11.12 FAQ12 - Final Destination 5

[Source of picture and text below: Boston Herald 8/14/2011]

“Final Destination 5” is the first movie to feature death by the common LASIK eye surgery procedure.

Question: For real?

Answer: “I think people are smart enough to know this is fiction,” said Dr. Samir Melki of Boston Laser in Brookline. “The machine cannot really turn itself on like in the movie.  . . . The laser turns off if (the patient) can’t keep their eye on the tracker.”

11.11 FAQ11 - A new imager BAOSO

[Source: http://www.foxnews.com/scitech/2011/06/09/historic-first-image-reveals-millions-light-sensors-in-human-eye/]

These images are from "Reflective afocal broadband adaptive optics scanning ophthalmoscope" by Alfredo Dubra and Yusufu Sulai, that has just appeared in
Biomedical Optics Express, Vol. 2, Issue 6, pp. 1757-1768 (2011) doi:10.1364/BOE.2.001757 [here].

Image on the left shows the cones in the fovea. And that on the right shows a more peripheral retinal location: the large bright dots with a dark ring around them are cones, and the surrounding smaller spots are rods.

Question: A historical first - as advertised?

Answer: Fundus photography has come a long way. This one, ultra-micro-imaging of the human retina, is absolutely astounding, indeed a historic first. It'll be interesting to see images of diseased retina. No doubt this is being actively pursued. Our congratulations to Drs Dubra and Sulai.

11.10 FAQ10 - Avastin vs Lucentis

News from Boston Globe today:

A much cheaper drug has proved just as good as a $2,000 monthly shot at treating a common eye disorder that can lead to blindness, a long-awaited study has found. It also shows that patients can be treated less often, sparing them a lot of pain and expense.

The results are expected to lead many doctors and patients to turn away from the pricier Lucentis and instead use $50 shots of Avastin for an age-related condition called wet macular degeneration.

Question: What kind of shots?

Answer: Avastin has long been used to treat macular degeneration. The new study finally verifies the efficacy of this generic version of Lucentis. And if you must know, this drug is delivered through injection into the vitreous. Pain? Just a little needle prick, really.

11.9 FAQ9 - The other right eye

News today on KTAU.com:

VANCOUVER, Wash. – When four-year-old Jesse Matlock went in for surgery last Wednesday, doctors were supposed to operate on his right eye to stop it from wandering. But his parents said that’s not what happened.

They said his eye surgeon first mistakenly operated on his left eye, realized her mistake and then repeated the same operation on his right eye – the correct eye.

“I have not noticed any improvement in the right eye and as far as I can tell the left is now wandering,” said Tasha Gaul, Jesse’s mother. Now Gaul is concerned about what this unnecessary surgery will do to his vision in the future.

The surgeon was Dr. Shawn Goodman of Lake Oswego. When KATU called her office on Monday a staff member said she was not in. She has not yet returned messages.

“My husband and I were in awe, we were like ‘can you repeat that again?” Gaul said. “She said, ‘frankly, I lost sense of direction and didn’t realize I had operated on the wrong eye until I was done operating on the eye.’”

The surgery was done at Legacy Emanuel Medical Center in Portland. The hospital’s Chief Administrative Officer, said they have procedures to help prevent mistakes like this.

“We have a critical incident team that will be responding to it, that will be interviewing all of our staff in the operating room as well as private practice physicians in the operating room that were involved,” said hospital CAO Dr. Lori Morgan. “Our hope is to never have it happen again in any of our hospitals.”

Dr. Goodman is not a Legacy employee but was using their operating facilities.

“Something went wrong with their checklist,” said Dale Matlock, Jesse’s father. “They came in and circled his eye, for which eye they were going to operate on. Then (Dr. Goodman) proceeded with the left, the wrong eye.”

Jesse’s parents have hired a lawyer and are considering a malpractice suit.

Question: Will the lawsuit be successful?

Answer: Probably not. This appears a case of strabismus surgery - to re-position the extraocular muscles of BOTH eyes so the two eyes can stay straight. Often multiple surgeries are needed. There is no damage to the eyeballs nor to patient's pre-op vision.

11.8 FAQ8 - More on 3D

Because of a lack of substantial data, the pros and cons of children playing with the Nintendo 3DS have evolved into a controversy of sorts.

According to USA Today - 3/18/2011:

U.S. eye specialists are welcoming the Nintendo 3DS game device, dismissing the manufacturer's warnings that its 3-D screen shouldn't be used by children 6 or younger because it may harm their immature vision.

On the contrary, the optometrists say, it's a good idea to get your kids to try the 3-D screen, especially if they're younger than 6. It won't do any harm, they say, and it could help catch vision disorders that have to be caught early to be fixed.

"The 3DS could be a godsend for identifying kids under 6 who need vision therapy," said Michael Duenas, associate director for health sciences and policy for the American Optometric Association.

On the other hand,

David Hunter, a pediatric ophthalmologist affiliated with the Children's Hospital in Boston and the American Academy of Ophthalmology, said the idea that off-the-shelf 3-D games or movies could help screen for vision problems such as amblyopia is "a little perplexing."

Kids with amblyopia don't have much depth perception in real life, he said, so if they don't see depth in a 3-D screen, they might not say anything because that wouldn't be much different from what they see around them.

It's not impossible that it could help, but it's "all sort of exploration and speculation," said Hunter, who has started a company that's developing a device for childhood screening of vision disorders.

Question: Who's right?

Answer: Taking self-interest out of the arguments, it is still neither. More research on binocularity is still the key.

11.7 FAQ7 - Esotropia and diet

So now we have an internet sensation: Heidi the resident "cross-eyed" opossum at Leipzig Zoo, complete with her own Facebook and YouTube appearances.

A spokeswoman at the Zoo has put forth the theory that Heidi's esotropia "could have come from a poor diet when she was young, causing large fat deposits to form behind her eyes". The white-haired marsupial has since been put on a diet and lost 400g of body weight.

Question: Are we witnessing a new type of strabismus?

Answer: Hardly. The photo above actually shows (1) corneal reflections are in the same 1 o'clock position, i.e., this is a case of pseudo-esotropia, commonly seen in babies in Asia; and (2) swollen conjunctiva in both eyes suggesting accumulation of fluids, or chemosis, which has further enhanced the esotropia illusion. Neither has anything to do with too much fat in the orbit. No crossed eyes here; instead, Heidi is probably suffering from some sort of allergies.

11.6 FAQ6 - 3D and children's eyes

On its website, Nintendo announces:

"6歳以下の小さなお子様の視覚は発達段階にあると言われており、専門家は、『ニンテンドー3DS』だけでなく、3D映画や3Dテレビなども含め、左右の目に異なる映像を届ける3D映像は、小さなお子様の目の成長に影響を与える可能性があるという見解をもっています。"

Translation: No Nintendo 3DS for kids under 6.

Question: Now what?

Answer: Let's be clear on one point, we live in a 3D world. Kids and babies included. We are programmed to perceive 3D accurately during the first year of our lives. And stereo-acuity actually matures between 3-5 years of age.

The two eyes each receives the same image from a slightly different angle - the same principle used for 3D gadgets. Shouldn't 3D viewing then enhance the performance of the visual system? The common complaint of asthenopia [eyestrain and headaches] from viewing 3D is an entirely different matter. Instead of real research on convergence and fusion, Nintendo mimics 3D TV manufactures by issuing simplistic warnings.

Lest we forget: CYA is not a real solution, real solutions require real R&D.