My involvement with LASIK began at its inception. Despite that early exposure, I never grew completely comfortable with the procedure. By mid-2001, my concerns were growing. I was already seeing more patients with problems than happy ones.

I wrote the following in the January 2002 issue of Review of Optometry: “Happy LASIK patients are ecstatic, but unsuccessful patients exist in a permanently altered waking nightmare from which there is presently no escape.” In this and other editorials, articles and lectures of that time, I urged caution and care in selecting appropriate LASIK candidates. Optometry's role is ideally served as gatekeepers of a procedure that can alter vision—and even—life permanently for better or for much worse.

So for me, today's headlines came with little surprise. Dr. Morris Waxler, a former FDA official largely responsible for the original approval of LASIK, called for the FDA to crack down on the procedure, including issuing a public health advisory that warns the public about the dangers and implementing stricter controls over device manufacturers and practitioners who perform the surgery.

Waxler stated that data show that “LASIK causes persistent vision problems and has an overall success rate of less than 50 percent; a failure rate of more than 50 percent.” Even with a good measure of doubt about the procedure, these numbers seem sensational to me. However, regardless of what any of us think, one thing is for certain: our patients expect us to have at least 20/20 foresight when it comes to their eyes.

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

 

 

Twenty-four eyes of 12 consecutive thyroid orbitopathy (TO) patients with dry eye findings instilled cyclosporine A 0.05% (CsA or Restasis) twice daily for 2 months to evaluate the effects of topical CsA on the signs and symptoms of dry eye, on apoptosis and on MMP-9 expression in conjunctiva epithelial cells in TO-related dry eye patients. Ocular surface disease index, Schirmer tear test, tear breakup time (TBUT), conjunctival apoptosis index and conjunctival MMP-9 expression were evaluated before and after 2 months treatment. Conjunctival biopsies were harvested from all eyes at baseline and after 2 months treatment. Apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP-nick end labeling (TUNEL) assay. MMP-9 expression was determined by immunohistochemistry.

After 2 months of topical CsA treatment, the mean OSDI score was significantly decreased from 58.08 ± 6.28 to 36.41 ± 11.75. At baseline, the mean Schirmer tear test score was 8.92 ± 5.52 mm. It was increased to 11.25 ± 4.71 mm after treatment. The mean TBUT increased significantly from 3.92 ± 2.18 sec to 9.16 ± 3.34 sec. The mean percentage of apoptosis index at baseline was 72.10 ± 35.82%. This was significantly decreased to 53.29 ± 34.46% after treatment. The mean percentage of MMP-9 expression of the conjunctival epithelial cells was significantly decreased from 48.12 ± 28.58% to 26.66 ± 25.13% following treatment.

Topical CsA treatment appears to improve the signs and symptoms of dry eye and inhibits apoptosis and MMP-9 expression in conjunctival epithelial cells in TO-related dry eye patients after 2 months of treatment.

Charts of patients who presented for soft contact lenses (SCL) care from October 2005 through March 2006 were reviewed and observed for a potential of at least 2 years to determine significant risk factors for any inflammatory and infectious events with SCL in a large retrospective clinical chart review. Charts from those with office visits involving an event-requiring pharmacologic treatment and/or interruption of SCL wear were scanned and later adjudicated by a masked panel. Significant factors from a univariate analysis were included in a multivariate analysis for all events and subcategories of events separately. Overnight wear was not consistently recorded and was not analyzed.

Charts from 1276 SCL wearers comprised 4120 visits and 1454 years of SCL wear (2908 eye/yr) and included 306 events of interest in 228 patients. In a multivariate analysis, age <25 years was significantly associated with presenting any event, inflammatory events, and infectious events that may or may not be CL-related. Ametropia >5.00 D increased risk of any event and for other infectious events. Use of daily disposable lenses associated with lid irritation but was not significantly associated with any other type of events. New and hydrogel lens wearers had a lower incidence of all event types.

Eighty-two percent of these SCL wearers did not present with any complications during the observation period >2 years. The risk factors for inflammatory and infectious events among SCL wearers in clinical practice are similar to those reported in prospective clinical trials. High ametropia and age <25 years are the risk factors that impact the most types of events.

A total of 33 eyes of 20 patients with pigment dispersion syndrome were evaluated to visualize the changes of the iris contour in patients with pigment dispersion syndrome after blinking, accommodation, and pharmacologic miosis using anterior segment optical coherence tomography. Each eye was imaged along the horizontal 0- to 180-degree meridian using the Visante Anterior Segment Imaging System (Carl Zeiss Meditec, Dublin, CA). Scans were performed at baseline and after focusing on an internal fixation target for 5 minutes, forced blinking, accommodation and pharmacologic miosis with pilocarpine 2%.

After 5 minutes of continual fixation, the iris became planar with the mean ± standard deviation curvature decreasing from 214 ± 74 µm to 67 ± 76 µm. The iris remained planar in all patients with pigment dispersion syndrome after forced blinking, but the iris concavity recovered to 227 ± 113 µm and 238 ± 119 µm with the –3.0 and –6.0D lenses, respectively. Pilocarpine-induced miosis caused the iris to assume a planar configuration in all subjects.

This study shows that the iris in pigment dispersion syndrome assumes a planar configuration when fixating and that the concavity of the iris surface is not restored by blinking. Accommodation restored the iris concavity, suggesting that the posterior curvature of the iris in pigment dispersion syndrome is induced and probably maintained, at least in part, by accommodation.