Tuesday, May 17, 2016
We're in the heavy pollen season here in Texas (and I presume most of the US) and we have a lot of ocular allergy patients with a lot of itching. When I was a 3rd year student in optometry school I had a patient who had obvious signs and symptoms of allergic conjunctivitis. I reported this to my supervisor at the time and he said something like: "great! Now what are you going to do about it?" I suggested Rx'ing the #1 topical antihistamine at the time, Patanol. "WHOA WHOA WHOA!!!!", he incredulously replied. "YOU NEED TO START WITH ARTIFICIAL TEARS!!!!" Uh, really? "YES REALLY!!", he exclaimed, getting increasingly agitated with me. As an aside this guy was not a fan of mine nor I of his, so I think he might have been just looking for some way to bust on me, but I digress. He made me tell this poor lady to use artificial tears 4x/day for a week and come back for a progress evaluation. A week later the lady was back with eyelids obviously swollen from heavy eye-rubbing and complaints of continued "intense" itching. We Rx'd her Patanol like I wanted to do 7 days earlier and she never came back, I assume (and would like to think) b/c she was finally less itchy. Well today I just read an article about "pink eye" suggesting that the #1 line of defense for allergic conjunctivitis is artificial tears. WHY? I still do not understand this. At all. We now have some great OTC topical antihistamines like Alaway. If your eyes are ITCHY you need to just skip the artificial tears go straight to topical antihistamines. Artificial tears will not treat ocular allergy. I'm sorry but they won't. The theory on this is that the artificial tears can be soothing to the cornea/eye and can "wash away" the allergens from the tear film. I mean OK but that's a little conservative IMO. You know it's itchy. Use the drop that is clinically designed for, and proven to stop the itch! Why are we wasting our time and the patient's time by going UBER CONSERVATIVE and telling them to start with tears? I don't. If they're itchy and I think its allergic I start with topical antihistamines. I think "dry eye" often gets improperly diagnosed in this profession when people complain of ocular itch, and I think OD's are taught that artificial tears are kind of a "cure-all" (or cure-most) for all sorts of eye problems. Maybe this harkens to a time when OD's couldn't Rx anything? Regardless, I am a fan of not wasting the patient's time nor mine. I make my 1st suggested treatment be the thing that is the MOST LIKELY TO WORK, not necessarily the thing that is the most conservative. EDIT: after posting this on Twitter with the hashtag #ocularallergy I read EVEN MORE articles suggesting dry eye and blepharitis/demodex as the cause of ocular itching. I just don't know if I agree. I'm not saying it's impossible for those to cause ocular itch but I *AM* saying that all things being equal and the presenting symptom being ocular itch that my 1st choice and everyone's should probably be antihistamines, not artificial tears. OK obviously during the exam if they have waxy buildup around lashes or punctate keratitis etc etc that changes things but we're not talking about that. We're talking about using antihistamines when you suspect an allergy cause and not wasting time with more a conservative suggestion of trying artificial tears.
Wednesday, May 11, 2016
20 years ago this summer the now classic progressive rock album "Masquerade Overture" by the British band Pendragon was released. I know because I ordered the CD as an import for $26 and had it shipped from England. I had just moved to New York City to attend optometry school and had an absolutely microscopic studio apartment at 77th & 1st on the Upper East Side in Manhattan. I didn't really know anyone yet and I must have listened to that CD hundreds of times that year (1996) while studying, while riding the 6 train to and from school, and while walking around in NYC. I memorized it. It was unlike anything I had ever heard. It still is. It's pretty much epic as far as "neo-progressive" albums go. It may be the quintessential neo-prog album of the 90's. Recently I got a new phone and I went thru my Amazon cloud catalog and re-downloaded this album, and then today this song "Paintbox" came up on shuffle in my car and I of course still knew every word. Not only that but all of the emotions and memories about that time in my life came flooding back as soon as the intro came on. Later on of course I would make some friends but at the time I had just been divorced and alone in NYC and had left Texas for the 1st time in my life... it was a totally new start. Exciting but scary. And this song brought it all back in about 8 seconds. That's pretty amazing to me how an album can do that.
Monday, May 9, 2016
A new study suggests that myopia is much more genetic than environmental, which is what many of us have been saying for a long time: IT'S IN YOUR GENES (for you myopia conspiracy theorists this means it's also not your glasses nor your optometrist!) "A complex formula of both environmental and genetic mechanisms may work collectively to trigger myopia development, scientists venture, after an international study pinpoints new genetic cues. "This will allow researchers to focus their efforts ... to unravel how and why myopia develops." Researchers with the Consortium for Refractive Error and Myopia (CREAM) at Johannes Gutenberg University Mainz in Germany uncovered nine new genetic risk factors in myopia development by studying the disorder's connection with education level. Published April 6 in the journal Nature Communications, the meta-analysis used 34 European and Asian studies—spanning more than 50,000 adults—to identify genetic mutations expressed as a factor of education level, given that educational attainment is generally considered a proxy for near work activity. Their work identified nine novel genetic loci associated with refractive error: three among populations of Asian descent and six among Europeans, in addition to confirming known associations at 17 previously published loci. These genetic variants are associated with proteins that perform crucial roles in the transmission of signals within the eye, according to the university news release. One such gene, GABRR1, is particularly interesting as it is responsible for the neurotransmitter, gamma-aminobutyric acid (GABA) in the eye, which previous studies have linked to greater activation in myopic eyes. This meta-analysis supported that role, as well. Although myopia development remains an intricate puzzle, the study's authors write that they hope these new genetic targets will help further therapeutic interventions for myopia and spur further work. Reflecting on refractive error Myopia—nearsightedness, colloquially—affects nearly 30 percent of the U.S. population, typically first occurring in school-age children and progressing until about age 20. Hereditary factors often control the growth and development of the eye; however, recent evidence suggests factors including near-work or even an 'outdoor effect' may impact ability to focus clearly. The exact cause of myopia is unknown, and that's why research, such as this CREAM study, proves so beneficial, says Jeffrey Walline, O.D., Ph.D., AOA Contact Lens & Cornea Section (CLCS) chair, and associate dean for research at The Ohio State University College of Optometry. "Scientists believe that there may be a genetic influence on environmental cues to myopia development, but that has rarely been found to be true, until now," Dr. Walline says, reviewing the study. "This large meta-analysis may have found the genetic-environment interaction by identifying genes that regulate visual signals potentially associated with myopia. The results are very preliminary, but deserve to be more fully investigated." The publication highlights a fascinating analytic technique to identify associations between genetic markers related to the development of myopia and the impact of environmental factors on the expression of these genetic factors, says Christopher J. Quinn, O.D., AOA vice president. "This will allow researchers to focus their efforts on these specific targets to unravel how and why myopia develops," Dr. Quinn says. AOA sponsors historic FDA workshop on myopia Those two questions are the catalyst behind a landmark U.S. Food and Drug Administration (FDA) workshop on myopia progression this fall, sponsored by AOA and other stakeholders. "Controlling the Progression of Myopia: Contact Lenses and Future Medical Devices" will bring together internationally renowned scientists and clinicians—including Drs. Walline and Quinn—to discuss the condition and design a clinical trial to analyze the efficacy of devices slowing myopia's progression. Topics of discussion, include: Myopia abroad, demographics and history Pediatric contact lens use, behaviors and hygiene Complications of contact lens use Devices used to control myopia and U.S. regulation of such devices Challenges to clinical trials, and barriers to participation and retention Want to attend? What: Controlling the Progression of Myopia: Contact Lenses and Future Medical Devices Where: FDA White Oak Campus in Silver Spring, Maryland; or via webinar When: 8 a.m. to 6 p.m. ET, Sept. 30, 2016"
Thursday, May 5, 2016
So I quit my job. For the last 9 and a half years I have commuted an hour each way to be the associate optometrist for the biggest practice in the relatively small town of Huntsville, TX. I won't get into all of the reasons why I left, but I left on good terms and AFAIK there are no hard feelings. For awhile now I have been friends with another OD and she and I agreed that it would be mutually beneficial and even fun to work together if the opportunity presented itself, and it recently did. So I left the practice in Huntsville to work in Bryan where I live. That means no more hour commute! Yay gas mileage!
Wednesday, March 23, 2016
It's that time of year again! I personally have *intense* ocular itch right now, and it's only Wed and I've already had 3 "pink eye that won't go away" cases who were Rx'd antibiotics by their primary care providers. This is not too surprising since the pollen count for Huntsville, TX (according to pollen.com) is a 10.5 out of a possible 12. All of our cars are covered in a light yellow dusting. My lymphatic cysts are back in my right eye, my eyes itch like mad and my lids are slightly swollen. I have been using Alaway antihistamine eye drops OTC twice a day for months but yesterday I put myself on steroids - twice a day of Lotemax gel. If your eyes are ITCHY...don't bother with artificial tears or Visine or anything from Similisan. Go straight for the Alaway or Zaditor OTC and if you're still itchy, consider a visit to your OD for a steroid Rx. Be careful out there! - Dr P
Monday, March 14, 2016
Ok I wrote/recorded a new song. It's Contemporary Christian so click or not, according to your music preferences haha. I'd love for you to give it a listen if you have time. Pro tip: the bridge is really good so try to make it at least that far, about the 2:30 mark :P WHEN YOU CARRY ME
Wednesday, March 2, 2016
Ever on the lookout for the next great cheap smartwatch, my latest is the now $35 Martian Notifier. I bought it on TNW Deals for $35, free shipping. Downloaded the Martian Notifier app from the Google Play Store to my Samsung Galaxy, charged up the watch, paired the devices on bluetooth...voila! Easiest setup ever! Especially given the problems I've blogged about before with pairing other devices. LIKES: easy setup, classy analog display, can still read time even when battery is run down b/c analog watch has separate battery, COST, can use Google Now voice commands thru it. DISLIKES: it's limited to whatever push notifications you get on your phone. There is no step counter or altimeter, etc, you can't download new apps on it or pay for things like you can on an Apple Watch, it only vibrates (no sound), it has a special/weird charger that you can't get anywhere else (non-standard), and my biggest dislike...it scrolls the push message twice and that's it. If you don't look at the watch during those 2 consecutive scrollings, you cannot look at the message later w/o digging out your phone. There's no way to pull the message back up again on the watch. Oh well...it's cheap and it works and the setup is a LOT easier than the other models I've used, and it's classy looking and I love it...until the next watch I try heheh. ***** MAY 10, 2016 UPDATE: see 1st comment below for information about firmware update