Treating Dry Eye Syndrome

Dry eye syndrome, or keratoconjunctivitis sicca (KCS) is an eye disease in which the amount, or quality, of tear production is decreased, or the evaporation of tear film is increased. The translation of  “keratoconjunctivitis sicca” from Latin is “dryness of the cornea and conjunctiva”.

Symptoms

The most frequent clinical findings of dry eye can be meibomitis, telangiectasis, blepharitis, superficial punctate keratopathy, and hyperemia. Commonly, we describe typical symptoms of keratoconjunctivitis as dryness, burning[3] and a sandy or gritty eye irritation that becomes worse as the day progresses.[1] Symptoms may also be described as itchy,[3] scratchy,[4] stingy[3] or tired[3] eyes. Other symptoms are pain,[5] redness,[5] a pulling sensation,[3] and pressure behind the eye[3]. Many patients report a feeling that something,[3] such as a speck of dirt,[5] is in the eye. The resultant damage to the eye’s corneal surface increases discomfort and sensitivity to bright light.[3] Both eyes usually are affected.[6] There may also be a stringy discharge from the eyes.[5] Although it may seem counterintuitive, dry eye can induce the eyes to water.[5] This watering occurs because the eyes are irritated.[5] One may experience excessive tearing in the same way as one would if something became lodged in the eye.[5] These watery reflex tears will not reduce the dry eye symptoms[5] because this type of tear is the watery type that are produced in response to injury, irritation, or emotion.[5] They do not have the lubricating and wound healing qualities necessary to prevent and heal dry eye.[5]

In those suffering from dry eye, blinking can have a negative impact as well as a positive. On the one hand, blinking causes the eyelid to induce shear forces on the cornea as the lid moves across the corneal surface. This force can be high and lead to abrasion of the corneal surface if the normal, protective tear film is not in place to absorb the shear forces. On the other hand, because in the normal eye blinking coats the corneal surface with tears,[5] symptoms can be worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes[3]. These activities include prolonged reading,[1] computer usage,[1][3][5] driving,[3] or watching television[3][5]. The severity of symptoms increase in windy,[5] dusty[3][5] or smoky (including cigarette smoke[5]) areas,[1][3] in dry environments[1][3], high altitudes including airplanes,[6] on days with low humidity,[3] and in areas where an air conditioner[5] (especially in a car[3]), fan,[3] heater,[3] or even a hair dryer[5] is being used. The severity of symptoms are reduced during cool, rainy, or foggy weather and in humid places, such as in the shower.[3]

Many people experiencing dry eyes exhibit mild irritation with no long-term effects.[5] However, if the condition progresses, complications may result that cause eye damage,[5] resulting in impaired vision or infrequently in the loss of vision[3,5].

Symptom assessment is a key component of dry eye diagnosis, and objective measurements often are unable to fully describe the disease. Several questionnaires have been developed to determine a score that would allow for dry eye diagnosis. The McMonnies & Ho dry eye questionnaire is frequently used in clinical studies of dry eyes. A version of  the questionnaire can be accessed at: http://www.dipolarhosting.net/agingeye/dryeye.asp.

Epidemiology and Etiology

Over time the condition of dry eye can lead to tiny abrasions on the surface of the eyes.[4] In advanced cases of dry eye, the epithelium undergoes pathologic changes, such as squamous metaplasia and loss of goblet cells.[1] Severe cases can also result in thickening of the corneal surface,[3] corneal erosion,[1] punctate keratopathy,[1] epithelial defects,[1] corneal ulceration (sterile and infected),[1] corneal neovascularization,[1] corneal scarring,[1][3] corneal thinning,[1] and even corneal perforation[1].

Keratoconjunctivitis sicca is relatively common within the United States, especially so in older patients.[1] Specifically, the persons most likely to be affected by dry eyes are those aged 40 or older.[6]

While persons with autoimmune diseases have a high likelihood of having dry eyes, most persons with dry eyes do not have an autoimmune disease.[6] Instances of Sjögren syndrome and keratoconjunctivitis sicca associated with it are present much more commonly in women, with a ratio of 9:1.[1] In addition, milder forms of keratoconjunctivitis sicca also are more common in women.[1] This is partly because hormonal changes,[6] such as those that occur in pregnancy, menstruation, and menopause,[6] can decrease tear production.[5] Dry eye is commom in areas of the world where malnutrition is common and the diet is deficient in vitamin A.[23] There are no racial correlates for this disease.[1]

An abnormality of any one of the three layers of tears produces an unstable or inadequate tear film composition, resulting in symptoms of keratitis sicca.[1] To help keep your eyes feeling comfortable and the optical components of your corneal surface in optimal condition, a normal, thin film of tears coats your eyes. Three main layers make up this tear film:

The innermost layer is the thinnest and is composed of mucin (or mucus). This thin layer of mucus is produced by the cells in the conjunctiva (the clear skin that lines the eye). The mucus has multiple functions and helps the overlying watery layer to spread evenly over the eye.

The middle layer is acqueous and is thickest. This layer is essentially a very dilute saltwater solution containing many important proteins for protection and healing. The lacrimal glands under the upper lids and the accessory tear glands produce this watery layer. This layer’s function is to keep the eye moist and comfortable, flush out any dust, debris, or foreign objects that may enter into the eye, and provide wound healing and protection. Defects of the aqueous layer are the most common cause of dry eye syndrome.

The most superficial layer of the tear film is a very thin layer of lipids (fats or oils). These lipids contain omega-3 fatty acids and are produced by the meibomian glands and the glands of Zeis (oil glands in the eyelids). The main function of this lipid layer is to help decrease evaporation of the watery layer beneath it.

Deficient tear production

Keratoconjunctivitis sicca is usually due to inadequate tear production.[1][3] The aqueous tear layer is affected, resulting in aqueous tear deficiency (ATD) or lacrimal hyposecretion.[1] The lacrimal gland does not produce sufficient tears to keep the entire conjunctiva and cornea covered by a complete layer.[3] This usually occurs in people who are otherwise healthy. Increased age is associated with decreased tearing.[1] This is the most common type found in postmenopausal women.[3][7]

Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation.[1] In rare cases, it may be a symptom of collagen vascular diseases, including rheumatoid arthritis[3], Wegener’s granulomatosis, and systemic lupus erythematosus.[1] Sjögren’s syndrome[3] and autoimmune diseases associated with Sjögren’s syndrome are also conditions associated with aqueous tear deficiency.[1] Drugs such as isotretinoin,[3] sedatives,[3][6] diuretics,[3] tricyclic antidepressants,[6] antihypertensives,[3] oral contraceptives,[1][3] antihistamines,[1][3][5] nasal decongestants,[5] beta-blockers,[1] phenothiazines,[1] atropine,[1], and pain relieving opiates such as morphine[6] can cause or worsen this condition. Infiltration of the lacrimal glands by sarcoidosis or tumors, or postradiation fibrosis of the lacrimal glands can also cause this condition.[1]

Abnormal tear composition

Keratoconjunctivitis sicca can also be caused by abnormal tear composition resulting in rapid evaporation[3] or premature destruction of the tears.[1] When caused by rapid evaporation, it is termed evaporative dry eyes.[3] In this, although the tear gland produces a sufficient amount of tears, the rate of evaporation of the tears is too rapid.[3] There is a loss of water from the tears that results in tears that are too “salty” or hypertonic. As a result, the entire conjunctiva and cornea cannot be kept covered with a complete layer of tears during certain activities or in certain environments.[3] Dry-eye disease is accompanied by an increase in the proinflammatory forms of IL-1 (IL-1 alpha and mature IL-1 beta) and a decrease in the biologically inactive precursor IL-1 beta in tear fluid. Increased protease activity on the ocular surface may be one mechanism by which precursor IL-1 beta is cleaved to the mature, biologically active form. The conjunctival epithelium appears to be one source of the increased concentration of IL-1 in the tear fluid of patients with dry-eye disease. These results suggest that IL-1 may play a key role in the pathogenesis of keratoconjunctivitis sicca. Other identified factors in the tear film that may be altered in dry eye include epidermal growth factor (EGF), monocyte chemoattractant protein (MCP)-1, IL-8, tissue inhibitor of metalloproteinase (TIMP)-1 and -2, and numerous previously undetected tear components, such as angiogenin (ANG), VEGF, and the CXC and CC chemokines IFN-gamma inducible protein (IP)-10, growth-related oncogene (GRO), epithelial neutrophil-activating protein (ENA)-78, and macrophage inflammatory protein (MIP)-3alpha.

One reason aging is associated with dry eye is because tear production decreases with age.[5] Dry eye  may also be caused by thermal or chemical burns, or (in epidemic cases) by adenoviruses. Diabetics are at increased risk for the disease.[8][9]

An eye injury or other problem with the eyes or eyelids, such as bulging eyes or a drooping eyelid can cause keratoconjunctivitis sicca.[4] Disorders of the eyelid can impair the complex blinking motion required to spread tears.[6]

About half of all people who wear contact lenses complain of dry eyes.[5] This is because soft contact lenses, which float on the tear film that covers the cornea, absorb liquid from the tears.[5] Dry eye also occurs or becomes worse After Lasik and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap.[5] The corneal nerves stimulate tear secretion.[5] Dry eyes caused by these procedures often, but not always, resolve after several months.[6] Persons who are thinking about refractive surgery should consider this possible side-effect.[5]

Abnormalities of the lipid tear layer caused by blepharitis and rosacea, and abnormalities of the mucin tear layer caused by vitamin A deficiency, trachoma, diphtheric keratoconjunctivitis, mucocutaneous disorders and certain topical medications are causes of keratoconjunctivitis sicca.[1]

Persons with keratoconjunctivitis sicca have elevated levels of tear nerve growth factor (NGF).[1] It is possible that this ocular surface NGF plays an important role in ocular surface inflammation associated with dry eyes.[1]

Rosacea is a chronic skin disorder, affecting the face and chest, and develops mostly in the 3rd to 6th decades of life. It is characterized by erythema, telangiectasias, and recurrent flushings. During the time of this chronic inflammation, skin typically develops papules, pustules, and swelling. Ocular involvement occurs in 3 to 58% of patients with skin changes. Common ocular signs include blepharoconjunctivitis, meibomitis, and dry eyes. Rosacea keratitis, when present, however, has a poor prognosis and may lead to blindness. Among skin diseases, Helicobacter pylori infection has sometimes been related with rosacea. A higher prevalence of indigestion and Helicobacter pylori infection in rosacea patients than in healthy controls has been reported in limited studies. However, no causal relation has been identified. On the other hand, oral treatment with metronidazole is beneficial in all of three mentioned manifestations of rosacea (skin, eye, indigestion). More research is required to explore this possible link.

Diagnosis

Dry eyes can usually be diagnosed by the symptoms alone.[3] Tests can determine both the quantity and the quality of the tears.[6] A slit lamp examination can be performed to diagnose dry eye and to document any damage to the corneal surface.[1][3]

A Schirmer’s test is used to measure the amount of moisture bathing the eye.[3] This test is useful for determining the severity of the condition.[5] A five-minute Schirmer’s test with and without anesthesia using a Whatman #41 filter paper 5 mm wide by 35 mm long is performed.[1] For this test, wetting under 5 mm with or without anesthesia is considered diagnostic for dry eyes.[1]

If the results for the Schirmer’s test are abnormal, a Schirmer II test can be performed to measure reflex secretion.[1] In this test, the nasal mucosa is irritated with a cotton-tipped applicator, after which tear production is measured with a Whatman #41 filter paper.[1] For this test, wetting under 15 mm after five minutes is considered abnormal.[1]

Tear breakup time (TBUT) tests measures the time it takes for tears to break up in the eye.[5] The tear breakup time is determined after placing a drop of fluorescein in the cul-de-sac (under the corner of the lower eyelid).[1]

A tear protein analysis test measures the lysozyme contained within tears.[1] In tears, lysozyme is part of the superficial immune system and accounts for more than 20 percent of total protein content.[1] A lactoferrin (an anti-microbial) analysis test provides good correlation with other tests.[1]

The presence of recently described molecules, the diadenosine polyphosphates, naturally occurring in tears, are abnormally high in different states of ocular dryness. One molecule, Ap4A, which is important in ocular healing (Mediero et al, 2006), can be quantified biochemically simply by acquiring a tear sample with a plain Schirmer test. Utilizing this technique it is possible to determine the concentrations of Ap4A in the tears of patients and in such a manner to diagnose objectively dry eye[10].

Treatment

A variety of approaches can be taken to treatment. These can be summarized as: avoidance of exacerbating factors, tear stimulation and supplementation, wound healing and prevention, increasing tear retention, eyelid cleansing, and treatment of eye inflammation.[11]

General measures

Dry eyes can be exacerbated by smokey environments, dust and air conditioning and by our natural tendency to reduce our blink rate when concentrating. Purposefully blinking, especially during computer use and resting tired eyes are basic steps that can be taken to minimise discomfort.[11] Rubbing one’s eyes can irritate them further, so should be avoided [6]. Conditions such as blepharitis can often co-exist[11] and paying particular attention to cleaning the eyelids morning and night with mild shampoos and warm compresses can improve both conditions.

Environmental control

Dry, drafty environments and those with smoke and dust should be avoided.[3] This includes avoiding hair dryers, heaters, air conditioners or fans, especially when these devices are directed toward the eyes.[6] Wearing glasses or directing gaze downward, for example, by lowering computer screens can be helpful to protect the eyes when aggravating environmental factors cannot be avoided [6]. Using a humidifier,[3][4] especially in the winter,[4] can help by adding moisture to the dry indoor air[6].[11]. For mild and moderate cases, supplemental lubrication is an important part of treatment.[1] Application of artificial tears every few hours[3] can provide temporary relief.

Autologous serum eye drops

None of the commercially available artificial tear preparations include essential tear components such as epidermal growth factor, hepatocyte growth factor, fibronectin, neurotrophic growth factor, and vitamin A-all of which have been shown to play important roles in the maintenance of a healthy ocular surface epithelial milieu. Autologous serum eye drops contain these essential factors. However, there is some controversy regarding the efficacy of this treatment. At least one study (PubMed) has demonstrated that this modality is more effective than artificial tears in a randomized control study.

Additional options

Lubricating tear ointments can be used during the day, but they generally are used at bedtime due to poor vision after application.[1] They contain white petrolatum, mineral oil, and similar lubricants.[1] They serve as a lubricant and an emollient.[1] Application requires pulling down the eyelid and applying a small amount (0.25 in) inside.[1] Depending on the severity of the condition, it may be applied from every hour to just at bedtime.[1] It should not be used with contact lenses.[1] Specially designed glasses that form a moisture chamber around the eye may be used to create additional humidity.[6]

Medication

Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical steroids or with topical immunosuppressants such as cyclosporin.[12][13] For example, elevated levels of tear NGF have been shown to be decreased with 0.1% prednisolone.[1]

Fish consumption and omega-3 fatty acids

Consumption of dietary omega-3 fatty acids is associated with a decreased incidence of dry eye syndrome in women.[14] The underlying mechanism may be a reduction in pro-inflammatory proteins in the tear film.[14]. Early experimental work on omega-3 has shown promising results when used in a topical application [15] or given orally.[16]. We suggest using omega-3 fatty acids in both ways; orally and topically (alpha-linolenic acid was used in the study of topicals) .

Restasis

Topical cyclosporine A (tCSA) 0.05% ophthalmic emulsion is an immunosuppressant, marketed in the United States by Allergan under the trade name Restasis[1]. Approved as a prescription drug by the U.S. Food and Drug Administration[5] in 2002, the eye drop is reported to decrease surface inflammation[6]. Restasis is thought to work through inhibition[17] of transcription factors required for cytokine production and T-lymphocyte maturation.[18] A review of the summary basis of approval from the FDA website shows in a trial involving 1200 people, Restasis demonstrated a small positive effect: increased tear production in 15% of patients, compared to 5% with placebo[5]. Thus, only 10% of dry eye patients benefit from Restasis.

The typical prescription for Restasis is one drop instilled in each eye twice a day, 12 hours apart.[1] Restasis should not be used while wearing contact lenses,[1] during eye infections [5] or in people with a history of herpes virus infections[6]. Side effects include burning sensation (common)[5], redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.[1][5] Long term use of cyclosporin at high doses is associated with an increased risk of cancer[19][20].

Generic alternatives

Less expensive generic alternatives to Restasis are available in some countries. In India, the generic is marketed as Cyclomune by Sun Pharma.[20]

Conserving tears

There are methods that allow both natural and artificial tears to stay longer, but have limited benefit[6]

Blocking tear drainage

In each eye, there are two puncta,[22]  which are small openings that drain tears into the tear ducts[5]. There are methods to partially or completely close the tear ducts.[6] This blocks the flow of tears into the nose, and thus more tears are available to the eyes.[3]

Punctal plugs

Punctal plug

Punctal plugs are inserted into the puncta to block tear drainage.[5] For people who have not found dry eye relief with drugs, punctal plugs may provide limited benefit.[5] The plugs are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate.[5]

Cauterization

If punctal plugs are effective, thermal[6] or electric[1] cauterization of puncti can be performed.

In thermal cauterization, a local anesthetic is used, and then a hot wire is applied.[6] This shrinks the drainage area tissues and causes scarring, which closes the tear duct.[6]

Customized contact lenses

Persons with severe dry eyes may benefit from the Boston Ocular Surface Prosthesis, which is a customized contact lens.[6] Resting on the sclera, the prosthesis creates a fluid filled layer over the cornea, thus preventing corneal drying.[6]

Surgery

In severe cases of keratoconjunctivitis sicca, tarsorrhaphy may be performed where the eyelids are partially sewn together. This reduces the palpebral fissure (eyelid separation), ideally leading to a reduction in tear evaporation.[3]

Experimental topical growth factors

Eye drops, containing the factors present in the normal, healthy corneal tissue, that are topically applied to the corneal surface are currently in clinical testing for moderate to severe dry eye. These eye drops are currently in development at A & G Therapeutics, Inc. of Irvine, CA in the USA.

Prognosis

Keratoconjunctivitis sicca usually is a chronic problem.[6] Prognosis of the disease shows considerable variance, depending upon the severity of the condition.[1] Many patients have mild-to-moderate cases, and can be treated symptomatically with lubricants[1] providing an adequate relief of symptoms.[1]

When dry eye symptoms are severe, vision and the quality of life is diminished.[5] People sometimes feel their vision blurs with use,[3] or severe irritation[3] to the point that they have trouble keeping their eyes open[5] or they may not be able to work or drive[5]. Those using a CRT or computer screen all day at work will likely experience extreme discomfort, sometimes to the point of being visually disabled.

Prevention

Experimental procedures to prevent dry eye are being studied. These methods include the topical application of stem cell derived proteins and other nutrients to revitalize the natural protein and nutrient content of the acqueous portion of the tear film.

References

1. “Keratoconjunctivitis, Sicca”. eMedicine. WebMD, Inc.. 2006-04-21. http://www.emedicine.com/oph/topic695.htm. Retrieved 2006-11-12. 
2. “Keratoconjunctivitis, Sicca”. The Merck Veterinary Manual. Merck & Co., Inc.. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/30107.htm. Retrieved 2006-11-18.  “Keratoconjunctivitis Sicca”. The Merck Manual, Home Edition. Merck & Co., Inc.. 2003-02-01. http://www.merck.com/mmhe/sec20/ch230/ch230d.html. Retrieved 2006-11-12. 
3. “Dry eyes”. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. 2006-10-04. http://www.nlm.nih.gov/medlineplus/ency/article/003087.htm. Retrieved 2006-11-16. 
4. Michelle (May-June 2005). “Dealing with Dry Eye”. FDA Consumer Magazine. U.S. Food and Drug Administration. http://www.fda.gov/fdac/features/2005/305_eye.html. Retrieved 2006-11-16. 
5. “Dry eyes”. Mayo Clinic. Mayo Foundation for Medical Education and Research. 2006-06-14. http://www.mayoclinic.com/health/dry-eyes/DS00463/DSECTION=1. Retrieved 2006-11-17. 
6. Sendecka M, Baryluk A, Polz-Dacewicz M (2004). “Prevalence and risk factors of dry eye syndrome”. Przegl Epidemiol 58 (1): 227–33. PMID 15218664. 
7. Kaiserman I, Kaiserman N, Nakar S, Vinker S (2005). “Dry eye in diabetic patients”. Am J Ophthalmol 139 (3): 498–503. doi:10.1016/j.ajo.2004.10.022. PMID 15767060. 
8. Li H, Pang G, Xu Z (2004). “Tear film function of patients with type 2 diabetes”. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 26 (6): 682–6. PMID 15663232. 
9. A. Peral, G. Carracedo, M.C. Acosta, J. Gallar, J. Pintor.”Increasing Levels of Diadenosine Polyphosphates in Dry Eye” (2006)Invest. Ophthalmol. Vis. Sci.47 (9):4053–4058 [1]
10. Lemp MA. (2008). “Management of Dry Eye”. American Journal of Managed Care 14 (4): S88–S101. PMID 18452372. 
11. Tatlipinar S, Akpek E (2005). “Topical cyclosporine in the treatment of ocular surface disorders”. Br J Ophthalmol 89 (10): 1363–7. doi:10.1136/bjo.2005.070888. PMID 16170133. 
12. Barber L, Pflugfelder S, Tauber J, Foulks G (2005). “Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years”. Ophthalmology 112 (10): 1790–4. doi:10.1016/j.ophtha.2005.05.013. PMID 16102833. 
13. Miljanović B, Trivedi K, Dana M, Gilbard J, Buring J, Schaumberg D (2005). “Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women”. Am J Clin Nutr 82 (4): 887–93. PMID 16210721. 
14. Rashid S, Jin Y, Ecoiffier T, Barabino S, Schaumberg M, Dana R D (2008). “Topical Omega-3 and Omega-6 Fatty Acids for Treatment of Dry Eye”. Arch Ophthalmol 126 (2): 219–225. doi:10.1001/archophthalmol.2007.61. PMID 18268213. 
15. Creuzot C, Passemard M, Viau S, Joffre C, Pouliquen P, Elena PP, Bron A, Brignole F (2008). “Improvement of dry eye symptoms with polyunsaturated fatty acids”. J Fr Ophtalmol 29 (8): 868–73. doi:JFO-10-2006-29-8-0181-5512-101019-200606358. PMID 17075501. 
16. Micromedex Healthcare Series, (electronic version). Thomson Micromedex, Greenwood Village, Colorado, USA. Available at: http://0-www.thomsonhc.com.library.uchsc.edu:80 (cited: 09/05/06).
17. Barber LD, Pflugfelder SC, Tauber J, Foulks GN. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology. 2005 Oct;112(10):1790-4.
18. “Restasis” (PDF). Allergan. January 2008. http://www.allergan.com/assets/pdf/restasis_pi.pdf. Retrieved 2008-07-23. 
19. Dantal J, Hourmant M, Cantarovich D, Giral M, Blancho G, Dreno B, Soulillou JP. (1998). “Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens”. The Lancet 351 (9103): 623–628. doi:10.1016/S0140-6736(97)08496-1. PMID 9500317.
20. “Sun Pharma Product List”. Sun Pharma. http://www.sunpharma.com/sunpharma-products/sunpharma-formulation/spopup11.php. Retrieved 2006-11-27. 
21. “Dry eye syndrome”. Health encyclopaedia. NHS Direct. 2006-04-10. http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=137&PrintPage=1. Retrieved 2007-02-26. 
22. “Dry eyes syndrome”. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. 2006-10-04. http://www.nlm.nih.gov/medlineplus/ency/article/000426.htm. Retrieved 2006-11-16. 
23. Meiero A, Peral A, Pintor J. (2006) Dual roles of diadenosine polyphosphates in corneal epithelial cell migration. Invest Ophthalmol Vis Sci. Oct;47(10):4500-6.

About the Author

Drs. Al-Qahtani and Maguire are Co-Founders of A & G Skin Solutions, Inc. of Irvine, California, USA(www.agskinsolutions.com). Both Al-Qahtani and Maguire are NIH-supported research scientists, professors at medical schools, with numerous peer-reviewed publications. Maguire was awarded the NIH’s prestigious Fogarty Fellowship for his work in studying the nervous system, and Al-Qahtani has received numerous international awards for his work in immunology and medicine. Both professors have been working on stem cells dating back to 1997

Donna Mayo’s LASIK at Eye Carolina Center

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

Do you wear your contacts at the beach?

I have ben wearing contacts for ~1year but I’m about to go to Hawaii (yeah!) and am stumped about whether I have to go with glasses the whole time (yuck) or if there is a safe way to do contacts.

What are contacts wearers experiences with beach situations? Any hints (other than suggesting LASIK befoe I go)? Thanks!

When I went to Hawaii, I wore my contacts the entire time. However, I would not suggest wearing them in the water if you are planning to submerge your head. Also, if there will be kids in the water with, I suggest wearing glasses as they may splash water in your eyes, and salt water is not pleasant. You should be be safe with contacts most of the time, but carry some contact solution and your glasses just in case.

Hawaii Lasik Surgery

Lasik Hawaii is a post from: Colorado Laser Eye Surgery

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Is it possible to have Laser Eye Correction surgery on the NHS? If so,how do i go about applying for it?

Nope, it is considered a cosmetic procedure.

NHS Eye Care

Laser Eye Nhs is a post from: Lasik Eye Surgery Costs

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Doesnt the optional medical care practices such as Lasik epitomize how privatized health care is the way to go?

The #1 thing that is causing such a crisis within our healthcare system isn’t even being addressed; ENORMOUS INFLATION IN HEALTH CARE COSTS.

When you look at prices relative to optional care, where free market competition is allowed to thrive, you can see there is a clear example of where the solution resides. Get lobbyists and all this monopolizing of insurance out of the way and we can, for once, allow free market to help dictate prices. Which, in turn, will allow for health care to be so affordable we may not even NEED insurance.

Look at the cost of x-ray’s and how the costs have INCREASED over time, despite advances in technology. Compare that to Lasik, and other optional procedures, i.e. plastic surgery, and see how the cost of those have DECREASED over the same time span.

Ever stop to analyze why?

Maybe now’s the time….

I agree. At one point, we relied upon insurance only for major medical expenses. Now people expect insurance to cover their every sniffle with little to no money out of pocket at the time of service. It’s led people to a false conclusion that health care is cheap. They really have NO idea what it costs. Consequently, demand has gone through the roof and cost has increased with it. I don’t think we need to do away with health insurance altogether, but I do believe we need to move back toward more consumer driven health care. I dropped out of a traditional plan three years ago and have saved thousands. I’ve found that I’m more selective about the doctors I use, opting for ones who practice medicine conservatively. I ask a ton more questions before agreeing to tests or procedures, and think twice about whether or not a trip to the doctor is really necessary. I believe that costs would go down considerably if more people became involved in their own health care decisions and paid attention to the cost. I know it’s been a real eye opener for me over the past three years.

Rand Paul at the University of the Cumberlands, Pt. 2

Lasik Free Market is a post from: Eye Surgery Astigmatism

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“When do you know your dog is suffering”?

I have a little chi, and she has a heart problem. She is 12 years old in January. I know she is getting old, but she is coughing alot, and the meds help, but unless i give her the tusigon for sedation for relaxing, or lasik pills to relieve stress on her, she coughs all the time. Sometimes perpetually. She does seem at peace at times..not coughing just walking around. She eats really well…almost too good. She wags her tail when i get home, she just getting tired. I know i am the best judge of when, but while she is coughing alot, i do not believe she is suffering. Does anyone have any ideas about this? Maybe someone has been here….? If so, i would appreciate a response. Thank you all so much…

We all suffer, no matter the species.
When I thought I was going to lose the great love of my life, King do to injury, my trusted vet told me these three things.
1 when he stopped playing with his favorite ball
2 When he lost his hunger for food
3 When he could no longer be happy, it was time.

I listened.
But I spent 13 years with my best friend and learned this from King. When he was done fighting this life, he would let me know. He did and I was the last loved one of his to let him go.
He gave me the gift of not making me feel guilty over my own decision.
He freed me.
Watch you little girl, when she is ready, she will let you know you will have sorrow and grief, but peace because it was her decision as to when to go home.
God bless you and her.

Fun With Deaf Animals!

Lasik Dogs is a post from: The Laser Eye Center

]]> Lasik Surgery on the NHS?

anyone know anything? or is it purely cosmetic?
yes, im on about eye surgery, and it would be for an eye that doesn’t stay in line, feels like its pulling outwards, if you get my meaning

It’s not covered by the NHS except in very unusual cases – extreme prescriptions usually (and only very rarely).

That’s not the usual sort of surgery for a turning eye anyway.

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

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Kim Kardashian Gets Lasik with Dr. Maloney in Beverly Hills

On a recent episode of Keeping up with the Kardashians, Kim undergoes laser vision correction with Los Angles Lasik Surgeon Dr. Robert Maloney of Maloney Vision Institute. The episode follows her and her sisters Khloe and Kourtney to Dr. Maloney’s office in Beverly Hills to get the Lasik Procedure before a highly anticipated Las Vegas performance with the Pussycat Dolls.

Kim blogged about her nervousness before the Lasik Los Angeles procedure:

“I am getting Lasik Eye Surgery soon and I’m sooo scared! Have any of you done it?”

She had been struggling with her vision since high school, but found contacts and glasses too uncomfortable to wear. At the beginning of the episode she and her mother are conversing on the importance of her getting the procedure, especially being in the entertainment industry. Kim agrees, and finally goes to Dr. Maloney for the customized Lasik Los Angeles procedure.

During her LASIK, Kourtney and Khloe, who were supposed to be there for moral support, ended up goofing around and getting grossed from watching. But Kim is a trooper and keeps it together throughout the whole procedure. She expresses relief once the Lasik is over, and goes home to rest. The next day she can see more clearly than ever!

Option for Blade-Free Lasik Surgery

LASIK Los Angeles procedures greatly vary in technique. Many people are familiar with the most common type of vision correction surgery, which is the Traditional Lasik procedure. During LASIK, a thin layer of tissue is folded back from the surface of the cornea. After the laser reshapes the cornea, the tissue is folded back into place, where it bonds quickly. This three-minute procedure requires no needles and no stitches, and patients usually have improved vision almost immediately. Most patients heal very quickly and can return to work the next day.

Yet as amazing as all this technology sounds, many people still are uncomfortable with the fact that there is a blade involved, to make the flap. Others still, find themselves not an ideal candidate for traditional LASIK eye surgery Los Angeles. For these and other patients, there are other options for vision correction.

With the IntraLase method, pulses of laser light create your corneal flap, which is then lifted so the next step of LASIK – the reshaping of your cornea – can be performed. When your Lasik Treatment is over, the flap is securely repositioned into place. A qualified laser eye surgeon Los Angeles will be able to determine whether you are a good candidate for the IntraLase Method.

At the Maloney Vision Institute Dr. Robert Maloney has had many years of clinical experience correcting the vision of thousands of patients using a variety of techniques, and has personally performed over 45,000 Lasik Procedures. In a nationwide survey of eye surgeons, Dr. Robert Maloney was voted one of America’s Top Ten Vision Correction Specialists. The Los Angeles LASIK specialists at Maloney Vision Institute are leading researchers in the field, and are able to offer customized vision correction options, as well as personalized vision care best suited for your individual eyes. If you’re not a good candidate for any given procedure, they’ll tell you.

About the Author

Dr. Robert Maloney ABC’s extreme makeover doctor, performed over 50,000 lasik surgery. Los angeles best Laser Eye Center, voted top 10 in USA. for more details visit us : http://www.maloneyvision.com

Las Vegas Lasik of Nevada Patient Testimonials

Las Vegas Lasik Eye Surgery is a post from: Lasik Risk

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i had Lasik Eye Surgery about 6 years ago and it was great! I just had a baby about 1 year ago and now my vision seems to be going back to where it was before the eye surgery, is it possible my pregnancy could have caused my eyesight to change permanantly again?

Unlikely. glasses prescription can sometimes change a little during pregnancy but will go back after delivery. Eyes can change power with time, so it is more likely that the six years caused the change.

Pregnancy And Lasik Surgery is a post from: Lasik Greeley

]]> New Innovations In Orthopedic Surgery Abroad

Orthopedic surgeries are designed to treat a number of bone and joint problems. The most common orthopedic issues today involve medical conditions such as arthritis, joint-related injuries and stress caused by obesity, and damage to bones and joints due to sports injuries or automobile accidents.

 

Who Needs Orthopedic Surgeries?
Orthopedic surgeries are designed to treat a number of bone and joint problems. The most common orthopedic issues today involve medical conditions such as arthritis, joint-related injuries and stress caused by obesity, and damage to bones and joints due to sports injuries or automobile accidents.

 

According to research performed by the American Academy of Orthopedic Surgeons, one in seven Americans currently suffers from bone or joint issues, for which consumers pay nearly $850 billion a year. Elderly individuals suffering from chronic arthritis conditions make up the largest demographic of those seeking orthopedic care. When it comes to injuries, back and knee injuries are the most common, and cost workers in the United States over 400 million lost workdays.

 

Innovations In Orthopedic Surgery
Research and development has improved the design and function of many orthopedic devices and procedures.  Two of the most recent include computer assisted hip resurfacing software.  Though widely utilized in Britain and Germany for many years, computer assisted resurfacing has stepped into the 21st century with a model based CE (Conformité Européenne) solution for hip resurfacing, called the VectorVision® hip SR. The process offers precise navigation system positioning and is able to calculate an optimal treatment plan for placement of femoral head components, hip geometry and hip replacement surfaces.

 

Another popular innovation has recently been used in Chennai, India.  The JOURNEY Knee in Oxinium provides an anatomical and fully functional knee joint system designed to feel and move like a normal knee, increasing flexion and stability. Oxinium materials offer state-of-the- art technology utilized in knee and hip implant components, producing exceptional performance and resistance to abrasion and friction. The device replicates functions of both the anterior cruciate ligament and posterior cruciate ligaments. Says Dr. A.K. Venkatachalam, a consulting orthopedic surgeon, “The JOURNEY knees system is well suited for high demand or active patients.  It is the only knee replacement on the market that offers patients more natural movement and function, and provides surgeons with an answer to the challenge of current total knee systems.”

 

Orthopedic Surgery Abroad
Due to increasing costs and wait times for orthopedic treatments and surgeries, more individuals are crossing international borders to seek treatment. Lower costs, decreased wait time, new technologies, and the expertise and experience of orthopedic surgeons in foreign destinations has created a boom in the number of individuals, especially the elderly, seeking treatment in such destinations as South America, India, and Middle East countries such as Jordan and Turkey.

 

PlacidWay, a medical tourism portal based in Denver, Colorado is a leader in consumer information, knowledge and awareness of orthopedic procedures and technologies offered with its regional partners. Medical facilities in various regions around the world, including those found in Korea, Thailand, and South Africa, offer certified, accredited, and quality care for orthopedic patients.

 

Cost Comparison
In the United States, cruciate ligament repair via knee arthroscopy averages $17,000 per knee, while in India, medical travelers may save up to 40%, paying just under $5,000 for the same procedure. Hip replacement procedures in the United States cost an average of $45,000, while the same procedure in Poland costs just over $5,000, with a 50-60% savings, or roughly $7,000 in Turkey, and $6,000 in India.

 

Lower costs do not reflect the expertise or experience of orthopedic surgeons in foreign destinations. Foreign medical providers in many locations offer world renowned surgeons utilizing state-of-the-art and high-tech equipment and are also accredited by the JCI (joint Commission International) as well as by Boards of Orthopedic Surgeons and Associations in their country of origin.

 

Conclusion
With healthcare rules and regulation changes on the horizon, the attractiveness and cost effectiveness of global medical tourism is likely to rise. Consumers accessing timely, up-to-date and relevant knowledge database is regarding foreign healthcare providers and facilities through website portals such as PlacidWay will find untold benefits, and cost savings, by looking beyond current borders for their orthopedic medical care.

About the Author

Our center specializes in Knee Surgery, Hip Replacement, and Shoulder Surgery. We treat local, national, and international patients with all types of joint disorders. Our surgeries are performed using advanced procedures in Orthopedics in a modern hospital environment.

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How do I decide which Lasik Vision Center in my area is the best?

Is there certain certification I should look for? A website that has ratings of clinics in my area perhaps? I live in the L.A. area by the way if anyone else in my area has recommendations.

This is an excellent question. Lasik Eye Surgery can be a life changing event so you really want to do your homework prior to your Lasik Surgery. First, you want to start with good Lasik Technology. We would recommend an all laser (bladeless) Lasik Treatment as well as a Custom Lasik treatment. The all laser system greatly improves the safety of the flap making process while the customVue treatment gives you the best vision. Second, you want the best surgeon. We would recommend a LASIK eye center in which your LASIK surgeon personally does your consultation and discusses with you if you are a good LASIK eye surgery candidate and goes over your every concern.

Lasik Ratings is a post from: Laser Eye Surgery Recovery

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Can military pilots fly with 20/400 vision?

Say I have 20/400 vision then go into college then Get Lasik and get 20/20 Can I still fly as a military pilot?

WASHINGTON, May 21, 2007 — Air Force officials have changed the policy to allow people applying for aviation and aviation-related jobs to have had Lasik Surgery. The change became effective May 21. The change also removes the altitude and high-performance aircraft restrictions for people who have had LASIK.

The decision to make these changes was based on studies that showed there was little to no effect on LASIK-treated eyes when subjected to the wind blast experienced during aircraft ejection or exposure to high altitude.

Due to stresses placed on the eyes during flight combined with the active lifestyle of military members, the recommended refractive surgeries are wavefront-guided PRK, or wavefront-guided All-Laser Lasik The eyes are more trauma resistant after surgery using one of these methods compared to other forms of refractive surgeries.

With all refractive surgeries, there is no guarantee of “perfect” sight after undergoing the procedures. Individuals must still meet the standards prescribed for entrance into the Air Force and aviation and special-duty positions.

Detailed additional policy information and guidance can be found at http://airforcemedicine.afms.mil/USAF-RS

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