Giant Eyeball Sculpture for Chicago

This story today from CNN:

http://www.cnn.com/2010/TRAVEL/06/07/chicago.eyeball.sculpture/index.html?hpt=C2

I say bring on this giant eyeball sculpture.  I am keeping my eyes on this plan, and I hope the folks in Illinois see it through.

Drinking vodka through your eyes?

http://www.dailymail.co.uk/news/article-1278583/Young-people-drinking-neat-vodka-EYE-quick-buzz.html

Thanks to a friend who sent me this link, I first became aware of a shocking new trend: obtaining an "instant buzz" by pouring vodka into the eye.  Really, Britannia?  I know the British university crowd likes to party (yeah, baby, yeah!), but for heavens' sake, spare the bloody cornea!  Or use tea, like descent Englishmen.  Peer pressure to perform vodka "eyeballing" has not yet hit the frat scene in the U.S. (surprisingly), and I am crossing my fingers and eyes that it never will.

Alcohol, especially in high concentrations (such as 40 proof vodka), separates the external layers of the cornea (the epithelium) from the eye and causes painful corneal abrasions.  If deep enough, the abrasions may lead to permanent corneal scarring, irregular astigmatism, and consequently blurry vision and pain *for life*!

The only instance in which we use alcohol on the cornea is at the time of a refractive surgical procedure, such as PRK.  We purposefully create a corneal abrasion in order to allow laser to reach the deeper layers of the cornea and permanently mold it into its new shape.  As a safety measure to prevent haze (a.k.a. scarring) from occurring, a chemotherapeutic drug (Mitomycin C) is applied to the eye.  The wounded cornea is then babied some more with a contact lens that allows for more comfortable and faster healing.  So, other than  PRK, America, please refrain from proofing your eyes with alcohol.  Put your vodka where your mouth is.

Iridology Uncovered

Did you know an extensive branch of alternative medicine is based on the interpretation of nooks and crannies in the iris?  It is called iridology, and has amassed a considerable cultish following.  Iridologists believe that alterations in iris texture, color, and structure can portend imminent changes in one's physical, mental, and spiritual well-being.  Much like augors who read the future in the entrails of sacrificial animals or coffee dregs, iridologists claim to portend "tissue weaknesses, inflammation or toxicity in organs or tissues". They use magnifying loops and a penlight (sometimes a video camera) to document their findings, while referring to iris maps such as this one, originally developed by Bernard Jensen in 1981 (from http://www.truevitality.com.au/wp-content/uploads/2009/08/iridology-eyechart.jpg)

Although I like to give everyone the benefit of the doubt, even when it comes to quacks, I came upon an interesting site entitled "Confessions of a Former Iridologist"  that convinced me otherwise (http://www.quackwatch.org/01QuackeryRelatedTopics/confessions.html).  Mr. Mather is a recovering iridologist who expresses dissenting views (infidel!) on the profession he once held at high esteem. His apprenticeship in western medicine and appreciation for evidence-based proof led him to re-examine the field using controlled conditions. He concluded that "not only did the light placement affect the appearance of structures; the slow draining of the batteries in the penlight changed the appearance of the eye color" and that iridology, therefore, has "no basis in real anatomy and physiology and . . . failed well-done trials and studies."  Still, the Iridology charts would make for cool coasters.



http://www.herbsbylisa.com/iridology.html http://www.truevitality.com.au/wp-content/uploads/2009/08/iridology-eyechart.jpg

Twitch Hunt

We all experience the lid twitch every now and then.  The upper or lower eyelid begins to intermittently spasm, and it seems the whole world can see it.  "I look like I have Tourette's," we think to ourselves.  In fact eyelid twitch, also known as eyelid myokymia, is almost imperceptible to others.  At least once a week, I see a handful of patients who rush in because their eyelids are doing the lambada.  If severe enough, eyelid myokymia may cause your world to seemingly bounce up and down as well (oscillopsia).

Why does this happen?  Essentially, the orbicularis muscle of the eye (in charge of opening and closing your eyelids) contracts rapidly in response to misbehaving nerves.  This usually occurs intermittently for a period of days, weeks, or even months.  Although extremely irritating, eyelid myokymia is benign (but if it lasts more than three months, call your eye doc).  It is triggered by such quotidian factors as inadequate sleep, fatigue, excessive caffeine, and emotional stress or anger.

Do you live in a large metropolitan area?  Do you down a grande latte mocaccino in your way to work?  Are you employed by the mafia or the CIA?  Or, are you leading a covert double-life and secretly hording a second family in Pennsylvania?  If you answered yes to any of the above, the lid twitch can happen to you at any moment.  Although there is no medicinal cure for it, eyelid myokymia improves with a good night's sleep, relaxation, and positive thinking.  Try to chillax with a glass of wine and a good Ingmar Bergman movie, or read the Seven Habits of Highly Effective People -- if nothing else it will help put you to sleep.


Walsh and Hoyt's clinical neuro-ophthalmology By Neil R. Miller, Frank Burton Walsh, William Fletcher Hoyt. 6th edition. Page 1216.

White Cadillacs

Cataracts, the bread and butter of ophthalmic surgery, are often referred to by the old folks as "Cadillacs."  That's fine by me, because there are about as many types of cataracts as there are Cadillacs: white, black, brown, front-loaded, back-loaded, with spikes on the sides. . . Unlike Cadillacs, though, cataracts never went out of style.  Everyone gets cataracts at some point, if s/he lives long enough.

Cataracts are opacified lenses.  Like a camera, your eye has a lens that sits in a bag ("capsule") behind the iris.  All your life, it works hard, changing shape to focus near and far objects, allow color and light to come through, and filter UV rays.  When you turn forty, the lens gets a little rusty and starts having difficulty focusing at near (like an old tire, it looses its flexibility).  And then, sometime after that  -- there is a sixty year range -- the lens begins to cloud up and transmit vision poorly.  Color vision is diminished (blues and greens take on a yellow-orange tinge), objects appear fuzzier, and people experience more glare.  Chemically speaking, the proteins in the lens morph into water-insoluble molecules and the lens medium becomes opaque.  Time to take it to the shop and trade it in for a new one!

In cataract surgery, we use tiny instruments, some ultrasound power, and a little pump to remove the old cataract.  Then we replace it with a shiny new lens implant that we place in the same bag that once held the cataract.  Of course, there are different models.  The standard government issued lens implants give you good vision at one specified distance (near or far).  The suped-up ones ("premium lenses") give you good vision at near and far, decrease night glare, or correct for astigmatism.  They do not come with heated seats, but you can get ones with tinted windows (the SN series by Alcon) and others that decrease the blurry vision you may get at night.  Of course, you should read the small print (or if you can't see small print anymore, get a magnifier), and make sure you understand the side-effects associated with the premium lenses (glare, cost, decreased contrast).

Being the most commonly performed surgery in America today, cataract extraction is now perfected to an art-form.  It can be done suturelessly, painlessly, and rapidly.  And we throw in an oil change.

UV and You

On a recent trip to SoHo, I witnessed sunglasses adorned with "100% UV protection" stickers sold for as low as $1.00. And would you believe it, they were also Coco Chanels, Guccis, and Dolce and Gabanas! OK, so the manufacturer labels may have been fictitious, but what about the Ultraviolet (UV) protection? Chances are these glasses really do filter UV rays, though the only way to be certain is to have them measured by an optician. Multiple studies have demonstrated that the price of sunglasses has little bearing on their ability to filter UV light, so don't rush to dismiss the bargain glasses.

UV filtration standards are assigned by continental jurisdiction: Australian, European, or American. The US standard is the lowest (land of the free!) We allow 1% UV transmittance of wavelengths up to 400 nm (Hence the UV 400 stickers), while the Europeans are a little more selective in awarding wavelengths VISAs (up to 380 nm). Our mates down-under fall somewhere in between. There is no enforcement of these standards in the US, so the presence of UV stickers may be misleading.

But what’s so bad about a little sunny delight for the eyes anyway?

UV rays may inflict damage in several layers of the eye cake. Too much UV exposure can cause squamous or basal cell carcinomas to crop up on the eyelids. Likewise, squamous cell carcinoma may develop on the skin of the eyeball (the conjunctiva) and spread onto the cornea. More commonly, chronic UV exposure may result in a growth called “pterygium” to spread over the cornea. Pterygium is Greek for “little wing,” which describes perfectly the shape of this flightless lesion. If these growths are detained on conjunctival territory, they look like little stumps and are fondly named “pinguecula.” Folks who spend their life outdoors are more prone to these conditions: farmers, sailors, the crew of Jersey Shore.

Intense UV exposure may also lead to corneal inflammation (keratitis) and cause a sterile conjunctivitis when the surface cells (epithilium) die off. Welders and DNA lab-workers or those who seek “perma-tans” in their friendly neighborhood spas also fall victim to this ultraviolet infliction.

Sun gazers (usually these folks are high on something, and it's not vitamin D) can damage their retinas with solar rays. The retinas of sober individuals who stare at solar eclipses may also be burned by the sun. The diagnosis “solar retinopathy” is not an eco-friendly energy solution, but rather a transient loss of central vision for one to twelve months!

Finally, some believe excess sun may play a role in the development of cataracts and macular degeneration, though far stronger genetic factors contribute to these entities.

In conclusion, the benefits of sun protection cannot be overstated. Thanks to role models such as Bon Jovi, Paris Hilton, and David Hasselhoff, these accessories are also considered really cool.  Right?

Color me Bad

I once asked a colleague of mine whether he was color blind, and he replied with great agitation that he was not color blind, but color deficient!  Defensive, are we?  Color perception is one of the great wonders of the human eye. Our retinas house a high-tech built-in imaging system that consists of 90 million rod and 4.5 million cone sensors.  Rods are in charge of night vision, peripheral vision, and large movements.  The cones, being more refined, take care of daylight vision, fine details, central vision, and color.

As you may remember from your physics days of yore, color is a wavelength of light that is reflected by an object.  And, like old technicolor televisions, we have three cone types capable of perceiving three color wavelengths: green, blue, and red.  This makes us trichromats.  Allegedly, there are individuals who have a fourth cone type, and they are called tetrachromats. (Although a tetrachromatic retina is exceedingly rare amongst humans, people immediately think they are tetras when they first read about it.)  Because the human lens filters out most ultraviolet light, we do not perceive it, but there have been reports of aphakic patients (patients without a lens) who see into the ultraviolet spectrum (!)

Many different forms of hereditary color deficiency and color blindness exist, and they usually have to do with either complete absence of one (or more) type of cone, or a reduced sensitivity of one cone type.  The most common type of color deficiency (red-green) is due to a reduced sensitivity of the green cones in affected individuals.  Because most of the genes that code for vision are on the X chromosome, males are much more likely to suffer from color deficiency and females are much more likely to be tetrachromats.  Seven to ten percent of males are color deficient (which explains why some dress the way they do).  Other reasons for deficient color perception are acquired causes related to optic nerve and retinal health.

But, it's not all bad news for color deficient folks.  Studies conducted by the military have shown an evolutionary advantage to color deficiency: the ability to see through camouflage.  Was GI Joe color deficient?  Maybe so.