A striking percentage of patients needing eye surgery, particularly cataract surgery have the signs and symptoms of preexisting “dry eye” consisting of tear film instability, rapid tear breakup time, ocular surface disease – all resulting from inspissated secretions clogging meibomian glands leading to blockage and dysfunction. The single most effective treatment in my practice involves a pre-treatment preparation of the glandular openings followed by a painless, 12-minute treatment delivering vectored thermal pulsation. A treatment that I did earlier today is best represented by the attached video of a patient who underwent successful treatment a year ago and now is back […]
I want to credit the insight given to me from Dr. Doug Rett, OD, FAAO:
“In 1958 Muro Pharmacal Labs was founded and it manufactured ophthalmic drugs. It was named Muro for the Italian word for “wall,” which I think is fitting given the barrier that the cornea plays in penetration of ocular drugs. With tight junctions, pH sensitivity and the hydrophobic nature of the epithelium and hydrophilic nature of the stroma, it’s difficult for modern-day drug companies to pass medication through the cornea, let alone in the 1950s. In 1968 Muro was sold to George Behrakis, a pharmacist from Lowell, […]
Corneal hydrops involving a rupture or break in Descemet’s membrane is a relatively uncommon event occurring in patients with advanced keratoconus or other or corneal ectasia – possibly caused by aggressive eye rubbing – is characterized by stromal edema due to leakage of aqueous humor through a tear in Descemet’s membrane. It was the Greek physician Hippocrates (ca. 460 BC–370 BC) who is often credited with developing the theory of the four humors—blood, yellow bile, black bile, and phlegm—and the influence of these “fluids” on the body and its emotions. Swelling associated with disease became known as oidêma (swelling) and […]
While much of our surgery in Ophthalmology has moved away from needing sutures, there are still procedures that require very delicate suturing, including corneal transplant procedures, deep anterior lamellar keratoplasty, traumatic injuries, sutured intraocular lens implants, and other procedures. I am grateful to Doug Mastel and the great folks at John Weiss & Son International for their help in bringing into production the Carlson-Troutman needle holder that serves as an extremely precise needle driver while simultaneously serving as a tying forcep – allowing the passage of a needle and also tying the suture without exchanging instrumentation – improving efficiency, precision, […]
New & Noteworthy Journal Articles
Compiled by Andrew E. Mathis, PhD, Medical Editor
► Keratoconus and sleep apnea. Noting the sparseness of post-keratoplasty patients among their elderly patients, ophthalmologists Preeya Gupta, M.D., Assistant Professor of Ophthalmology and Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal Service at the Duke Eye Center in Durham, NC, undertook a study to determine whether there was any correlation between keratoconus and mortality, looking specifically at sleep apnea as a primary symptom. They report their findings in the June 2012 issue of Cornea.
The authors conducted telephone interviews with 101 patients diagnosed with […]
Thanks to Bill and Kathy Hudson and LC Industries for their generosity toward the new state-of-the-art clinical Duke Eye Center in Durham, NC.
From: Victor J. Dzau, M.D., Chancellor for Health Affairs; CEO, DUHS
Subject: Ceremonial Ground-Breaking for New Eye Center Clinical Facility
This morning we held a ground-breaking ceremony for a new, state-of-the-art Duke Eye Center building that will add much-needed clinical examination space and enhance the patient experience.
The ceremony celebrated the team effort that has turned this dream of building a new Eye Center clinical facility into a reality. Thanks to the collaborative efforts of our legion of generous donors, […]
Early results representing my clinical observations and also the subjective response of several patients after treatment have overall led me to believe that the LipiFlow Thermal Pulsation device from TearScience has been one of the most worthwhile additions to my clinical practice in recent years. Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC subspecializes in cataract surgery, corneal transplantation, and laser vision correction (LASIK) and as studied optimizing surgical outcomes for best practices and recognizes that the treatment of symptomatic dry eye syndromes is […]
Are there mechanisms of which we can take advantage for patients with a high degree of astigmatism including residual, post-surgical astigmatism? Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC has observed that the astigmatic patient becomes particularly symptomatic under poorly lit conditions. An example of this would include the “drop off” in quality of vision while driving at night under poorly lit conditions. This might also include added eye strain with prolonged reading or computer usage. This latter group of patients may benefit from […]
DALK (Deep Anterior Lamellar Keratoplasty) For Advanced Keratoectasia Caused by Radial Keratotomy (RK)
I am very excited about the recent success I have experienced using a partial thickness or “lamellar” corneal transplant procedure referred to as DALK (deep anterior lamellar keratoplasty) for the treatment of keratoconus, post-LASIK Keratoectasia, and post-RK Keratoectasia. This technique allows retention of the host endothelium which means that donor rejection is essentially eliminated. Since post-RK keratoectasia has been the most challenging, I thought I would tackle that condition and discuss how to correct it. Most patients with post-RK Keratoectasia have multiple and deep incisions and if these incisions perforate Descemet’s membrane, it will be difficult to use the so […]