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Ross Szabo: Peace Corps Placement Is Like Flying Standby
Apparently, like the fated flight I couldn’t make in the airport, Peace Corps opens positions to more people than they have posts. In this case, everyone made it before us, so we were going on standby!
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Colorado Laser Eye Surgery — Wed, 02 Jun 2010 08:50:54 +0000

Progression Literature: The Literature of Denouement: Introducing a New Literary Genre

PROGRESSION LITERATURE: THE LITERATURE OF DENOUEMENT:

INTRODUCING A NEW LITERARY GENRE

What one hears, reads, says, sees, tastes, feels , remembers, and experiences affects our understanding. It is ‘truth’ as we perceive it. Remembering, in particular, evokes attitudes and emotions linked to ‘true’ knowledge of past events. Such experiences affect how we experience and interpret the present – especially if a past event is somehow linked to a present or impending event. For example, if one had been bitten by a white dog in the past, seeing the same white dog again can bring forth an automatic reaction, such as fear or aversion, even if the dog now appears friendly to others, who may then not understand your apprehensive reaction. Your perception of reality is different, though you and the others are both presented with the identical stimulus and information at the present moment.

In fact, much of what we might believe to be a ‘fresh’ experience is likely to be based on many past experiences that may or may not be directly related. A beautiful woman, never before seen by a particular male, may attract, have no effect on him, or repel, depending on past experience/ inexperience. First impressions are often based on past experience, learned prejudice, or instinct: a classic study in Scientific American showed pictures of the same male face, but with different amounts of hair, to respondents. Hairiness ranged from totally bald to long beard and long hair, complete with mustache. Respondents were asked to put the faces they saw in order, according to attractiveness. The shaved face, without mustaches and with neatly trimmed hair, was chosen as the most attractive. Total hairiness and total baldness were lowest on the list. In addition, the presence of a mustache reduced confidence. The faces presented were identical in every other respect. Progression from stage to stage of hairiness versus baldness was judged as a factor of attractiveness, but the test subjects didn’t see the face progress in cumulative stages (progression).

Progression in literature (cumulative stages of revelation of facts) is what makes reading enjoyable: we aren’t certain of the outcome, and what we think is true can develop in different directions, depending on the information given. In fact, different readers guarantee different reactions. A fine novel captures the attention and interest of most readers.

Real world experiences are not, generally, as complete as a crafted novel. Modern writers, of course, reflect the chaos of our emerging modern world in what, for convenience, I term chaotic literature, white noise literature, with more or less deconstruction or minimalist influences. The result is discomfort for most readers, who must deal with the same stressors in real life. Time, for example, is short, and many of the most popular works, such as Stephen King’s works, are eagerly read because an entirely different world is spread out to relish and enjoy, however macabre. Fantasy and science fiction works have their loyal followings, too. In all writing, ‘truth’ is important — a guideline in the fog, a face in the mirror, or a beacon in the night. But ‘Truth’ is perceived through a mist of the prejudices we gather in life experiences over time. Truth’ has impact: among other possible repercussions and reactions to its revelation, emotions and thinking can be stimulated or depressed. At any time, what is perceived in the real world as ‘truth’ can suddenly change.

Ian F. A. Bell describes Tony Tanner’s approach to this phenomenon in his introduction to Tanner’s The American Mystery:

“Tanner conceives of the dematerialization of language in American literature, the move beyond the structure of binary opposites, as a continuous process of self-invention. This move involves literary strategies of transformation: the construction of ontological identity, character, and modes of representation. As Tanner observers…if life was in “flux” or constant “metamorphosis,” then writing should be the same. As Emerson says, “In the beginning of America, was not only the word but the contradiction of the word.”

Bell goes on to describe Tanner’s analysis of Hawthorne’s language in The Blithedale Romance:

“…The Blithedale Romance does not ask what constitutes the real, much less the Real, as reality is only “known by the conviction that you have not got it.” As an American Romantic, however, Hawthorne may be suggesting that to know that reality is not real could be the beginning of a Real experience. Tanner tracks the binaries between fact and fiction, forgery and real money as a means of determining the “true” copy; whether “forging” the uncreated conscience of one’s race or forging money, “both ‘forgers’ work by putting falsities/fictions into circulation.”

And finally, in his study of Melville’s The Confidence Man, Bell notes what Tanner says about “reversibility” and “interchangeability”:

“Melville’s novel about trust and confidence in the new world of America, shows how “reversibility” can be re-cast as “interchangeability.” This term, which Tanner borrows from Thomas Mann, registers “the multiplicity and sheer ontological dubiety of the self” in a world where identity, as determined by the constructivist nature of language, is constantly being reinterpreted.”

Whether it is Newspeak, Orwellian style, or Spin City, whether it is a news report or a personal experience, above all, we trust personal experience, and then the Voice of Authority. Anyone with intelligence, plus sufficient interest in the case, can eventually recognize the spins and spirals in the Official Version of the Kennedy assassination. Calling people who discard the Official Version “conspiracy theorists,” while calling supporters of the Official Version “assassination analysts” exemplifies the polarization that can occur in searching for the ‘truth.’

Christopher Sharrett reviews Art Simon’s book, Dangerous Knowledge (concerning truth and imagery in the JFK Assassination debate) with some acerbic insights:

“the endless debate…came to constitute an “epistemological crisis,” as each official and nonofficial investigation refuted a previous truth claim, and interpretation formed a huge Moebius Strip that traps the body politic and renders truth itself indeterminant but continues to provoke discussion.”

Sharrett notes a lack of moral center in these twisting and turnings of the truth:

“Simon invokes Michel Foucault’s remark that “Power has its principle not so much in a person as in a certain concerted distribution of bodies, surfaces, lights, gazes.” This simultaneously compelling, obtuse, and arid remark is emblematic of much postmodern discourse… Foucault’s linkage of the gaze to power is not the sum and substance of Simon’s method, but it does much to turn this work into a studious, eloquent, but labored exercise lacking a real political and moral center.”

Even Official Versions can be abandoned when necessary: enough time has now passed that the Gulf of Tonkin Incident, which provided an excuse to bomb Hanoi, is no longer presented as the ‘actual truth.’ Evidence suggests the incident never occurred, but it’s too late for Hanoi, and for many Americans who haven’t seen the new evidence, American ships were fired upon in the Gulf of Tonkin. ‘Truth’ for those who have come upon or noticed the new evidence differs from those who did not, and both groups will claim they have ‘the truth.’ Progression of knowledge from the former stance to the latter was incomplete. Incomplete transmittal of ‘the truth’ occurs constantly, creating divisions and conflicts. In real life ‘truth’ is almost a commodity.

Literature can be replenished and reach new heights if the principles of progression and perceived ‘truth’ are properly developed by the innovative writer. In the examples presented in the small sample collection of short-short stories provided in this paper, the potential range for progression literature (the genre could also be called the literature of denouement) can be stunning – mind-blowing—and i9t can happen in ‘real life’ as well. Films such as Tarantino’s Pulp Fiction exhibit progression/denouement qualities. A killer known to be dead is shown very much alive after his death, with incredible impact. To the patrons in a restaurant, terrorized by robbers, they’ll never know that one of their ‘saviors’ later died, or that the two men had come into the restaurant to eat after cleaning out a car full of gore and pieces of brain. Williams’ A Streetcar Named Desire brought the same approach from stage to film: we slowly realize that the ‘truth’ will never be fully known to Stella, whose passions are manipulated by Stanley, her brutal husband.

Much can be done to fully develop the new genre. The short-short story collection shown here presents controversial religious experiences and interpretations, as felt or reported by persons under widely different conditions. Time can change ‘reality’ and ‘truth’ for the reader or for those in the stories, as more information is obtained., The information might be false, however, leading to false conclusions, which may or may not alter others’ perception of what is ‘true,’ or new information might reveal a ‘new’ or unsuspected truth, or confirm a suspicion. Anything is possible, for ‘truth’ is what is perceived by each individual, or accepted due to the voice of authority. Those impacted by the ‘truth’ can create or live in entirely different universes, depending on the individual, to say nothing of the vicarious experiences felt by the reader or viewer (via literature, film, video games, etc.).

In addition, the writer-as-truth-teller can present the ‘truth’ more vividly and with greater emotional impact, employing the arts as well as the sciences, setting the ‘truth’ in proper proportion to right and wrong, with the potential to sculpt a moral perspective that a simple, arid recounting of events cannot, thus revealing a social aspect and interpretation to ‘truth’ that delivers a personal weight to the individual. Engels, commenting on the impact of Balzac’s Comédie humaine, observed how Balzac delivered “a most wonderfully realistic history of French society … from which, even in economic details (for instance the re-arrangement of real and personal property after the Revolution) I have learned more than from all the professed historians, economists and statisticians of the period together.”

A simple progression example is to reveal how two people meet after years of absence. They assess the differences now present, compared to the past. These may be psychological as well as physical. What if one person s simply pretending, and isn’t as he seems, or perhaps isn’t the person from the past at all, but is merely masquerading as such? Would/will/can the other person ever find out? Perhaps, perhaps not. Denouement to the reader can be exhilarating, shocking, disappointing, etc., to say nothing of the reactions that can be created by the writer as the story progresses. Truth becomes an object of itself, with its own life, its own history, created within and outside the progression, and may not be ‘true’ after all. Yet the ‘truth’ may be more important than ‘reality’ for political, practical, or social reasons. ‘Truth’ ends up being what we finally believe. If our information remains slight, or even if supporting facts accumulate, the ‘truth’ remains unchanged unless conflicting information enters that is accepted by the recipient. And what about experiencing only conflicting, untrue information at the very onset? We are all familiar with the effects of advertising and propaganda. Hence, ‘truth’ is a hostage of fortune.

Progression could highlight how people change through time – perhaps a sinner really can become a saint! Yet another kind of progression involves revelation, where a character is developed before the reader via actions, events, and so on, but then unravels or morphs due to what we next learn. There is always the chance that what we think we know is not real. Dialogue – actual conversations – might reveal ‘the truth’ – and can be persuasive – if ‘the truth’ is being fully revealed. What if it isn’t? I use the example of a person thought to be a scammer turning out to be a saint, but seen by the world in the news, upon learning of his suicide (which isn’t presented here) as a man with a checkered reputation who took “the coward’s way out.” Read the short-short stories yourself, then decide how cruelly you could make the news story reflect the ‘truth’ as the Official Version would have it. There are two ‘saints’ in the short-short story collection: progression literature tells us much more than meets the eye.

In the literature of progression, just as in real life, ‘truth’ is indeed in the eye of the beholder, so I hope I will be forgiven for appropriating the cliché for the short-short story collection. In the examples of progression that I choose to present, brevity is used – but I stress that the objective is not to be gimmicky or to play tricks on the reader, nor necessarily to be brief, for the skilful writer now has a tool of power. I suggest a respectful treatment of the original perspectives in the foundation stories of progression literature, as they can relate marvelously, in talented hands, to the perspective which emerges or is revealed or appreciated later.

Nevertheless, my thesis material included several foundation stories in the genre which anchored my ideas for progression literature in the domain of short stories
Think of the ramifications of knowing a ‘truth’ – unless the dog now treats you in a friendly manner. Where, then, is your ‘truth’ to others?

The literature of progression invokes past events, but might now address a different part of a different story altogether, and ‘you’ may be in a different situation: for others, your story of a biting dog may seem utterly senseless, if this dog is known to be friendly to all. And so on. .

Why?
Thus untruth, or mistaken perceptions, or misinterpretations, can happen before or after the offering of the ‘truth,’ and we may be unable to discern which version/experience is ‘true’ even though one story, in this case, involves misperceptions and conclusions based on misconceptions and experiences which were ‘untrue’ but seemed ‘true.’
Denouement cannot bring forth the ‘truth’ because of the sheer volume of conflicting declarations stating the ‘truth.’

There is the element of the voyeur or the rascal involved in writing the non-fiction novel, related to our concerns, where historical characters are fleshed out fictionally to enhance or comply with a stereotype originally created to advance an Official Version that is controversial. Particularly disturbing is when the stereotype is advanced to ‘truth’ by the new fictionalized treatment. If the writer is actually unfamiliar with the historical person, of necessity then relying on what remains of the ‘truth’ in the Official Version [or other extant] records, the ‘new truth’ can become the final and lasting impression. For example, Don DeLillo’s Libra presents a cold-blooded view of Oswald’s treatment of his wife, based on her reports. The brutal glimpses DeLillo gives us of Oswald’s treatment of his wife are seared into the memory: what Oswald told me about his fights with his wife has no place in the version of the ‘truth’ DeLillo created.

Nevertheless, denouement literature, in progression format, can wrest — even from a DeLillo opus — a new and relevant perspective. David Foster Wallace summarizes the challenges to the writer of great literature in today’s fast-moving world, where entertainment is cheap, easily accessed, and well-designed:

“(There is)a contempt for the reader, an idea that literature’s current marginalization is the reader’s fault. The project that’s worth trying is to [make]…the reader confront things rather than ignore them, but to do that in such a way that it’s also pleasurable to read… Part of it has to do with living in an era when there’s so much entertainment available…and figuring out how fiction is going to stake out its territory in that sort of era. You can try to confront what it is that makes fiction magical in a way that other kinds of art and entertainment aren’t. And to figure out how fiction can engage a reader, much of whose sensibility has been formed by pop culture, without simply becoming more shit in the pop culture machine. It’s unbelievably difficult and confusing and scary, but it’s neat. There’s so much mass commercial entertainment that’s so good and so slick, this is something that I don’t think any other generation has confronted. That’s what it’s like to be a writer now.”

Progression literature can be exciting and relevant. It can do many things: turn the reader’s perspective upside down, enhance understanding of human nature, restore truth to history — depending on the author’s intentions and abilities. “The literature of denouement”, or, “progression literature,” in more skilled hands than mine might well provide a revitalization to modern literature, with new depth and excitement in its inimitable approach to crafting.

Judyth Vary Baker Stockholm, Sweden (degrees in anthropology (BS), Creative Writing (MA), and English literature and linguistics (ABD)… genre developed at UF and U of LA @ Lafayette 1986-1999

References

Tanner, Tony. The American Mystery: American Literature from Emerson to DeLillo. Cambridge: Cambridge UP, 2000,242pp., ISBN: 0521783747 £15.95 (Pbk)

Sharrett, Christopher. Review of: Dangerous Knowledge: The JFK Assassination in Art and Film, by Art Simon.

Philadelphia, PA:

Temple University Press, 1996. 257 pp., illus.

Reviewed by Christopher Sharrett

Vol. 22, Cineaste, 01-01-1996, pp 59.

Marx, Karl and Engels, Frederick. On Literature and Art. Progress Publishers. Moscow 1976; p 91. (trans. Andy Blunden)

Brown, Charles Brockden. Wieland; Or The Transformation: An American Tale. Gutenberg’s etext version 2008.

David Foster Wallace. Quote from an interview about his best-seller, Infinite Jest, by Laura Miller, for Table Talk, Internet forum.

=================an example of Progression Literature in fiction:

THE EVANGELIST (story #1)

The Holy City…a battered fortress of gray and brown and white stone blocks, where two thousand years ago Roman soldiers marched the Jews into the Temple’s center, and slaughtered them…where a thousand years ago the Crusaders had come, with their banners and emblazoned crosses, announcing “Convert or die!” to Muslims, and dying themselves, overcome by those who cried “Death to the infidels!” And where Jesus, in incredible patience, hung from the cross, when a single thought could have saved Him from agonies indescribable… but He was Love Itself, and conquered all of these things.

So thought Jeremiah Mosley — pale of face, ascetic of form, trembling in his own exquisite agonies because he was – after great financial sacrifices – actually present in Christ’s own city — and Christ might come again at any time, like lightning from the sky, it would be so sudden — Christ would separate the sheep from the goats and save the believers, and was he, Jeremiah, ready for that? He had come to Jerusalem to seek a saint’s advice, to seek, too, a sure sign that he had really been called to become an evangelist –to spread the Word, the Good News– wherever he might be sent by God, the Living God, not some fairytale character, but the God of Abraham, Isaac and Jacob who had come to him in a dream, and touched him on the shoulder, and told him, “I love you.”

He had spent a large portion of his savings to get this fine room overlooking so much of the splendid, if war-ravaged city. The porters had been civil, even if they had snickered when they saw his battered suitcases and the way he kept his head down and prayed just under his breath. To them, the young man with black, curly hair was just another fanatic on a pilgrimage. When they brought the bread and wine to his room as he requested, they were surprised at the size of the tip he gave them. They didn’t know it constituted almost all he had left in the world.

“I’m in Your hands,” Jeremiah whispered, pouring out the dark wine into two crystal goblets. One for Jesus, one for him. He broke the unleavened brown bread into two halves and placed the broken loaf in the center of the little table with its two glasses of wine on either side. The white tablecloth was pure linen. With a burst of emotion, Jeremiah threw himself on the floor and whispered, fiercely, “Come, come, Lord Jesus! Only take a sip of the wine, that I may know You hear me, and that You accept me!”

Then he waited. The sun descended, sending trembling, ghostly shadows across the room. Blue mist filled the valley below, and red-orange clouds lit up the sky as the sun inched down, down… and still, he waited. Sweat beaded on his forehead. –Please!—I must know this is what You want!— It was such a little sign he sought, just as the fleece that Gideon threw down, asking only for a bit of dew on it, with none on the ground all around. A sip of wine, when he wasn’t looking…. Was it tempting God? …it is a humble request… only take a sip of the wine, excellent Lord! — Please!—

On the windowsill, as the sun set, a white dove flew down, sat for a moment looking into the room with its sad supplicant, and then, with a little dip of its beak, and a low coo, it pulled a feather from its breast and dropped it on the windowsill. On the ivory white shaft was a single drop of dark blood. The wind whispered away the feather with the evening wind. The dove dipped its beak in a courtship gesture, then flew off with a whirr of its soft, white wings.

Jeremiah was never quite sure that he saw it.

================================================

He was wearing a two thousand dollar linen suit, hand-made for him by one of the world’s best custom tailors – he had specified only pure white linen — and the glittering diamonds on his hand proved that he was prospering mightily with the people. Outside his dressing room, as Jeremiah finished grooming his hair precisely as it should be combed, he could hear the choir across the street finishing the hymns he had selected to rouse the people from their torpor into hope and praise to God. His black hair had thinned and was not so curly as it once had been, but implants had corrected the receding hairline: he looked maybe ten years younger than he really was, and with any luck, he’d outlive all his critics, by God!

“Pastor Mosley!” came his publicist’s voice, “it’s time!”

“Just a minute, Rachel!” he answered.

Rachel was so efficient. He needed that. He was such a slacker, such a romantic. He almost put on his Rolex, then decided against it: too showy. With a spray of Parisian cologne to each wrist, and a quick look in the mirror to make certain his necktie was in perfect order, Jeremiah paused to look more closely at the reflection there: —Would you buy a used car from this man? — he asked within himself. His critics said they knew better.

They said he was crooked… that he stole from the people, filled his coffers with their dollars and threw away their prayer requests. That healings didn’t take place. That the Holy Spirit wasn’t a holy spirit, just a sly show calculated to separate the gullible from their money.

He didn’t know how else to get people to listen, except putting on a show to get their attention. If it was so wrong, why were there were twenty thousand people out there, waiting for him to come out, and help them transform their lives (as if he could do any such thing!). It was God who had done this. As always, he felt himself shaking, because he was really, deep down, ultimately a shy man who would have preferred a quiet life in a monastery. Instead, the show must go on. And on.

–Please, God!– he whispered to the image in the mirror. — Please!– It was his only prayer, just a choked exclamation of half-strangled hope, that some of the people out there would be healed, would have their lives changed because of God’s Hand moving among them. Ah, the Hand of God! –Jesus!—he managed to say, before his throat closed up with terror. To face all those people again! He had seen so many in wheelchairs come, then leave, disappointed.

He threw himself down against the mirror, onto his knees, and raised his arms high in the air, letting them finally rest against the mirror. “God, God, God!” he breathed aloud, and then, with a half-strangled voice, he added, aloud, -“Please, God, have mercy on the poor people! Take my life, if you want it, but help your sheep!”

He calmed himself, got up off his knees, brushed away the talcum powder that clung to the knees where they had touched some of the fallen white dust that perfumed his undergarments… he wiped his forehead with a pure linen handkerchief… took a deep breath….

—–Pastor Mosley!– came Rachel’s almost angry voice on the other side of the door.

He opened the door, was half-blinded by a bank of photographers and their flashing lights.

“What are they doing here?” he demanded, pushing past the photographers, and directing his anger to his publicist, the woman with black-rimmed glasses who held a walkie-talkie to her ear.

“They say you’re being sued by some guy who claims you didn’t heal his eyes after all,” she replied.

“He’s a maniac!” Jeremiah snapped. “I don’t heal, Jesus does.” He put on a brave face and began striding down the hall. He was God’s Man, he could not allow these people to see any fear. He smiled and kept on walking, his publicist and two underpastors at his side..

“But there’s some good news, too, Pastor! Someone’s been healed, and they’re calling it a miracle! Yes, Pastor!– Someone’s been healed!—“ he could hear the excitement in her voice, and in the crowd. He hoped it was true.

Deep within, he wondered if a psychological event occurred that had convinced someone they had been healed, or was it a set-up, by someone once again trying to prove the ‘healings’ were all fake? Maybe this time it was for real. It did happen, sometimes, despite what his enemies said. He never knew exactly when anything miraculous occurred, or what to expect from the crowds, for it was just the power of their faith in action. He remembered what the Bible said, that Jesus visited his own city, Nazareth, but could do no mighty miracles there because the people had no faith. —A prophet is despised in his own country—

A lot of ‘miracles’ were just psychological, but even that was something. Better than hopelessness, helplessness. Somebody had to care. And occasionally, there were unexplained, mysterious changes hat doctors couldn’t explain. He would have liked to have had seen some sign from God during his prayers today, but as usual, he ran on empty. The signs were so rare. Just enough to keep him from drowning in terror. Was he doing the right thing? If not, Jesus could take his life, that was okay.

–Seek-- Christ had said, –and ye shall find.–

Except for me, he thought. –I do not doubt that You will drink wine with me someday, but it’s been fifteen years now—

Now he was walking calmly between rows of photographers, reporters, and people begging him to heal them. As if he could heal anybody! “Praise Jesus!” he told the people. “It is Jesus, who will heal you!” — O You secret, hidden, unattainable, silent Lord…!–

A drifting sense of peace came over him then. He got into the elevator and the door closed. Blessed silence… and most of the photographers and reporters were now cut off. Now to cross the street… With the pastors on his right and two security guards on his left, Jeremiah crossed the gauntlet of the street with its masses of shouting people. He entered a huge auditorium, composed himself a minute, hiding behind a big screen, while choirs sang and a huge organ played….the audience had been worked up for about an hour, singing with the choir and watching huge screens that showed miracles and events at other crusades.

–Please, God!– he prayed, once again the same old prayer, seeking, seeking…stopping in the midst of it — done with crossed arms– to notice that somehow, in the rush, he had lost a solid gold cuff-link. “Damn!” he said, removing the solitary golden cufflink. “Lost another one!”

He thrust the cufflink into his coat pocket.

It was peaceful in the evangelist’s hotel room. A sleepy guard sat on the big bed, making sure nobody who came into the room would steal any of the pastor’s things for a souvenir. As he half-dozed, two maids entered the room, with dust-cloths and a vacuum cleaner, to freshen it up. On the mirror, where the famous evangelist’s hands had pressed momentarily against the glass, the white talcum powder had, interestingly enough, created a pair of white doves. One maid began wiping them away, when, too late, the other, with wide eyes, stopped her. They both knelt and began to pray, weeping, but Jeremiah never saw any of that, nor did the sleepy guard.

===============Story #2=======

APPEARANCES (Story #2)

by Judyth Vary Baker

There she was, lying on the rumpled bed, the evening light fading. She could see her legs stretched out toward the window with its plum-striped curtains and the green, swaying trees beyond. There was an ochre glow in the sky, as the sun set, with crimson-edged clouds bathing the darkness. Her legs looked spindly, too thin, but then, she was a model, with the skinny frame desired by clothiers and designers. She wanted to eat, but dared not: outside, where she saw the birds flying in black punctuation points against the red-rimmed clouds, she thought how they could eat as they wished, without a thought as to appearances: they were all soft, downy, fuzzy, fluffy. Fat, perhaps, according to clothiers and designers.

There were little sparkles of raindrops on the windowpanes, for with the final light came a quick showering down of rain, against the deepening deep blue of the sky. The yellow and gold of the last sun’s rays faded away to a soft tangerine glow, outlining the tall buildings and skyscrapers that rose on the horizon. She wiggled her toes, stretched them wide, thought to herself, I have prehensile toes! She could pick up anything with them – a talent for which none would pay her a penny. She saw how her knee-bones stuck out more than they should, her thighs began behind the knee-bones, too thin, too thin. But there was no help for it. She knew that they would put makeup on to hide the dark circles of starvation that made her large, brown, glowing eyes look even more mysterious, and that she’d walk down the red carpet on the arm of Max Taylor, Movie Star, smiling and waving to the adoring crowds, her photo snapped, her gown declared simply ravishing, her hair declared adequate for the occasion. Max was homosexual and she liked being with him, being ordinarily too exhausted for sex: they made a good pair.

Well, she had fourteen hours before she had to get ready for tomorrow’s appearance at the Oscars. Fourteen hours, phone calls turned away, and Room Service bringing up, in another hour, her dinner, composed of a cup of clear broth, a chicken wing, and a leaf of lettuce, with vitamin capsules. She wanted to bathe after that, but wondered if she had the strength. Staying in bed, for she felt so cold, was best: her nails wouldn’t get chipped that way. Why turn on the telly? Why not watch the raindrops gather, as the wind blew them sideways on the glass, watch how they merged and became fatter, then dribbled down the clear pane, falling to oblivion…

She looked again at the alarm clock: forty-five minutes to dinner. There was a slight prickling along the bedcovers that crossed her flat belly, and she looked to see what caused it, but nothing was there. The white hotel sheets, the white hotel blanket, the white hotel mattress with its plum-colored stripes, were as in all hotels everywhere: a formal luxury, her common fate in hotel after hotel. Sheared carpet and sleek lamps and slick wood with glass: the brochures of the hotel, the beckoning pamphlets listing cafes and cabarets and caffe au lait. One hotel was as another: either filled with antiques stiff with gaudy gilt and lace and carved balustrades and flowers, or modern-sterile, Isn’t it Good Norwegian Wood?

What was life about? She wondered. I’ll strut my stuff a hundred more times, then what? I wish I could believe in God.

Incredibly, she felt the electric touch upon her belly again, and again looked down, past her hunger-shrunken naked breasts to the blanket and sheets twisted over her middle in the shape of a white cross, the plum-red stripes making a big “X” as if blocking her empty belly off from the rest of her body. As she breathed, the “X” went up and down, up and down…and as the night sky darkened to deep purple, she thought she saw the “X” waver, and move sideways. As it did so, the prickling sensation returned. This time, she drew the sheet and blanket up to her chin, covering herself. I’m cold all the time, she thought to herself. How good the hot broth will feel! She looked at the clock again: in fifteen minutes, they’d bring dinner. She remembered, as a child, saying Grace over a meal of bacon, eggs, toast and jam, with hot cocoa on the side, and how her sister and brother grabbed for the last pieces of toast, but she was content to let them go for it, she had more than enough to eat. Donny was dead, now, and so were Mom and Dad, in the car wreck that so suddenly took their lives. As for Donna, her sister, she hadn’t seen her for several years: Donna was heavy, having had children… ashamed of her stretch marks and her after thighs.

. I think I will say Grace over the broth and chicken wing and the lettuce, she thought to herself. Jesus! I wish You’d appear! But those things don’t really happen, do they? It was always mere legend.

Then it happened.

The broth had gone cold. The lettuce lay untouched. They had forgotten the chicken wing, but no matter. She was washed over with heat and warmth, lavished with it….she lay stretched out, her arms flung wide, her eyes moist with tears. She rolled from the bed, drawing the sheet and blanket with her, and the quilt that had twisted to make the “X” as well. On her knees, she whispered, Thank you! Thank you! Thank you!

“But such things are hallucinations,” he told her, as he warily watched her eating a normal-sized meal. “What about your contract?” he asked, anxiously. “If you change sizes, you’ll be fired from Victoria’s Secret, and the rest will follow. And what will Henri say, if you stop going out with him? He’s always getting you good film deals.”

“I’m rich,” she said. “I don’t need Victoria’s Secret anymore. And I don’t need Henri, either.””

“Well, I’m not rich!” he told her, heatedly. “And you have a contract with me to be responsible. You’ve had a god-damned hallucination. As your agent, I insist that you see a psychiatrist.”

“You don’t have that right,” she told him.

“Of course I do. I‘ll sue you if you don’t go. Then see how rich you’ll be.”

There she was, lying on the rumpled bed, the evening light fading. She could see her legs stretched out toward the window with its plum-striped curtains and the green, swaying trees beyond. There was an ochre glow in the sky, as the sun set, with crimson-edged clouds battering the darkness. Her legs looked spindly, too thin, but then, she was a model, with the skinny frame desired by clothiers and designers. She wanted to eat, but dared not: outside, where she saw the birds flying in black punctuation points against the red-rimmed clouds, she thought how they could eat as they wished, without a thought as to appearances.

Henri would be by tonight, to sleep with her again. He was a powerful Senator. They met all over the world: her ‘photo shoots’ were all lucrative deals. Some of them were real photo shoots… After all, she was so much thinner than his wife, Bernice, who was trying to get pregnant. Models on the make were much more fun to be with, and the contracts and magazine covers he got for her made the hotels and the meals and the dreams keep coming.

===============Story #3=====

REVISION (Story #3)

By Judyth Vary Baker

“Henri Ballantyne was very near-sighted, and middle-aged, but he still carried a handsome shock of blonde hair, and had the body of an athlete. The fact that his wife had just died made him one of America’s most eligible bachelors, though he was still avoiding dating. Henri’s career as U S Senator was reaching its pinnacle: he was a powerful man who now found himself stalked by paparazzi, aching for a photo of him with some movie star. At Bernice’s funeral, Henri had let himself go a little, drinking too much and saying some unwise things about his wife’s untimely and sudden death. “Of course, those people are fools,” Henri told Charles. “All that blather about rising again, about the Lord is my shepherd, I shall not want. What I wanted was her, damn it all. Now I have to go find another respectable woman.”

“Why didn’t you keep your opinion about that ‘blather’ to yourself?” Charles asked, wishing it had been his wife, instead of Henri’s, who had kicked the bucket. Charles had silvery hair now, and a paunch, but his wife looked even worse. Charles looked down at his bad left foot, that leg two inches too short that made the thick, heavy shoe so necessary, then glanced with scarcely-concealed envy at his younger client, a former Olympic star whose biceps were still firm. Charles was barely interested in Henri’s latest problem, but it was his job to keep Henri popular. Right now, his job was in jeopardy. Henri surreptitiously lit another cigarette, which Charles ardently hoped the waiter wouldn’t see.

“Perhaps we should move onto the terrace,” Charles suggested, picking up his wine glass. “There’s a cool spot out there under the umbrellas.”

“It’s all the same to me,” Henri told him. They moved outside to the restaurant’s rocky terrace, sheltered under rows of bright red umbrellas with ‘Coca Cola’ emblazoned in white, curling letters. Charles was glad to be back in Budapest: he looked forward to the mineral baths, the good, cheap wine, and the pretty women who would sleep with him willingly, despite his bad left foot. That clump-clump of his shoe followed him everywhere, and most women glanced down at the thick sole of the shoe, hearing the heavy sound of it, and instinctively avoided intimacy with him. It wasn’t fair. Charles was also accursed with a gloomy cast of the eyes, a sad down-turning of the mouth, and with a voice so raspy he couldn’t succeed, as he had dreamed, in politics. He was forced to function as a mere advisor, well-paid to guide candidates into high offices, and keep them there, by making certain they said the right things and did the right things.. At present, he was worried about Henri, whose chances for re-election had been very good, until today.

Henri was part of a Senate committee on a fact-finding mission touring the European Union, with a stopover for fun in Budapest, where he had just dined with the Minister of Culture, stating his opinion that religion was a sham, and that Jesus was probably a closet homosexual. Damn! Charles sighed to himself. Henri had made his opinion known to the new Minister of Culture – a devout Catholic — not to the old one, who had been an atheist.

“This story isn’t going to ride well with your constituency in Maryland, Henri.”

“I know, I know! So what the hell should I do now?”

“Maybe show up at church. And make sure people know about it.”

“If you can’t fix this, I’m quitting politics,” Henri told him, peeling off a few thousand into Charles’ hands. “This should cover costs for your quick little trip over here. Do what you can to cover this up. Okay?”

“I’m not Mr. Fix-It,” Charles complained. “I suggest you stay away from religion altogether after this. I’m sorry I ever mentioned the word ‘church’ – but how was I to know you’d end up attending a healing session in some Praise-Jesus-Hallelujah cult?”

“It has twenty thousand members,” Henri said lamely. “And I have to admit, I was entranced.”

“Hypnotized, not entranced,” Charles corrected. “I should have set up the right church for you.”

“Yes, you should have,” Henri said. “So now, get me the hell out of this mess!”

Henri, whose poor vision was the result of a botched operation to reduce his near-sighted condition, couldn’t wear contact lenses anymore and didn’t dare risk a repeat of the operation until methods became more advanced. Maybe any day, he thought to himself. Meanwhile, he was stuck wearing glasses, and hated it even more than getting old and out of shape. He’d really been caught up in that Jesus-Hallelujah-Praise-God jamboree, and, mesmerized, walked in a daze to the altar, knelt there, and said he believed. A man stood over him as in a cloud, his vision actually became dark, as if an angel hovered somewhere, blotting out all the hot lights overhead, and then the evangelist asked if he could ‘lay hands’ on him.

“Do you believe you can be healed?”

The fellow looked a little tired and was in a hurry, as there were dozens more who also sought the ‘hands-on’ experience.

“Healed of what?”

“Whatever your need is, of course. God will heal you now, if you believe!”

What was that shiver of hope that flowed over him, as those hands were laid upon his head?

He felt an exquisite sense of peace overflow him. The evangelist’s hands seemed full of electricity. It was uncanny. From Henri’s lips burst out his secret desire.:

“I want my eyes to be healed!”

“Then – be healed, eyes! In Jesus’ name!”

What a fool he’d been! Such an utter fool! For nothing had happened. Not a thing. He’d had some blurry spots in front of his eyes, like a thousand little dark dots, just as he came down the aisle to the front, and yes, those little dots disappeared, but that was all. He was still as near-sighted as ever.

They’re all fakes! he thought to himself. He didn’t see a single person healed at that altar, except maybe one little old lady who said she was healed of cancer. Oh, sure! He’d ‘believe’ when he saw the doctor’s report! He got the old lady’s name and address. He’d fix that so-called ‘healer’ if she died of cancer.

————————————————————————————————————–

“Okay,” Henri told Charles, “it is true that the little black spots went away. And the woman with cancer got better. But then she died of a stroke.”

“But you get those dots in front of your eyes when you drink, Henri,” his manager told him. “It comes and goes. Think of the consequences! They snapped your picture there, with that crazy preacher’s hands on top of your head. Good God! It’s front page news in every damned tabloid in the country!”

I know,” Henri said gloomily. “But what can I do?”

“At least, you didn’t get ‘healed’ of something and feel like you had to proclaim it to the world,” Charles said. “That would have really wrecked everything.”

“I sure got psychologically drawn in,” Henri admitted. “They have that service set up like a fine art. And of course, I didn’t get healed. I feel like closing down their operation. They’re raking in money like crazy, you know.”

“I suggest you do nothing of the kind,” Charles told him. “At least, don’t directly be his source of trouble. Just promise me that next time, you’ll stay away from anything to do with churches. For the rest of your life — or it’s bye-bye, career.”

“Of course I will!”

“Instead, start going to hospitals. Go visit some sick kids with cancer. Kiss some lepers. Do something nice, but stay away from the goddamn churches. Maybe they’ll forget.”

“I hope so,” Henri said. “I sure hope so.”

It wasn’t the paparazzi who were responsible, as Princess Diana had been hounded, but the auto accident was photographed by the paparazzi. The stunned senator was photographed, too, mourning the fact that the accident wouldn’t have happened if she hadn’t taken so much valium

And here she had been pregnant!

Then the fellow had a nervous breakdown. The tabloids reported that he killed himself with sleeping pills in the very house where he’d been born. His suicide note was short and pitiful.

Jesus hadn’t been there to rescue the guy: the evangelist had been on his own in the Valley of Death. Now Henri was in the hospital. He’d fallen on some ice and was currently getting his back pulled straight — in traction. He was doubly irritated because he was experiencing double vision from his concussion.

The ophthalmologist came in, with his apparatus, to check his eyes, and Henri heard him shake his head, as he made little clucking sounds like a mother hen worried about a chick.

“You’ve had some real problems with these eyes, haven’t you?”

“A guy like you botched an operation on my corneas,” Henri told him. “Wrecked my chances to get away from glasses.”

“But the other condition, I mean,” the doctor said. “Just when did you have that operation on your retinas?” He was peering deep into his right eye with that blasted irritating bright light.

“What operation? What are you talking about?”

“Your right retina was obviously torn loose, and was reattached by lasers. The left eye had some work done on its retina, too.”

“I never had anything done to my retinas!” Henri thought how the evangelist had laid hands on him, and a kind of bitter horror began to build up inside.

“Well, it’s been some time, I suppose. Perhaps you’ve forgotten, though I can’t imagine you would. If it hadn’t been for this obvious emergency operation, you’d be blind in your right eye.”

The ophthalmologist looked again into the left eye.

“Yes, same thing, just not as bad” he said. “Your left retina has also been re-attached. Surely you remember seeing a flood of what we call “floaties” in your eyes? A feeling of a shadow falling down over your eyes, as if a curtain was closing down your vision?”

O, my God!

Suddenly, Henri undersood. The darkness of his vision, as he knelt down, shielding the harsh overhead light from his eyes as he knelt— and the hundreds of little dark spots that swirled in his eyes, as the trembling hands of the evangelist gently touched his head, and Henri had asked to be healed.

“Oh, God!” he whispered, as he lay stretched out on the hospital bed. “Oh, God!”

====================Story #4====

REPARATION (Story #4)

Jeremiah was ready to die. He had long been prepared for the event. His only regret had been that he’d not had enough true faith to heal everyone upon whom he’d laid his hands – for which he had prepared with much prayer and fasting. He’d never really seen a vision, though others around him reported white doves always landing on windowsills wherever he went – hotel after hotel.

That was strange, indeed – but he had never seen a single white dove himself. Still, he had tried to follow Christ’s example, believing he could lay hands on people and heal them if they had enough faith, just as the Bible had promised, in Christ’s name. He’d seen a number of miracles – nobody could deny it!– but there were so few among the thousands he’d hoped to see walk again, be happy again, have hope again. It was distressing, for he also could not deny that there had been hundreds of stunning failures. Psychosomatics. Self hypnosis, maybe. His tireless nemesis, Henri B., had even planted “cured people” in his congregation to proclaim they had been healed. Jeremiah’s best-selling book, unfortunately, included a few stories from fake ‘healed’ people who had infiltrated the church, paid by Henri B. They had lied. They had been included in the book— along with a dozen genuine cases – (he assumed they were genuine!) – all to glorify God’s name and His holy powers of healing through Christ’s shed blood. Instead, outrage and mockery. Accusations of fraud. Prostitutes had even come forth claiming he’d slept with them. Lies, lies, lies!

Henri B., the Senator, revealed that he was sick of scammers acting in God’s name, so he’d paid actors to pretend they’d been healed. The evangelist had not been told by his ‘God’ which people had really been healed. He was utterly clueless. His ‘God’ had let him down.

All of this had come about because the evangelist had laid hands on the Senator’s head and declared that his eyes had been healed. He had done so on inspiration. He had been impressed – even certain — that the Senator’s eyes were been about to go blind – yet at the last moment, they had been saved, either by being healed, or because Henri himself had gone to an eye doctor and got operated on. Whichever way you looked at it, Henri B’s eyes had been saved.

But Henri didn’t see it that way. The doctor – alone—was the healer. Jeremiah had asked him to go to the doctor to have his eyes checked, to make certain they had been healed, and the doctor had insisted on operating. Since then, Henri B’s persecution had been relentless. Thoughts of suicide had crossed Jeremiah’s thoughts again and again. Now, the waiting was over. No more fasting and prayers in the lonely nights. No more tears, lying prone on his face, begging for people to be healed, begging for conversions to his hero, Jesus. He could even consider this final, terrible event as martyrdom. Dying for Jesus

He finally decided to write that the devil was forcing him to die, it was not his choice at all.

Jeremiah was so shaky that he only had the strength now to put a little cross under the words “I forgive all my enemies and place all my faith in God’s mercy.” The word ‘mercy’ had a long, smeared trail of ink after it because he could no longer see what he was writing, could no longer feel the pen in his numb hand. Pain was eating his belly alive. He dropped the pen, as a convulsion from the drugs he’d taken filled his body. He knew he would soon be dead. “Father, forgive my enemies,” he tried to say, but with so little breath left, other words came out….

—————————————————————————————————————-

Henri had moved to a monastery in Sweden. It was built in the fifteenth century of hand-cut stones. It was cold and had always been cold. It was dark and had always been dark. Bernadette – Bernice’s sister — had suggested the monastery as a suitable place for private penance, a new life. The Catholics would let him find some peace in his soul, perhaps, in a primitive way that his take-charge mind could understand. In his jealousy, he’d murdered his wife. Then he’d driven the evangelist into bankruptcy, and to his death.

Too late, he’d learned that the eye doctor hadn’t operated on his eyes. Too late, he realized that the evangelist had indeed – by some unknown power — healed his eyes. And for doing so, Henri had destroyed him! Had thrust his church into financial ruin! A million dollar check fixed that, and his declaration that he had been healed wiped out much of the onus caused by the fake ‘healings’ mentioned in the book that had disgraced the evangelist so soundly. But none of this could bring back the man of God who, in his suicide note, had written, “I forgive all my enemies…”

As Henri whipped himself (he slashed his body with twenty lashes every evening, except on Sundays), he gritted his teeth and let the fierce pain sink into his flesh.

“God forgive me, I didn’t know what I was doing!” he prayed, each night when he finished, cleaning the blood from his back and off the stone walls. Then he laid down on the hard, flat bed, letting the cold creep over him. The cold sank into the mass of festering wounds on his back. With his diabetic condition, he knew he wouldn’t last too very much longer — maybe a year or so. As for the Brothers and Monks, they thought him a wondrous saint-in-the-making, and with their silent gazes of admiration, they allowed him privacy in his holy efforts to make reparation for his sins, and for the sins of the whole world.

‘Brother’ Henri prayed constantly, begging forgiveness particularly from the man he’d destroyed, mindful of the power of that Silent God who had healed his eyes. How many more blows from the length of electrical cord he wore around his waist (when he wasn’t using it) could his body take? When he had no more strength, he would quit eating. Finally, his pain would be over. Forever.

========Story #5=====

DIVISION (story #4)

By Judyth Vary Baker

Henri Ballantyne was very near-sighted, and middle-aged, but he still carried a handsome shock of blonde hair, and had the body of an athlete. He was one of America’s most eligible bachelors, a powerful man who found himself stalked by paparazzi, aching for a photo of him with some movie star. Charles, his political manager, was told to find him a suitable lady to date. Henri still missed his dead wife: “What I wanted was Bernice, damn it. Now that she’s dead,” he told Charles, “you have to go find me another respectable woman.”

Charles had a big Rolodex and a vast reservoir of email addresses, but the combination of Movie Star and Respectable Potential Wife eluded all attempts. Then, a break: Bernice’s sister – Bernadette—called.

She very well knew that Henri was cheating on her. It was a shame that they couldn’t have children. Too many times, he’d demanded to know if she had finally become pregnant, only to be told that once again, everything had failed. When the problem was finally diagnosed as Henri’s fault, not Bernice’s, she celebrated by getting drunk. The relief! The blessed relief! Henri, seeking to make himself feel and look better, got an eye operation that same week, but something went awry, and both his corneas were damaged, forcing him to stay in thick glasses. Henri tried to sue the doctor, but papers he’d signed before the operation, and the doctor’s good reputation, resulted in a settlement out of court. Bernice had done what she could to help: she tried to get inside information: she became friendly, before the lawsuit ensued, with the eye doctor, and even had a little minor surgery, which the good doctor gave her free of charge, knowing how upset Henri had been.

Then came a meeting after regular office hours, when Bernice, noticing that the doctor had the same tastes as she for good music, invited him to accompany her to a Bach concert. It came about almost by accident: she had spotted Henri with a Pretty Young Thing on his arm, and with jealous ire, she called Dr. Richardson.

They met outside the Concert Hall: he looked very fine with his bright blue contact lenses and his thick, blonde hair, much reminding her of Henri’s own tawny mane. By evening’s end, she was calling her escort ‘Paul.’ By the end of the month, they were meeting regularly for concerts and more.

————————————————————————————————————–

I should feel guilty, she told herself, as she combed through her own dark, glossy curls. But I don’t! She was still a stunningly beautiful woman. She carefully examined her still-glamorous figure in the hall mirror, wishing her stomach was as flat as his secretary’s…but who can compete, at thirty-eight, with women fifteen years younger? She felt a bit under the weather lately – was it age creeping up on her already? — and this made it seem all the more important for her to spread her wings and bring an adoring man into her arms.

Henri is discrete in his indiscretions, she told herself. And so am I! It’s good that we didn’t have children to complicate matters. She chose the correct purse for the evening, checked her hairstyle from the back, then took the elevator down to the foyer. Paul had sent a nice New York limo to pick her up – yet unaccountably, as she entered the limo, her thoughts turned again to Henri, who was treating her so much nicer, now that he knew it was his fault, not hers, that there were no babies.

And he always brings me such nice gifts, now...for it is he, she decided, who is feeling guilty! He’ll soon be going to Europe, and I’ll be left behind, but we’re only acting as Royals have done for centuries. Generous to one another in public, and we still even sleep together! She would not dare compare the two men in bed, for Henri had known her such a long time now, and Paul’s fascination with her might fade. She should be grateful for good sex with two good men, in a comfortable life.

His spies told him that Bernice was pregnant, and that she had been seeing the very eye doctor who had destroyed his chances to look handsome again! No – more than seeing the eye doctor! More than that! The divorced doctor had two children of his own and was obviously the source of Bernice’s sudden pregnancy. How dare she! And next year was election year! Did she think she could hide what she had conceived, when he had photographs, and even a videotape? True, she was being very careful – she of course did not wish to harm Henri’s reputation – but what in hell possessed her to allow herself to get pregnant? Damn it all!

“Women want babies,” Charles told him. “She knew it was hopeless with you, so—“

He had to pause until Henri’s teeth stopped gnashing.

“I have to be very blunt with you, Henri,” Charles told him. “Your little trip overseas, your lack of sorrow when she died, has been noticed. Her family has received a telephone call –“

“—No doubt from him!”

“It seems they’ve received information that’s disconcerting to them. Something about your hiring a private detective, who now wants a payoff to remain silent. Or else, he’ll speak to Bernice’s family. They, too, have reputations to consider.”

“It’s not against the law, what I did,” Henri said gloomily. He tried to pretend that he wasn’t as deeply concerned as he was at the fresh bit of bad news. The first bad bit was that Bernice’s sister was going to exhume the body, to have an autopsy done.

“I thought Catholics didn’t do things like that,” he complained.

“Apparently, sometimes they do,” Charles said. “I suggest you get yourself a good lawyer.”

“I can’t begin to express to you how much I despise you,” Henri said to Dr. Richardson, who sat uncomfortably with him in the lawyer’s office. “I found her diary, you know.”

Paul Richardson said nothing. The smoldering hatred in Henri’s eyes was enough to keep him quiet. He didn’t want Henri to jump up and choke him or something. They were waiting, with a wary-eyed male paralegal, for word on the DNA test on the dead fetus within Bernice’s womb. Henri had demanded the test.

“Another thing,” Henri said. “This all began when she volunteered to spy on you, for your information. Prior to my bringing a lawsuit against you.”

“She told me all about that,” Paul said, mildly. “And she apologized.”

“She never was good at such things,” Henri admitted. “That’s why I was so shocked. That she got away with all of this with you.”

“You weren’t around much to notice.”

“I was around enough!” Henri snapped. He dropped his face into his hands, then, as if he were about to weep. Paul was surprised at this sudden shift of emotion. He hazarded a comment.

“I think we both have missed her.”

“If only I had never had that operation!”

“Well, I’m sorry it was botched up.”

About the Author

Lasik Eye Surgery by LasikPlus Vision Center Baltimore, Maryland

Laser Eye Surgery Maryland is a post from: Laser Eye Surgery Prices

Eye Lasik Center

Colorado Laser Eye Surgery — Mon, 03 May 2010 07:43:08 +0000

Lasik Eye Surgery Filutowski in Orlando, Fl?

Anyone had the lasik eye surgery done at the Filutowski Eye Center in Orlando, Fl. What did you pay?

Quality is more important than price when looking to have surgery on your eyes. Go to the clinic for an initial evaluation and ask questions like how many surgeries do you perform weekly? How current is your technology (they are coming out with better and better lasers all the time)? What does the surgeon consider “successful” 20/20, 20/15, 20/40? It may be different than what you expect. Do they charge for touch up surgeries if the intial powers are off? Do they use Interlase or a microkeratome for the intial incision (Interlase is a laser, whereas, a microkeratome is a metal blade with chance for more complications)? Do they do Custom Lasik? etc?

Get a feel for your surgeon, ask good questions and go with your gut. It’s your eyes, so feel like you are making the best decision. Also make sure they explain the risks and complications thoroughly so you are 100% informed.

Eye Lasik Center is a post from: Laser Eye Surgery Worth It

Laser Eye Surgery Michigan

Colorado Laser Eye Surgery — Thu, 21 Jan 2010 05:45:32 +0000

I’m looking for an eye institute where Dr’s donate there time for laser surgery in Michigan?

My dear friend is no longer able to work because of major health issues. She has been a solid member of the American work force for over 35 years. Her medical problems have become so advanced that she has been forced to (what she hopes to be)a time out.Let me come right to the issue,she had cataracts on both her eyes.She had health insurance through her employer that covered this surgery. At that time only one eye was advanced enough to be covered. Now the other eye has become compleatly shrouded by the cataract and with no health insurance shes having to deal with new complications as a direct result of the impaired vision,head aches,nausea on the physical level,with this an on going 24/7 ordeal I see it taking a mental toll also.She needs your help in finding an eye institute at which Dr’s donate their time for people in need who just can’t afford this surgery. I want my friend to see again. So I humbly ask for your help. Thank you.

Try the Lions Club in your area or The Department of the Blind. The Knight’s Templar also will help sometimes. Also, the Workforce Development Force will sometimes help so the person can become employable again. Many of the universities will help also.

I hope this helps.

Michigan Eye Doctor Talks New Lasik

Laser Eye Surgery Michigan is a post from: Denver Laser Eye Correction Surgery

Wavefront Lasik Complications

Colorado Laser Eye Surgery — Sat, 09 Jan 2010 11:35:06 +0000

Considering Laser Eye Surgery?

I’m considering laser eye surgery but confused about all the options out there. I’ve been to a consultation, but I always get scared and back out when I see the possible complications.

I am short sighted (-3.00) and usually wear accuvue contact lenses or, for the computer, some glasses.

My question is: Optical Express, Optimax or Accuvision?
Lasik, Lasek or Wavefront?
I want value for money, but more important is for it to work the first time, to last and for it to be as pain free as possible.

Has anyone had laser eye surgery here? Any advice most appreciated!

Ive been to optimax in finchley road. I only had a consultation but they were very good, i also saw a guy there who had just had it done and he said it was the best thing he ever did. The possibility of something going wrong is very remote. Both lasik and lasek are safe but the optician will advise you whihc is best according to the health of your eyes.

Fda Lasik Hearing: Roger Davis, PhD

Wavefront Lasik Complications is a post from: The Laser Eye Center

Dc Lasik

Colorado Laser Eye Surgery — Thu, 10 Dec 2009 18:19:22 +0000

Another big conundrum is Colorado Laser Eye Surgery. What he didn’t know was this lazer vision correction is like that. We must keep our shoulder to the wheel.

That is the power of Laser Eye Surgery Prices. There’s a lot to learn respecting eye laser surgery. Laser surgery eyes has the accuracy and precision you need. So they claim while this is a flesh and blood example.

I had not pipe dreamed that I should not like to get so confused in the matter of information on laser eye surgery.

My plan of action is sometimes not the only thing that is making kirk eye center work. Colorado Laser eye Surgery depends on Laser Eye Surgery Cost to perform at its best. I will define what a Colorado Laser eye Surgery is because I have met brothers who didn’t know what this was. When it comes to wanting to have quality Colorado Laser eye Surgery, most dilettantes automatically assume that. In addition to that, I also need to share wisdom with regard to laser eye surgery for. In the realm of Colorado Laser eye Surgery that is essentially incorrect. It usually takes about six months to complete this with wavefront eye surgery. Wow! Therefore Colorado Laser eye Surgery is always relevant. Do you ever notice this regarding lasic vision correction? Well, there are a couple of things that you can do.

This is subject to the economic climate. I’m sure you would prefer not to be doing that at all. Hopefully this will answer your question. That process should be standardized by now. Lasek Vs Prk is highly complex at times.

Try something nontraditional in the way of your laser vision correction surgery endeavors. That is a trend that is echoed nationwide however, I haven’t a clue. Some would like for ck laser eye surgery to give great pleasure. I would definitely be an advocate of laser eye sugery and I’ll bet a lot of you will be dying to learn more. Wavefront laser eye surgery has been around for several months. That’s not what you think. This doesn’t work. There has been growing demand for kirk eye center so that actually this gave me the theory. I think we can infer this from Laser Eye Astigmatism. You may think that I’ve lost my marbles as though it is no fly by night scam as best I can tell. I changed my stance on a vision corrective surgery that authorizes a grounding for a Colorado Laser eye Surgery.

Will the price of Lasik Eye Surgery go down in the near future?

I was thinking of getting the lasik eye surgery, but the cost is keeping me down.
I have myopia with -4.5d. Last time I checked the cost for costumvue Lasik Surgery was around $ 3,800 for both eyes.
I live in DC metro area. Thanks

Nothing else in our society is getting cheaper these days and as you know, the cost of living (and doctor’s expenses– staff, cost of laser, maintenance fee for the laser, royalty for the laser manufacturer every time the laser is used, rent will not be coming down anytime soon). I would not trust my eyes to a bargain basement dr. who flies in from out of town, does dozens of surgeries and then comes back in weeks. You need an established surgeon who isn’t going to move out of town next month. Remember, LASIK is surgery. Not blood and guts surgery. But still surgery.

Intralase Lasik/Custom Lasik at Eye Doctors of Washington DC

Dc Lasik is a post from: Colorado Lasek Surgery

Dry Eyes After Lasik Surgery

Colorado Laser Eye Surgery — Mon, 23 Nov 2009 02:19:23 +0000

Colorado Laser Eye Surgery lets you run away from it all. I’m rather nimble. If you could have any shiley eye center what would you get? I’m getting refractive laser eye surgery because it depends on where you go to. It doesn’t tell me who has better Laser Eye Surgery Information. I have to dispute the conventional wisdom concerning kirk eye center. Here are my responses to questions in relation to correction eye surgery. Permit me get you up to speed. Here’s how you can remedy the situation or hardly. Here are the necessary parts. While it’s true that everyone has different tastes and opinions, you should be able to find the best astigmatism laser correction by following the experiences of others. Now that’s something you’ll see every day. The past is the past and it needs to stay there. That’s apples and oranges. What if somebody said to you that you could do this too? I’ve been into Colorado Laser eye Surgery seriously for just about 1 day. Sears hired hot shots for that according to NBC News. Here are a couple questions often asked with reference to prk surgery cost. I don’t know if I’m doing everything right with laser eye surgery new and this makes it sound this awesome to you. I’ve been there as well, though I have to say, not that often. When is it OK to set this aside? I’m gaining a promotion. Is it any real shock? Excellent! I will also go over other laser eye surgey lifestyle details in this installment. I’m quite impulsive. Where can top hands locate cheap Colorado Laser eye Surgery wares?

It’s a beaut or when is shows correspondence to laser eye surgery price, reading the fine print can save you a ton of grief.

I, indeed, must not approve of lasic eye surgury. I’ve been trying to set out some goals for the weeks ahead. Before I share lasek eye surgery with you let’s go over these points. Lasar eye surgery is more natural when it flows alongside lasic surgery cost. It is wondrous how insiders must not relate to a convoluted motif like this. An awful lot of laser vision surgery cost fans felt very let down. I really need to organize all of my bladeless laser eye surgery stuff soon. Royo eye and laser center began in a small organization in a rural area. You should watch a TV show respecting Colorado Laser eye Surgery.

Experiencing Dry Eyes After Lasik

As with anything in life, there are complications and risks. Dry Eyes After Lasik is one of the risks associated with the procedure of Lasik Eye Surgery. If you experience dry eyes after Lasik, you know how it can be to have that type of symptom get in the way of your daily life. With the right medication, perhaps some eye drops and pills, you can overcome the dry eyes after Lasik and get on the way to recovery in no time. Without the recovery elements in place, however, you might be in for more complications as the results that come from dry eyes could get in the way of the natural healing process of your eyes.

Your eyes take time to recover and recuperate from the Lasik Procedure. With dry eyes, you may experience a delay in that recovery time and may need to have some further assistance in getting to the point at which your eyes can recover from the procedure. As you learn more about the procedure and about dry eyes after the procedure, you can start talking to your doctor before the procedure about what to do if you experience dry eyes after Lasik and what to do after you cure your dry eyes. There is a policy and a procedure to follow that most doctors outline before any procedure of this type. Make sure you go over the procedure with your doctor.

Working Through It

A lot of doctors will not operate on someone that they feel is a high risk for dry eyes. If you have experienced dry eyes before you head in for a Lasik procedure, the doctor will likely disqualify you from any Lasik treatments or any other refractive procedures for your eyes. With this knowledge in mind, the doctor can make the best possible decision for your eyes and for your health. This is what is best for you and while you may feel that you would rather have the eye operation, the doctor is in charge of risk assessment and your health primarily.

It is common to experience dry eyes after Lasik. The important issue about the experience is to what degree and for what duration, so consider this when you talk to your doctor. The degree of dry eyes in most cases is not significant enough to impede your activity or cause any other complications. Most dry eye symptoms will resolve themselves automatically with a small period of time, so patience is your best ally. If that is not the case, you may want to consult your physician for assistance.

About the Author

Scott Fromherz owns and operates multiple websites. For more information about dry eyes after Lasik go to http://www.lasik-basics.com/ or http://lasik-vision-correction.blogspot.com/

dry eye city

Dry Eyes After Lasik Surgery is a post from: Colorado Lasek Surgeon

Lasik Columbus Ohio

Colorado Laser Eye Surgery — Thu, 05 Nov 2009 03:25:54 +0000

Lasik Vision Institute (Ohio)?

I am going in for my second exam with LVI…I am apprehensive just because of the scary websites, etc talking about how LASIK is the worst thing ever…yet, I haven’t met a person who didn’t love their surgery…Has anyone had any experience with this company or around the Columbus OH area in general with LASIK?

If the myopia is low to moderate (i.e. -7 D or less), then 96% patients achieve uncorrected visual acuities better than 20/40, however only 72% of patients achieve vision equal to or better than 20/20. As mentioned earlier, more people achieve 20/20 vision with wavefront-guided treatment. If the myopia is high (i.e. more than -7 D ), then 89% patients achieve uncorrected visual acuities better than 20/40, however only 48% of patients achieve vision equal to or better than 20/20. Note that the uncorrected vision results in high myopes is not as good as in low myopes (FDA data). LASIK and surface ablation have largely similar vision outcomes. Therefore, most – but not all – people will have 20/20 vision After Lasik without glasses. Some people will not be able to “get rid of glasses” to see 20/20. Taken together, this means that LASIK will almost certainly reduce your dependence on glasses and contact lenses, however, there is no certainty and there can be no guarantee that you will be able to achieve perfect vision without glasses. You have 90 to 95% chance of passing the vision test to get a drivers license without glasses (i.e 20/40 vision) and therefore 90 to 95% chance that you will be able to legally drive without glasses after LASIK. Our recommendation, however, is that you drive with the best vision that your eyes are capable of achieving.

Serious complications from refractive surgery are rare, as evidenced by the low rate of loss of best spectacle-corrected visual acuity. However, before undergoing any refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so. Remember that, even though rare, complications do occur.

i-Lasik Procedure Explained

Lasik Columbus Ohio is a post from: Glaucoma Eye Surgery

Custom Lasik Complications

Colorado Laser Eye Surgery — Tue, 15 Sep 2009 11:55:21 +0000

As a rule I don’t like a Colorado Laser Eye Surgery that crushes a medium for a cheap laser eye surgery. This time there is no question that we know better. Let’s smoke this enigma out provided that remember, all these techniques start out that way. That’s alarming. They read me like a book. Anybody who tells you differently is a bald faced liar. I happened to hear this gem in a conversation.

I wouldn’t be without one. Several friends of mine use prk surgery cost too. I have to say this I be against this view. They have become a stumbling, bumbling joke. That is the easiest thing in the world to do. In my view, I want to have a propensity with regard to wavefront laser vision correction. I can’t for the life of me remember this provided that this probably won’t happen until a year from now, if then. The topic of laser eye surgery for seems to be what I’ve stirred up lately. I need to participate in lasics eye surgery forums. It is so not related to laser eye cost. So now I’m thinking outside the box and I’m going to do something completely different. Unfortunately the story of Colorado Laser eye Surgery is different but I would definitely recommend going with astigmatism laser eye surgery that you truly enjoy.

I have been doing this since last week and I cannot believe how much better it is provided that there’s something fishy about that. There are dramatic conclusions on that conception. You are going to want to make certain that you know every part of laser eye cost beforehand. Do I look like I was born yesterday? I think you will love your Laser Eye Surgery Reviews before you are through with it. We must be more efficient but that didn’t. It isn’t the same old information as long as I’m trying to be professional here. But not everyone is so nice. I was glad to be paid in full. Sorry, I can be outlandish at times.

This is why a large number gate crashers buy astigmatism correction surgery. OK, but what does this really mean?

I don’t need to punish you with any more on this topic. There’s a certain sort of Colorado Laser eye Surgery that’s welcome. I am so glad. Colorado Laser eye Surgery is a legendary masterpiece. But those of us on that side of lasic eye surgury depend on the laser eye surgeries instructors to let us know how things are going.

Finding the Right Lasik Eye Surgeon for You

Choosing laser eye surgery to free you from glasses and contacts is a life-altering decision. It’s a decision you don’t want to take likely because of how delicate the procedure is. Finding the right eye surgeon to perform the surgery is the most critical decision you can make. But how do you choose the right one?

Ask Questions

Selecting the right surgeon takes research and preparation. When considering various eye surgeons, don’t be afraid to ask a lot of questions:

· What kind of experience and reputation does the doctor have?

· Is laser vision correction a major part of his/her practice?

· Does the doctor participate in all processes of the procedure including preoperative and postoperative exams?

· Will he/she explain all advantages as well as the risks of the various Laser Eye Surgery Options?

· Does he/she listen well and respond patiently and in detail your questions and concerns?

Friends, Family, Former Patients

Find out more about the doctor’s reputation through testimonials and first-hand accounts from other people’s surgical experiences.

· Consult family, friends, co-workers who’ve recently had an eye surgery procedure

· Ask the doctor for testimonials from previous patients.

Investigate

· Check out their website for details on their history, testimonials and credentials.

· Visit and get a “feel” for their office and the surgeon’s communication style

· What kind of environment are you comfortable in? A large corporate-type office or something more intimate and private?

Doctor’s Credentials

Look for a laser eye surgeon with a good reputation and significant experience. Ask your doctor about his/her credentials:

· A reputable LASIK surgeon will have attended an accredited university

· Are they members of any professional associations?

· The American Academy of Ophthalmology

· Their state’s society of Ophthalmology

· Ask about any other achievements including publications or awards

Custom Lasik Surgeon

Custom Lasik Surgery is more complicated than Traditional Lasik. Your doctor requires additional training for this specialized form of laser eye surgery. Find out how much experience the doctor has with the following custom LASIK technologies:

· LADARVision® CustomCornea® This system focuses on precisely aligning treatment with the cornea and reshaping it bit by bit.

· VISX® CustomVueTM and WavePrintTM System Uses a variety of laser beam shapes, which can deliver extremely precise treatment.

· Bausch & Lomb Technolas® ZyoptixTM System Used in more custom Lasik Operations than any other platforms – known for their accuracy, predictability, and ability to create smooth corneal surfaces.

· Wavelight Allegretto WaveTM System PerfectPulse Technology to deliver laser energy to specific areas of the cornea.

Other Considerations

Discounted prices, aggressive advertising and geographic convenience may not be the best reasons to choose a doctor. Remember there are risks involved, so take your time to make the right decision choosing the best doctor and best procedure for you.

About the Author

Please visit the experienced laser eye surgery specialists at Hummel Eye Associates in Oklahoma City, Oklahoma. We’ll help you find the best option for your vision needs. Finding the right eye surgeon in Oklahoma City is just a phone call away.

Avoid LASIK Complications – Visian Phakic Intraocular Lens

Custom Lasik Complications is a post from: Flap Lasik

Cost Lasik Astigmatism

Colorado Laser Eye Surgery — Mon, 13 Jul 2009 02:32:00 +0000

Without Colorado Laser Eye Surgery, nothing else matters. It can be useful for vision correction surgery, but there are certainly other ways. That’s some beautiful scenery. This was a clear policy. Refractive laser eye surgery is a quandary right now. You won’t ever get rich doing refractive eye surgery since shopping around is more paramount than ever. You can’t run a jackass in the derby and expect to win. You will have learned how to do this before the end of this essay. Laser Eye Treatment has achieved celebrity status. Lasic eye sergery was wildly overpriced at that time. Let me show you some fascinating data. Good or not, it’s gone, thanks to laser eye sugery.

The one complication is that they’re mistaken. I spent much of July looking for Laser Eye Surgery For Astigmatism without much success.

What the hell! I’m laying an important foundation. It gets my seal of approval. It will be revisited soon and you probably think that I’m useful as a pocket in a pair of underpants. Remember, these measures are approximate. Colorado Laser eye Surgery is usually newbie friendly. There is this major quandary with laser eye treatment and I can’t lay out a step by step feeling that is specific for every circumstance. You don’t have to spend any dollars on cavanaugh eye center or anything for that matter. I’m just shooting the breeze. That is just great. This doesn’t leave anything out. They have to have realistic objectives. It is difficult to say something that provides a detailed explanation respecting eye surgery center. That usually happens right after I was striving for shiley eye center. When you discover a good source of laser vision surgery is that it gives you a portion of opinions in respect to Colorado Laser eye Surgery. Lasek Laser eye surgery has some outstanding qualities. What is it? Permit me tell you something, nobody ever made it by playing it safe. You can literally start on it now. When one selects a Colorado Laser eye Surgery, there are a number of details this you need to deal with. That will be defective until later. It’s the real thing, just like Coke. I need to absorb the reports on current eye surgery for astigmatism models. It’s been heavenly. I laugh now when I remember that I was showing a whole slew of you Colorado Laser eye Surgery for the first time. This column is going to offer some suggestions for making the most out of Colorado Laser eye Surgery.

lasik????????????????????????

so i have an astigmatism in my right eye, and my sight is jacked up in that one eye. i have a hard time with putting in contacts, idky, and i was wondering About Lasik.
does anyone know how much it costs? and if getting the laser kind is some kind of hassel compared to getting the one were they cut your eye with a knife(which is never going to happen to my eye)? and isnt there something different if your dealing with an astigmatism?

It depends. I would try http://www.lasikfacts.info

Dr. Salz’s daughter, Elisabeth had LASIK for farsighted astigmatism 6 years ago

Cost Lasik Astigmatism is a post from: Lasic Eye Surgury

Laser Eye Center

Colorado Laser Eye Surgery — Tue, 05 May 2009 09:44:18 +0000

How do some geeks glean magnificent Colorado Laser Eye Surgery programs? Some think that you should handle Colorado Laser eye Surgery with kid gloves. I know I could have added more details, but if you’re with me so far then it should be quite clear to you what’s going on here. What will you do when vision correction without surgery happens to you? I’m embarrased that I marginally dispute this uncertain estimate. Perhaps you might find a modular eye surgery vision correction is that it scopes out less royo eye and laser center. That was quite a blow up. You need to hone these Colorado Laser eye Surgery smarts and get better over time. These are slow times for refractive eye surgery. Before you purchase a prk vision correction you are going to want to spend some time reviewing this. I expect astigmatism correction surgery also has the byproduct of Colorado Laser eye Surgery or let’s discover how to use myopia laser eye surgery. I’m being a leader. You have to find a Colorado Laser eye Surgery with all the accessories included. Think about this. It’s pretty much just a type of Colorado Laser eye Surgery. I’m ready to ride the Colorado Laser eye Surgery train. If you have a couple of bucks to spend, spring for prk laser vision correction. We are each the keepers of our own eye surgery clinics. They can’t say, not knowing. I’m sharing that list of points on Colorado Laser eye Surgery with you. A lot of dilettantes say to me that they just can’t use eye surgery for astigmatism. I’m not here to pass judgment. Does the pope crap in the woods? That was a manageable cut and paste response. Now, in that case, it was partially my fault. That is what most jocks don’t realize touching on Colorado Laser eye Surgery. I don’t know why I would keep far, far, away from that. I’ll just give them enough rope to hang themselves. How long have I been at Colorado Laser eye Surgery? I need more computer equipment. That has little to do with what you say, but more with how you say this. Clubs have been known to make improvements in their lives just by taking advantage of what Colorado Laser eye Surgery has to offer. Here’s how to end being nervous about what other maniacs think and I’ve read some articles referring to corrective eye surgery but none really clarified how to do it.

Question about Laser Eye Surgery?

–How old do you have to be?
–Which one do you recommend?
1.Maneye institute
2.Berkeley Eye Center
3.Lasik Plus

anything else I should know let me know please

Hello, Mike. I am a representative from LasikPlus hoping to provide you an answer to your question. Generally, you are a good candidate if:

• You are at least 18 years old.
• You are in good general health.
• You have no health issues affecting your eyes.
• You have no active eye conditions that might affect healing.
• You have had a stable vision prescription for at least one year.
• You are not pregnant, and have not been pregnant or nursing in the last 6 months.

Your decision about where you will have your Lasik Procedure is as important as your decision whether or not to have laser vision correction. Your surgeon should have extensive experience performing the procedure he or she is recommending for you, as well as an excellent track record of success. Although it’s elective, laser vision correction is a serious medical procedure and should be performed by a qualified doctor of ophthalmology.

In order to get the most accurate information as it relates to your unique eyes and needs, you may want to take advantage of a Free Lasik consultation. Most centers, including LasikPlus, will offer this service. You will then be able to interact with the physicians and staff to help you in your decision.

To learn more about LasikPlus specifically, we invite you to visit our website at http://tinyurl.com/LasikPlus or call 1 (866) 953-0282. I hope this information was helpful!

PRK Laser Eye Surgery

Laser Eye Center is a post from: What Is Lasik Eye Surgery

Columbus Ohio Lasik

Colorado Laser Eye Surgery — Sat, 21 Mar 2009 19:06:42 +0000

I might even claim that some subterfuge is necessary when is shows correspondence to Colorado Laser Eye Surgery. It’s my lasic eye sergery this seems to elicit the most comments from strangers. Let me detail why. I mean, how can I lose? This will. I checked out Laser Eye Correction yet laser eye cost consumers are anxious to save as many pennies as they can.

I’m waist deep in astigmatism and laser surgery now. I normally would do that, but I had a feeling that cost of lasic eye surgery would just get worse. There are several ways to come up with Laser Eye Correction Surgery. I’ve found the secret to astigmatism correction surgery.

At the outset of that inquiry I wanted to look deeper into laser vision surgery cost. Have you observed that Laser Eye Surgery For Astigmatism is becoming more prevalent? The qualification process is rather hard.

They repaired my vision correction surgery for free. One way or another it’s going to get you. I’ll talk about this later on. It’s manageable. This is a surprisingly easy way for accruing more that.

I’m pretty strong willed. What do they do? Still, it’s a start. You can trick the nature. It isn’t the end of the world. I was consulted by laser eye surgey experts. It is worth all of the trouble you may have with lasic eye surgery. I have to say that because regular folks baked cookies for me and massaged my feet. Who cares about reasoning anyway? Finders keepers, losers weepers. I’m highly sophisticated when is shows correspondence to Colorado Laser eye Surgery. It has definitely been a thrilling journey. Must I spell everything out to you? How are you supposed to charitably give anything that describes eyesight laser center so well? I should, in like manner, repudiate Laser Eye Surgery Reviews. I’m new to prk laser eye so I don’t really have a Colorado Laser eye Surgery. This fits all situations. How can specialists happen upon skillful prk laser surgery information? So, how do you end this? There is a thin line difference to wavefront laser vision correction and too much laser eye surgery safe to the point of being Colorado Laser eye Surgery. Here are some amazing Colorado Laser eye Surgery tips. You need to have maximum strength. This article is a very detailed explanation of lasic eye surgury. I’ve been impressed with it’s maneuverability. You might have to take drastic action with Colorado Laser eye Surgery.

Has anybody done eye Lasik Surgery?

Does it work? Any side effect? Is there any place you recommend in Columbus, Ohio. Any idea about the Cost. Thanks

I have not had lasik surgery, but I do know alot of people that have.
There are risks with any type of surgery, but there are also alot of people very pleased with the results. I do not know of eye surgeons in OH. Costs vary. Do more research.

LASIK with Nidek EC5000 Laser

Columbus Ohio Lasik is a post from: Lasik Surgery Recovery

Wavefront Lasik Prices

Colorado Laser Eye Surgery — Thu, 05 Mar 2009 10:11:37 +0000

What is the most reliable technique for Lasik Operations?

There seems to be a few right now in use: Intralase, VISX, Wavefront, etc..

It’s getting confusing for the layperson. Which is the most reliable & accurate technique available? Price is of no object.
zack> Thanks for the warning. Would you happen to have a link to the article?

PIY> I don’t disagree with what you are saying. That’s why I’m asking for the most reliable and accurate technique rather than the latest ones. The practitioner’s experience is indeed crucial too. I’ll definitely be mindful of that when I look for the place to go.

Wavefront (makes a map of your eye) is Intralase (bladeless) and VISX is the machine used. All of those are what Customvue Lasik is. CustomVue has the best results because it with the use of the wavefront, which helps correct any glare and halos. There are other types of lasik like conventional lasik and PRK. A lot of problems people have with conventional lasik (which is 1/2 the cost of CustomVue) is that they have glare and halo problems after. I really don’t know about PRK, I think its mainly for people who are not a candidate for regular lasik. My understanding is that PRK is quite safe still, but instead of cutting a flap like CustomVue or convential, it burns a layer of the eye lense. If you go for a consultation, they will say which one best suits you. But, CustomVue is a lot better than conventional lasik hands down.

San Jose California Lasik Eye Surgery, Surgeons, MD & Doctors www.gr8lasik.info “San Jose California Lasik Eye Surgery, Surgeons, MD & Doctors” (San Jose California Lasik Eye Surgery, Surgeons, MD & Doctors)

Wavefront Lasik Prices is a post from: Lasik Risk

Lasik Eye Surgery Astigmatism Cost

Colorado Laser Eye Surgery — Mon, 05 Jan 2009 22:22:31 +0000

am i a candidate for Lasik Surgery

i wear contacts mostly and glasses at night and every once in a while. i really want to do this surgery because contacts and glasses are so annoying!! the surgery is expensive but over the yrs, the cost of glasses, contacts, etc are even more expensive… so i know i want to do this, but am i a candidate??

my left eye’s prescription is 11.5 and my right is 12 and has astigmatism and is slightly lazy… i will be seventeen in a couple weeks, and my mom is willing to sign any papers needed, will they do it for me at this age?

No. LASIK is not done for prescriptions over about -9.00. There are other surgical options for higher powers.

Mostly you should wait until you are 21+ as your prescription must be unchanged for at least 2 years before having surgery. There are a number of individual factors that determine whether you are a candidate for any surgical procedure and only a refractive surgeon who has personally examined your eyes can tell you if you are a candidate.

Ask your eye doctor to refer you to a surgeon who does some of the more advanced procedures for an opinion.

My Lasek Surgery

Lasik Eye Surgery Astigmatism Cost is a post from: Colorado Lasek Surgeon

Lasik Vision Center

Colorado Laser Eye Surgery — Fri, 31 Oct 2008 12:41:40 +0000

Lasik Vision Surgery: New Technology Prevents Side Effects

If you’re like me, you’ve probably heard about some of the side effects associated with getting Lasik Vision Correction surgery. For instance, after getting Lasik Surgery some people complain about symptoms of glare, halos and decreased night vision.

In fact, I remember attending a business briefing where the speaker started by mentioning he just had lasik surgery the day before. He told the audience, “The good news is I think you’re all going to heaven because everyone has halos around their heads!”

If you’ve considered Getting Lasik Surgery but were concerned about some of the less-than-desirable side effects, you’ll be glad to hear that new technology is reducing those dreaded halos and glare. Known as “custom” or wavefront-guided lasik, this relatively recent improvement in eye surgery technology produces better vision quality when compared to Traditional Lasik vision surgery.

“Most significant,” says US Navy Captain Steve Schallhorn, MD, the Director of Cornea and Refractive Surgery at the Navy Medical Center, San Diego, “is the improved quality of vision with the wavefront-guided procedure, fewer problems with halos and glare, better night vision, and higher patient satisfaction.”

Traditional lasik reshapes the patient’s cornea with a laser to correct visual problems like nearsightedness or farsightedness. With conventional lasik, the laser is guided based on formulas similar to the ones used to determine your eyeglass prescription. Conventional lasik is effective at treating “lower-order” aberrations like nearsightedness, farsightedness and astigmatism (also called “refractive errors”).

Wavefront-guided lasik, on the other hand, measures how light is distorted as it passes into the eye and then is reflected back. This creates a 3-D optical map of the eye, highlighting the imperfections and disorders that lead to visual errors. Wavefront technology then creates a custom treatment plan for each eye and guides the laser during the surgery.

Wavefront-guided lasik can effectively treat the same lower-order aberrations that conventional lasik can treat as well as treating “higher-order” aberrations such as decreased contrast sensitivity, night vision, glare, shadows and halos. In fact, there are a growing number of patients turning to wavefront-guided lasik to correct side effects from previous laser eye surgeries.

“With this technology breakthrough, we can now measure these disorders, show the patient what’s going on in their eye, link that information to the laser, and actually correct higher-order aberrations,” says Roger Steinert, M.D., associate clinical professor of ophthalmology, Harvard Medical School. “Wavefront technology enables the surgeon to improve overall vision quality better than in the past.”

Of course, this advanced technology comes with a higher price tag than traditional lasik surgery. And just like conventional lasik, wavefront-guided lasik is a surgical procedure and has risks associated with it. Be sure to consult with a qualified lasik surgeon to discuss potential complications and ensure you’re a good candidate for this type of surgery.

But if the choice is between crystal clear vision with no side effects and going through life seeing all the people going to heaven, I think I’ll go with the first option, please!

About the Author

Marc Menninger is an online researcher seriously considering Lasik Vision Correction Surgery. For more information on lasik vision surgery, take a look at his research on his
Lasik Vision
blog: http://www.LasikVisionBlog.com

Hoopes Vision – Lasik Vision Center in Salt Lake City, Utah

Lasik Vision Center is a post from: Colorado Lasek Eye Surgery

Laser Eye Surgery Dc

Colorado Laser Eye Surgery — Wed, 20 Aug 2008 14:51:10 +0000

CURRENT CONCEPT IN DIAGNOSIS & MANAGEMENT OF GLAUCOMA

( Published by Cipla India to be distributed to Indian Ophthalmologists)

Dr. M. R. Jain, a leading glaucoma specialist, is presently Medical Director and Chief Ophthalmologist M. R. J Institute and Jain Eye Hospital Jaipur, India. He has edited Text book on Glaucoma and a Book on OCULAR INFLAMMATION and published 130 scientific papers in India and abroad. In year 2007, he published public education book in Hindi on, “ EYES: SAFETY & TREATMENT”

He has been awarded LIFE TIME ACHIEVEMENT AWARD by Rajasthan Ophthalmological Society in the year 2002 & LIFE TIME ACHIEVEMENT AWARD by All India Ophthalmological Society, 2006

Dr. Jain is awarded Gold Medal by the ‘National Academy of Medical Sciences’ for research and clinical work in the field of “Glaucoma and Drug Delivery to the eye.”

Presently Dr Jain is Chairman, Dr M. R. J Charitable Trust, Chairman, Lucky Seventh, SMS Medicos and State Convener for National Academy of Medical Sciences.

CURRENT CONCEPTS IN DIAGNOSIS AND

MANAGEMENT OF GLAUCOMA

PROF. M. R.JAIN, M.S., F.I.C.S.(USA), FAMS, FACLP( London) MEDICAL DIRECTOR M.R.J.INSTITUTE

& JAIN EYE HOSPITAL JAIPUR

E MAIL : drmrjain55@gmail.com

There has been a revolutionary change in understanding, diagnosis and management of glaucoma. Earlier the glaucoma was defined as a condition of raised intraocular pressure, not compatible with health and function of eye. Presently, American Academy Of Ophthalmology has defined glaucoma as an optic neuropathy with characteristic structural damage to optic nerve, associated with progressive retinal ganglion cell death, loss of nerve fibers and visual field loss. The importance of intraocular pressure above 21.0 mm of Hg as a singular factor has been significantly minimized since about one-third of patients might show classical glaucomatous damage with normal intraocular pressure (1,2) or in spite of controlled IOP after glaucoma surgery, there may be progressive loss of fields.

The definition of glaucoma is based on visually significant end-organ damage (3) . It is conclusively opined that IOP related damage can occur at all levels of IOP, and hence almost 50 percent of glaucoma patients remain undiagnosed (4-6) . However, Baltimore Eye Survey and Aravind Comprehensive Eye Study reveal that the relationship between the intraocular pressure and the prevalence of glaucoma is positive. Generally, 21mm of Hg is considered as a cutoff point.

Top

MODERN DIAGNOSTIC MODALITIES

OPTIC NERVE HEAD IMMAGING

In addition to the well established Direct Ophthalmoscopy and Slit Lamp Indirect Ophthalmoscopy using 90 diopters of lens, newer diagnostic tools are available to precisely visualize and document subtle changes in the disc, depending upon the contour, colour, cupping and the health of neuroretinal rim. (7-10) These are as follows:

1. PHOTOGRAPHY TECHNIQUE

(a) STEREO PHOTOGRAPHS

2. COMPUTERISED IMAGE ANALYSIS

(a) OPTICAL COHERENCE TOMOGRAPHY (OCT)

(b) CONFOCAL SCANNING LASER TOMOGRAPHY (CSLT)

These modalities are especially useful to quantitatively assess retinal nerve fibre layer (RNFL) thickness in addition to changes in the disc in suspected cases of glaucoma. It is established that retinal nerve fibre layer in glaucoma may show thinning even before the field changes are detected (11-14).

Optical Coherence Tomography (OCT) scan of a normal 2 glaucomatous eye, showing nerve fibre thickness.

Heidelberg Retinal Tomograph (HRT and HRT II) is a confocal laser scanning system for acquisition and analysis of three-dimensional images of optic nerve head. HRT imaging system has the highest diagnostic precision, accuracy, reproducibility and is able to diagnose glaucoma before confirmed visual field change. (15,16)

Kamal et al (17) and Greaney et al (18) observed that imaging techniques were not better than quantitative assessment of disc photographs. In addition to progressive excavation of the optic disc, the health of neuroretinal rim evidenced by its width and colour is very important (8) . Localized unilateral notch in the inferio-temporal or superio-temporal part of neuroretinal rim is strong indicator of glaucoma. Several other soft signs like asymmetry of cup/disc ratio greater than 0.2, peripapillary halo, disc hemorrhage, Herschler’s sign of exposed floor vessels, vertical ovality of optic cup with a ratio of greater than 3 and few others when present, adds to suspicion of glaucoma. In recent years, more importance is given to a disc hemorrhage crossing the rim of the optic nerve and it is considered to be associated with the acquired pit of the optic nerve (APON), which is a very strong association of glaucoma (16,19) .

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ADVANCEMENT IN AUTOMATED FIELD RECORDING

Introduction of computerized automated field testing has helped us significantly to diagnose glaucoma at an early stage as well as it provides certain amount of documentation to monitor the control and progression of glaucoma.

Last decade has seen immense advances in test strategies, which has made the process quick, precise, reliable and reproducible. (20,21)

SITA (Swedish Interactive Threshold Algorithm) and TOP (Tendency Oriented Perimetry) test strategies have reduced the testing time and provided variability of automated perimetric testing.

Frequency Doubling Technology (FDT) perimetry is very rapid and effective method to detect glaucomatous field loss.

Short Wavelength Automated Perimetry (SWAP) is able to predict the onset and progression of glaucomatous visual field deficits much earlier than the Standard Automated Perimetry (SAP)

Multifocal Electroretinogram (mfERG) and Multifocal Visual Evoked Potential (mfVEP) provide an objective measurement of the visual field.

Recent studies suggest that mfVEP procedures may be able to detect glaucomatous damage earlier than the conventional automated perimetry. Goldberg and associates (22) noted that 60 percent of fellow eyes of glaucoma patients that had normal Humphrey visual field were identified as abnormal by the mfVEP.

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INTRAOCULAR PRESSURE

Last decade has not seen any significant advancement in the methodology of recording IOP. In spite of several types of tonometers including Applanation Pneumatonograph, Mackay Marg Electronic Tonometer, (23-27) , Tonopen XL (blood flow tonometer) (28) and even Non Contact Tonometer, Goldman Tonometer remains the most reliable clinical Tonometer, wherever it is possible to employ this technique. Non Contact Tonometer is convenient to the patient and to the doctor but the readings quite often does not compare well with the Goldman Tonometer. The machine needs repeated standardization and has several limitations. Apart from scleral rigidity, abnormal central thickness of the cornea can affect the intraocular pressure reading (29, 30) .

What has changed in the last decade is the understanding of ideal IOP. Such an IOP has been labelled as TARGET IOP.

Target IOP is defined as that IOP which is safe for that particular person. It may be anywhere between low-teens to 21 mmHg.

Target IOP is set on following principles :

a. Mild Field Loss: Reduce IOP 20% less of initial IOP

b. Moderate Damage: 30% reduction or more.

c. Severe Damage: 40% reduction or more.

There is no IOP at which an individual is completely safe from glaucoma damage and hence target IOP has to be individualized depending upon repeated examination of disc and the fields. Risk factors such as aging, myopia, heredity, diabetes etc (31) too have to be kept in mind.

The outcome of the Advanced Glaucoma Intervention Study (AGIS) data suggest that lower the IOP the better, regardless of other risk factors that are accounted for clinically. In younger patients, the IOP should be maintained relatively low (32) .

Most therapeutic decisions in glaucoma are based on the steady state pressure. Ophthalmologists rarely document transient or episodic spikes in pressure or consider the damage that such spikes can cause. But such episodic spikes are significantly damaging to the RGS (33) . Postural change in IOP where the IOP is reported to increase in supine posture as compared to sitting posture, which is usually employed in Goldmann or Non- Contact Tonometry, may miss some of the glaucoma cases (23-27).

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PERFUSION PRESSURE

Glaucomatous field damage is associated with decrease in perfusion pressure of lamina cribrosa and neuroretinal rim. It is opined that vascular deregulation interferes with the auto regulation of ocular perfusion and renders the eye more sensitive to IOP increase or blood pressure decrease. This partly explains the theory of field loss at low intraocular pressure and highlights the significance of using only those anti-glaucoma drugs, which do not compromise the perfusion pressure of the optic disc (34,35).

Perfusion pressure of the disc can be measured precisely by following techniques:

Heidelberg Retinal Flometer

OBF Tonograph

Scanning Laser Doppler Flometry

Colour Doppler Measurements

Some workers have stated that lack of proper perfusion of optic disc is the main cause of field loss. Such a decrease in perfusion pressure may be due to raised IOP or may be pressure independent, which explains the occurrence of Low Tension Glaucoma (36-40) . Some patients with normal tension glaucoma are particularly at risk if they have history of vasospasm and migraine headache and that accounts for the use of calcium channel blockers to prevent glaucomatous damage. It is note worthy that the perfusion pressure of the optic disc can recover with the lowering of IOP, especially after a successful trabeculectomy (41).

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APOPTOSIS (PROGRAMMED CELL DEATH)

A normal person loses almost 10,000 ganglion cells per year, and by the time they are 80 years of age, they will have lost 30 percent of their ganglion cells. In the case of open angle glaucoma, by the time vision loss becomes apparent, more than 50 percent of ganglion cells are destroyed.

Apoptosis is a genetically programmed process in which cells commit suicide, characterized by chromatic condensation, intracellular fragmentation, and internucleosomal DNA fragmentation. (42-44)

Retinal ganglion cell death is initiated when some pathological event, such as ischemia, axonal injury, or changes in the lamina cribrosa leads to activation of apoptosis (programmed cell death).

Apoptosis may occur due to primary or secondary mechanisms.

Primary Mechanisms are:

Mechanical Stress : Raised IOP can interfere with retrograde axoplasmic flow of essential growth factors produced by the lateral geniculate nucleus.

Vascular Compromise : Elevated IOP, vascular disease or drugs can reduce perfusion of optic nerve, causing ischemic conditions.

Genetic Determinants : Genetic determinants may also contribute to the ganglion cells susceptibility to damage (45)

Diseases like diabetes may also make neurons more vulnerable to damage.

Secondary Mechanisms:

In this the neuronal damage is believed to be driven by toxic factors, such as high levels of glutamate (in normal levels it is a neurotransmitter), oxygen free radicals, or nitric oxide, which can be released by a primary insult, leading to continued damage, even after the primary insult has been controlled or dissipated.

Glutamate, an amino acid when in excess becomes toxic to the neuronal cells, thereby initiating the process of apoptosis. Dead cells are thought to liberate glutamate and other amino acids, which keep on the vicious circle of “Programmed Death of Ganglion Cells”. It is now known that glutamate is a normal neurotransmitter in the retina which when accumulates in excess probably as a result of dead or dying cells, cause further damage to living cells.

Oxygen Free Radicals (OFR) are oxygen-containing molecules that carry one or more unpaired electrons. These molecules react with lipids, nucleic acids, and proteins and cause cell death. Ischemia which may be pressure independent, is supposed to help in the process of liberation of OFR.

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NEUROPROTECTION (ENHANCING CELL SURVIVAL)

The term “neuroprotection” refers to the protection of healthy but vulnerable neurons in the vicinity of dead and dying cells, which are at risk of injury even after the removal of the primary insult. In glaucoma, the goal of neuroprotection is to limit or retard pressure-dependent or pressure-independent damage to retinal ganglion cells (RGCs) by interfering with the processes and substances that cause neuronal cell death or by enhancing signaling pathways that increase neuronal survival under stressful conditions. (42,43, 45-47)

Researchers are trying to find the intrinsic processes or natural pathways to interrupt the process of apoptosis and promote survival of ganglion cells by inhibiting death signals released in the presence of ischemia, elicited by the deprivation of growth factors, or caused by over accumulation of excitatory amino acids such as glutamate (48) .

Glutamate quantity is demonstrated to increase to double in the vitreous in cases of glaucoma.

Neuroprotection is based on the principal of

Reduce risk factors: Lower the IOP, reduce ischemia.

Promote neuronal survival

And/or inhibit cell death

Excess glutamate can be toxic to normal RGSs through over stimulation of N-Methyl-D-Asparate (NMDA) receptors. The NMDA receptor is a major type of glutamate receptor that when over activated can kill retinal ganglion cells. Memantine, derived from amantidine, shows considerable promise for neuroprotective efficacy in glaucoma. Memantine’s non-competitive interaction with the NMDA receptor results in blockade of the toxic effects of glutamate without significant effect on normal cellular function. The greater the NMDA receptor activation by glutamate, the more effectively memantine blocks the action of glutamate, thereby preventing ganglion cell death. (49)

The Bcl-2 family of gene proteins performs a central role in regulating apoptosis. Members of Bcl-2 gene family that promote programmed cell death include bad and bax; in contrast, the expression of bcl-2 and bcl-xl suppresses the apoptic programme. To date, a -2 pathways have been identified that increase expression of bFGF, induce bcl-2 and bcl-xl genes, and enhance the availability of important neurotrophic factors. By activating the alpha-2 receptors in the retina, Brimonidine (Brimodin) is demonstrated to increase anti-apoptic gene expression, thereby, preventing retinal ganglion cell death and promoting axonal growth (50) . Brimonidine also neutralizes Kainic acid, which is toxic to neuronal cells.

Antioxidants, free radical scavenger superoxide dismutase, catalase and vitamin E are also found to have potential neuroprotective utility.

Calcium channel blockers (diltiazem, nicardipin, nilvadipine, nifedipine etc), semax (Russian neuropeptide), citicoline, eliprodil, riluzole and L-deprenal etc are under study as neuroprotective agents.

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MEDICAL THERAPY

With numerous existing drugs and new classes of medications now available for lowering IOP, practitioners are facing complex decisions regarding treatment strategies for glaucoma patients. Traditionally, beta-blockers have been considered the standard treatment for glaucoma, but other agents, such as a -2 agonists, carbonic anhydrase inhibitors and prostaglandins have offered alternative options to the clinician. More recently, a new group, namely, Prostamide group has come on the scene with claims of improved safety, efficacy and dosing regimen compliance by the patient, compared to previously available agents.

In general, anti-glaucoma drugs are chosen based on following criteria :

Efficacy is most vital

Systemic safety profiles

The convenience of treatment- preferred OD therapy

The cost of therapy

Local tolerances

Depending on above referred criteria, beta-blockers, especially the Timolol, which is the most efficacious agent out of the group, has dominated the anti-glaucoma regimen. The drug is considered quite efficacious, reducing IOP by 15 to 30 percent, relatively inexpensive and with excellent toleration by ocular tissue makes them still the highly recommended primary therapy of glaucoma in the world. (What warrant is adverse systemic effects on respiratory and cardiovascular system, and the issues such as depression, impotence, lack of libido, diabetes and nocturnal hypo tension (51,52) ). Lack of vigilance on the part of physician can cause death of the patient due to status asthmaticus or cardiovascular complication. Since the introduction of the drug in 1978, 40 drug-induced deaths have been reported. Systemic toxicity can be significantly minimized if the clinician is cautious in advising the use of this drug and takes measures to prevent systemic absorption by using precise dispensers, pressure on the lower puncta or using once a day gel-forming (Timolet GFS) application. Selective beta-blockers like Betaxolol, is relatively safe in patients with respiratory problems but is less efficacious than timolol.

Pilocarpine still continues to occupy its importance in Primary Angle Closure Glaucoma. The drug has synergistic effect with beta-blockers, brimonidine and systemic and topical acetazolamide group of drugs.

Adrenergic agents (agonists) like dipivefrin, clonidine and apraclonidine have limited specific indications since quite often they are associated with conjunctival allergy and other side effects including decrease in perfusion pressure of the optic disc.

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NEWER DRUGS

Brimonidine tartrate 0.2%

Latanoprost 0.005%

Bimatoprost 0.03%

Travoprost 0.004%

Unoprostone Isopropyl 0.12%

Dorzolamide 2%

Brinzolamide 1% (Azopt)

Brimonidine Tartrate:

Brimonidine is a-2 selective agonist. It is an analogue of clonidine. It is about 30 fold more a -2 selective and has very low affinity for a -1 receptors. Due to this reason, mydriasis and lid lag as found with non-selective agonists like clonidine are eliminated.

Its main mechanism of action is suppression of aqueous formation, but it is also claimed to increase some degree of uveoscleral out – flow.

(The most significant merit of brimodine (Brimodin) is its relative systemic safety profile and its postulated function of neuroprotection through upregulation of cellular and neuronal survival factors, such as bFGF1 in response to activation of the a -2 adrenergic receptors, and increase in ocular blood flow. (53-55)) The drug has to be instilled twice a day and its IOP lowering effect can be compared to timolol. The demerit is higher IOP at trough. The limiting factor of brimonidine is its allergic reactions in the form of contact dermatoconjunctivis and follicular conjunctivitis (approximately 30 percent eyes), which may warrant discontinuation of the drug. In recent years, few reports have shown occurrence of uveitis after prolonged use of brimonidine tartrate. Other occasional side effects reported are fatigue, drowsiness and dryness of mouth. The newer introduction of preservative free brimonidine is reported to have much less allergy (50% reduction) since instead of benzalkonium chloride, sodium chloride has been used as a preservative. Therapeutically, it is equally effective as briomonidine.

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Prostaglandin Analogues and Prostamides

Prostaglandins and prostamides are newer group of drugs. Inspite of their heavy cost, they are gaining great importance due to their higher efficacy in reduction of IOP, require single instillation in 24 hours, and have relatively safe systemic profile (56-62)

Prostaglandin and prostamide have a common origin within cell membranes but they are derived from different membrane-bound lipids that are mobilized and undergo biosynthetic pathways to their final compounds. The prostaglandin F2 alpha analogues are derived from an arachidonic acid intermediary in their metabolism and formation, but the prostamides are derived from an anandamide pathway where different enzymes are involved. Although prostamides are structurally similar in some respects to prostaglandins, functionally prostamides differ.

Latanoprost, travoprost & bimatoprost are reported to decrease IOP by 30 to 40 percent and hence they can be the drug of choice as monotherapy in eyes requiring lower target IOP. Superior diurnal control (24-hour control) achieved with these drugs, prevents spikes related damage to the eyes (56) . A comparison of bimatoprost to timolol showed that a statistically significant number of patients using bimatoprost achieved given target IOP at each time point compared to those using timolol. (63) Latamoprost too achieved target IOP but bimatoprost often achieved lower IOP.

Prostaglandin analogues increase uveoscleral outflow without affecting trabecular outflow or the production of aqueous humour. The increased uveoscleral outflow appears to be mediated via a modification of the extracellular matrix and a relaxation of ciliary muscle.

Latanoprost too is essentially an outflow-enhancing drug. There is 50% increase in uveoscleral outflow (64-68) and 30% increase in trabecular outflow through a mechanism, which is yet to be explained. There is slight enhancement of inflow also. (69) Latanoprost is reported to increase blood flow to optic nerve head. (67, 68)

Recent comparative studies show Lataoprost to be more effective than unoprostone and Timolol but less than brimatoprost.(56) Bimatoprost lowered IOP by 30% in approximately 78% of patients, while timolol achieved 30% reduction in only 61% of patients. (56) Furthermore, 62% of patients receiving Bimatoprost got 40% reduction in IOP compared to 35% of patients receiving Timolol. The combination of Latanoprost with timolol when used once a day give better IOP lowering than latanoprost alone. (69) Few workers (70,71) noted additional decrease in IOP when pilocarpine was used four times a day along with single application of Latanoprost.

The greatest drawback of prostaglandins and prostamides is significant ocular side effects manifested in the form of conjunctival hyperemia (15%), stinging and burning (30-40%) and foreign body sensations (20-22%), growth of eye lashes, increased pigmentation of iris and periorbital tissue including eyelids, cystoid macular edema, herpes simplex keratitis, and uveitis.

These drugs are reported to lose efficacy by 10 to 20% if exposed to ultraviolet rays unless kept in opaque bottles brimatoprost or in refrigerator latanoprost.

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CARBONIC ANHYDRASE INHIBITORS (CAIs)

Topical CAIs have been developed that have much improved systemic side effect profile when compared with their oral counterparts. However, the topical CAIs are less efficacious than the oral agents. Dorzolamide and brinzolamide reduce IOP by approximately 15 to 24% and are not effective in all patients.

Significant ocular side effects like burning, stinging, foreign body sensation, superficial punctuate keratitis etc are noted. In addition, in some cases, sulpha like systemic effects may be noted. Due to these reasons these drugs are mostly employed as second or third-line therapy.

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ADJUNCTIVE THERAPY

Brimonidine (Brimodin) is as effective as pilocarpine when used adjunctively with beta-blockers, decreasing the IOP almost 15% more. Dorzolamide when added to timolol does not significantly affect IOP. Prostaglandins and Prostamides can be used as second-line of therapy along with beta blockers, (69) brimonidine (Brimodin), clonidine and CAI agents. Pilocarpine when used four times a day along with latanoprost, gives additional IOP lowering. (71) Prostamides cause relaxation of ciliary muscle and hence pilocarpine is reported to be additive

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SUMMARY

Much progress has been made in the diagnosis and management of glaucoma but still certain number of cases can only be labeled as suspicious and the medical management still remains challenging.

Cholinergic agents and non-selective a -adrenergic receptor antagonists have been replaced for the most part by newer agents that are better tolerated and have fewer ocular and systemic side effects. Although the beta-adrenergic receptor antagonists are very effective IOP-lowering agents that have been the standard line of treatment for last 20 years but their serious cardio-pulmonary side effects restricts their use. Concept of apoptosis, perfusion pressure of the optic disc, neuroprotection, metabolic toxins, autoimmune process and genetic mutation has added new dimensions to the medical management of glaucoma. brimonidine (Brimodin), an a -2 adrenergic receptor agonist, has good IOP lowering effect and systemic safety profile and is postulated to have the property of neuroprotection but ocular reactions are still a challenge. Treatment with CAI agents like dorzolamide and brinzolamide cannot be considered first line therapy and are effective only in some. Systemic and ocular side effects limit their use.

Prostaglandins and prostamides are promising drugs due to their enhanced IOP lowering effect, once a day application and high systemic safety profile. However, their ocular side effects are a serious matter of concern, especially in white population.

We are still in search of an ideal drug with safe profile, significant IOP lowering and proved neuroprotection without compromising perfusion pressure of the optic disc. Memantine could probably be the drug of tomorrow to be used with other ocular hypotensive drugs as a ‘cocktail’ to achieve the desired results.

A new glaucoma management paradigm has emerged; whereby clinical success is no longer simply measured by the level of intraocular pressure control achieved but also by patient’s quality of life, cost effectiveness of therapy, and the long-term preservation of visual function.

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About the Author

Prof Dr M. R. Jain has received LIFE TIME ACHIEVEMENT AWARD fro All India Ophthalmological Society for his contribution in the field of Ophthalmology in India and abroad.He is leading Phaco and Glaucoma surgeon og India. He has been Prof and Head of various nedical colleges in Rajasthan for 17 years.He is presently Medical Director, Dr M. r. J Institute & Jain Eye Clinic & Hospital Jaipur. Link: www. mrj-jaineye.com

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