PRINCIPLES OF IOP

Review of Ophthalmology, Vol. No: 13:03 Issue: 3/15/2006

Trough IOP levels tend to occur at the end of the waking period; peak IOP is usually recorded at the end of the nocturnal sleep period.

The combination of high IOP and low systemic blood pressure (during sleep) can cause a critical reduction in ocular perfusion pressure.

RD AFTER ICL IN HIGH MYOPES

JOURNAL OF REFRACTIVE SURGERY Vol. 22 No. 3 March 2006

According to this article:

"The risk of retinal detachment in eyes implanted with phakic lenses for the
correction of high myopia is higher in eyes with axial length >30.24 mm."

TELESCOPIC MULTIFOCAL IOL

Ocular Surgery News, TOP STORIES 3/21/2006
This article states:

"The central optical zone of this new (foldable) telescopic IOL provides 3x magnification for central vision, and a peripheral zone provides normal peripheral vision."

It will be ideal for patients with significant vision loss from macular degeneration.

Popular Blood-Thinning Therapy Can Double Death Risk

According to a March 2006 article in HealthCentral.com a common blood-thinning therapy, the combination Aspirin and Plavix, may double the death risk if used to prevent first time heart attack. This therapy appeared to be beneficial to those participants with a history of diagnosed heart disease, but potentially fatal if used for preventing first time heart attack. The study included more than 15,000 patients with risk factors for heart disease or diagnosed heart disease.

BP CONTROL AND DIABETIC RETINOPATHY

Blood pressure control in Type II diabetics with diabetic retinopathy. Eye 2006; Feb 24 [Epub ahead of print].

According to this study:

"The target BP of 140/80 mm Hg was achieved only in 38 percent of the patients. Sixty-five percent of the patients requiring diabetic macular laser treatment had suboptimal BP control. Despite the unequivocal fact that lowering BP significantly reduces morbidity and mortality in diabetics, the majority of patients are not treated with a goal BP in mind."

Perhaps we need to emphasize the importance of blood pressure control in our diabetic patients better than we do.

AVASTIN AND PDR

Retina. 26(3):275-278, March 2006.


According to this article in Retina:

"Initial treatment results of patients with vitreous hemorrhage and proliferative diabetic retinopathy did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in marked regression of neovascularization and rapid resolution of vitreous hemorrhage."

The Lowdown on Benign Eyelid Myokymia

From Primary Care Optometry News March 2006:
Benign Eyelid Myokymia (BEM)is a benign twitching of the obicularis oculi muscle. Usually unilateral, self-limiting, and last from several hours to several weeks.
Causes: Not well understood, but precipitating factors include fatigue, stress, excessive alcohol/caffeine/nicotine intake.
History: Ask about antipsychotic medication usage, past CN VII palsy and prior injection around the eye. Observe for other neurological symptoms.
Biomicroscopy: Rule out trichiasis, blepharitis, keratitis, dry eyes, corneal abrasion, recurrent corneal erosion, and foreign body. In most cases, BEM will not be observed during the course of the examination.
Rule out Superior Oblique Myokymia(SOM) by having the patient look down and in towards their nose while viewing the suspected eyelid with the slit lamp. If SOM is present, the lid will demonstrate subtle oscillations lasting less than 10 seconds.
Differential diagnosis of BEM: Blepharospasm, hemifacial spasm, Meige syndrome, aberrant regeneration of CN VII, trigeminal neuralgia, Tourette syndrome, spastic-paretic facial contracture, and SOM.
Treatment: Reassurance that condition is self-limiting. If patient desires treatment, the condition does not improve, or oscillopsia is present topical antihistamines have shown to be effective in some cases. Emadine, Patanol, Elestat, Zaditor, Optivar are among the choices. Botox injections are used in severe cases.

Special Sunglasses for Dry Eye?

Patients with severe dry eye now have another option. "Designer" goggle sunglasses from Panoptx Inc. are designed to help patients cope with severe dry eye. Dr. Robert A. Latkany, director of the Dry Eye Clinic at New York Eye & Ear Infirmary conducted a study of 21 patients in the summer of 2005. He used the Ocular Surface Disease Index Score to determine the level of severity of dry eye. On a scale of 0 to 52, patients on average noted a reduction of symptoms from 30.2 to 18.0 after wearing the Panoptx sunglasses for one month.

RECURRENT CORNEAL EROSION THERAPY

Ophthalmology Volume 113, Issue 3 , March 2006, Pages 404-411 According to this article:

"Alcohol delamination appears to be a novel, simple, inexpensive treatment for RCEs."

SLEEP APNEA AND FLOPPY EYELID SYNDROME

Sleep Medicine Volume 7, Issue 2 , March 2006, Pages 117-122

According to this study:

"Floppy eyelid syndrome is originally described in obese men with easily everted upper eyelids. Recent studies have found an interesting association with obstructive sleep apnea that has both diagnostic and therapeutic implications; Floppy eyelid syndrome may be a presenting symptom in patients with undiagnosed obstructive sleep apnea , and, in addition, treatment of obesity and sleep apnea may have a favorable effect on the course of floppy eyelid syndrome."

In another recent article in the journal Sleep Medicine, a paper concluded:

"Reported ophthalmic findings in patients with sleep apnea syndrome include floppy eyelid syndrome, glaucoma, and non-arteritic anterior ischemic optic neuropathy."

MIGRAINE AND REFRACTIVE ERROR

Optometry & Vision Science. 83(2):82-87, February 2006.

According to this study:

"low degrees of astigmatism and anisometropia are relevant in migraine. Our most significant finding was of higher degrees of astigmatism in the migraine group. This study does indicate that people who experience migraine headaches should attend their optometrist regularly to ensure that their refractive errors are appropriately corrected."

Nocturnal Blood Pressure and Normal Tension Glaucoma

(Investigative Ophthalmology and Visual Science. 2006;47:831-836.)

This study states:

"Marked circadian mean ocular perfusion pressure fluctuation was associated with nocturnal BP reduction. Circadian MOPP fluctuation may be a risk factor for the development of normal tension glaucoma."

OCT Repeatability

Investigative Ophthalmology and Visual Science. 2006;47:964-967

This paper reviews the reproducibility of OCT in evaluating RNFL thickness average. It concludes:

"A retinal-tracking system was successfully developed and integrated into a commercial OCT unit. Tracking OCT improved the consistency of scan registration, but did not influence NFL thickness measurement reproducibility in this small sample study."

I have

I have found that OCT monitoring of RNFL year to year is meaningless unless the patients previous scan is brought up and the same scan loci are used.