08
May 12

Wavefront Universe

Thus far, the ARVO meeting has exceeded my expectations.  It’s such a boost to the psyche to see so many talented people working in so many different facets of research in one place.  Vision research is indeed alive and well.  I arrived Ft. Lauderdale late Saturday, and my inaugural session was on Sunday.  I met my patient/student at 7:30 and we walked over to the convention center to print out our badges.  We then spent the next 5 hours or so reading posters and chatting with exhibitors.  The technology on display was mind-boggling, with many products not yet in production or even FDA approved in the case of foreign manufacturers.  My 20/7 patient, who is an optometry student, was quite in awe, especially when I would point out someone notable.

Sunday also turned out to be the most productive day in terms of meeting and greeting.  At one point I was speaking with a poster who is doing wavefront contact lens research in Houston for Ray Applegate when none other than the father of wavefront himself, Ray Applegate walked up behind me and we introduced ourselves.  He even invited me to come visit him.  Meeting number 2 was when I saw David Williams of the University of Rochester walk by.  I’ve been following his work for years as well.  I ran him down and we had a very nice chat.  He told me what he has been doing in the areas of 2 photon imaging and adaptive optics.  He said that I should meet one of his colleagues at the University of Rochester, Geunyoung Yoon, whom I met today.  So, in the space of 2 days I had the opportunity of meeting everybody I know who is working in the field of wavefront correction(besides yours truly).  I also had a nice chat with Lynette Johns from the Boston Foundation for Sight in front of their poster, a case study of a keratoconus patient.  The keynote address by J. Craig Venter was quite inspiring.  As the first person to map the human genome, he is considered one of this centuries greatest scientists.

This afternoon I am going for a run on the beach.  Tomorrow is my last day, and a new batch of posters to visit.  Then it’s back home to my world.

Update:  Today was my last day at the conference.  Pity because there is so much of interest yet to come.  But, I did have a chance to chat with several scientists who are doing refraction studies of the peripheral retina.  This information will provide the databases upon which new technologies will be built for the purpose of reducing axial length growth that leads to myopic progression.  The last symposium was about optical, retinal, and neural limits to vision, with emphasis on wavefront studies.  Jason Marsack of the University of Houston presented some of his work on coma-correcting contact lenses for keratoconus.  We exchanged business cards.  Although I didn’t get to submit a poster this year, I at least got to see where my work fits into the universe of wavefront corrections and got to meet just about everybody who is actively working in this universe.  It was a great experience.


08
May 12

LASIK dry eye: 3 helpful treatments

The dry eye from LASIK and other similar surgeries such as PKP, PRK, LASEK, etc., is primarily neurotrophic.  Severing of the corneal nerves causes a disruption in the normal feeback loops regulating tears.  There may be other overlapping contributors, such as meibomian gland disease.  Because I have spent many years working with these patients, I have compiled a very short list of treatments that seem to have been the most effective.  These may be done separately or in combination:

  1. Cyclosporin-A (Restasis).  This drug combats inflammation via the suppression of T-lymphocytes.  It also has other properties that are being discovered.  Long term use is required.
  2. Punctal plugs cause more tears to be retained in the cul-de-sac of the eye.  I only recommend plugging one duct in each eye.  If more occlusion is required, then flow-controller plugs are recommended to ensure that some drainage is maintained to remove inflammatory products.  I do not recommend any kind of intracanalicular plugs.  Cautery is an acceptable substitute for punctal plugs, except that cautery is not as readily reversed.
  3. Scleral lenses.  These are very useful for protecting the cornea against tear evaporation, and are especially helpful for heavy computer users or those who need to be outdoors in windy, dusty environments.

For some patients, initiating all of the above therapies can be helpful.  If and when tear function is restored, then a stepwise reversal is possible, i.e. reducing scleral lens use, removing plugs, etc.

Autologous serum?  This is generally classified as an anti-inflammatory, but is difficult to procure and is very perishable.