Ancient Cataract Surgery

When did the first cataract surgery occur?

"That wasn't so bad, now, was it?"

According to the Sushruta Samhita, it was around 800 B.C.E.

This development is contemporary with the Epics of Homer, the first Olympics, India's Iron Age, the Biblical prophet Isaiah, and the adoption of the alphabet by the Greeks. 

THE FIRST OLYMPICS: 776 B.C.E.

THE BIBLICAL PROPHET ISAIAH: 8th CENTURY B.C.E.

THE EPICS OF HOMER: 8TH CENTURY B.C.E.

THE FIRST CATARACT SURGERY IS PERFORMED BY SUSHRUTA, THE "FOUNDING FATHER OF SURGERY": 800 B.C.E.

Here is a translated breakdown of the surgery provided in Duke Elder's Systems of Ophthalmology:

Preoperative care:

1) The patient was recommended to have an oily massage followed by a kind of heat-bath.

Operative technique:

1) The patient was asked to sit on a high stool, with the

surgeon sitting in front of him face to face.

2) He was instructed to look at the surgeon's nose while the operator rested his little finger on the outer eye socket bone, and held a sharp-pointed needle between his thumb, index, and middle

finger.

3) The point entered the anterior chamber, at the

junction of the medial and lateral two-thirds of the outer

portion of the white layer of the eye ball. If a sound

was produced followed by the gushing of watery fluid, then

the surgeon's needle was considered to be in the correct

part of the eye ball, but if this puncture was followed by

bleeding, it meant that it was misplaced. Care was taken

to avoid blood vessels present in that region.

4)The tip of the needle was then made to incise the capsule

of the lens.

5) With the needle in this position, the patient was

asked to blow down the nostril, while closing the opposite

side of the nose.

After this procedure, according to Sushruta, lens

material came out alongside the needle. When the

patient was able to perceive objects, the needle was

removed.

Post-operative care:

A few indigenous medicines (roots and leaves) were applied

to the eye, with a bandage. The patient was then

instructed to lie flat on his back and avoid any movement,

particularly sneezing and coughing. The operated eye was

examined daily until the tenth day. If the whitish mass

appeared again in the pupillary area the same procedure

had to be repeated.

Healthy Habits: Cosmetics

Many of us are familiar with the saying, "every old barn needs a little paint." If you embrace this philiosophy, this post is for you.

MISS PIGGY KNOWS A THING OR TWO ABOUT PAPERING HERSELF.

Here are some great tips from the American Academy of Ophthalmology for keeping your eyes healthy as you emphasize their intrinsic beauty:

Throw away eye makeup after three months. 

Infection-causing bacteria grow easily in creamy or liquid eye makeup. If you develop an eye infection, immediately toss all of your eye makeup.

Never share eye makeup

 AND when sampling makeup in stores, use only fresh applicators and samples that have not been contaminated by multiple users. (The safest choice is to avoid store samples altogether.)

If you tend to be allergic, introduce only one new eye makeup or care product at a time. 

If there is no reaction, add another new product, and so on. If you notice an allergic reaction, find out what the ingredients are and let your doctor know. Avoid products that contain untested or harmful chemicals.

Before applying makeup, be sure your face and eyelids are very clean. 

Always apply makeup outside the lash line, away from the eye, to avoid blocking the oil glands of the upper or lower eyelid. These glands secrete oil that protects the eye’s surface. Never apply makeup while in a moving vehicle.

Do not separate your mascara-clumped lashes with sharp items.

Remove all eye makeup at night before sleeping

 especially mascara that can stick to the lashes. Brush a clean cotton swab along the base of the eyelashes to remove all makeup remnants. If you use eye makeup remover, avoid getting it in your eyes and thoroughly rinse remover off your eyelids.

If you have eye surgery, do not wear makeup around the eye 

until your ophthalmologist tells you it is safe to do so, and then use only fresh, new makeup.

If you tend to have dry eyes, avoid metallic/glitter, powder or other makeup that flakes. 

Flakes can get into the tear film and increase your eyes’ irritation. Glitter eye makeup is a common cause of corneal irritation or infection, especially in contact lens users.

 And here are some more make-up related images for the pure fun of it. 

 

This information is from eyeSmart, distributing eye health information from the American Academy of Ophthalmology.

http://www.geteyesmart.org/eyesmart/living/eye-makeup.cfm

Six Smart Things College Students Should Do for Their Eyes

From the American Academy of Ophthalmology:

American Academy of Ophthalmology offers parents sight-saving advice for teens headed to college

Don't shower or swim in contact lenses. 

Acanthamoeba is a parasite that lives in water and can cause a rare but serious eye infection called Acanthamoeba keratitis. According to the CDC, 85 percent of Acanthamoeba eye infections occur in contact lens wearers, one of the main risks being exposure of lenses to water. To avoid this dangerous infection, do not wear contact lenses in showers, hot tubs or when swimming in lakes or pools. Also, never use water to clean or store contact lenses; only use sterile contact lens disinfecting solution and a clean contact lens case.  

Go outside. 

Scholastically-inclined students spend much of their time studying indoors, which can put them at risk of becoming more nearsighted, or myopic. A 2014 study found that more than 50 percent of college graduates are nearsighted, with eyesight worsening for each year in school. Other research shows that spending more time outdoors can protect vision from getting worse. Head outside when possible.

Wash your hands.

 Conjunctivitis, often called pink eye, spreads fast in schools and dorms. An outbreak struck more than 1,000 Ivy League college students in 2002. Avoid rubbing the eyes and wash hands with soap to avoid catching and spreading pink eye, not to mention other infections.

Give your eyes a break. 

Nearly 80 percent of engineering and medical school students experienced symptoms such as dry eyes and redness, according to a study of students at one Indian university. To help avoid eye strain, follow the 20-20-20 rule: look at something 20 feet away every 20 minutes for 20 seconds. Because dry eye can also cause painful corneal ulcers, which are open sores on the front part of the eye, blink regularly and fully to keep eyes moist. 

Don't share makeup. 

Harmless as it may seem, sharing makeup is a surefire way to spread infection such as herpes keratitis among friends. Infection-causing bacteria grow easily in creamy or liquid eye makeup. Stick to your own makeup and throw it away after three months. If you develop an eye infection, immediately toss all of your eye makeup.  

Protect your eyes during the game. 

Nearly 1 in 18 college athletes will get an eye injury playing sports.[v] Common injuries, like scratches on the eye surface and broken bones near the eye socket, happen most often in high-risk sports such as baseball, basketball and lacrosse. Athletes should consider wearing polycarbonate sports glasses to help keep stray balls and elbows from hitting their eyes

"For many teens just starting college, taking care of their eye health may be the last thing on their minds," said Rebecca Taylor, M.D., comprehensive ophthalmologist and clinical spokesperson for the American Academy of Ophthalmology. "But the fact is that an eye injury or condition can affect their grades and social life, causing days or even a lifetime of poor vision. We hope that parents will remind their kids of these risks before they fly the coop this fall."

For more information on back-to-school eye health, visit the American Academy of Ophthalmology's public education website www.geteyesmart.org.

Why Do We Get "Sleep" in Our Eyes?

Ever wonder what those small gold nuggets are doing in the corners of your eyes every morning? You should find this article from the Huffington Post enlightening:

Why do we get "sleep" in our eyes?
       You may call it "sleep," others might call it "crust" or "sand." Some doctors call it "mattering," and a less-commonly used term is "rheum." But no matter the name you use, you know it when you see it -- that white-yellow crumbly gunk on your eyes after you've had some shut-eye.

       The crusty stuff is actually made up of a bunch of different materials, including discarded cells, mucus and debris (including bacteria, bits of oil from the eyelids, and dust), that are collected as the eyelids sweep across the eye, explains Dr. Ivan Schwab, M.D., a professor of opthalmology at the University of California Davis School of Medicine and a member of the American Academy of Ophthalmology.

      Our eyelids close similarly to a zipper, from the cheek side toward the nose. When they do that, they push the tears across the eye, picking up all these different materials along the way. This discharge ultimately collects in the corner of the eyes or the lower lid, and a bit may also collect on the upper lid, he says.
       "It may be a bit like using an exfoliant on your skin: You're cleaning off dead skin or any surface debris you don't want," Schwab explains to HuffPost.

       So is "sleep" clean? Schwab says that it's not sterile -- nothing on your body really is, including the surface of your eye, or even the surface of your skin. That being said, if you use your hands to wipe away eye crust (which you shouldn't be doing in the first place, Schwab says -- a warm, wet washcloth is better for cleaning your eyes) -- it is probably a good idea to wash your hands afterward. 
 

       Normal "sleep" has a slight cream-like tint to it, though it could appear darker if you wear makeup. An active bacterial or viral infection could also increase the amount of eye discharge, and make it more yellow- or green-tinted (at which point, you should see an eye doctor).
Eye discharge that's on the drier side may be indicative of a drier environment, Schwab says. In addition, you might experience more eye discharge if you have an increase in mucus -- allergies are a big culprit.

       "The eye produces mucus in response to allergens in the air," according to Schwab. "Allergies like pollen, they get in the eye [and] they cause the eye to create mucus [that] surrounds the pollen and takes it to the corner" of the eye.

       In addition, contact lens-wearers may experience more eye discharge because they are technically walking around with a foreign body in their eyes all day. If a contact lens fits perfectly, you'll still experience a little excess mucus production -- and if the contact lens fits less than perfectly, or traps debris (such as pollen) beneath the lens, then the eye will produce even more mucus, he says.

       Changes to the amount of eye "sleep" your body is producing could be a sign of an eye infection or other problem. Meanwhile, if you have chronic discharge that hasn't changed (but there's a lot of it), that could reflect something else, such as irritation from dust, or even allergies. If you have so much eye crust along your lashes to the point where your eyes are stuck together in the morning, this could actually be a sign of blepharitis, a disorder where there is a low-grade inflammation of the eyelids.

Article by Amanda L. Chan
in the Healthy Living section
of the Huffington Post

http://www.huffingtonpost.com/2014/05/29/eye-sleep-rheum-sand-crust-mattering_n_5399559.html

New Year, Take Charge of your Health

New Year’s Post

My son, Gideon,  called me recently concerned that his good friend, Brad, in his mid-20s had been diagnosed with diabetic retinopathy. His friend although an insulin-dependant diabetic, didn’t seem to watch his dietary intake very seriously, would eat erratically and drink alcohol like a frat-rat.  He appeared somewhat overweight and rarely exercised. Gideon himself had been in  that rut for sometime and realized although himself not diabetic, should adjust his lifestyle.

Consequently after reading about food choices, adjusting his diet and commencing a vigorous exercise program he lost 20lb and reduced his waste from a 36 to a comfortable 32 inches over a period of 6 months. The enthusiasm was contagious and Brad decided to follow Gideon’s approach.

Within a few month’s Brad lost weight, people commented about his dramatic change in physique, but most importantly his retinopathy was noted to have completely resolved. WIth improved diet, eating habits and regular exercise Brad’s diabetic control dramatically improved.

Brad had picked up a copy of Richard Bernstein, M.D.’s book entitled: Diabetic Solution.. Diabetics all know that their greatest struggle is controlling their blood sugar levels. In this book, Dr. Bernstein details a ‘solution’ to obesity, fatigue, and many of the health risks associated with diabetes by following a structured diet controling protein, fat, and complex carbohydrate intake. Dr. Bernstein himself has had insulin-dependant diabetes for over sixty years since. After years of fighting with this metabolic disorder, he entered medical school at age 45 determined to discover a way to keep his blood-sugar levels normal. It was primarily in adjusting food intake that he saw dramatic improvement in diabetic control that he could achieve for both himself and his patients.  Since opening his own practice in 1985 Bernstein has helped hundreds of patients improve their diabetic control with dietary restraint.  

As an ophthalmologist, I see a tremendous amount of ocular complications including retinal hemorrhage, retinal swelling and detachment in patients with uncontrolled diabetes. Poor control can also cause cataracts and increase risk of severe infections. There is also a higher chance of developing glaucoma which can cause blindness.

By managing blood sugar levels through a modified appropriate to diet and exercise, many of these problems can be avoided or even reversed. Look for more updates to my blog including fun and healthy recipes that will change your life and your health.

Dr. Bernstein’s Website

http://www.diabetes-solution.net/

Child Proof your Home

Blog

Childproof your home

A young mom brought in her 4 month old daughter with the story that two days prior, her 3 year old son had sprayed Lysol into the baby’s face. The children had been under the care of the father at the time.

There was no clear history of any immediate care such as irrigating the eyes. The infant was later taken to a medi-clinic and I saw the patient two days later.

The child mildly distressed and opening her eyes for the first time that day. The eyelids were red and swollen, the eyes themselves were beefy and watering and the central cornea were denuded of large areas of tissue.

With some difficulty I was able to remove some debris, apply a cortisone/antibiotic ointment and prescribed appropriate pain medication.

The prognosis is guarded because Lysol like most household cleaners, including bleach, contain alkali which is very toxic to the eye. The alkali penetrates deep into the  tissue structures  of the eye. This can cause corneal ulcers, glaucoma, but most damaging of all is the formation of scar tissue on the outside of the eye. This results in destruction of the mucus membranes including the lubricating glands around the eye. Consequently the eyes become very dry, and the corneas cloudy with blood vessel ingrowth. Normally the corneas are clear and allow light to pass through unhindered. Any disruption of the cornea with scarring, dry eyes or blood vessels can result in a variable amount of blindness.

One cannot stress enough the need to be constantly vigilant when one has young children in your care. First and foremost is the need to childproof your home. Lock up household cleaners and anything that could be used as a weapon - even a wire hanger!

Other eye injuries I have seen while in practice include paintball injuries, scissors, bamboo and other sticks, bungee cords and knife injuries. I once treated a 12 year old boy who had a pencil shoot into his eye that was launched with a balloon - like a catapult. This boy lost his eye after undergoing multiple surgeries.

Please share my concern with friends and family.

The best treatment is prevention - safety first!

 

New Cure for Watery Eyes

Watery Eye

Dennis Matzkin, MD

 

There is a new treatment for watery burning eyes!

In this blog I would like to talk about a unique but simple procedure that I have found very effective in treating patients who have watery eyes, associated with burning and grittiness.

Often watery eyes are due to blockage of the tear drainage system of the eyes. However if the plumbing system is open but you still have watery burning eyes, then you might benefit from conjunctival rejuvenation.

This is not dissimilar to cosmetic surgery for other parts of the body, like the eyelids, face, breasts etc. As we age gravity causes all tissue - even in the eye - to sag.

The underlying support system of the outer layer of the eye, called the conjunctiva, is affected and becomes very loosely adherent to the deeper tissue. The conjunctiva then flops around, gets in the way and irritates the eye causing watering, burning and grittiness.

By shrinking or removing this tissue with an electronic probe, taking less than 5 minutes in the office, symptoms are resolved within 2-3days.

Insurance usually covers this elegant surgical procedure.