American Academy of Ophthalmology: Kentuckians’ Vision Jeopardized with Governor’s Stroke of Pen

Despite an aggressive campaign waged by a coalition of medical groups to educate him on the inherent risks contained in the optometric surgery legislation that flew through the Kentucky legislature, Gov. Steve Beshear turned a blind eye to the dangers and signed SB 110 into law this afternoon. Beshear claims three reasons as the basis for signing the legislation into law, despite the vehement opposition of the Academy, the Kentucky Academy of Eye Physicians and Surgeons and the Kentucky Medical Association and so many of you who contacted him. His reasons for signing SB 110:

• “Access to quality health care across the state”
• The overwhelming, bipartisan vote
• The “little or no fiscal impact on the Medicaid budget”

The bill arrived on Gov. Beshear’s desk after the Kentucky House of Representatives voted last Friday to approve the legislation, which threatens the vision of all Kentuckians; the Senate took similar action the previous week. SB 110 grants optometrists authority to perform:

• Laser procedures, including laser trabeculoplasty, peripheral iridotomy, iridoplasty and capsulotomy, YAG capsulotomies, LASEK and laser “only” clear-lens extraction, as well as other laser procedures
• Scalpel procedures, with exceptions
• All methods of administering pharmaceutical agents including injection procedures, except schedules I and II
• Anesthesia, except general anesthesia
• Emergency inoculations, as requested by the commissioner of health

Ophthalmology: Differences between D.O.s and M.D.s are not as important as what we can accomplish together.

An often asked question: What's the difference between an M.D. and a D.O. ophthalmologist? Some D.O. ophthalmologists would reply: "Practically speaking, very little, or nothing". My own reply, and the intent of this article are to go beyond the "practically speaking" response, and offer another perspective.

Personal History

My osteopathic heritage begins with my father, a 1952 graduate of Kirksville College of Osteopathic Medicine (where osteopathy originated). He received his postgraduate training in orthopedic surgery at the Detroit Osteopathic Hospital, lovingly referred to as the "mecca" of osteopathic specialty training.

My own path started at Michigan State University College of Osteopathic Medicine, followed by an osteopathic internship. Ophthalmology residencies were scarce in the D.O. world when it was my turn to apply — only two openings were available in the entire United States. I was fortunate to have been accepted to the Kresge Eye Institute. Having just married a D.O. ophthalmologist whose medical educational route mirrored that of my father's, I found myself in a unique position to compare the educational experiences and philosophical differences.

Osteopathic principles and philosophy were founded by Andrew Taylor Still, M.D., toward the end of the 19th century. He noted that the medical treatments of the day were killing more people than they were curing.

He felt strongly that the body has an inherent ability to heal itself, and that structure and blood supply are vital to that healing process. He developed manipulative techniques that strive to restore skeletal alignment and improve blood/lymphatic flow throughout the body. One of the many tenets of osteopathic medicine states that the body has the potential to make all substances necessary to insure its health. No medical approach can exceed the efficacy of the body's natural defense systems if those defenses are functioning properly. Teaching the patient to care for his own health and to prevent disease is part of a physician's responsibility.

An Eye M.D.'s perspective: Practicing Another Brand of Medicine

 

If I brag about one of my sons, it wouldn't surprise or necessarily impress any of you, because we're all proud of our children, and we all think they are special (for the most part). But let me brag anyway for just a moment.

My middle child, Michael, has been a great kid to raise. He excelled in sports, was a natural leader in many areas, went on several medical mission trips with me, and was very gifted academically. He finished college in 3 years with a 4.0 GPA. But he, like so many, struggles on standardized tests … including the MCAT. So while his MCAT scores were respectable, they fell just shy of what the major medical schools sought. The allopathic medical schools, that is.

The Alternative

It turns out there's a whole other brand of medical school, the osteopathic variety, about which many of us "M.D.s" and our patients know precious little. It seems they also look at MCAT scores, but don't consider them the rigid screening criteria our traditional M.D. programs do. They focus more on your grade pattern over the years, your character and the kind of doctor you'll turn out to be. Let's face it — when you were in medical school, you saw some of your fellow students who, while brilliant, seemed, well, socially maladjusted. And those students are now doctors! Surely we can strike a balance between intelligence and a good ability to interact with patients.

Retina Specialty: what does a retina specialist do?

Physicians Specializing in Retinal Eye Disease and Macular Degeneration:

. Retina Specialist: A retina specialist is an ophthalmologist who has completed additional training of 2 year-long fellowship in vitreo-retinal surgery and diseases. They commonly treat people with blinding conditions if left untreated such as diabetic eye diseas, macular degeneration, retina detachment, traumatic eye injury, inflammatory diseases of the eye.

: Light-sensitive layer in the eye that converts images from the eye's optical system into electrical impulses that are sent along the optic nerve to the brain.

Vision: Making Inroads in Macular Degeneration

In 2004, scientists at the National Eye Institute predicted that as the population aged, the rate of macular degeneration, an incurable eye disease with no known cause, would increase substantially. They appear to have been wrong.

Via The New York Times: Vision: Making Inroads in Macular Degeneration

There have been tremendous research efforts in treating the blinding condition of macular degeneration. Currently, there are good treatments to stabilize the wet macular degenration and the treatments of dry macular degeneration are within horizons. It is encouraging that the trend of the disease prevalence has decreased by 9% over the past decade. Healthy lifestyle, smoking cessation and blood pressure control seem to have contributed to the reversing trend.

Acupuncture makes news in the ophthalmic world.

A recent randomized and controlled study of acupuncture treatment in older children, between 8 and 12 year-old, with anisometropic amblyopia (lazy eye due to optic power difference of the 2 eyes) showed better results than the current standard of eye-patching treatment.

Ambyopia, aka, lazy eye, is the medical term used when the vision in one of the eyes is reduced even though the eye is anatomically and structurally normal. During the development milestones, the eye and the brain are not working together properly and the brain favors the other eye and thus not allows a proper development of connections between the lazy eye and the brain. If no treatment was initiated during young age, the individual can have permanent poor vision in the lazy eye depending on the severity. This condition affects about 3% of children.

• "Acupuncture...has been used for treating ophthalmic disorders such as dry eye, myopia, and amblyopia. In recent years, the use of functional magnetic resonance imaging has demonstrated a correlation between vision-related acupoint stimulation and visual cortical activation, suggesting a possible basis for the use of acupuncture in treating amblyopia."

Medscape Ophthalmology: Acupuncture May Be Effective for Amblyopia in Some Older Children

Eye Health Stats

Sometimes I am surprised by some eye trivia. For example, the American Academy of Ophthalmology publishes some interesting and trivial facts about blindness and eye health. It is sobering to realize that eye care has progressed in the last 100 years and that we just now learning how to treat many of the eye maladies. But comparing the US to the rest of the world really shows how lucky we are to live in the United States.

Man who lost his sight every time he had sex

A man was forced to seek medical help after going temporarily blind every time he had sex. No, this isn't a tabloid headline. It actually happens. The victim of this predicament never lost his sight with other strenuous physical activity except when he climaxed during intercourse. This is a rare but true phenomenon!  

 It was reported that was not due to embolism to the vessels (ophthalmic artery) supplying the eye as it is a recurring condition in this young man. It can be speculated that vasoconstriction of ophthalmic artery is the cause and the patient is treated with a vasodilator. I suspect that the patient may have an optic nerve with cup-disc at risk, meaning that the blood vessels traveling through a narrow space within the optic nerve. Vasodilator or baby aspirin could possibly help to prevent the transient mini-stroke/ visual loss in this patient and hot have to explain embarrassing health details to potential partners.

 You can see all more of the details here.

Refractive Errors in the US

Refractive Errors: Some of us have to wear either glasses or contact lenses in order to see clearer. The corrective devices (glasses, contact lenses, and magnifiers) help to bring the image onto the retina. There are four typical refractive errors, which cause our vision to be blurred if we do not wear corrective devices.

• Myopia or nearsightedness--Close objects appear sharp but those in the distance are blurred. The eyeball is longer than normal from front to back, so images focus in front of the retina instead of on it.
• Hyperopia (hypermetropia) or farsightedness--Distant objects can be seen clearly but objects up close are blurred. The eyeball is shorter than normal, so images focus behind the retina.
• Astigmatism--Objects are blurred at any distance. The cornea, lens, or both are shaped so that images aren't focused sharply on the retina.
• Presbyopia or aging eye--The eye loses its ability to change focus due to the natural aging process. This usually occurs between ages 40 and 50.

Vodka Eyeballing

What is vodka eyeballing? It is a new fad of alcohol drinking has been taking place among young people. It supposedly started in Britain and is now gaining popularity in the US. The “eyeballers” pour vodka directly onto their eyes in the hope of obtaining quick high from the alcohol. They claim that “vodka eyeballing” induces drunkenness faster than drinking the vodka. The urban myth is that the alcohol passes easily through the mucous membrane and enters the bloodstream directly through veins at the back of the eye. This could not be more wrong. The volume of vodka absorbed by the conjunctiva and cornea is too small to have that effect.

Sight problems illustrated

Many people are often confused by the different sight problems and what they mean. I have found that the best way to explain the common sight problems is via illustrations. Physicians often use these illustrations when they first begin to study about these sight problems. Normal and clear vision is shown below. Physicians use an Amsler grid, which helps to monitor central vision disturbances and distortions. People with normal vision see a perfect grid.

Find the right eye doctor

It can be hard to find the right eye doctor for the first time or have just moved. Here is some basic information if you are looking for someone to help you with your vision. There are two types of eye doctors, optometrists and ophthalmologists. There are about 35,000 optometrists and 19,000 ophthalmologists practicing the U.S.A.

Optometrists

Optometrists obtain their doctorate of optometry upon completion of 4-year graduate education in optometry. Optometric students generally spend the first two years in learning basic sciences and the last two years in learning to refract patients for corrective wears (glasses and contact lens) and examine ocular diseases. Upon graduation and passing the licensing board examinations, optometrists can practice optometry. Clinical residency opportunities are available to optometrists who wish to obtain to advanced clinical competence in an area. These specialty areas include family practice optometry, pediatric optometry, geriatric optometry, vision therapy and rehabilitation, low-vision rehabilitation, cornea and contact lenses, refractive and ocular surgery, and primary eye care optometry, and ocular disease,

Ophthalmologists

Ophthalmologists are complete physicians, either M.D. (doctor of medicine) or D.O. (doctor of osteopathic medicine), who must have obtained their medical degree, completed one year of internship, and followed by 3 years of residency in ophthalmology. Upon completion of internship year and passing the national medical board examinations, these physicians are fully-licensed physicians. During the 3 years of residency in ophthalmology, the resident physicians learn about the eye's anatomy, to treat all spectrum of eye diseases and to perform surgeries of different subspecialties of ophthalmology. There are about nine to ten subspecialties: pediatric, cornea, refractive, glaucoma, neuro-ophthalmology, ocular oncology, ocular pathology, ocular plastics, uveitis, and vitreo-retinal surgery. Upon completing the residency, these physicians can practice ophthalmology and become board-certified after passing the written and oral specialty board examinations.

As the trend of health care delivery has become more specializing, about 30-40% of ophthalmologists choose to spend additional one to three years in fellowships in the above subspecialties.

Which is the right eye doctor?

How does the eye work?

Many of my young patients ask me “How does the eye work”? The answer is actually pretty fascinating and often helps patients relax before any procedure. The eye is analogous to a camera, which helps to capture the image or picture. Each structure of the eye plays a vital role in providing clear vision. The cornea behaves very much like a lens cover, which focuses rays of light through the pupil. The iris and pupil act as the aperture of a camera. Refractive or Lasik surgeons work on the surface of the cornea in order to reshape the curvature of the cornea and thus helping patients from wearing correction wears (what the everyone else calls glasses or contact lenses).

The natural lens of the eye helps to focus the light to the back of the eye onto the retina, which serves as a film of the camera. During the natural aging process, the natural lens becomes more yellow. This yellowing is called cataract. Patients with cataracts are just like wearing sunglasses all the time, which can impair their vision and cause glares. Therefore, cataracts can be removed by surgery and replaced with an intraocular implant.