Study: Sensitivity and dryness

Here's one for everybody with that classic "menthol" sensation:

Conjunctival and corneal pneumatic sensitivity is associated with signs and symptoms of ocular dryness.
Situ P, Simpson T, Fonn D, Jones LW.
Invest Ophthalmol Vis Sci. 2008 Apr 4 [Epub ahead of print]

Purpose: To investigate the relationships between dry eye symptoms, corneal and conjunctival sensitivity to pneumatic stimulation, tear film stability and clinical ocular surface characteristics in symptomatic and asymptomatic subjects.

Methods: 97 subjects were enrolled and grouped by a questionnaire based single score for symptom of ocular dryness (none to trace= "non-dry", mild to severe= "symptomatic"); 43 were symptomatic and 54 were non-dry. Corneal (K) and conjunctival (C) sensitivity were measured using a computer controlled Belmonte pneumatic (room temperature) stimulus. Symptoms were assessed using Ocular Surface Disease Index (OSDI). Ocular surface staining with fluorescein (FL) and Lissamine Green (LG), non-invasive tear film break-up time (NIBUT), and the Phenol Red Thread test (PRT) were assessed.

Results: The symptomatic group showed lower K and C thresholds (p0.01), greater corneal FL staining and conjunctival LG staining, and shorter NIBUT than the non-dry eye group (all others p0.05). OSDI scores were higher in the symptomatic group (p0.001). K and C thresholds, NIBUT were inversely correlated with OSDI scores and corneal and conjunctival staining (all p0.05). K and C threshold and NIBUT (all p0.01) were positively correlated. Stepwise multiple regression analysis showed that ocular surface sensitivity and NIBUT were significant predictors of OSDI scores.

Conclusion: Ocular irritation assessed using OSDI is associated with ocular surface hyperesthesia to cooling, corneal epitheliopathy and tear film instability. Although cause and effect are unclear, our analysis shows that altered corneal and conjunctival sensory processing and tear film attributes are essential aspects of what characterizes dry eye.

Report: UV implicated in lasik dry eye?

This is remarkable. I've seen a lot of studies trying to pin down the cause(s) of dry eye after LASIK and it has surprised me how, over time, they're still finding more possible mechanisms. When I come across something this obvious (in a sense) newly discovered it's downright disturbing. Kudos to Dr. Barraquer for taking the time to study this.

OSN Supersite, April 7th
UV protection during LASIK lowers dry eye incidence, surgeon says

Dry eye after LASIK may result from ultraviolet light exposure from the excimer laser itself, according to a speaker here, and UV protection during the excimer laser ablation can lower the incidence of post-LASIK dry eye occurrence by 70%....

"In our clinical surgical experience, we have never seen such a syndrome after penetrating grafts, after lamellar grafts, after ... keratomileusis," she said. "What is the difference then between LASIK ... and grafts or refractive procedures before excimer? Well, the most obvious answer is the excimer laser."

Dr. Barraquer hypothesized that the UV light in the laser interacts with oxygen, producing ozone, and "every pulse is associated with an equal area of collateral damage" to the eye.

In order to test her theory, she conducted a randomized, controlled, open label clinical trial in which she performed LASIK on 300 eyes: 150 with the standard procedure and 150 with her protective procedure....

"With the protected technique you have almost 70% less possibility of getting dry eye syndrome and ... females have three times more possibility of having dry eye syndrome" when they receive the standard treatment, she said.

Abstract: Dry eye diagnosis

Dry eye diagnosis.
Khanal S, Tomlinson A, McFadyen A, Diaper C, Ramaesh K.
Invest Ophthalmol Vis Sci. 2008 Apr;49(4):1407-14

PURPOSE: To determine the most effective objective tests, applied singly or in combination in the diagnosis of dry eye disease. METHODS: Two groups of subjects-41 with dry eye and 32 with no ocular surface disease-had symptoms, tear film quality, evaporation, tear turnover rate (TTR), volume and osmolarity, and meibomian gland dropout score assessed.

RESULTS: The subjects with dry eye had TTR, tear evaporation, and osmolarity significantly different from that of healthy normal subjects. Cutoff values between the groups were determined from distribution curves for each aspect of tear physiology, and the effectiveness of the cutoff was determined from receiver operator characteristic (ROC) curves. Values of 12%/min for TTR, 33 g/m(-2)/h for evaporation, and 317 mOsmol/L for osmolarity were found to give sensitivities, specificities, and overall accuracies of 80%, 72%, and 77%; 51%, 96%, and 67%; and 78, 78%, and 79%, respectively when applied singly as diagnostic criteria in dry eye. In combination, they yielded sensitivities, specificities, and overall accuracy of 100%, 66%, and 86% (in parallel) and 38%, 100%, and 63% (in series), respectively. Discriminant function analysis incorporating these three factors in an equation allowed diagnosis with a sensitivity of 93%, specificity of 88%, and overall accuracy of 89%.

CONCLUSIONS: Tear osmolarity is the best single test for the diagnosis of dry eye, whereas a battery of tests employing a weighted comparison of TTR, evaporation, and osmolarity measurements derived from discriminant function analysis is the most effective.

Study: If it's bad for mice...

For those not inclined to take seriously the role of humidity in dry eye symptoms... or for those whose employers (!) don't, have a look at this study. They built an environmental model to illustrate the role of environment on the eye surface in mice.

See highlighted text in the abstract for what happened to the mice subjected to 15% humidity with airflow for six weeks. I know, too many polysyllabic words but trust me it's bad. And many of you are working in office environments that aren't all that much better than this.

What to do? Put a flea in the ear of the HR people... don some moisture chambers... get a humidifier... get vents redirected... check DryEyeTalk for more tips, especially about computer use.

A murine model of dry eye induced by an intelligently controlled environmental system.
Chen W, Zhang X, Zhang J, Chen J, Wang S, Wang Q, Qu J.
Invest Ophthalmol Vis Sci. 2008 Apr;49(4):1386-91.

PURPOSE: To establish a novel murine model of dry eye using an intelligently controlled environmental system (ICES).

METHODS: Thirty BALB/c mice aged 4 to 6 weeks were housed in the ICES in which the relative humidity, airflow, and temperature were maintained at 15.3% +/- 3% (mean +/- SD), 2.1 +/- 0.2 m/s, and 21 degrees to 23 degrees C, respectively, for 42 days. Thirty mice of similar age and housed in a normal environment were controls (relative humidity, 60%-80%; no airflow; temperature, 21 degrees -23 degrees C). The ocular surfaces of the animals in both groups were analyzed before and 3, 7, 14, 28, and 42 days after the experiment for aqueous tear production, corneal barrier function, conjunctival morphology, and goblet cell density. The level of apoptosis on the ocular surface also was assessed using active caspase-3 at 42 days.

RESULTS: A low-humidity environment was maintained constantly by the ICES. Animals in this environment had decreased aqueous tear production, increased corneal fluorescein staining, and marked thinning and accelerated desquamation of the apical corneal epithelium compared with control eyes. Squamous metaplasia of the conjunctival epithelium with decreased goblet cell density also developed in the animals housed in the ICES. Active caspase-3 was highly expressed on the ocular surfaces of the animals housed in the ICES at 42 days.

CONCLUSIONS: The biological and morphologic changes of dry eye induced by ICES in mice are similar to those in humans. This dry eye environment appears to upregulate apoptosis on the ocular surface.

Abstract: Use of digital cameras in corneal damage assessment

Documentation of corneal epithelial defects with fluorescein-enhanced digital fundus camera photography.
Dean SJ, Novitskaya ES, Moore TC, Moore JE, Sharma A.
Clin Experiment Ophthalmol. 2008 Mar;36(2):113-8

The advent of digital photography in the ophthalmic setting has provided not only a means of documenting pathology, but with instantaneous results, it is possible to aid clinical diagnosis and management. This study was designed to demonstrate the ability to image corneal epithelial lesions stained with fluorescein, with a digital fundus camera set on fluorescein angiography settings. The contrast of this technique demonstrated both gross and subtle corneal epithelial lesions better than traditional methods. The results obtained demonstrated the high sensitivity and high contrast images this technique can facilitate in every ophthalmic practice equipped with a fundus camera with digital fluorescein angiography capability.

Study: Dry eye risks for diabetics after cataract surgery

Looks like a straightforward study indicating diabetics are at distinctly higher risk for dry eye after cat surgery than people without diabetes.

Changes of tear film and tear secretion after phacoemulsification in diabetic patients.
Liu X, Gu YS, Xu YS.
J Zhejiang Univ Sci B. 2008 Apr;9(4):324-8

Objective: To evaluate tear film stability and tear secretion in patients with diabetes after phacoemulsification. Methods: Twenty-five diabetic cataract patients and 20 age-matched non-diabetic cataract patients as control underwent phacoemulsification. Tear film break-up time (TFBUT), Schirmer I test (SIT), corneal fluorescein staining, and dry eye symptoms were measured pre- and postoperatively. Results: Diabetics had a decreased preoperative TFBUT and SIT. TFBUT was reduced on Day 1 and recovered on Day 180 postoperatively in both groups. SIT was increased after phacoemulsification, but returned to preoperative levels by Day 180 in non-diabetics, whereas it was lower than preoperative level in diabetics. Positive corneal fluorescein staining was elevated in both groups, and returned to preoperative levels only in controls. Dry eye symptoms were similar to fluorescein staining in both groups. Conclusion: Tear secretion was reduced in diabetic cataract patients after phacoemulsification, which worsened dry eye symptoms and predisposed those patients to ocular damage.

Study: LASIK dry eye

Truth be told... I've always had a little bit of a grudge against this journal because although it is dedicated exclusively to refractive surgery, it rarely talks about dry eye - which just happens to be the #1 side effect of laser refractive surgery.

But today, hats off and grudges begone. Wow! Thank you for acknowledging what so badly needs to be said.

Now if we could just get this included in every LASIK informed consent form.

My only reservation/criticism about this abstract is that some use this kind of thing to justify what amounts to temporarily suppressing a chronic ocular surface problem in order to justify LASIK on a high risk candidate. Even that might not be as much of a problem as it is were it not that ocular surface diseases are so frequently misdiagnosed and undertreated (see my article on diagnosis.

LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment
Renato Ambrósio Jr, MD, PhD; Timo Tervo, MD; Steven E. Wilson, MD
Journal of Refractive Surgery Vol. 24 No. 4 April 2008

PURPOSE
To review the pathophysiology of LASIK-associated dry eye conditions and provide insights into prophylaxis to decrease the incidence of dry eye after LASIK and to treat the condition when it occurs.

METHODS
A review of the literature was performed on LASIK-associated dry eye and the experience of the authors was summarized.

RESULTS
LASIK has a neurotrophic effect on the cornea, along with other changes in corneal shape, that affect tear dynamics causing ocular surface desiccation. Dry eye is one of the most common complications of LASIK surgery. Symptoms of dryness may occur in more than 50% of patients, with other complications such as fluctuating vision, decreased best spectacle-corrected visiual acuity, and severe discomfort occurring in approximately 10% of patients. Preoperative dry eye condition is a major risk factor for more severe dry eye after surgery and should be identified prior to surgery. Optimization with artificial tears, nutrition supplementation, punctal occlusion, and topical cyclosporine A in patients with symptoms or signs of dry eye prior to LASIK decreases the incidence of more bothersome symptoms following surgery. Patients with LASIK-induced neurotrophic epitheliopathy often respond to topical cyclosporine A treatment, which treats the underlying inflammation and may benefit nerve regeneration.

CONCLUSIONS
LASIK-induced dry eye and neurotrophic epitheliopathy are common complications of LASIK surgery. Optimization of the ocular surface prior to surgery decreases the incidence and severity of postoperative symptoms of the condition.

Drug news: Cationorm - OTC drop from Novagali released in France

According to an April 9 press release, Cationorm has been released in France as an unpreserved over-the-counter drug and is expected to be released as an OTC in the US by the end of 2008. It is described as:

a cationic emulsion with no active principle, for the relief of mild dry eye syndrome

utilizing Novagali's "Novasorb" technology which is "based on the electrostatic attraction that occurs between the droplets of a positively-charged emulsion and the negatively charged cells of the ocular surface, including cornea and conjunctiva."

Last time I heard any news of this one was from ARVO last year where it was reportedly "well tolerated" and showed "upward trending" in clinical signs. My notes to myself at the time included "But did it outperform placebo?" Well, if any of you try it and like it, let me know.

Rebecca's Omega 3 journal: Echoing Dr. Macsai on supplements...

With all the cornea docs congregating in Chicago the past few days for the annual ASCRS conference, I feel a bit like a dog waiting patiently under the table to be thrown a bone. The overwhelming focus of the meeting is, of course, as the name states (cataract and refractive surgery) but with enough cornea brains in one place there are bound to be one or two pearls about dry eye emerging somewhere. We can always hope, anyway.

So the last email update I got had OSN Supersite quoting Dr. Marion Macsai (some of you know her... prominent cornea/lasik doc practicing north of Chicago) about supplements:

More research needed on the most effective nutritional supplementation for dry eye

CHICAGO — The use of nutritional supplements, including flax seed oil, fish oils and vitamin E, to combat the effects of dry eye appears to have positive effects on the disease, but an objective study is needed to know for sure, according to a speaker here.

"There's probably a role for dietary supplementation, Marian S. Macsai, MD, said here at Cornea Day held before the American Society of Cataract and Refractive Surgery meeting. "Clearly they work, but objective data is needed to validate the dose, the effects and the exact combination."

Dr. Macsai said current published literature evaluates the diaries of patients to establish a correlation between the patients' diets and changes in their dry eye symptoms.

Dr. Macsai said patients with Sjögren's syndrome have been shown to have lower vitamin E levels, so there might be a need for supplementation, she said.

"The question is: 'Which vitamin E,'" she said. "There's a tendency to think they are all the same."

Dr. Macsai said clinicians should make sure to tell patients to buy flax seed oil pills that are sold in opaque bottles so the oil does not lose its potency. Those pills seem most effective, she said.

"Ground flax seed is a great source of fiber, but it's not going to help your dry eye," Dr. Macsai said.

As regards objective studies, you bet! Any takers...???

Industry news: Upcoming FDA hearing on quality of life after LASIK

I've been following this for some time but did not comment earlier because I was not sure what to make of it. I'm still not, but the most recent press report irked me enough that I need to make a start on it. Since dry eye is well documented as the #1 complaint following LASIK, any serious post-market surveillance the FDA is doing needs to be taking a good look at dry eye.

Last month, there was an announcement that ASCRS, AAO and the FDA were forming a joint task force "charged with formulating a viable study design to identify dissatisfied post-LASIK patients, define their significant symptoms and evaluate the influence of those symptoms on quality of life, according to a joint press release from ASCRS and AAO."

OSN Supersite's March 17 article explains the origins of this meeting as follows:

Encouraged by FDA petitions urging for an effective freeze on nonessential eye surgeries, the FDA initially approached ASCRS in fall 2006 for assistance in designing the post-LASIK quality-of-life trial. Although the FDA did not deem the majority of requests worthy of new investigation, the agency has permitted the petitioners to present testimony at a special meeting of the Ophthalmic Devices Panel scheduled for April.

...suggesting that unhappy LASIK patients have been successful in getting some amount of attention from the FDA.

More recently, the FDA confirmed the date for the next ODP meeting as April 25th. This is open to public participation.

Today, ASCRS in this release...

ASCRS To Participate In and Co-Fund Study on Post-LASIK Quality of Life with U.S. Food and Drug Administration

...elaborated, a little anyway, on how it is teaming up with the FDA, NEI and AAO for the study.

Now down to the part that is really irking me. Read this:

Between 1998 and 2006, the FDA received a total of 140 comments relating to LASIK dissatisfaction, representing less than 1 in 10,000 U.S. LASIK patients. In 2006, the FDA re-evaluated symptoms and satisfaction data and reaffirmed that while the vast majority of LASIK patients were indeed satisfied with their outcomes, a few were not.

While I'm not going to dispute that a large majority of LASIK patients are satisfied, this quote bothers me terribly. It appears to be trying to convey that the dissatisfaction rate is as low as 1 in 10,000 and I think this is a disingenuous use of the statistics, i.e. the 140 "comments" received by the FDA.

First of all, a rate of 1 in 10,000 (0.01%) is flatly contradicted by pretty much every study of patient satisfaction I've ever seen.

Second, most consumers who are dissatisfied after a surgery are not going to file a complaint with the FDA. Why? Because we (consumers) associate surgeries with doctors, not devices, and the FDA regulates only the latter not the former. Of the people who are dissatisfied with their outcome, the minority who go so far as to try to file some kind of complaint are far more likely to contact the bodies overseeing the doctors, i.e. state medical boards. Complaints to state medical boards are, in general, kept confidential, except in those very exceptional cases where the complaint actually results in disciplinary action.

Third, what are these 140 "comments" received by the FDA about patient dissatisfaction? What reporting system did they go into? I don't suppose it occurred to anyone to check the MAUDE database. Surely, at least some of the device malfunctions serious enough to be reported as an MDR must have resulted in dissatisfied patients? In the time period covered by those 140 comments (1998-2006), there were 339 MDRs filed on the LADARvision excimer laser alone. Another 156 on the Intralase femtosecond flap-making laser. To say nothing of the various mechanical microkeratomes.

Like I said, I'm not arguing that everyone's unhappy after LASIK. But LASIK dry eye IS a widespread problem; patients know it; doctors know it; and our Dry Eye Talk community bulletin boards provide ample daily evidence of the dramatic impact on "quality of life" for those unfortunate enough to experience it.

Business news: Novartis to acquire stake in Alcon

Novartis is acquiring a minority stake in Nestle-owned Alcon and an option to acquire a majority stake, which would make it the 2nd-largest

Novartis to buy Alcon stake for $39 billion

Novartis AG (NOVN.VX) has agreed to buy Nestle AG's (NESN.VX) 77 percent stake in U.S. company Alcon (ACL.N) in a deal worth up to $39 billion to boost its eye care business, the Swiss drugmaker said on Monday.

Novartis will acquire a first, 25 percent stake in Alcon for $11 billion and is set to buy Nestle's remaining 52 percent for a fixed price of $28 billion between January 2010 and July 2011.

Product news: Three new over-the-counter drops

OASIS TEARS
OASIS TEARS PLUS
These are new preservative-free glycerin (0.2%) artificial tears on the market. I keep forgetting to try it before I get my sclerals in so I can’t tell you what it feels like (and I’m so set in my ways with regard to drops that my opinion probably won’t be beneficial anyway) but for the inveterate new drop tryers, check it out. If you click on the “Special Offer” tab you’ll get a $3 off coupon.
http://www.oasistears.com

Not all eye drops are the same. Oasis TEARS™ is a new type of eye drop with a unique, viscoadaptive formula, optimized to provide longer lasting comfort. Oasis TEARS™ Lubricant Eye Drops:

Provide instant relief of dry eye symptoms
Provide prolonged comfort with fewer applications required
Provide moistening and lubrication of the cornea and other surfaces of the eye
Natural; contain no toxic biopolymers
Preservative-free; eliminates the source of toxic irritation
Offer two treatment options

BLINK(R) TEARS (AMO)
I gather this is an artificial tears counterpart to Blink contact lens drops. Funny, usually it works the other way, i.e. they start with an artificial tear and then add a contact lens version. Anyway, Blink(R) is described in the press release as a 'new line' of products, so presumably they will have a thicker/thinner one etc.
Here’s a news release about it.

"The introduction of blink(R) Tears lubricating eye drops is our first entree into the dry eye category and marks an important expansion of AMO's complete refractive solution of eye care products," said AMO Chairman and CEO Jim Mazzo. "It will be used to relieve mild to moderate dry eye whether used alone or in conjunction with ophthalmic pharmaceutical therapies."

Misc: The LASIK/PRK switcheroo

I stick pretty much exclusively to dry eye in the blog, but occasionally if something else related to eyecare is on my mind I'll digress....

One of the discussion forums I'm involved with (lasermyeye.org/forums) deals exclusively with refractive surgery. It used to mostly be home to lasik complications patients but it's evolved a lot and these days, with the interesting shift back to surface ablation that we've been seeing, it's mostly dominated by patients who are experiencing unexpected bumps in healing after PRK. While some end up with long-term issues, I'd say the majority of visitors to D'Eyealogues were simply poorly informed about what to expect during healing from PRK, or are experiencing an unusually long and bumpy recovery, or both.

These patients are often scared to death when they find they can't work or drive three weeks post-op and don't understand why their doctor seems unconcerned. Or they are concerned at how dramatic the ups and downs of their vision seem in the weeks and months after surgery - often wondering, is there still hope my vision will get better or is this it for me? Often all they need is to read the stories of fellow patients and with a little hand-holding, a little coaching about being patient, they come to understand that what they are experiencing is (relatively) normal and that in all probability they will be just fine. At the same time, though, when I come across patients who are in real emotional distress and have clearly not had any heads up at all about the possibility that PRK healing might interfere this much with life, I encourage them to make their feelings known to their surgeon and clinic, for the benefit of future patients.

Coming to the point now....

I am amazed that we continue to periodically get reports of patients being scheduled for LASIK surgery and then, on the day of surgery, being switched to PRK at the last minute after the surgeon decides their corneas are too thin for LASIK or spots some topographical abnormality.

Guys/gals, is this within the standard of care for refractive surgery? If so, in my opinion, it should not be.

There is, of course, considerable variety in how these situations are handled, ranging from moderately rational-sounding to absolutely appalling. In the best cases I've come across, the patient is given a new informed consent form, shown a video, and given some time to ask questions, as well as a choice about whether to go ahead with surgery that day or re-schedule. In other cases... well, there are the ones who have signed their forms and taken their valium and then are told they're going to have PRK instead. There are even some who were NOT told, or at any rate did not understand - and left the clinic after the surgery UNSURE of what kind of surgery they had just undergone. (I kid you not.) Most worrying to me of all are one or two switcheroo cases where the change was made but the file was not updated and so the patient was given post-operative instructions for LASIK although they had had PRK. We had a case like that where the patient did not know anything was amiss until they described their postop medication regimen to us in the forum. Even then, the patient had to go over the head of a stubborn, misinformed clinic staff member in order to get it straightened out. All while re-epithelializing. Beautiful, just beautiful.

This stuff is very worrying to me. It's bad enough how many people we hear from who were scheduled for PRK and were given, er, "optimistic" descriptions of what re-epithelialization and subsequent vision fluctuation would/could be like. But when a surgical plan is changed that drastically on the very day of surgery, the patient does not have the opportunity to do their own research at their leisure about how surface ablation differs from LASIK and what it will mean for them in the short and long term.

My question to surgeons: Given the risk of the patient not fully understanding the implications of doing surface ablation rather than LASIK, how can you justify switching surgeries on the day of the scheduled surgery? Why not re-schedule the surgery, allowing the patient time to educate him/herself and review their options?

The only reasons I can think of to proceed as scheduled are exclusively for the benefit of the clinic and surgeon. After all, if the patient is sent away to think about it, they might...

1) Decide not to have surgery at all.
2) Decide to postpone it indefinitely.
3) Start questioning the competence of a doctor who didn't figure out until the day of surgery that LASIK was not the best option.
4) Go get surgery someplace else.

In my opinion, the ethical case is cut and dried. Surgeons have an obligation to put the best interests of the patient first. Period.

If you've been too busy patting yourself on the back for noticing the patient's increased risk before firing up the microkeratome or the intralase to think about this aspect of the "patient's best interests", please step back a moment to see things from the patient's point of view.

You may think you can justify a same-day switch on the basis that you told the patient all about PRK and s/he seemed to understand and confidently voiced agreement to go ahead. But put yourself in the position of the patient. They've been planning this for quite awhile, and steeling themselves for a surgery to a really important part of their body. They showed up, they swiped their credit card, they filled out the forms, they're all prepared - and they feel all the pressure of messing up other people's day if they bow out. There is simply no way a patient can be expected to make a thoroughly objective decision on their own under those circumstances.

Or you might justify a same-day change on the basis that if you send the patient away, worse will happen. Maybe the lasik mill down the street will take them on and, given their thin corneas, they'll end up with ectasia. (And golly aren't you great for identifying their risk factor and admitting it rather than going ahead!) True, some patients are foolish enough to "shop around" for someone to do LASIK even when told it's not safe for them. I'm still not inclined to let you off the hook. You're just rationalizing. Two wrongs don't make a right.

Patients undergoing elective vision correction surgery deserve the opportunity to thoroughly understand the surgery they are getting. Please don't take this away from them by switching surgical plans at the last moment. At the end of the day, it's very little different than taking walk-in patients for same-day surgery.

The honourable, ethical thing to do when you determine that LASIK is inappropriate on the day of surgery is to refuse to perform surgery on that patient that day. Send them away with lots of information to review, schedule a surgery for another day if you want, but give them time.

Sensible patients will truly value you for it.

Rebecca's Omega 3 journal

We're (slurp) halfway through a bottle of lemon flavored Barleans flaxseed oil. I'm still mixing it with Nancy's lowfat yoghurt, but with the lemon oil I don't bother so much with the berries anymore. I think that the cinnamon is still my favorite but by a relatively small margin. I plan to alternate for the foreseeable future. (By the way, there are plenty of free samples of both cinnamon and lemon available in The Shop with any purchase. I've also modified it so you can get one of each if you want!)

I've not had much time for 'light reading' lately but I have been just barely starting to make an effort to learn about the flaxseed oil/prostate cancer "thing".

It's very difficult to approach medical literature without some kind of bias, be you medical professional or layperson. Increasingly, my bias is that irrepressible feeling of disgust I get when I read things like "Thus-and-such supplement has been linked to thus-and-such type cancer, therefore it should be avoided at all costs" especially since it's almost always written by someone who, to coin a phrase, "has been linked" to a competing company's product.

First of all, I roll my eyes because it seems inevitable that practicaly every natural, unnatural and man-made substance on this planet will eventually be "linked" to some kind of cancer in some way. Second, I get just plain pissed off at the constant abuse by commercial interests of any reference, however obscure, to cancer.
I want to know about real cancer risks, of course, but I could care less if thus-and-such supplement - whose quality, production and packaging methods are unknown to me - has been linked to brain cancer in six month old rats that have been enjoying quite a different diet than I have in my thirty-nine years on this earth. And the cancer issues are, of course, but one of the many capitalized upon by the myriads of commercial voices determined to outshout each other.

WHAT'S A FRIGGIN' CONSUMER TO DO ALREADY???????????

Here's a very apt quote from Udo Erasmus after a lengthy summary of studies on prostate cancer and flaxseed oil. It pretty well sums up how I feel:

Science has become so technical that we’re nearing the Tower of Babble, where everyone talks and no one understands. We get lost in a sea of details, lose our common sense, and only drug manufacturers, whose products suppress symptoms without effecting cure, benefit from the confusion.

It is not difficult to see that these various findings by researchers must leave most people confused. The problem with these studies is the isolation in which they are carried out.

Ah, me. I wish there were just somebody really smart out there somewhere who could tell me what to think of it all. Of course, there is, or are rather, but how will I know them from the crowd.

IT SHOULDN'T BE THIS HARD. It just shouldn't. But it is, and I'll try to hold my spleen for awhile till I start getting my brain around it a little better.

----
p.s. Sorry for the accidental mixed metaphors there. Re-reading it, on Easter no less when I'm remembering past Easters in Greece with their traditional soup (hint: it's not macaroni floating in there), it made me suddenly think of kokoretsi. It's one of those souvlaki-esque things. There was an outdoor grill not far from where we lived ages ago in the 'old town' part of Thessaloniki by the ancient city wall that used to make it. It's basically pieces of heart, liver and spleen (lamb I think, or is it veal? I forget) on a skewer, wrapped all over in strands of... thoroughly cleansed... intestines and grilled. Sounds appalling, and don't EVER watch them prepare it, but it's actually not that bad, though it doesn't exactly 'taste like chicken'.

Study: Rats

Probably only of interest to the indefatigable dry eye fans: New rat model for studying dry eye.

Time course of ocular surface and lacrimal gland changes in a new scopolamine-induced dry eye model.
Viau S, Maire MA, Pasquis B, Grégoire S, Fourgeux C, Acar N, Bretillon L, Creuzot-Garcher CP, Joffre C.
Graefes Arch Clin Exp Ophthalmol. 2008 Mar 21

BACKGROUND: The aim of this study was to set up an animal model of dry eye showing disturbance in several components of the lacrimal functional unit, and to describe the time course of the appearance of clinical signs and inflammatory markers.
METHODS: Dry eye was induced in 6-week-old female Lewis rats by a systemic and continuous delivery of scopolamine via osmotic pumps implanted subcutaneously. We first determined the appropriate dose of scopolamine (6, 12.5, or 25 mg/day) for 28 days. In a second set of experiments, we determined markers after 1, 2, 3, 7, 10, 17, or 28 days of a 12.5-mg/day dose. Clinical signs of corneal dryness were evaluated in vivo using fluorescein staining. MHC II expression and mucin Muc5AC production were detected on the conjunctival epithelium using immunostaining. The level of IL-1beta, IL-6, TNF-alpha, and IFN-gamma mRNA was evaluated by real-time polymerase chain reaction in conjunctiva and exorbital lacrimal gland (LG). Lipids were extracted from the exorbital LG for fatty acid analysis.
RESULTS: Daily scopolamine doses of 12.5 mg and 25 mg applied for a 28-day period induced keratitis, a decrease in Muc5AC immunostaining density in the conjunctival epithelium, and modifications in the fatty acid composition of the exorbital LG. Animals treated with a 12.5-mg/day dose of scopolamine exhibited an increase in corneal fluorescein staining after 2, 10, and 28 days. All animals exhibited unilateral or bilateral keratitis after 17 days. In the conjunctival epithelium, a significant decrease in Muc5AC immunostaining density was observed at early and late time points, and MHC II expression tended to be increased after 1, 7, 10, and 28 days, without reaching statistical significance. The levels of TNF-alpha, IL-1beta and IL-6 mRNA were increased with scopolamine treatment in both conjunctiva and exorbital LG. Arachidonic acid and the Delta5 desaturase index were significantly increased in the exorbital LG of dry eye animals at each time point.
CONCLUSIONS: This systemic and continuous scopolamine-induced model of dry eye in the rat may represent a helpful tool to investigate moderate dry eye, and makes a contribution in the field of dry eye study.