the more devastating eye diseases that are genetic like Retinitis Pigmentosa and Leber’s Congenital Amaurosis.  Gene Therapy offers the potential, in the future, to truly help these patients regain or maintain their vision and their independence.

 

This post is not intended to be an in depth scientific explanation of genetics because that would be boring, but rather a quick overview of gene therapy and the potential these therapies hold to improve the lives of many people who suffer from vision loss caused by genetic diseases.

 

First some quick definitions;

 

DNADNA: The complete genetic code that makes an organism.  Each cell within an organism contains this complete set of instructions.  Basically DNA is the recipe for you and I or any other living thing.

 

Genes: The individual genetic codes that cause particular traits to be expressed.  Whether your eyes are blue or brown is determined by which gene is present in your DNA.  Your risks for certain medical conditions are determined by the presence or lack of certain genes.  Genes also control what a particular cell within the body does.  While every cell within the body contains the complete genetic code or DNA, only certain genes are turned on in each cell.  Which genes are turned on determines what a cell does.  Heart cells are heart cells because the heart cell genes in the DNA are turned on.  There are approximately 20,000 different genes in the human DNA.

 

Mutation:  The changing of the structure of a gene.  Since the structure of a gene determines what it does, changing that structure changes what it does.  Effects of mutations in genes can have wide ranging effects both positive and negative.  Think of the X-Men.  Their mutations gave them amazing powers but also challenges.  Now back to the real world.  I have 2 red headed daughters.  I read an interesting article in National Geographic this weekend that taught me that the gene for being a redhead resulted from a mutation.  Not only is there a change in hair color associated with this mutation but also a change in perception of pain making them more susceptible to pain caused by heat or cold.  Redheads also require more anesthesia to control pain then the rest of us which is something my wife and I had noted following surgery for one of our daughters.  While their hair is beautiful, it comes with a cost.

 

What Causes Genetic Diseases?

 

Genetic disease result when one of three things occur;

 

  1. A gene is present or turned on and when it should not be.

  2. A gene is missing or turned off that is needed for some essential function.

  3. A gene has mutated.  The genes recipe has been changed so it makes the wrong thing.

 

These errors can occur because of faulty genes being passed to offspring by parents( heredity) or can occur due to spontaneous changes( mutation) in the genes of an individual.

 

Gene Therapy in Theory:

Gene therapy is based on this thought,  what if we could turn on a gene that needs to be turned on, turn off genes that need to be turned off or rewriteHow Viruses Work the recipe for genes that have mutated, that could solve a lot of problems.  The challenge is how do we get into cells to do this.  One of the potential methods happens to use something we all have experience with, viruses.

 

Gene Therapy We probably hear more about viruses infecting our computers then our bodies these days and looking at them in that way is a good way for us to understand what a virus does.  In our computers viruses are small pieces of computer code that hijack our computers for their own nefarious purposes.  In our bodies viruses inject small pieces of genetic code or genes into the cells and hijack them to producing more viruses.  All of us have experienced the downside of these nasty critters in the form of cold sores, colds, the chickenpox or shingles.  Now researchers are finding ways to to alter or mutate what viruses inject into cells.  Turn about is fair play right?  Instead of a piece of genetic code that replicates more viruses, they can insert a missing gene or instructions to turn on a gene.  It could also turn off a gene or even insert a corrected piece of code to replace a mutated one.  The result would be to restore normal function to a gene, a cell or even an organ and the curing of a disease state.  Now that is awesome in theory but does it work?  

 

Gene Therapy Results:

 

Results are promising in conditions that are caused by a  defect in a single gene that can be identified.  One such disease is Leber’s Congenital Amaurosis, a retinal condition which causes severe visual impairment from birth.  A defect in a gene called RPE65 was identified as the cause.   An modified Adenovirus( a common virus that causes pink eye) containing a correct copy of the RPE65 gene was used to insert that gene back into the retinal cells.  All patients who participated in the study were found to have improved vision.  So in this case it was shown to work.

 

In diseases such as macular degeneration and glaucoma where many genes and lifestyle issues have a part, gene therapy has not shown as much promise but lets see what the future holds.


Here’s the take home, Gene Therapy shows  promise for conditions that are caused by identifiable genes.  In conditions where many genes and combinations of genes play a role it does not show as much potential  Gene therapy probably will not play a role in protecting a lot of my patients vision, but for those few who it will help the future is bright.

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I recently read a book by Aldo Leopold a professor of ecology and pioneer of consevation, in the early 20th century.  The book was called A sand County Almanac and was a month by month account of the wonderful and beautiful things that marked each season of the year on his farm in Sand County, Wisconsin.  From the first tinkling of running water in the January thaw to the honking of the gesse returning to his marsh in April and the appearence of small flowers in June to the alder thickets turning crimson to announce the end of fall professor Leopold walks us through the amazing sights and sounds of the passing of a year that we can see if we are awake and aware enough to recognize them.  In one section of the book he expresses his saddness that a niehbor of his, also a professor, missed experiencing the beaties that surrounded him because he spent all his time inside his cabin. 

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I am not really into new technology in many parts of my life.  In many ways I feel like I was born a least a century to late.  When I hunt I like to use an old patch and ball muzzle loader that is no different from what the mountainmen first used in this area in the 1840's.  When I fly fish I use a horse hair line I make myself and is the same as one used in Japan up to 500 years ago.  Even more shocking is the fact that I only moved away from my flip phone when my wife hid it.  I now have a Iphone 4S but have never actually ever used Siri.  Heck I don't even know if I spelled her name right. 

One area where I do love technology however is in my practice.  When I started optometry school 20 years ago the equipment in an Optometrists office Retinal Photohad not changed significantly in 50 years.  Since that time it has exploded.  At that time we had a semester long class on taking fundus photos, pictures of the back of the eye.  At that point only specialty clinics or university settings could afford the equipment and dedicated employee's required to offer such a service.  Five years later digital photography had changed all of that.  When I started a practice I put in a digital camera that could take better pictures than the camera I used in the university and I could train my staff to use it effectively in an hour.  That camera has allowed me to take better care of my patients.  That was awesome!  

Well technology continues to march on and with it so does my ability to offer even better care to my patients.  We have recently added two new pieces OCT normal retinaof equipment that allow me to find conditions earlier, diagnose more accurately and treat more effectively.  The first is an Optical Coherence Tomographer or OCT.  This device allows me to take scans of the structure of the back of the eye and look for changes that would indicate a need for intervention.  Basically it allows me to evaluate the retina, macula or optic nerve down to the cellular level and look for the damage caused by diseases such as glaucoma, diabetic retinopathy or macular degeneration.  In the past I would not have had this information or I would have had to refer a patient for more invasive testing to get it.  Now if I have a question about whether one of these conditions is there or is getting worse, in a matter of minutes, with no significant discomfort or inconvenience to the patient we can have the information we need to make the best decision for the patient.  That is awesome.

The second is not a totally new type of equipment for us.  It is just better, more sensitive and much faster.  It is a new visual field.  This is an OCT diabetic eye diseaseinstrument that allows us to make sure that all information your eye takes in, makes it to your brain.  While the OCT looks at structure of the retina or optic nerve, this looks at how the visual pathway is functioning.  The visual pathway goes from the eye and passes through almost all parts of the brain. Because of this it allows us to find conditions that not only affect the eye( glaucoma, retinal detachments) but the brain( tumors, strokes).  We have found all of these is our office.  Our new technology has allowed us to find patients who may be at risk sooner however.  

One quick story that offers an example of how this technology has improved our patient care.  A long time patient came  in for an exam.  Our new visual field flagged him as being a potential glaucoma patient.  This alerted me and made me much more suspicious during the exam which allowed me to notice subtle changes in his optic nerves.  Still unsure however we took five minutes to run an OCT scan which showed definite glaucomatous damage to his optic nerve.  Because of our new technology we diagnosed and were able to treat him 5 to10 years earlier and save vision that would have been lost without it.  So while I will continue to use my old muzzle loader and I probably will not use Siri, I love our new technology.  Stop by have a cookie and I would love to show it to you.

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My wife forwarded me a Facebbok post she received the other day telling the story of a young girl, Rylee,who's vision was saved because of a photo her mother posted on Facebook to show off the girls new hairdo.  In that photo  Rylee's pupils had been illuminated by the flash of the camera and one pupil was white instead of red.  A concerned friend let the mother know that this could be a sign of an eye problem and the mother wisely took her daughter in to be evaluated.  Rylee was diagnosed with Coats Disease which can cause blindness.  Luckily Rylee was caught early so she can receive the best treatment possible and save as much of her eye sight as possible.

 

This is not the first time that this has happened. I can recall another instance when a photo posted on Facebook prompted a child's parents to seek eye care in Australia.  In this case the child upon getting an eye exam was diagnosed with retinoblastoma, a type of cancer that can be fatal if not caught early.  I am grateful that the technology of today made this photo available so somebody could alert the parents to the threat to this child's vision and health.  As a health care professionalI I do have one piece of advice however, do not trust your health or the health of your children to Facebook!  Long before Facebook was developed there was another invention that is even more sensitive to threats to your childs vision and health than Facebook.  It is call your eye doctor!  While not as sexy as Facebook it is a heck of alot more effective.

 

It is a weekly occurence in our office that we uncover a vision or medical issue that our patient was unaware of.  Most of the time these issues are visualChorodial Melanoma in nature and by solving them we improve the quality of their lives.  Occasionally these issues pose a threat to thier vision or health so that by addressing them we protect sight and life.  One of the most rewarding experiences of my carrer occured when a 43 year old man who had never worn glasses and was seeing fine came in for an eye exam.  The photos of the back of the eye, which we take as part of every eye exam, revealed a deadly type of cancer called Chorodial Melanoma. If this man would have waited until he noticed vision problems to come see me a wife would have been deprived of her husband and four children would have been robbed of their father way to soon. I always get asked how often should I or my kids come in.  Every time we find one of these problems it reinforces to me the importance of yearly eye exams.  It's not always a life we save.  Most of the time it is just a life improved like last weeks 8 year old girl who now does better in school or this weeks 15 year old boy who can now land his 25 foot table top jumps on his bike.  Wait maybe I did save another life there!  So keep up with your friends on Facebook but leave your eye care to the professionals.

 

 

 

 

 

  

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This week Cody at my office greeted me one morning as I walked in saying "did you see this?"  On her screen was a Facebook posting recounting the storyBBQ Eye?
 of a 21 year old woman who had her contact lens melt to her eye while attending a barbeque.  The story said she had been looking at the coals for 2-3 minutes when all of the sudden she just started screaming.  Her friends rushed her to the hospital only to be told she had been permanently blinded because the contact had melted to her cornea.  Cody asked, "can this really happen?"  In my 20 years in this profession, I had never heard of or seen such a thing but I thought it deserved some research.  To make a long story short, this is a hoax that first appeared on the internet in 2002 and has made periodic appearances every few years with only small changes in the story.  A quick search for any reports of such incidences in medical literature came up empty as well.  So while I do not worry about my patients grilling with their lenses on, I do have other concerns.  Today's soft contact lenses are more healthy and comfortable than ever.  Because of this, many of my patients forget that these are prescribed medical devices that when used improperly can have very painful and even sight threatening side effects.  Here are just a few tips to help you enjoy comfortable and worry free contact lens wear.

1. Stick to your prescribed wearing schedule.  Some contacts are designed to be taken out every night. Some have been designed to be worn continuously for up to 1 month.  Your doctor may also vary your wearing time depending on how your eyes handle contact lens wear.  Wear them only for as long as your Doctor prescribes them.

2. Throw your contact lenses away on time.  Many of my patients admit to trying to "stretch" their contacts to save money.  A year supply of contacts, $180, your vision, priceless!  I would bet that 80% of all the contact lens related complications I see are in patients who are trying to save money in this way.  Don't risk it.  If you get in a pinch and need a pair to get you through a month, come on in and I will give you a months supply.

3.  Clean them appropriately.  Today's newer lenses usually work better with the newer formulations of contact lens cleaners.  Many times, late day dryness can be solved by going to one of the new cleaners.  Some of my favorites are Opti-Free Pure Moist by Alcon and Clear Care by Ciba.  Bargain cleaners are usually older formulations that have not been designed to work with newer lens materials.  As usual you get what you pay for. 

4. Remember that soft contacts are sponges.  Soft contacts will absorb whatever surrounds them in the environment, concentrate it and hold it against your eye for long periods of time.  This can result in irritation.  If you are using preserved eye drops( prescribed or over the counter), work in an environment that is dirty or has chemical fumes or swim regularly with contacts in, you should probably consider a daily disposable lens.

So barbeque all you want, just be wise in caring for your contacts and your eyes because Life is Worth Seeing!

 

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I passed a milestone of sorts in my life yesterday.  I had my first actinic keratosis burned off. Yea!?! Now this is probably not a milestone any of you have marked on your calander but for me it marks the passage into middle age.  I had a little talk with the dermatologist about how I could avoid similar fun in the future and he basically said you can't!  I responded that I am very good about using sun screen now and wouldn't that help.  He pointed to the side of his nose at an obvious scar and said you and I are both in the same boat.  When we were young sunscreen was not around yet and as a result both of us experienced significant exposure to the solar rays in our youth.  This, he explained, has damaged the DNA of our skin and unfortunately he knew of no way of fixing it.  My only recourse now is to wait for more of these nasty little scaley things to appear and when they do go in and have them frozen so that I do not end up with a scar like his.  If only I had known about and been able to protect myself from the harmful effects of Ultra Violet (UV) light in my youth, me and my new dermatologist friend would not become as good of buddies as I think we are about to. Today, I would like to sound the warning cry for others so maybe they can avoid similar but even more devestating ocular effects of UV radiation.  I would also like to discuss the effects of High Energy Visible(HEV) light on the eyes,  which I am guessing most people are less familiar with. 

 

What Are UV and HEV Light?

Usually when we think of light we think of something that we can see.  This is not the case with UV light.  The visible spectrum of light runs from 380nm-780nm.  UV light has a wave length below 380nm or just  violet light in a rainbow.  It is emitted by natural sources such as the sun and can also be produced by man made sources such as arc welders and mercury vapor lamps.  It is low wave length and high energy and has the ability with extended exposure to cause damage our bodies.  

HEV light has a slightly longer wave length than UV ranging from 380-460.  It is visible as violet to blue light on the rainbow.  It helps to regulate melatonin production within our brains and can also with extended exposure cause damages to our bodies.  It is emitted by the sun and also flourescent lights, flat screen televisionss, computer screens and by all of our portable electronic devices.  It also has a short wave length and high energy and with prolonged exposure can cause damage to our bodies.

 

What Do UV and HEV Light Do To Us?

I am sure we have all experienced the most common negative effect of UV exposure, sun burn.  In addition to this painful but short term effect UV light sunburncan cause strutural changes to the DNA of the tissues of our bodies.  This can result in everything from pre-cancerous lesions such as the actinic keratosis which I recently had frozen off to deadly cancers like melanoma.  In the eye UV radiation can cause unsightly surface lesions called pterygiums, clouding of the lens of the eye called cataracts and probably the condition which causes the most fear in my patients, Age-related Macular Degeneration(AMD) which results in the loss of the ability to read, recognize faces and drive.

The effects of HEV light are not as noticable initially and so we are just beginning to realize its effects.  Because of its ability to supress melatonin formation, HEV light exposure in the evenings can interfere with our sleep/wake cycle.  I was speaking with my daughter recently and she mentioned that alot of her friends have trouble sleeping at night.  Probably not surprising.  Recent studies have tied extended HEV light exposure to decreased immunity function and increased rates of type II diabetes.  In the eye HEV light is thought to cause cataract formation and AMD similar to UV.

 

What Can We Do About It?

Staying inside with no flourescent lights or electronic devices on would work but is not very practical.  

For UV we have all been educated on sunscreen and limiting sun exposure.  Just do it.  If you wear glasses make sure the lenses give you 100% UVa and UVb protection.  The lenses can be clear and still offer this. Just ask your eye care professional and they will make sure you have it.  If you don't wear glasses get a good pair of sunglasses.  The sunglasses you bought at the gas station will not do this for you.  Even if they say 100% UV the coating is sprayed on and will wipe off fairly quickly.  A good guide is to spend at least $50 and look for polycarbonate lenses.  Better yet do yourself a favor and buy a really good pair like Maui Jim's.  You will have the protection you need and will be amazed at how much better the world looks and how much more comfortable your eyes are.  

For HEV light we now have coatings that will block these harmful rays as well as UV.  The one we use in our office is called Prevencia.  I now recommend it to all my patients who spend a significant amount of time on electronic devices for school, work or recreation.  

I wish I had had the opportunity to protect my skin when I was younger.  I do have the ability to help my patients protect their eyes now.  I think by doing so I will be able to help them rest better and and have better health and vision because Life is Worth Seeing. 

For more information on blue violet light follow this link.http://www.visionmonday.com/business/labs/article/the-new-blue-vm-090913/

For an information video on Prevencia follow this link.http://www.youtube.com/watch?v=2j6SjECTn6g

Or just give me a call.

 

 

 

 

 

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TUESDAY, DECEMBER 6, 2009

Understanding LASIK First Hand

I wrote this article in 2009 on another blog but thought it might still be of interest to some of my patients.  Just by way of note I still love my LASIK.  My distance vision is great and my wife now has to wear reading glasses and I am still fine with out.  She hates it but I love it.

 
I had LASIK yesterday. As an Optometrist I have been around, recommended and participated in this procedure for many years. I just had never got around to having it myself. I think my motivation for having LASIK was probably different than most. It wasn't that I hated my glasses and want to get rid of them, I actually liked them in most situations. It wasn't that I was blind. I could see alright without glasses, It bothered me some to drive, watch sporting events or movies without glasses but otherwise I did pretty well. I did it for two reasons;

1. My wife was always saying I should. I think she was just tired of me asking what the score was in the game I was watching on TV.

2. I thought it would be a great educational opportunity. Here I am telling patients they should do this(LASIK) and here is what to expect when I truely did not know.

So at my wifes urging I called Danyelle Madrid atHoopes Vision( Sandy, UT) a week ago and said lets do it. Danyelle is the co-management co-ordinator extrodinair for Hoopes Vision. She said great I'm having LASIK on Monday, want to be my surgery buddy? Well there is no time like the present so I did it. This blog will be a log of my experience and I hope will be educational and insightful.

 

Surgery Day:

I probably had less butterflies than most patients. This was not my first rodeo as the saying goes but I was surprised by my concern about whether I was making a good choice for me. Even though I have held many hands as people approached surgery, I still needed a little hand holding and reassurance myself as surgery approached. If I needed it, others for whom it is not as common place certainly will and I need to make sure I provide that.

The procedure itself held some suprises. Dr. Phillip Hoopes Sr. was great and made me feel relaxed through the whole procedure. I have always told people it does not hurt at all. Well that is 95% true. I did experience small amount of pain during the Intralase procedure( laser flap creation). It was not great, probably more accurately described as pressure, but it was there so don't be surprised. The visual sensations I experienced were interesting. My vision going black when the suction ring induced pressure during the Intralase procedure was expected, just how blurry my vision was following the flap creation was not. The coolest thing was having the tissue flap lifted and my vision totally blur out and then having it laid back down and it immediately clearing again. I don't think I experienced the dramatic change in vision that most experience upon sitting up. Once again my prescription was not huge to begin with and the residual haze from the surgery cancelled out any noticable improvement in my vision. I was 20/20 in each eye however even through the haze.

I was planning on going back to my office and seeing patients following surgery. I figured I'm a tough guy and I can handle it. I think we did everybody a great service by moving my patients however. Take my advice, stop by In and Out in Draper, grab a burger and fries, go home and close your eyes after surgery. My vision was not great and my eyes needed the rest.

My eyes felt great aside from a little dryness the first night. The haze cleared after a couple hours and while sitting home watching Monday Night Football I had my first I can see that moment. I could actually see the score and time left in the game. My wife finally had a night of peace without me asking her the score or time left. Both of us were happy. The only residual effect I still had was halos around lights. I imagine if this persisted long term it could become a problem but this night it was just cool. My christmas tree never looked more beautiful with each light appearing like a bright star burst. I imagine people pay good money for recreational substances to achieve the same effect. I anticipated wearing the eye shields at night would be a pain. Besides looking goofy they did not bother me at all.

Day 1:

I woke up the next morning and did something else I had not been able to do. See the clock across the room. Another fun I can see that moment. Eyes felt great, no pain and no dryness. The sticky residue from the tape that held the eye shields in place was hard to remove when you are trying to be gentle around your eyes. Put in my drops and lets go. Full day of work seeing patients and my eyes felt great all day. Vision is good, 20/15 in the right eye and 20/20- in the left when Blanine Bird O.D. checked my eyes. I wanted my right eye to be perfect without glasses and my left to be just slightly near sighted to help with near vision and delay for a few years the need for reading glasses. Nailed it perfectly. Towards the end of the day my eyes felt a little tired and maybe slightly dry but nothing that a quick dose of artificial tears did not handle. Still some haloing around lights on my drive home but that just adds to the Christmas spirit and should disappear about the time the holidays are over so no problem. Worst part of the whole deal so far is that the steroid and anti-biotic drops taste horrible.

Day 2:

Eyes feel fine. Still hard to get all the sticky residue from the tape off my face. Vision is great however. Still some halos but my vision is remarably sharp and crisp. Mountains are vivid as I drive to work. I am use to seeing this much detail with my glasses but it just looks better, more defined, each snow covered tree is visible. Cool again. As I go throughout the day I notice my eyes get tired if I miss my hourly dose of artificial tears.

Day 3:

Suprisingly my eye have been more tired today than any day previous. This may be due to the fact it has been so easy to forget about the drops. I am trying to keep on my drop schedule but when my eyes feel great I just keep working. It is only when I feel them get tired I remember to drop them. Vision is fine. Halos are still present but they should be. I now can see the eye chart as I am working with patients much better. In the past when I have been in the exam room I have not worn my glasses. Today I was working with my patients when I noticed how much dust was on the projector slide for my eye chart. There were little dust spots every where on my chart. I'm sure they have been there for a long time, I just did not see well enough to notice them. I have heard similar stories from ladies in their 70's and 80's who have had cataract surgery and then are embarassed to go home and find out that their kitchens are not as clean as they thought they were. Now I understand.

Day 7:  Still some halos but improving all the time.  Morning dryness is also present  and occasionally throughout the day.  Vision is great however.  Hate the taste of the steroid drops and can not wait to be done with them.

Day 14:  Continued improvement but still some morning dryness.  Vision is great.

Day 20: (Dec. 26th) Had my traditional day after Christmas duck hunt with my father-inlaw today.  Ducks came in and flaired against the pink of the eastern sky early in the morning and it was like watching it in HD.  Have never seen it that clearly.  Awesome!  Love this!  The steam off the water, the sunset, it all looked better.  Still some occasional dryness and still hate the taste of the steroid drops but love how well I see.

Day 30: Done with steroid drops. Yea!!  Vision great and having few dryness issues.  Love it.

Day 65: Went fly fish today.  Better vision makes every thing better.  Saw the size 18 fly on the water with ease.  Saw the spray off my line as I cast.   Getting more than just an education out of this.  Better then I expected.  Wife loves not having to tell me how much time is left in the game.

Day 180: No dryness for over a month now.  Vision is great.  I hardley think about even having had LASIK any more.  My vision is just great and I do not have to think about it.  That is what I call success!

 

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As an Optometrist I can not tell you how many times I have had a contact lens rep. come in and tell me that how incredible and awesome a new contact lens is, how it is going to change my patients world.  Well as with all such claims I have come to take these with a grain of salt.  Wonderful improvements have come to the contact lens world but usually in small improvements over time.  As a result the lenses of today are much healthier and more comfortable then they were years ago.  We may, however, have a game changer in Ciba's new Dailies Total 1 daily disposable contacts.  This contact is the result of ten years of research and developement and a totally new way of thinking about contacts and some thing called lubricity.  What the heck lubricity?

First lets have a quick history lesson on soft contacts.  Don't worry I will make this fast and painless.  Soft contacts first appeared in the early 70's with the developement of Hydrogel materials. Disposables contacts become available in the mid 80's greatly simplifying the care required and the comfort of contacts.  Through the 90's improvements were made to the Hydrogel materials increasing their water content( up to 60%) which improved both health and comfort.  Problems persisted due mainly to decreased oxygen getting to the corneal surface and protien depositing on the contact lens surfaces however.  In the late 90's a quantum leap in soft contact lens was achieved when a new type of material was developed, SiliconeHydrogel.  This material was 5-7 times more oxygen permiable making these lenses much more healthy then traditional Hydrogels.  They did not develope protien deposits as easily and were easier to handle as well so this truely was a wonderful improvement. SiloconeHydrogel had much lower water contents(30%) and as a result did not wet as well as Hydrogel materials so all day comfort was comprimised in some cases.  So while they were better there was still room for improvement.

Well the improvement may be here in Ciba's new Dailies Total 1 contacts lens incorporating what they are calling water gradient technology.  The concept is basically you take a SiloconeHydrogel core to get the oxygen transmission and handling benefits it offers but that cores water content increases from 30% in the center to almost 100% at the lens surface making an incredibly wettable and therefore comfortable lens.  When you handle the lens it just feels soft and slick.  This is lubricity.  It is basically how smooth and slick something is.  The surface being almost 100% water has resulted in an amazingly comfortable lens.  I do not wear contact lenses but I put some in today and am actually wearing them as I type this.  I have never been able to be comfortable in contacts but this one feels better then anything else I have tried.  The remarkable thing is that I do not feel it at all.  I think we may have a winner here.

You can not get these lenses just any where, in fact I think only 8 offices in the state currently have fitting sets and we are proud to be one of them.  If you have had trouble with contact lens comfort and dryness in the past its time to try again. Come on in and lets give it another try because the world of contact lenses may have just changed.

 

P.S.  Ended up wearing the lens total of 10 hours that day.  I forgot I had it in until I got home that night and was getting ready to go to bed.  Now I have taught thousands of people how to get lenses out of their eyes but had never actually taken one out of my own.  Heck of a time to learn.  Truely this is a great lens so if you have had problems in the past it may be worth a look.

 

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Its always surprises me how events in your life that you would never wish for can teach you important lessons.  Situations you would think you would never want to face can make you appreciate some of the amazing and wonderful parts of this life that you have be oblivious to, and still would, if you had not experienced the difficult situation. 

On a Tuesday night about a month ago I recieved a call from my wife.  Her mother had a stoke and she needed me home immediately so she could go to Salt Lake and be with her Mother and Father.  The stroke had occurred in the right side of her brain leaving the the left side of her body totally incapacitated.  She could not move her left arm or leg.  Her vision was totally gone on the left side as well.  Not only could she not see on the left, her brain refuses to acknowledge anything exists on her left side, a condition called visual neglect or hemispatial inattention is common in right side stroke victims.  As we were sitting and eating dinner with her she would only eat the food on the right side of her plate and did not know my oldest daughter, who was seated to her left, even though my daughter had been talking to her.  I had studied this condition in school but I am now coming to understand its impact.  Her face drooped and she no longer looked like or sounded like the woman I had known and loved over the last 25 years.  I am grateful that the facial palsy and speech problems have almost resolved now. 

You always hear about strokes but they occur to someone outside of your immediate circle, or you think they should anyway.  I only came to realize how devestating a stroke can be only when they affected someone very close to me.  Additionally I felt like I bore some of the responsibility.  You see I am her eye doctor as well as her son-inlaw.  I knew she had high blood pressure.  I had measured it.  I had seen her constricted blood vessels and hemorhages( mini strokes) in the back of her eye.( see images of normal eye v. eye withhyperetensive retinopathy)

Hypertensive Retinopathy

  I had strongly encouraged her to control it but had not insisted upon it.  I wished I had done more, I wished I would have driven her to an internist myself. 

As I have watched my in-laws deal with this my feelings have changed from devistation to awe.  Awe at how tough and resilient they have been.  I have never seen them get down, they have been positive and upbeat in a time when it would be very easy to be depressed.  I have seen they be thrilled as her left leg has progressed from being a lifeless mass of flesh to being able to move an inch.  She can now put weight on it which was cause for celebration.

Healthy Retina

What Have I learned from this experience?

  Appreciate what you have, people and physical abilities, right now.  More on this in a later blog. 

 A good attitude will make you more able to handle the difficult twists that life will throw at you.  Smiling is better then crying. 

I am going to take better care of myself.  My elliptical gets regular use ever since her stroke.  I’m working on my diet which for me is a hard thing but I am now motivated.

I am going to be more insistent with my patients when I see a problem.  I do not ever want to feel again that I could have and should have done more.  When you come see me please understand if I seem  firm about certain health isuues, its because I care.

As a further note on something I found helpful.  A book called My Stroke of Insight by Jill Bolte Taylor Phd, a Nuero-scientist who experienced a stroke and has some unique insights and help full rehabilitation hints.

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I am typically sceptical of claims of a cure all product. I remember listening to the only radio station that would come in clearly as I was driving across rural Utah one evening and hearing couple of people make such claims. No matter the ailment someone called in with, their product would cure it and each conversation would end with them making the same statement, “and remember you can not take too much”. I was sceptical to say the least. As I have reviewed nutritional supplement however, Omega 3 fatty acids may be as close to a cure all as anything I have seen. I want to be clear about a couple things; first I have no financial interest in any company who produces or sells supplements and second Omega 3 is not a cure all but it sure seems to be a help all. From your brain to your heart to your eyes medical studies seem to indicate that it helps.

So what is this magical substance and where can you find it? Fatty acids are the building blocks of fats in our bodies. Fats have a bad rap but some are essential for us to be healthy and for our bodies to function properly. While our bodies can produce some of these fatty acids, it can not produce all of them. The Omega 3 fatty acids; docosahexaenoic acid(DHA), eicoapentaaenoic acid(EPA) and alpha-linolenic acid(ALA), are essential fatty acids meaning our bodies can not produce them so we must acquire them through our diets. DHA and EPA are found in high concentrations in cold water fish such salmon, sardines, herring and tuna. The American Heart Association recommends a minimum of two servings of these a week. If you do not like fish or have a difficult time getting two servings a week you can also take fish oil supplements. ALA can be aquired through flaxseeds, flax seed oil, walnuts and dark green leafy vegatables although your body can not process ALA as easily as DHA and EPA.

What may it do for you? As you read the literature on Omega 3's the most common word you find is “may”. It is thought that Omega 3's “may” reduce the risk for cardio-vascular disease, reduce dry eye syndrome and reduce the risk of developing glaucoma. Eurpopean studies have found it also reduces the incedence of wet macular degeneration which is the most visually destructive form of the disease. I could go on and on with what it may do but I think it is better to say it is thought to help in alot of ways. I have personally seen many patients who suffer from dry eye who have benefited from taking Omega 3 and it is my preffered first line treatment for mild to moderate dry eye syndrome.

How much do you need? There is no RDA for Omega 3 but the American Heart Association recommends 500-1800 milligrams of combined DHA and EPA a day. What does that mean? About 2 servings of salmon or other cold water fish a week or 1 to 2 capsules of fish oil supplements daily. For my dry eye patients I have found that 500 to 1000mg of DHA/ EPA seems to provide relief after about 4-6 weeks.

Where should you get it? If you can do it through your diet great, two servings of cold water fish and lots of green leafy vegatables. If you can’t or don’t get it through your diet, supplement. Buy them where ever you feel most comfortable, online or in your local health food store or pharmacy. A recent article I read indicated that there was not much difference in how easy it was for your body to absorb the Omega 3 from different suppliers so I personally would not pay alot extra for “bioavailability” but you may feel different and thats ok. Be aware that some supplers provide more DHA/EPA per 1200mg capsule. I found that it can range from around 350 up to 1000 mg DHA/EPA per 1200mg capsule so pay attention to how much DHA/EPA the capsule provides you and not the capsule size. The other thing you should consider is getting capsules that are enteric coated. This will eliminate or minimize the most annoying side effect of taking fish oil, fishy burpes, which I have alot of patients complain about. All said and done you can pay as little as 25 cents a day or less for 500-1000mg DHA/EPA.

So just as a wrap up, Omega 3 is something your heart, brain and eyes “may” and most likely will benefit from. I recommend that all my patients get 500-1000mg daily either from their diet or through supplementation and you do not have to spend a ton to do it, so do it! If you want to study more on the beneficial effects of Omega 3 visit the following links.

http://www.nei.nih.gov/news/pressreleases/062407.asp

http://www.nei.nih.gov/news/scienceadvances/advances/omega.asp

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