A few years ago, I was headed back to NYC from the AOA Spring Planning meeting in St. Louis. Rather than go home, I was going to catch a plane to Ft. Lauderdale for ARVO and an editorial board meeting the next morning.

I sensed the plane was starting to descend. It seemed early, but I figured we must have had a decent tailwind. As we headed down, it got a bit bumpy and I decided it might be a good to time to visit the lavatory. I didn't have much time between flights.

I shut and locked the lavatory door, but before I could do another thing, a violent bump propelled me upward and my head into the ceiling. Within seconds, the plane was engulfed in the worst turbulence I have experienced in more than 3 million miles of flying.

At first, the gin and tonic I just had made me think it wasn't that bad and that it would pass quickly. Thirty seconds later—seconds that seemed like minutes—I started to realize that far from normal turbulence, this was serious, real serious. I shoved my feet into the base of the toilet and my back against the door pushing up against the ceiling with all of my might. It was the only way I could keep from being violently slammed into the walls and ceiling. I began to wonder if my life would end alone in an airplane lavatory, never to see another human being.

It seemed like forever; certainly long enough for me to become exhausted from the effort, but when it calmed a bit, I decided to make a run for it and try to get back to my seat. I poked my head out of the lav door tentatively. The fight attendants screamed. “Are you ok? Get back to your seat. Hurry, hurry.” Food and drinks were everywhere and eyes were wide with fright. Yet, as I ran back to my seat, the entire plane broke out in applause.

After I buckled in, I turned to my seat mate and grinned. He smiled back and told me, “You know, half the plane thought you would end up being carried out unconscious.” “The other half,” I asked? He laughed and said, “They thought you would come out looking like one of the Blue Man Group.” True story.

Arthur B. Epstein, OD, FAAO Chief Medical Editor [email protected]

 

Editor's note: Jack Runninger, is a dear friend, a personal hero and role model and an Optometric legend. One of the best writers to ever hold both a pen and an OD degree, Jack has graced us with another book. His humor chock full of useful pearls and life lessons. I highly recommend "Fixing Stupid, Two Curmudgeon's Pet Peeves". Dear Friends, If you'll excuse the crass commercialism, a retired judge and I have written a new book, "Fixing Stupid, Two Curmudgeons Pet Peeves." By way of description, the Editor's Note at the beginning of the book says in part, "The second part was written by Humorist Jack Runninger who has received many state and national awards for his newspaper and magazine humor columns. His approach is on seeking the humor and satire in the crazy and aggravating things that people do." I've read the book, and of course think it's great. If you feel a copy will lighten up your life, send me a check for $12.95 at 2663 N. Broad Ext., Rome, GA 30161. If you'll allow me to autograph it so I can feel like a big wheel, I'll pay the mailing charges. And again please excuse the crass commercialism. Jack Runninger

 

 

The purpose of this article is to report the incidence and cause of diplopia following cataract surgery and laser in-situ keratomileusis (LASIK).

Ocular misalignment following cataract extraction with retrobulbar anesthesia has an incidence of approximately 7%. Diplopia ranges in this group of patients from 0.23 to 0.98%.The incidence of ocular misalignment decreases with topical anesthesia for cataract extraction to 5%, and diplopia occurs with an incidence of 0.21-0%. Although there are small case series, the incidence of diplopia following LASIK has not been reported. The causes of diplopia following cataract extraction and LASIK include decompensation of pre-existing strabismus, new-onset accommodative esotropia, concurrent onset of systemic disease, disruption of central fusion, and monocular diplopia. The leading cause for diplopia following retrobulbar anesthesia for cataract extraction is extraocular muscle paresis/restriction and is unique to this type of procedure. In cases of topical anesthesia for cataract extraction and for LASIK procedures, the leading cause of diplopia is decompensation of pre-existing strabismus.

Detailed history and evaluation for pre-existing strabismus can dramatically decrease the incidence of unexpected diplopia following refractive procedures.

Seventeen eyes of 17 consecutive patients with naïve retinal vein occlusion were evaluated for the efficacy and safety of intravitreal ranibizumab (Lucentis) in patients with treatment-naïve retinal vein occlusion. Consecutive patients were recruited and received, on demand, intravitreal 0.5 mg of ranibizumab; nine had central retinal vein occlusion (CRVO) and eight had branch retinal vein occlusion (BRVO). Pre- and postoperative clinical evaluation included measurement of best corrected visual acuity (BCVA) for distance and near vision (MNREAD time, reading fluency), contrast sensitivity, colour fundus photography, fluorescein angiography and optical coherence tomography (OCT). All subjects were followed for a minimum of 12 months. Main outcome measures were change in BCVA, contrast sensitivity, angiographic leakage, OCT central macular thickness (CMT), number of treatments.

Patients with CRVO had mean pre-treatment BCVA of 20/240 and final BCVA of 20/46, with significant improvement at 1 year of follow up. At 12 months, mean BCVA improved to 36.7 letters, with a gain of 6.4 lines and OCT showed that the mean CMT was 271 µm, with a mean reduction of 360 µm from baseline. Patients with BRVO had mean pre-treatment BCVA of 20/126 and final BCVA of 20/50. The mean OCT CMT was 278 µm, with a mean reduction of 275 µm from baseline. Contrast sensitivity, MNREAD time and reading fluency improved significantly in the treated eyes. No ocular or systemic side effects were observed. Eyes with CRVO received an average of 3.0 injections (range 2-4) and those with BRVO 3.6 (range 3-4).

Intravitreal ranibizumab for the management of naive CRVO or BRVO can favorably modify the course of the occlusion, indicating that short- and long-term blockade of vascular endothelial growth factor (VEGF)-A may restore the integrity of the inner blood-retinal barrier, reduce CMT and significantly improve visual function, with a good safety profile. Further prospective long-term studies are warranted to confirm the efficacy, safety and optimal treatment regimen for intravitreal ranibizumab.

Clinical parameters, including adverse response rates and corneal staining, and symptomatology rating during lens wear were collected from a series of clinical tests comprising four different silicone hydrogel lenses with four different multipurpose solutions to correlate clinical responses during contact lens wear with the amount of protein or cholesterol extracted from lenses after wear. To test for correlates, the amount of total protein or cholesterol extracted from lenses after daily wear were compared statistically to clinical parameters.

The amount of protein or cholesterol extracted from lenses was higher for those subjects who showed solution-induced corneal staining. Amount of protein extracted was correlated with conjunctival staining, lens front surface wetting and lens fit tightness. These clinical parameters accounted for 48% of lens protein deposition. The amount of cholesterol extracted from lenses was much more weakly associated with clinical variables. Amount of protein or cholesterol extracted from lenses was not associated with the production of any corneal infiltrative or mechanical adverse event during wear and was only very weakly correlated with insertion comfort of lenses.

These results suggest that there may be no physiologically relevant consequence of cholesterol depositing on silicone hydrogel lenses. The amount of protein that deposits onto silicone hydrogel lenses during wear may have more affect on lens performance on-eye. However, the correlations were generally small and may still not indicate any causative relevant physiological response. Further work is required to determine whether there is any direct causative effect to support these correlative findings.