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Sharon Kleyne Hour - Power of Water
Radio Talk Show - Water, Health, Environment, Dehydration, Dry Air, Dry Eye


Dry Eye Alternatives for the Global Dry Eye Crisis

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July 21, 2008

The Basics of LASIK Surgery

Guest #1 - Dr. Marguerite McDonald (New York, NY), refractive eye surgeon.

Restoring Migratory Fish to the Connecticut River

Guest #2 - Jan Rowan (Sunderland, MA), US Fish and Wildlife Service.

Sharon Kleyne (paraphrased): Welcome to the Sharon Kleyne Hour - the power of water and your health. My guest today is my friend Dr. Marguerite McDonald, a pioneer in the field of LASIK eye surgery and Professor of Ophthalmology at Tulane University in New Orleans. Good morning, Dr. McDonald. Could you tell our listeners a little more about yourself?

Dr. McDonald (paraphrased): Well, I'm a native New Yorker and graduated from Columbia University School of Medicine. At Louisiana State University, I helped build the first excimer laser for vision correction. In the process, I had the honor of performing the world’s first refractive eye surgery using lasers. I moved back to New York after hurricane Katrina and am now teaching at NYU and working with an eye clinic on Long Island. But I'm still an Adjunct Professor at Tulane.

S: Are you finding in your practice, as I have, that otherwise health conscious people know far too little about vision care?

M: It's amazing. Everyone knows smoking is bad for you. And salt and fats. But even people who have family members with eye diseases don't seem to worry about eye health or perceive a personal risk. I refer your listeners to the EyeSmart campaign at www.GetEyeSmart.com for a wealth of information about vision care, especially if they’re over 40. Chronic dry eye, cataracts, glaucoma, diabetic vision problems and macular degeneration are very real, can be dangerous and are all treatable.

S: We had Dr. Scott Jens on a few weeks ago, who talked about infant eye care and eye development. He pointed out that visual development is critical to learning and relationships and that eye care education for parents can be critical.

M: Definitely. Some hospitals now have all newborns checked by an ophthalmologist. Retinal blastoma, of course, is a fairly common eye cancer in newborns and can be life threatening. I recommend a visit to a pediatric ophthalmologist at six weeks to check on eye development. We’re finding that one infant in 250 is now born with cataracts.

S: I’ve been told that prisons are full of people with poor vision and that visual abnormalities can affect social integration, stress levels and other aspects of mental and emotional functioning. But tell us more about LASIK. What do we all need to know?

M: The two most popular types of refractive laser surgery are LASIK and PRK. These are by far the most popular elective surgeries in the history of medicine. Although they can be expensive, they have high benefit and very low risk. With LASIK, they cut a flap in the corneal membrane with an oscillating blade, reshape the cornea with an excimer laser and close the flap. They now cut the flap with a second laser, which his much easier and safer. The results are so good that NASA is now accepting astronauts who have had all-laser LASIK.

S: And what is PRK?

M: With PRK, they don’t cut a flap so it's less risky. However, PRK has a somewhat longer delay before vision returns to normal. With LASIK, the return is almost instantaneous. Both procedures have been impacted by "Wave Front" technology – the computer system that tells the laser how to reshape your cornea. We used to just enter your eyeglass prescription. Now we can get highly individualized and the results are better vision, better contrast sensitivity and better night vision.

S: I’ve noticed more children wearing glasses.

M: That's because kids these days spend most of their time indoors staring at a high-intensity screen. That is very bad for visual development and can induce myopia.

S: What has been your youngest LASIK patient?

M: We normally wait until the child is 18 or 20 and their vision is stabilized. However, I once operated on a 15 year old who wanted to be a Navy SEAL. He'll be fine but he might need a touch-up down the line.

S: Could you talk about dry eye, since we’re a show about health and water?

M: Everyone get situational dry eye. We normally blink about 20 times per minute but when we’re intensely occupied with something, the rate can drop to three times per minute. Dry eye symptoms are the number one reason for visits to the eye doctor. Contact lenses wearers are especially vulnerable. And keeping your eyes healthy improves your candidacy for LASIK surgery.

S: Are longtime contact lens wearers good LASIK candidates?

M: Yes but excessive contact lens use can reshape your cornea. That is very rare, though. With Wave Front, we can now correct this.

S: Tell us about contact lenses.

M: Part of the problem is that they are badly abused. People wear them too long, don’t take them out at night, don’t clean them well enough. This can not only cause severe dry eye, it can cause corneal ulcers. For those who tend not to follow instructions, especially teenagers, I recommend daily disposable contact lenses.

S: What's the difference between an optometrist and an optician?

M: An optician makes eyeglasses and helps with frame selection and fitting. They also sell various kinds of contact lenses but they don't fit them.

S: Are cut-rate contacts OK?

M: Small stores can be more expensive but they usually specialize in good service. Cut-rate stores are cheaper but offer little or no service. Which to patronize depends on your needs. You don't want to buy a whole bunch of disposable contact lenses if your prescription is likely to change. And if you do, you want a dealer who can buy them back.

S: Talk about the tear film.

M: The tear film is the interface between the eye and the environment. It's also the eye’s most important refractive surface. And it protects they eye from infections.

S: How important is moisture to vision?

M: As I said, dry eye is the most common reason for eye doctor visits. Lack of moisture can have a profound impact on vision. Aside from discomfort, it can cause depression, lowered productivity and poor appearance. I've treated TV news anchors because their jobs were on the line – their employer said they needed to look more alert. And by the way, blood pressure and cholesterol lowering medication can also cause dry eye symptoms.

S: I understand you're involved with the Ophthalmology Academy in Beijing. Are there special eye problems is Asia?

M: Asian eyes are the same as any other eye except they tend to expose slightly less cornea and their corneas are slightly thinner. But that’s all statistical. The main thing is that air pollution in China is terrible and causes severe dry eye symptoms.

S: Thank you for joining us again. Do you have any parting words?

M: Only to remember that dry eye is easily treatable.

S: My next guest is Jan Rowan, of the U.S. Fish and Wildlife Service, who is going to talk about restoration of migratory fish in the Connecticut River, which forms the boundary between New Hampshire and Vermont and also cuts across Massachusetts and Connecticut before emptying into Long Island Sound. In 1790, the Connecticut had major runs of migratory fish, including Atlantic salmon, alewife and shad; sea lamprey, American eel and sturgeon. Because of dams and pollution, they had mostly vanished. But now they’re back.