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  • MD Health Insurance

    When a medical emergency involves a child and he or she must see an MD health insurance can be a godsend.  Unfortunately, not all children are covered under health insurance programs but, thanks to a recent congressional ruling, more American children than ever have benefit of medical insurance coverage.

    Expansion of the State Children’s Health Insurance Program (SCHIP) means that an additional 4 million children can see an MD when needed, bringing the number of children enrolled in this program to 11 million.  That also means millions of mothers, fathers, and grandparents can rest easy knowing that if their child needs an MD health insurance is no longer an obstacle.

    The expanded program is projected to cost $32.8 billion.  To fund these new visits to an MD health insurance for these kids will be funded by an increase in the federal excise tax paid on cigarettes, which is going up from 62 cents to $1.01 a pack.

  • Health Insurance Kaiser

    Perhaps nothing makes good health a priority the way bringing home a newborn baby does.  Thoughts of medical care and insurance often induce finance-related headaches but one major health insurer has recently begun recommending a very low-cost means of providing a do-it-yourself form of baby’s health insurance.  Kaiser Permanente’s research division says simply turning on a fan in the room where a baby sleeps is an ideal way to reduce his or her risk of sudden infant death syndrome (SIDS).

    One theory as to why this tragic event occurs is that newborns simply don’t have the muscular strength or control to move their heads during sleep.  This immobility means they inhale the carbon-dioxide-laden air they’ve just expelled, in effect poisoning themselves during sleep.  By turning on a fan to improve circulation of fresh, healthy air, the baby breathes easier and stays healthier.

    While it’s vitally important to maintain health insurance Kaiser Permanente’s research indicates the rate of SIDS can be reduced by as much as 72% when the baby’s room is well ventilated, especially while he or she is sleeping.

  • Prevent Glaucoma

    Dubbed the sneak thief of sight, glaucoma refers to a group of diseases affecting the optic nerve which result in optic neuropathy, or damage to the nerve.  Its main characteristic is increased pressure in the fluid that fills the eye (ocular hypertension). It’s this increased pressure that is responsible for the damaged nerve.

    Most forms of glaucoma fall into one of two categories: open angle (chronic) or closed angle (acute).  Either form of the disease eventually jeopardizes visual acuity and irreparable blindness can result.  On a global basis, glaucoma is the second most common cause of blindness.  One of every hundred people, age 50 and younger, is affected by glaucoma.  By age 80, one in ten is affected.

    It’s currently impossible to prevent glaucoma or to cure it once it’s developed but early detection can preserve the vision as long as possible. The disease is often identified during routine eye examinations before any symptoms become apparent to the patient.

    Symptoms a glaucoma patient might experience include a loss of contrast, which causes a fuzziness in visual acuity.  Patchy peripheral vision is another sign that nerve cells are becoming damaged.  One patient may be able to withstand an extremely high amount of ocular pressure with no damage or loss of vision while the next patient may suffer damage when ocular pressure is only slightly elevated.

    The eye produces fluid that flows from the interior of the eye out the pupil.  From here, it normally drains through a series of meshwork that drains the fluid off the eye and into the bloodstream, where it is absorbed.  In open angle (chronic) glaucoma, the meshwork doesn’t allow ample amounts of fluid to drain into the bloodstream.  The undrained fluid is the source of pressure within the eye.  In closed angle (acute) glaucoma, pressure pushes the iris too tightly against the meshwork for adequate drainage to occur.

    Ethnicity plays a large role in one’s risk of developing glaucoma as does gender.  The average woman runs a risk for glaucoma at a rate three times higher than the average man because her eye chambers are typically smaller.  Eye shape determined by race or ethnicity, as well as other factors, increases risk as follows:

    • People of African heritage are at three times greater risk for open angle glaucoma.
    • The shallower eye chamber of people of Asian descent increases their chance of closed angle glaucoma.
    • The Inuit population faces a risk 20 to 40 times higher than Caucasians.
    • Myopic (nearsighted) individuals, those who have thin corneas, and older people are at higher risk.
    • A family history of glaucoma increases one’s risk by about 6%.

    Prolonged steroid use, diabetes, trauma, and other conditions also heighten one’s risk of developing glaucoma.  In other cases, the cause of the disease is genetic.  Hypertension has been associated with but not proven to be a cause of glaucoma.  Studies on vitamin deficiencies and supplements have been inconclusive thus far.

    While there is no way to prevent glaucoma, early detection and diligent maintenance efforts are vital for preventing blindness.  Eye drops that ease the pressure are most effective and are usually the first order of treatment.  Regular eye exams are critical.  Failure to comply with medical orders and missed eye exams are the main reason glaucoma patients lose their vision.

    There are a number of drugs available to treat glaucoma and still more under study or development.  Only an eye care professional can diagnose glaucoma and only an eye care professional can know which patient is most likely to receive benefit from a particular course of treatment.

    In cases where surgery is an option, a hole is made through the meshwork surrounding the pupil.  By enlarging the hole through which intraocular fluid drains, pressure within the eye is relieved.  In some surgical procedures, lasers are used but others involve the placement of tubular catheters to induce drainage.

  • Optic Nerve

    All vision relies on the optic nerve and its ability to relay the images our eyes detect to our brains for processing.  There are twelve paired nerves that relay information from the body to the brain and the optic nerve is the second pair of this twelve.  Thus, it is frequently referred to as cranial nerve II.

    The optic nerve is a part of the body’s central nervous system.  As such, damage to this nerve cannot be repaired.  Any impaired vision that results from injury or illness that affects the optic nerve is permanent.

    At the center point of the back of the eye, fibers from the retina form the optic nerve.  Behind the eyes, the optic nerve from each eye joins together, forming the optic chiasm.  Visual signals cross over to the other side of the brain in the chiasm and, from here, travel to nine primary visual nuclei along both sides of the brain.

    The retina is lined with a collection of tiny organs that resemble rods and cones.  The rods detect light and the cones color.  These visual images are transferred to the brain via retinal fibers and then the optic nerve.

    Although it isn’t obvious, thanks to the placement of both our eyes, every eye has a blind spot, where there are no rods or cones.  It is this spot that the optic nerve connects with the eye.

    Some experts believe a large part of visual processing occurs in the eye itself because there are about 100 million photoreceptors (rods and cones) in the retina but only 1.2 million retinal nerve fibers traveling to the brain.  Others dispute this, saying the signal capacity of the fibers of the optic nerve is great enough to carry only signals to the brain, where all the processing is done.

    Regardless of where the processing is done, damage anywhere along the optic nerve results in permanent loss of vision, with vision loss equal to severity of the damage.  When the optic nerve becomes damaged, the pupil is also affected.  Optic nerve damage influences the pupil’s reflex ability, which hinders diagnosis of many eye disorders.  Pupil reflex is vital also in diagnosing other disorders that affect the body system wide.

    Visual impairment caused by damage to the optic nerve depends upon where along the nerve the damage occurs.  When damage occurs in front of the optic chiasm (between eye and chiasm), loss of vision will be discerned in the eye on the same side (left or right) as the damage itself.  When the chiasm itself is damaged, visual loss affects both eyes.

    Damage to the optic nerve beyond the chiasm causes visual loss in the eye opposite the damage.  In this case, damage to the optic nerve on the right side of the brain causes visual loss in the left eye.

    The chiasm is situated near the pituitary gland, leaving it vulnerable to damage when certain pituitary tumors are present.  Traumatic injury, inflammation, toxicity, stroke, and compression from an aneurysm or tumor can all cause damage to the optic nerve to the extent vision is impaired.  Injury can also occur when Leber’s Hereditary Optic Neuropathy, a congenital condition, is present.

    The three most common medical conditions that affect the optic nerve include glaucoma, which is a neuropathy causing loss of peripheral vision but which can progress to loss of central vision as well.  Multiple sclerosis patients risk optic neuritis, or inflammation of the optic nerve, which commonly happens before age 50, and patients at heightened risk for cardiovascular disease risk anterior ischemic optic neuropathy after age 50.

  • Macular Degeneration

    After the age of 50, the most common cause of blindness worldwide is macular degeneration, which causes loss of vision at the center of focus while peripheral vision, around the outer edges of the field of vision, remains relatively clear.  Both forms of the disorder, wet or dry, result in the same visual symptoms.  Limited to mostly older people, a juvenile form of the disease occurs, too.

    Without actually resulting in total loss of vision, except in rare cases, macular degeneration causes enough vision loss that the patient cannot read, identify people in photographs, enjoy watching television or movies, or drive safely.  In many cases, the disorder stems from genetic origins (especially where juvenile macular degeneration is involved) but continued research indicates lifestyle choices can play a role in slowing onset or progression of the disease, where genetic factors are less influential.

    Wet macular degeneration, also called exudative age-related macular degeneration (AMD), occurs when blood vessels grow abnormally in the area behind the retina.  These abnormal blood vessels eventually leak proteins and blood into the vitreous humor, the gel-like substance that fills the eyeball.  When this leakage obstructs the macula (the center of the field of vision), AMD begins.  If not treated, wet AMD can cause rapid loss of vision as the eye’s photoreceptors (the eye’s rods and cones) become damaged irreversibly.

    Dry (non-exudative) AMD occurs when the layer beneath the retina atrophies (withers) enough to destroy photoreceptors in the central vision area.  Advanced AMD is associated with yellow deposits collecting in the macula.  Called drusen, these deposits are similar to the plaque deposits associated with atherosclerosis and Alzheimer’s disease.

    Symptoms of AMD include a blurring of the vision although the blurring may not seem associated with just the center of the vision at first.  When vision loss is rapid, wet AMD is most often developing.  The macula forms about 35% of the field of vision so most AMD patients retain about 65% of the field of vision.  Unfortunately, that 65% is around the outside, not the center, of vision.

    Other symptoms include shadows or areas of vision that seem to be missing (central scotomas) and distortion of vision is especially noticeable when looking at a grid of straight lines.  The straight lines may appear wavy or have gaps.  This symptom is most often noticed first when looking at the mini-blinds in one’s own home.

    Color is affected, too.  Distinguishing one dark color from another or one light color from another become particularly difficult with the onset of AMD.  Contrast sensitivity is frequently noted, making everything appear fuzzy, and AMD patients are often slow to recover clear vision after exposure to bright lighting or sunlight.

    While little can be done at this time to offset the effects of genetic factors, lifestyle choices thought to improve AMD or delay its onset include successful management of high blood pressure, maintenance of cardiovascular health (reduce cholesterol counts and avoid excess pounds), and limit fat in the diet to no more than 25% of total caloric intake (the average American diet is 42% fat).  The disorder is more common in older white people than in those of color.

    Oxidative stress is thought to play a role in the development of AMD and certain antioxidants are thought to be beneficial, including high doses of beta-carotene, vitamins C and E, and zinc.  Two nutrients from eggs and green vegetables (lutein and zeaxanthin) are thought to have preventive effects.  A diet rich in cold-water fish and nuts is thought to be beneficial, too.

    The drugs Lucentis, Avastin, and Macugen are currently being used to treat AMD.  Treatment involves monthly or bi-monthly injections directly into the eye.  Lucentis costs about $3,000 per injection and Avastin about $150 per treatment (although it is not FDA-approved for this condition).  Some drugs commonly prescribed for controlling cholesterol are used, too, as a means of controlling the drusen accumulations in the eye.

  • LASIK

    The familiar term, LASIK, is an acronym for laser-assisted in situ keratomileusis, which is a form of surgery ophthalmologists perform on patients suffering from a host of visual complaints, including nearsightedness, farsightedness, and astigmatism.  This type surgery, using a laser instead of more traditional surgical tools, is called refractive surgery because it alters the shape of the surface of the eye so light, and therefore vision, is processed differently.  Refractive surgery techniques are not limited to the LASIK procedures and lasers are used for other surgical procedures as well.

    Most candidates for LASIK surgery have a history of wearing eyeglasses or contact lenses for vision correction and view surgery as a final solution to the daily hassles associated with glasses and contacts.  Studies vary but the American Society of Cataract and Refractive Surgery estimates a 95.4% rate of satisfaction following LASIK surgery.  This success rate, reported in March 2008, involved evaluation of 19 studies involving 2,200 patients and review of more than 3,000 LASIK-related articles published in medical journals during the previous 10-year period.

    Nearsightedness, or myopia, is the most common ailment treated via LASIK but, as technologies improve, more and more patients suffering from farsightedness (hyperopia) and astigmatism are undergoing laser surgeries, too.  Best results seem to come from patients who experience only mild to moderate levels of visual distortion.

    Individual need determines which variation of LASIK is most appropriate for a given patient but the training and expertise of the surgeon is another consideration, as procedures vary.  In any case, the best outcomes are achieved only after a thorough eye examination that involves full dilation of the pupils and the results evaluated by qualified professionals.  LASIK is not a cosmetic procedure and must never be taken lightly.

    As a general rule, surgery involves using a laser to slice off the corneal layer that covers the eye lens, leaving just a flap of tissue holding the flap to the eye.  This flap is then folded back, revealing the surface of the lens underneath.  At this point, the surgeon will guide the laser as it resculpts the natural curvature of the eye lens.  Visual acuity is determined by the curvature of the lens and distance from the retina at the back of the eye.  LASIK optimizes curvature to produce the best vision possible.  Once the eye has been resurfaced, the corneal flap is replaced so the healing process can reattach it firmly and permanently in place.

    LASIK works best on young adults who have enjoyed stable vision for at least two years prior to surgery.  A growing number of middle-aged patients, however, are turning to laser surgery to eliminate the need for reading glasses caused by the aging process.  This procedure, called slight monovision, mimics the effect of bifocal glasses.

    To achieve monovision, the LASIK surgeon sculpts the patient’s dominant eye to better perceive distance vision while the non-dominant eye is sculpted so visual acuity is similar to the reading glasses the patient has been using.  Post-surgical results require a period of adjustment, just as bifocal lenses do, but most patients report satisfactory results.  Many surgeons fit a perspective monovision patient with contact lenses that replicate post-surgical effects so the patient can spend a few days becoming familiar with the projected outcome before committing to surgery.

    While the vast majority of patients declare the surgery a success, satisfaction cannot be guaranteed nor is it 100%.  Some patients become dismayed with blurry vision following surgery but, in many cases, the blurring clears over time.  Because each patient is unique, the healing process varies from person to person.  Some people report clear vision within a week or two but others experience permanent blurring.

  • Laser Eye Surgery

    One of the most remarkable medical technologies developed in recent years is laser eye surgery, or any number of surgical procedures performed on the eye using laser technology.  There are several different types of lasers or techniques that can be used, depending upon physician training and the visual issues that are meant to be corrected.  Laser eye surgery is seen as miraculous by some patients but not every person is a candidate for this type treatment.

    The vast majority of patients seeking laser eye surgery are nearsighted, also called shortsighted or myopic.  Surgery works best when myopia (nearsightedness) is mild to moderate.  Severe myopia may be better treated by other means, some surgical but others not.  People experiencing farsightedness (hyperopia) and those with astigmatisms are usually not considered for laser eye surgery but more and more people with these issues are enjoying success with laser surgery, thanks in large part to the continued efforts at improving the technique and adapting it to a wider array of visual problems.

    Although ongoing research and development have expanded the number and types of surgical procedures available, laser eye surgery, in general, is basically the same.  During the procedure itself, the laser beam slices through the outermost layer of cornea, leaving just a flap connecting it to the eye.  Once the flap has been created, the surgeon folds it back, out of the way, and uses the laser to reshape the eye’s natural lens underneath.  This reshaping alters the patient’s visual acuity.  To complete the surgery, the flap is returned to its natural position, where the healing process secures it over time.

    Other surgical procedures, used before the advent of laser eye surgery, were often painful and took a substantial amount of time for healing and recovery.  One of the most desired aspects of laser surgery is the reduction in pain and the shorter recovery time.

    Patient expectation following laser eye surgery is generally rather high but many patients discover complications that leave their vision affected in ways that were nonexistent before surgery.  Some people see halos or ghosting (double vision) and others develop problems with glare and loss of contrast, which makes the vision seem foggy.  Some patients also develop hemorrhages in the eye as a result of surgery and almost one-third of all patients report excessively dry eyes six months after surgery, according to a March 2006 issue of the medical journal, “American Journal of Ophthalmology.’  In some cases, the dry eye issue is permanent, according to the US Food and Drug Administration (FDA).

    It’s these post-surgical complications that led the FDA to issue the following statement regarding laser eye surgery:  “Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.”

    FDA approval for laser eye surgery limits treatment to only people 18 years old or older.  Before that, eye development hasn’t yet stabilized, making a permanent fix, such as eye surgery, inappropriate and capable of only short-term improvements at best.  To address the changes in vision that naturally occur in everyone, FDA guidelines require a patient’s visual acuity be stable for at least two years before undergoing surgery.

    After the age of 50, other means of visual correction may be more appropriate than laser eye surgery.  Regardless of age, only a qualified surgeon can determine which patients are best suited to eye surgery and only after a complete eye exam involving full dilation of the pupils of the eye.

  • Eye Surgery

    For many generations past, people have been employing doctors of all kinds to perform eye surgery when problems of the eyes arise.  Such surgeries were documented in the Middle Ages and are mentioned in the Bible and in ancient Hindu documents, too.  Modern surgical procedures and our current understanding of bacteria, viruses, and other germs have made eye surgery a much safer procedure than ever before, as has the evolution of surgical tools.  Modern medical science is now able to save vision when it previously might have been lost to injury or infection and, when the eye is otherwise healthy, today’s eye surgeons can improve a wide array of visual acuity issues as well.

    Injury or sudden, severe infection may require immediate surgery, with no time for advance preparation.  In the many instances where surgery is more elective, scheduled long in advance, it is wise to refrain from the use of cosmetics and other skin care products in the eye area for at least a week before the surgery is to be performed.  This absence of chemical products will ensure the eye itself is as sterile and free from foreign substances as it can be.  The cleaner the eye at the time of the surgery, the less risk of complication the patient will experience.

    After any surgical procedure, these same chemical substances should be avoided until the surgeon says the eye has healed completely.  In some cases, this may take a week or two but complications to healing can delay that time.  When in doubt, ask your surgeon before applying cosmetics after eye surgery of any kind.

    One of the most respected breakthroughs in recent eye surgery techniques involve the use of laser technologies to replace many traditional surgical tools.  In many cases, laser surgery is less invasive than traditional techniques, leaving less damage from which to heal, fewer scars, and a shorter healing time in general.  Less pain and fewer restrictions on the recovering patient’s activities are also associated with laser eye surgery.

    The most common reason for eye surgery is to remove cataracts, a cloudy film that develops in the eye’s lens that can cloud or block one’s ability to see clearly.  Often associated with aging, cataracts can also be the result of injury or illness and many forms of it are congenital, developing before or shortly after birth.  The oldest known forms of eye surgery were done to remove cataracts.

    The World Health Organization (WHO) estimates about 48% of all cases of blindness in the world today are attributed to cataracts, representing about 18 million people.  In the United States, about 42% of all people between 52 and 64 years of age have signs of age-related cataracts.  That percentage goes up to 91% for those age 75 and older.

    In rare cases, the manipulation of the iris, the colored part of the eye that surrounds the black pupil, leaves the pupil itself smaller and more rigid than it was before cataract surgery.  In many cases, the patient isn’t bothered by this outcome but when it is bothersome, many eye care professionals will administer intracameral phenylephrine as a first course of treatment.  If this medication doesn’t relieve the patient’s discomfort, there are several surgical procedures that can be considered but only an eye surgeon can determine which procedure is most appropriate for which patient.

    In rare cases of extreme injury or infection, a patient’s eye must be removed altogether, a surgical procedure known as enucleation.  This particular form of eye removal involves excision of the entire eyeball but the muscles and orbital contents surrounding the damaged eye remain intact.

    Whenever possible enucleation is avoided so before undergoing this type surgery, ask your doctor about any other treatment options that can be explored to save the eye before surgery.  After surgery, prosthetic eyes can be used for cosmetic purposes.  Discussing this possibility with your surgeon before undergoing surgery is always a good idea.

  • Eye Treatment

    At the innermost corner of the eye, nearest the nose, are the tear ducts, or a series of tiny organs known collectively as the lacryminal apparatus.  When we have a cold, the flu, or an attack of hay fever, we are likely to think there is no way to stop this part of the eye from secreting tears but a blockage of this system does happen and it can become very painful indeed.

    Each of the different organs that comprise the lacrimal apparatus can become injured or damaged due to illness or infection.  There are different types of surgery associated with each of these organs.

    The lacrimal gland, actually located on the upper, outer portion of the eye just below the brow bone is where tears are created and secreted through ducts, which bring the fluid tears to the surface and inner corner of the eye.  In the inner corner of the eye are the lacrimal canaliculi, the lacrimal sac, and the nasolacrimal duct, all involved with carrying tears into the nose cavity for drainage.

    One of the first symptoms of blockage within the lacrimal apparatus is a blocked eye duct.  This blockage makes it impossible for the eye to stay properly lubricated and it can become painful and swollen.  The blockage can occur at any point within the lacrimal system and the type of surgery required depends upon the location of the blockage.

    Some of the more common forms of blocked eye duct and the surgical procedures that correct the blockage include:

    • When the nasolacrimal duct is blocked, a dacryocystorhinostomy or dacryocystorhinotomy  (DCR) is performed.  This procedure will restore the flow of tears from the eye area and into the nose for drainage via the lacrimal sac.
    • Congenital blockage of the blocked eye duct can cause the duct to close, or collapse, and prevent tears from flowing into the nose.  A canaliculodacryocystostomy surgically corrects this condition by bypassing the blockage and adjoining the open end of the duct to the lacrimal sac.
    • A damaged lacrimal gland is removed in a procedure called dacryoadenectomy.
    • Partial removal of a damaged lacrimal gland is called dacryocystectomy.
    • A dacryocystostomy involves surgical incision of the lacrimal sac to promote drainage.
    • Another form of lacrimal sac incision to relieve a blocked eye duct is a dacrocystotomy.

     

  • Eye Infection

    Itchy, red eyes that are watery, swollen, and painful may have fallen victim to infection of some sort.  The first step in getting relief is to identify the source of the infection.  Different causes call for different treatment methods.

    The two most common sources of eye infection are bacterial or viral infection.  Less common are infections caused by other microbial agents but less common doesn’t mean less alarming.  In other cases, allergic reactions lead to eye infections.

    While an infection is in full swing, vision may be temporarily blurred or otherwise impaired.  Once the infection is cleared up, vision almost always returns to normal.  In rare circumstances, however, an eye infection can lead to blindness so no eye infection should go untreated.  Sometimes immediate action can save one’s vision.

    Bacterial infections are frequently associated with use of contact lenses.  When these visual aids aren’t disinfected properly, bacterial build-up on the lens itself can contaminate the eye.  In many cases, an eye care professional will prescribe antibiotic drops and a few days without contact lenses.  This is also a good time to reinforce appropriate disinfection procedures, too.

    Conjunctivitis, often called pink eye, is a rather common eye infection that most people experience from time to time.  The most telltale symptom of this form of infection is a reddened or swollen conjunctiva, the mucous membrane that lines the eyelid and outer surface of the eye, from which the disease gets its name.

    Again, conjunctivitis can be caused by bacterial or viral sources so it’s important to determine the source of infection and treat the condition accordingly.  Bacterial conjunctivitis will usually respond to antibiotic drops but viral infection is more likely caused by the common cold, sore throat, or respiratory infection.  Treating the source of the viral infection will almost always improve the related conjunctivitis.

    The eye can become inflamed when allergens come in contact with sensitive eyes, leading to allergic conjunctivitis.  Eliminating exposure to the harmful substance will usually cause the eye infection to heal.  Some of the more common allergens include cosmetics, drugs, fumes, dust mites, and airborne chemicals.

    When viral or bacterial, pink eye can be quite contagious.  It is important to minimize contact with others while under treatment for a viral or bacterial eye infection.  Even indirect contact can spread the infection.

    For example, rubbing one’s infected eye with the fingers, then using the telephone is an indirect means of spreading the eye infection.  The next person who picks up the phone also picks up the bacteria or virus and can spread it to their own eyes if they rub them without washing their hands first.

    When treating any eye infection, cleanliness is vital.  Wash hands frequently, especially after touching the infected eye for any reason.  Never share eye drops, cosmetics, or any other products that come in direct contact with the eye, whether infection is present or not.

    Although the risk is rather small, the risk of causing permanent damage is present with all eye infections.  Prevention is preferred but when an infection is suspected, see an eye care professional immediately and follow his or her eye care instructions meticulously.