Saturday See-Food Diet

For cocktail hour, make eyeball-tini's using radishes and pimento olives. Stirred, not shaken, at: http://showmevegan.blogspot.com/2008/10/veganmofo-eyeball-martini.html




As an opener, keep your eyes on the taco salad. This delicious recipe was sighted on: http://www.tasteofhome.com/Recipes/Eyeball-Taco-Salad













Next, antipasti! Eyeball pasta is easy to make, and capers can substitute the green pesto irises here. Look for this recipe at:
http://www.bbcgoodfood.com/recipes/12856/eyeball-pasta







For desert, eyeball cupcakes will see to it that your party ends on a sweet note. Recipe found at: http://www.epicurious.com/recipes/food/views/Eyeball-Cupcakes-232942

New Graphic from Eric Hou

I am thrilled to announce that Eye Spy has unveiled a new logo, designed by no other than illustrious cartoon artist, Eric Hou. Eric's brilliant plume captured the essence of this site with a spy, an eye, and a chart in the medical record room. Check out his awesome cartoon store at: http://shop.saltykisses.com/

Put a Plug in It

What can we do you for, if you still suffer from dry eyes symptoms, even after squeezing bottle after bottle of artificial tears onto your eyeballs? To answer my dear reader, Avitalle, on a comment posted 2/17/10, I would like to address the topic of punctal plugs. And my answer to you comes from an age-old idiom: waste not, want not.

Your eyelids serve not only the important function of lubrication (call them cornea squeegies), they also contain a little toilet bowl that drains those tears. This little toilet bowl is called the punctum and it marks the beginning of the tear drainage system. Each one of the four lids contains a little punctum -- take a look at the nasal portion of your eyelid margins in the mirror and you will see these little holes. The puncta (plural form of punctum) drain excess tears by a complex vacuum mechanism that synchronizes perfectly to suck tears down the drain with each blink. Tears are then are emptied into the vast dumping ground of your nasal cavity via the tear ducts. In other words: what the eyelid giveth (tear glands) the eyelid taketh away (puncta). It is a sort of deity, perhaps a dictator, that can make or break your tear film.

If your eyes are as dry as Avitalle's, you are probably not producing enough aqueous to keep the cornea moist. So, it seems only logical to throw a wrench into those puncta and show them who's boss. Plugging up the puncta allows your eyes to keep all the tear volume they naturally produce and then some.

How does it work? Punctal plugs are tiny silicone wonders that can be deployed straight into the punctal opening, where they expand and stay until they fall out (typically 6 months to a year later). Planting the punctal plugs (do I get points for alliteration?) takes approximately a minute a punctum, is completely painless, and can be done in the comfort of your friendly neighborhood eye clinic. Depending on the severity of the symptoms, just the lower, or both upper and lower puncta can be plugged.

Most of my patients are very satisfied with the procedure and return with a healthy tear lake on follow-up. There is a small (but vocal) minority who can feel the plug if they look in its direction (Don't do that!) Rest assured though, the plugs can be removed as easily as they were placed, and they are completely inert otherwise (i.e. they do not elicit any immune response or allergy).

Yoga under Pressure

Yoga is arguably the most popular fitness fad of the decade. It claims entire specialty stores devoted to clothing, accessories, gear, and mats. You can do zen yoga, aerobic yoga, steamy yoga, strrrretchy yoga, pre-natal yoga, and even Wii Yoga. Any yoga may be tailored to fit your lifestyle (and some tailor their lifestyle to squeeze in some yoga). So, can anything that feels so good be so bad. . . for your intra-ocular (eye) pressure?

Sirsana yoga is a type that involves headstands. One study of Sirsana yoga practitioners in India showed a two-fold increase in intra-ocular pressure during head-stands. Without getting too graphic, imagine a two-fold increase in any function of your body! Multiple studies have demonstrated progression of glaucoma in followers of this extreme form of yoga; and many other studies are now underway on the question of yoga and eye pressure.

Consider some of your favorite yoga (or other recreational) positions: downward facing dog, downward forward bend, child pose, the wheel, or even more exotic ones like the camel or the fish. Amidst this zoo of poses, your head is placed below heart-level. Blood gravitates to the head, pressure in the cerebrospinal fluid surrounding the brain increases, and intra-ocular pressure rises in turn. The same fluid that surrounds your brain, encases your optic nerves as well, so it follows that when cerebral pressure rises, the pressure on your eyeballs increases.

Glaucoma is the most common disease of the optic nerve. According to the Glaucoma Research Foundation, it is the leading cause of blindness in African Americans and the second most common cause of blindness world-wide. While the exact mechanism of glaucoma is not well understood, we do know that it is linked to eye pressure. Intra-ocular pressure that is too high for any particular optic nerve will cause glaucoma damage, in most cases irreversibly.

I am not looking to direct the national tide of yoga aficionados back to the elliptical, but as with everything else, use good sense and moderation. If you know you have glaucoma or a family history of glaucoma, reconsider positions that involve prolonged suspension of the head below heart level. For glaucoma folks, yoga may be an extreme sport -- stick to sky diving! Do not forget to pay your friendly neighborhood eye doc a visit for an intra-ocular pressure check and a peer at your optic nerves.

Sunday Morning Art Looking at You

Gabriel Orzco's Under Elephant Foot. Currently on Exhibit at the MoMA, NYC. Eyeballs studded into a Beaucarnea tree trunk.

From Lafayette Square in New Orleans, bronze eye sculptures by Louise Bourgeois serve as benches. This 90 year old artist also created a great eyeball sculpture for the Williams College Campus.

Takashi Murakami's Jellyfish Eyes. Much more on this artist to come on Eye Spy.

Flax or Fiction

No visit to your local Trader Joe's or Whole Foods is replete without a leisurely stroll down flax-seed lane. This natural grain, originally used in the making of cloth and paint (!), now comes in many edible forms: whole seeds, ground seeds (for sprinkling on your corn-flakes or baking), tablets, cereals, breads, power bars, and even muffins. I was first introduced to ground flax-seed ten years ago when my college friend, a devout health-nut, poured it into blueberry-pancake mix. It was part of a Suzanne Summers diet recipe, because of its ability to control satiety and curb hunger, while keeping calories to a minimum.

The two main types of flax-seed, brown and yellow, contain equal amounts of short chain omega-3 fatty acids. You have heard countless tales about the beneficial effects of omega-3 fatty acids on the heart, blood pressure, immune system, and mental health, but did you know omega-3's are great for your eyes as well? Blepharitis, or eyelid inflammation, can benefit from this oil's anti-inflammatory action. Treating eyelid inflammation leads to improvement in dry eye disease (see my post "A Dry Subject," 2/16/10). A large study conducted at the Northwestern Feinberg School of Medicine has shown a 30-36% reduction of blepharitis symptoms in subjects who consumed omega-3 fatty acids as compared with placebo. Dry eye specialists often recommend tablets of flax-seed oil or its aquatic counterpart, fish oil, as part of a dry eye treatment regimen. Italian researchers obtained similar findings (pescatarians that they are). The advantage of flax-seed over fish-oil is apparent to vegetarians as well as those suffering from gastroesophageal reflux disease, otherwise known as fish-burp syndrome. Flax-seed is one of the only non-animal sources of omega-3 fatty acids.

But there are other salubrious benefits to flax-seed. Lignans, a lesser famed but equally loved oil family, have been shown to lower the incidence of cancer (particularly breast cancer) and heart disease. Also, the high fiber content of flax-seed helps to regulate bowel movements in the constipated and presumably lower rates of colon cancer.

Just how much flax seed is enough? Experts recommend supplementing your diet with 1000 to 2000 mg a day of flax-seed. This is most easily accomplished with tablets. You may want to titrate your exact dosage based on the gastrointestinal side-effects. There is some controversy about whether flax-seed causes prostate cancer, but evidence in either direction is scant. If you want to give flax-seed a shot at improving symptoms of dry eye, take it for at least a month and give it a chance to kick into your system.

For some flax-seed recipes, check out: http://www.flaxmatters.com/recipe.home.php

Macsai, MS. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction. Transaction of the American Ophthalmological Society. 2008;106:336-56.

Pinna A et al. Effect of oral linoleic and gamma-linolenic acid on meibomian gland dysfunction. Cornea. 2007 Apr;26(3):260-4.

A Dry Subject

Dry eye syndrome, the most common ophthalmic diagnosis today, affects us all sooner or later. Severe dry eye syndrome, also known as keratoconjunctivitis sicca, usually afflicts people with systemic disorders, such as rheumatoid arthritis. One blog entry cannot approach an exhaustive discussion of this topic, so I will start with some "dry science" that is crucial to understanding dry eye disease and its treatment.

All dry eyes are not created equal. The tear film is composed of three main ingredients: aqueous, mucin, and sebum. Much like a soufflé, your tear-film demands exact proportions of these main ingredients to remain stable and form a smooth surface over the cornea. Too much of one ingredient and not enough of another leads to premature break-up (instability) or drying up of the tear film, such that you may feel any one of the following uncomfortable sensations: burning, stabbing pain, itching, foreign body sensation (feeling of sand or eyelash in the eye), and blurry vision. A fourth important factor involved in regulating the tear film is the blink reflex. Most people blink between 6-8 times a minute. A good blink is a complete one (the upper and lower eyelids make contact) and spreads the tear film evenly across the cornea.

Two of the main ingredients in the tear recipe, sebum and aqueous, are released from your eyelid margin (from glands that sit behind your lashes). The third ingredient, mucin, is produced by marshmallow-shaped cells in the gooey skin of the eyeball, the conjunctiva. It then follows that eyelid inflammation will disrupt the production of sebum and aqueous and therefore affect the tear film. In a very common condition known as blepharitis (eyelid inflammation), dry eye syndrome results from faulty sebum or aqueous release. Reduced blinking rates or incomplete blinking also lead to drier eyes, because the tear film coats only those surfaces covered by the blink, leaving the remainder of the cornea high and dry. You may have noticed yourself that when you read a book/Kindle or work on the computer for a prolonged period of time, your eyes begin to burn and your vision blurs. Studies have shown that subjects focusing on these highly visual tasks blink less frequently. A reduced blink reflex means faster tear break-up and discomfort or pain. Why the blurry vision? Being a very powerful refractive surface (a surface that focuses light onto your retina), the tear film must be "just right" (think soufflé) in order to produce clear vision. As soon as it breaks up or dries up, the refractive surface is damaged and the image projected into your eye becomes unfocused and fuzzy.

My patients often ask me, with Nancy Kerriganian alarm and a dearth of tears in their eyes, "why me?!" The reasons for poor blinking and tear-film deficiency are multifactorial. First and foremost among these is aging. As sure as death, taxes, and cataracts, our aqueous tear production decreases with age. Another gender misfortune is female sex, especially as menopause nears and hormones involved in tear film regulation change. Drugs, such as anti-depressants, blood pressure, neurologic, and allergy medicines, contribute to dry eyes. Smoking (you heard it here first!) is bad for you, and interrupts proper tear-film production at its root and with second-hand smoke. Crack cocaine smoking is even worse and can lead to full-fledged corneal abrasions. Sorry to pull the race card, but white folks (you know who you are) with Rosacea, are more prone to blepharitis and, therefore, dry eyes. And, finally, disease states such as Lupus, Rheumatoid Arthritis, and Sjögren's Disease all contribute to dry eyes.

Now that we know the basics of tear production, lets talk about treatments. Depending on the underlying cause of dry eyes, I like to tailor therapy to target the specific problem. For example, if you have eyelid inflammation, I treat your ailing eyelids first, and if you have tear film deficiency I recommend lubricating the ocular surface or stimulating tear production with a prescription drop. If you sleep with your eye-lids slightly ajar (lagophthalmos), I recommend a drop that will keep your corneas moist at night. The corner-stone of dry eye treatment is artificial tears. By this I do not mean Visine, Naphcon-A, or any vasoconstricting drops. In fact, I would recommend you cease and desist use of the aforementioned, if you do. In the next few blog posts I will delve into therapies for different dry eye scenarios and talk about drops, gadgets, supplements, and routines that can help dry eyes feel better.

If you seem to have severe dry eye symptoms and have not found an answer to your predicament in this post, hold on to your seat-belt, I have only reached the tip of the iceberg. Please comment with your particular problem and I will address it in a future post.

Eyeballs 101

I owe the idea of this blog to a friend of mine who recently became a journalist, and has always encouraged my love for writing. The concept is to share ideas and updates about eyes, vision, optics, and even the healthcare industry with non-ophthalmologists who are eye-curious. My first few blog entries will be centered on some basic topics that seem to come up daily in my clinic. As interesting cases come up, I will blog about them discretely as well. I encourage your interaction and questions.