One of the great things about living in Southwest Florida is that I get to go to the beach whenever I want. Recently, I was enjoying a sunny day at the beach and, as it turned out, it was Spring break. Needless to say, there were scores of teens and what really struck me was the number of them that smoked. Maybe someone could actually quote a statistic that indicates that less teens smoke today than in previous generations, but why does this still continue, given the potential health risks?

This observation brought me back to a book I am reading, “Applied Economics,” by Thomas Sowell. This book looks at the long-term economic impact of previous and potential future political decisions, both domestic and international. Sowell has an interesting chapter on the economics of health care in which he makes a distinction between medical care and health care. Essentially, and in his view, medical care is what we physicians provide to patients who have medical or surgical diseases in an effort to make them healthy. Health care is more so a practice whereby risk factors for future health disease (such as smoking) are identified and recommendations are made or steps implemented to overt or minimize heath risks for an individual in the future.

Sowell goes on to say that governmental provision of medical care is politically expedient and possesses mass appeal, but it provides minimal if any foundation to improve the health of any nation or minimize the financial burdens of a society in the long run. Let's face it, preventative medicine is not that sexy, but can be very effective over time. I think it is time for this nation to have an honest discussion about addressing the uninsured as well as the inevitable financial burden that will come when Baby Boomers age. Part of the plan should be a program for minimization of health risks. This will require politicians to look beyond the next election and actually do the right thing for generations to come. Physicians must join the discussion in order to educate politicians and citizens in general about the potential long-term impact of their myopic decisions.

Stephen Pascucci, MD, FACS

This Polish study evaluated the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and monitoring treatment results in eye injury cases. A total of 38 eyes of 34 patients (mean age = 33.8 years) with different types of ocular injuries (penetrating injury [8 eyes], perforating injury [2 eyes], intraocular foreign body [4 eyes], ocular burn [9 eyes], contusion [13 eyes] and lamellar laceration [2 eyes]) were examined and AS OCT examination was performed at the initial visit, directly after injury and repeated as treatment progressed. Both anterior chamber components and corneal pachymetry were evaluated.

Slit lamp exam did not provide a clear diagnosis in three eyes after contusion because of a nontransparent cornea. In one case of a 44-year-old male patient, only corneal edema was noticed during slit lamp exam, whereas AS OCT revealed Descemet's membrane detachment. And in a 17-year-old male patient with blood infiltrating the cornea, OCT revealed acute angle closure with a pupillary block. OCT was valuable for monitoring the corneal healing progress after amniotic membrane application in patients with corneal burns and was also useful for determining whether a lamellar or penetrating technique should be applied in patients who qualified for corneal transplantation. Additionally, AS OCT was helpful in establishing the localization and size of foreign bodies in patients with foreign bodies.

AS OCT was determined to be a very valuable tool for early diagnosis and monitoring treatment progress in ophthalmic departments dealing with ocular trauma.

To determine the ocular safety of glitazones (a class of oral hypoglycemics) in diabetic patients, researchers conducted a prospective cohort study to investigate the association of diabetic macular edema (DME) in a large population of glitazone users.

They identified approximately 170,000 patients with diabetes using the Diabetes Case Identification Database and obtained information on glitazone drug use from the pharmacy database. The main outcome measure was the development of macular edema (ME). The researchers used the x2 test to compare proportions and t tests for means. Additionally, they used logistic regression analysis to adjust for potential confounding variables.

A total of 996 new cases of ME cropped up in 2006 and the researchers found that glitazone users were more likely to develop ME in 2006 (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.4 to 3.0). After excluding patients who did not have the drug benefit, did not have an eye exam and had an HgA1c <7.0, glitazone use was still associated with an increased risk of developing ME (OR, 1.6; 95% CI, 1.4 to 1.8).

According to the researchers, their study appears to show that the glitazone class of drug is associated with DME and that, even after adjusting for confounding factors of age, glycemic control and insulin use, glitazones are still modestly associated with DME. A more in-depth study is needed to evaluate the role of other confounding factors. The researchers advise that when treating DME patients, ophthalmologists consider the role of the glitazones.