Optometry

OK, colleagues. Thinking back to your boards, answer this easy question: How long do pressure spikes typically take to develop after starting a topical ophthalmic steroid? a. 1 day b. 2 to 5 days c. Around 2 weeks d. After 3 to 4 weeks If we believe our classic teaching, the correct answer is, “c. Around 2 weeks.” However, a recent, better understanding about steroid delivery though eye drops has helped us to realize that, with a consistently delivered steroid, press...

The longer I practice ophthalmology, the less certain I have become that we really understand glaucoma. Sure, I can follow accepted standards of care, setting target pressures and assessing regularly for compliance and efficacy, but I feel less and less like we really know what’s going on, especially with the enigmas we call low-tension glaucoma and ocular hypertension. New technologies such as high-resolution optical coherence tomography scans give us reason for hope, offering unpreceden...

Last week, my children’s favorite aunt, who works in marketing for Mattel, gave my 7-year-old daughter a brilliant toy called Fijit. Fijit is a 9-inch-tall robot that talks to kids, tells them jokes ("Why was Cinderella such a poor soccer player? Because she kept running away from the ball!"), dances to music that you play and then asks, "What do you want to do now?" Needless to say, Fijit has provided my kids with hours of entertainment. As I’ve watched them engage in conversation with this ...

Just a few years ago, I used to regularly make fun of my more senior friends and colleagues when they donned their reading glasses to see fine print. Now, at age 46, presbyopia doesn’t seem so funny anymore. Thankfully, a number of great technologies promise hope for us oldies. Personally, I love offering patients both the multifocal and accommodating IOLs that are approved but am very excited about newer, better IOL technologies. That is, if the FDA will ever approve them. More exciting ...

When I grew up in the early 1970s, I remember considering different professional careers. Among the most desirable were becoming a doctor, a lawyer, an engineer and a pilot. These were the most respected and best paid mainstream career choices. I chose to be a physician because I loved science and loved helping people, but I always thought about becoming a pilot as well. Aviation offered an extremely respected place in society, highly technical skill, great pay and a reasonable workweek. But ...

I believe there are a lot of reasons why doctors and patients will come to love the results of microinvasive glaucoma surgery. One of the best is its friendliness to the ocular surface. The best way to reduce the toxicity of medications is to not use them at all. Minimally invasive glaucoma surgery (MIGS) involves the implantation of a device to bypass the trabecular meshwork and allow aqueous a more direct exit from the eye. Some devices such as the Glaukos iStent and the Ivantis Hydrus direct...

One of the more promising trends in eye care is the move toward lower-concentration drugs and fewer preservatives in topical medications. Where the ocular surface is concerned, less is clearly more. (See my blog on limbal stem cell deficiency as a complication of chronic glaucoma medications here.) For the record, I’m no great fan of pharmaceutical companies tweaking the formulation of a drug and marketing it as an entirely new product. This is known in the industry as a “line exte...

A recent ruling in the U.S. Court of Appeals for the Second Circuit may have monumental implications for both medical education and the promotion of drugs and medical devices to medical providers. Alfred Caronia, a representative of Orphan Medical (now Jazz Pharmaceuticals), was accused of violating U.S. Food and Drug Administration regulations regarding the off-label promotion of Xyrem (sodium oxybate) when he spoke before a group of doctors about Xyrem’s use in a setting that is not incl...

At every Academy meeting, there’s a topic that dominates exhibit hall and hotel bar discussions. For the past couple of meetings it has been femtosecond cataract surgery, but this time it distinctly changed to health care reform. With President Obama continuing in office, the likelihood of repeal of the Affordable Care Act is quite small. How can the private practice physician survive in an environment of declining reimbursement and increasing regulation? I believe there are three things...