Friday, August 17, 2007

Study: Mechanical debridement for ABMD

This seems like a reasonably useful study to give patients considering debridement a reasonable understanding of the potential range of outcomes:
- 26% experienced subepithelial haze
- Almost half of the patients had a recurrence of ABMD within 5 years
- Which, though it doesn't sound very positive, still means it's at least as helpful as other ABMD treatments.

Surprisingly, however, I see nothing in the abstract about erosion symptoms after debridement.

Outcomes of epithelial debridement for anterior basement membrane dystrophy.

Am J Ophthalmol. 2007 Aug;144(2):217-221. Epub 2007 Jun 5
Itty S, Hamilton SS, Baratz KH, Diehl NN, Maguire LJ.
Mayo Clinic College of Medicine, Mayo Medical School, Rochester, Minnesota.

PURPOSE: To evaluate the outcomes of simple mechanical debridement for the management of anterior basement membrane dystrophy (ABMD) in a cohort of patients treated primarily for visual symptoms. DESIGN: Retrospective, observational case series. METHODS: setting: Single center. study population: Seventy-four eyes of 55 patients treated with mechanical epithelial debridement over a 15-year period. observation procedures: We recorded symptoms, pre- and postoperative best-corrected visual acuity (BCVA), surgical technique, complications, and evidence of disease recurrence. main outcome measures: Mean best-corrected logMAR acuity and refractive errors, compared by using paired t tests or Wilcoxon signed-rank tests. Interval to recurrence of ABMD was determined by using Kaplan-Meier estimates. RESULTS: Mean patient age was 74 years, and 80% were female. Visual difficulty was reported by the patient before the procedure in 61 eyes (82%), and erosion symptoms alone were noted before the procedure in the remaining 13 eyes. Mean BCVA improved from 20/44 before surgery to 20/30 (P = .0001) at the early follow-up visit and 20/33 (P = .0001) at the last follow-up (mean = 33 months). The mean refractive spherical equivalent changed -0.6 diopters (range, -4.75 to +2.0 diopters). No infections or persistent epithelial defects occurred. The most common postoperative complication was subepithelial haze, occurring in 19 eyes (26%). The five-year cumulative probability of recurrence of ABMD was 44.7%. CONCLUSIONS: Our results with this simple technique are comparable to outcomes reported with other procedures used to treat ABMD. We recommend manual debridement as an effective option for ABMD affecting visual acuity.

Sunday, August 12, 2007

Newsclip: Visine risks highlighted by ballplayer...

Rowand back in lineup after vision problem

DelawareOnline, August 12

Rowand left the series opener against Atlanta after striking out in the first inning and went to Wills Eye Hospital, where he was diagnosed with a scratched eyeball caused by allergies and dry eyes. The Phillies center fielder received ointment and eye drops and was seeing clearly enough to go 1-for-4 with a homer Saturday night.

"I guess it was the combination of my eyes being dry, so they scratch easier, and they got worse when I put the Visine in my eye."

Sigh. There are so many consumer pitfalls out there for people with dry eye who have not yet been to a doctor for advice. I have a particular grudge against Visine because of the deliberate use of the Visine brand to sell artificial tear products. There are 9 (count 'em) products in the "There's a Visine for that" lineup - SIX of which (including some marketed specifically for dry eye) contain benzalkonium chloride, which any optometrist or ophthalmologist that's not a complete dunce would tell any dry eye patient to avoid at all costs. And many vasoconstrictors now say they are also lubricants. If what this ballplayer picked up was the "get the red out" stuff, it's exactly the wrong thing to put on a dry eye. But how do people know that? They don't.

Moral of the story: If you think you may have dry eyes, GET THEE TO A DOCTOR, and get some decent advice before dumping any over-the-counter product in your eye.