gdebel

Hi, ophthalmologist here :-) The good news is that if there is no underlying pathology (such as keratoconus, which should be sought in case of progressing astigmatism), every ametropia can be corrected with the right glasses and allow a good working comfort.

First, check your prescription with an ophthalmologist (or optometrist, depending on your country). You may benefit from a cycloplegic refraction, to ensure that you don't have an undercorrected hyperopia.

Then, always wear your glasses when working.

Your floaters don't have a direct relationship with your astigmatism and you may need a fundus examination, which will be done at the same time as your cycloplegic refraction (pupils will be dilated using eye drops).

Reducing the screen light and using a blue filter may also help. But good prescription is key.

I had the opportunity to taste this berry where I live (French Polynesia) and indeed very surprised by its powerful sweetening effect. It looks like an under-exploited potential to me.

I'm genuinely interested in your testimony. Did you, by any chance, underwent a refraction after cycloplegia (cyclopentolate) anytime in your life? Cyclopentolate suppresses the ciliary spasm and allows to measure the real, residual myopia.

I would be very impressed if I had the opportunity to observe a myopic regression in a patient after cycloplegia (for both exams, of course).

Yes, hyperopia is a very ungrateful condition... The usual situation is patients which had a perfect vision all their life, and, around 40, lose their near vision, and their far vision a few years later. This is always a little bit depressing. My only advice for hyperopia would be (I'm sorry for that) to not wait too long to wear a correction for near vision. Sadly you won't heal hyperopia by training your eyes to look closer, but you will certainly be very tired at the end of the day if you need convex glasses and don't have them.

There is indeed much more evidence for this advice. This is my I do with my kids. Using your far vision a lot I childhood, with enough light exposure, could be a real preventive habit.

No you can't do that, because the patient must look at a target. There is an eye tracker in the laser but you have to look in the right direction. The surgery is much less impressive that you can imagine. Take an advice with a reputable, trained surgeon which will carefully look for any contraindication !

The problem is that you can't measure axial length with an autorefractometer. You need a biometer. The autoref will tell you the objective refraction of the patient (which is quite imprecise).

The eyeball gets longer with time in high (pathological) myopia. Serious surgeons will check that the myopia is stable (1-2 years) before doing a surgery. The eye doesn't, usually, gets longer in patients with moderated myopia. All the work, in refractive surgery, is in good patients selection. It is very unusual to observe a significant myopic regression in patients with a stabilized myopia after 21 years. Of course the eye is an organ, there is no absolute rule in the human body. However, patients which were correctly selected for surgery don't, usually, see their myopia coming back with time.

Ophthalmologist here. The myopia epidemic is real thing. The advice given in this post is not a dangerous thing to try. However, I doubt that the theory is true, and I doubt that following this method will really help myopic patients. Let's try to justify this point :

"The long-term use of over-correcting glasses induces myopia" This is quite true. But it induces a myopia which is reversible. Overcorrection (which we try to avoid) leads to ciliary spasm. When the patient gets older, the lens gets less flexible (for everyone, this is what leads to presbyopia) and the myopia, if it was overcorrected, diminishes. It is common to reduce the correction for patients around 40.

We have a good, natural model in nature for over-corrected myopic eyes: hyperopic patients. They don't become myopic with time. Around 40-45 years, their hyperopia becomes clinically significant (they didn't need glasses before and they progressively need to have their hyperopia corrected at 45, or a little bit later if the hyperopia is slight).

"Repair is fast at first as you clear the ciliary spasm, and then slows down as you work on shortening the eyeball itself." No. Clearing the ciliary spasm (which is not present in every myopic patient, only the overcorrected ones) will indeed reduce the amount of myopia (the eye will return to its normal state: less myopia). However, we happen to have a very precise way to mesure the axial length of the eyeball (interferometry). While we commonly observe a lengthening of the eyeball in high, pathological myopia, I've never heard of an eyeball which shortened, nor read any paper which related this phenomenon. We don't know why the eyeball elongates in high myopia. But, as far as I know, eyeball never shorten.

"If you are considering laser eye surgery, please skim Lasik Complications." Yes, please do. You must be informed and your surgeon must inform you. However, you could also look at the number of refractive surgeons who underwent themselves this surgery, or operated their family. It is a common thing to operate our residents at the end of their internship because they saw the outcomes and want the procedure. Please note that any serious refractive surgeon will perform a refraction after cycloplegia, to remove any ciliary spasm and correct only the "real" myopia.

https://theophthalmologist.com/business-profession/do-ophtha...

Well, by looking at all the answers, I obviously missed my point. Sorry for that :-) (I'm not a native english speaker as you noticed so it may also explain the misunderstanding ?)

Of course this is not how I talk to my patients... I usually explain the cataract surgery procedure as follows : "the only thing you will feel is water on the side of your face, and the only thing you will see is a very powerful light. You won't see anything scary and you won't feel any pain. We will talk during the surgery and when it will be over, you will tell me that you shouldn't have been afraid". And that's how it goes.

The eye injection procedure is even faster and painless.

Sorry for the gruesome details I gave.

Also, yes, don't look any Youtube videos, because your experience will be totally different than watching the procedure. Youtube videos are scary.

(Ophthalmologist): To any future HN reader scared by those intraocular injections: don't fear them. I'm on my way to the operating room and going to perform cataract surgery under topical (=eyedrops only) anesthesia, as I always do, and as most surgeons today do. Patients won't feel anything except water slightly flowing on the eye surface. The surgical knife is 2.2mm wide : the 25 Gauge needle is 0.260mm wide. Anesthetic eyedrop work amazingly. Patients can actually feel the eye speculum (pro tip: open wide both eyes++, it will be less disturbing) and the itchy feeling of Betadine, and the touch of the needle : that's usually all.

Don't postpone eye injections because of fear: if it is indicated, there is usually some degree of emergency.

Yes, of course. A simple Pubmed query will bring a lot of occurrences : https://pubmed.ncbi.nlm.nih.gov/?term=Keratoconus+eye+rubbin...

For a complete argumentation and discussion about the case for the role of eye rubbing in keratoconus genesis, please look at this website : https://defeatkeratoconus.com/

(Disclaimer: I work closely with one of the main proponent of the eye rubbing hypothesis. However, please believe that I don't have any conflict of interest in this topic. I don't have anything to gain in raising awareness about this problem, except feeling that I'm doing something right)

This is infuriating. This is why I always comment when I see people talking about KC on HN (guess what? There is a lot. I won't do the research but I'm almost sure that this is the most frequent pathologie people here talk about. Lots of computers, lots of concentration, lots of eye dryness,lots of eye rubbing).

There is more and more evidence to support the fact that KC is purely induced by eye rubbing.

Don't rub your eyes !

Hi, I'm an ophthalmologist, corneal specialist (and regular HN reader). I just would like to draw your attention to the absolute necessity to avoid any eye rubbing. This point is very often ignored by some colleagues, for various reasons. CXL will never increase your visual acuity, it is aimed at stabilizing the evolution (it is a controversial procedure). The most effective thing to stabilize your pathology is to avoid any eye rubbing. Please inform yourself about scleral lenses, too. Write me if you need to.

Says "scientific fact" on the landing page. No scientific paper cited.

(empirical, non scientific opinion): usually, wearing contact lenses tends to prevent vigorous eye rubbing, during the day. Also, people with sensitive, itchy eyes tend to avoid contact lenses: this is a two-way relationship. Nefarious eye rubbing is usually related to a daily, compulsory "habit", involving a vigorous pressure on the eye using the knuckles or the side of the index, also frequently present while sleeping.

If the outcomes are as great as they look, I think one could expect "mainstream adoption" (specialized centers and unfrequent indications) in 2-3 years ? This is a hard guess!

Sorry, I thought it was public. I updated my profile.

To start with, full disclosure : this is a controversial topic. The majority of eye surgeons are still convinced that there is a genetic predisposition to keratoconus, and that eye rubbing is an optional trigger. Other (a growing number) think that this is the sole responsible of keratoconus.

My mentor is the main proponent of the eye rubbing theory. I was a skeptic, and became convinced by learning with him how to properly interview patients on this subject, how to prevent eye rubbing, and by seeing the absence of progression after full awareness of the patients (without cross-linking. We don't do any CXL in my department, ever. KC screening and care is one of our main activity: not doing CXL is a financial loss). My mentor's website : https://www.gatinel.com/recherche-formation/keratocone-2/no-... (No conflict of interest except loyalty).

The main difficulty is that it is almost impossible to design an experiment to prove the theory (if someone has a genius idea, please don't hesitate). Usually other surgeons or students become convinced after visiting the department and spread the good practices back home : still a long way to go.

The harmful eye rubbing is made with the hard parts of the hand (knuckles). It is frequently nocturnal and almost everytime ignored. Awareness comes when the patient has been informed and told to look for this habit. At the second consultation, the eye rubbing is reported in the vast majority of cases. I count the keratoconus patients that deny eye rubbing after 2-3 consultations on one hand. We prescribe a transparent eye shell to sleep with when the patient denies eye rubbing : it allows them to realize that they rub during the night. We prescribe eye drops to ease the eye irritation which triggers rubbing, and instruct to rub the inner part of the eyelid, against the nose (no eye deformation) if necessary. Sleep position is frequently pathological too (eye vs hand or arm contact. In those cases the KC is very asymetrical).

Doctors in our team can predict the eye rubbing habit frequency and intensity by looking at a corneal topography. It is incredible that the role of this habit was ignored so long. I suppose that we doctors don't talk enough with our patients. The financial incentive of performing CXL and surgeries is so clearly detrimental the the adoption of those practices.

I sympathize. I don't know what kind of procedure you underwent. If the blurry vision comes form an irregular anterior corneal surface, scleral lenses can be a game-changer. Also, cellular therapy could be an option in a few years, you're not condemned to another surgery with a little bit of luck. Don't hesitate to write me if you need an informal, general advice.

Corneal surgeon here ! (Note : I never implanted a keratoprosthesis. This is an extremely unfrequent procedure, usually performed by a handful of surgeons in a given country). Some insights about this topic. This looks like a great device (never heard before !). This is a keratoprosthesis, meaning this is a last recourse, "no-hope-except-maybe-that", procedure. However it looks infinitely more simple and respectful of the eye integrity than current keratoprosthesis, and, if it really acts like a scaffold for native corneal cells and allows a colonization and the obtention of a satisfying corneal surface, it could be a game changer. It is way too soon to know.

A significant percentage (I would say around 40-70%, depending on the country) of corneal graft indications originates from pathologies coming from the inner layer of the cornea (corneal endothelium). Posterior lamellar graft (DMEK) allows today to change only the thin cellular layer which is pathological, with an usually quick recovery. Even the best performing keratoprosthesis won't replace this procedure, because we care to preserve the eye's integrity as much as we can.

It is interesting to remember that corneal transplantation is a very special topic because the cornea is not vascularized, meaning less rejection. There still is, of course, but the outcomes as usually good. Keratoprosthesis are today indicated when previous grafts where rejected, when the other structures of the eye are healthy, and when the vision is extremely low. This allows to gain a few years of very low vision before, usually, losing the eye due to infection or high ocular pressure.

The technology presented has the potential: - to replace current keratoprosthesis and lower the threshold to decide to perform the procedure : yes, almost sure if the device is well-tolerated - to replace perforating keratoplasty (full corneal replacement, unfrequent today) where the cornea is damaged in its entirety: maybe, highly uncertain for the moment. That would be an incredible step forward, a revolution in our practice. - to replace anterior lamellar keratoplasty, where the anterior wall of the cornea is replaced : highly unlikely - to replace posterior lamellar keratoplasty, where the cornea lacks transparency because of inner layer cellular dysfunction: almost impossible.

I would also like to raise awareness on the topic of eye rubbing. The eye surgeon community progressively discovers the highly harmful consequences of vigorous and daily eye rubbing. A few teams (mine, notably) even think that it is the single trigger for keratoconus. You will find a nice illustrations of what a rubbed eye looks like in MRI I by googling "don't rub your eye" (this is me in the MRI ;-) and more explanations here : https://defeatkeratoconus.com/

Thank you, great work.

Haha, nope ! As a convenience procedure, and as such exposed to liability risks, and because of the extremely high cost of the lasers, you'll have to pay 2-3000 euros for both eyes (in France, at least). It is in fact cheaper in the US.

However, I'm always surprised by the cost of health in the US. The most surprising thing is that it looks like most Americans seem to not realize that it is perfectly possible to have high quality medicine and well payed doctors if the insurances don't suck all the money between the healthcare system and the patient. Our system has flaws, sure, but the US system looks like crazy to me.

Lasers revolutionized medicine, particularly in two specialties where the organ is accessible to light: dermatology and ophthalmology. We use : - excimer laser (UV) for their photoablative properties, to change to anterior corneal radius of curvature in refractive surgery (fun fact: the first attempt to use this laser was pure serendipity : "oh I got this excimer in my lab, here is a chicken sandwich, let's see what is gives on organic tissues") - ND:Yag laser to pierce a small hole in the iris when it is necessary to establish a communication, or to locally break the posterior lens capsule when it opacifies after cataract surgery ; those two procedures where far from benign when they had to be performed surgically , today it is made in the office in a few seconds - femtosecond lasers to cut a thin layer of cornea , which is lifted , before applying the excimer laser, in LASIK procedures - diode lasers to reduce the intraocular pressure by destroying parts of the ciliary body in very specific cases - various lasers to photocoagulate lesions on the retina....

Ophthalmology without lasers would look like a middle-ages practice.

I agree on the very long term possibilities. However, the first problem to solve is the data collection. Saving doctors and nurses from their horrible professional softwares and replacing them with user-friendly, well-thought, data collection friendly softwares would be a huge step forward.

Honestly, I don't know what to think. Ophthalmology is a great field for AI researchers (lots of images: the eye is an organ that you can photograph and analyze visually in every angles, almost like in dermatology). In Ophthalmology, diabetic retinopathy is an evident take : lots of people involved, lots of annotated pictures available, screening programs.

However, I would like to see the performances of the algorithm on different fundus camera. It is also important to realize that diabetic retinopathy classification is very easy to learn, to the point that if the screening is such a problem, it is easier to ask the person that takes the pictures (In France, a nurse or an orthoptist) to phone the doctor when he/she sees something strange on the eye fundus.

This is exacerbated by the fact that if the AI told the doctor that there is a doubt, no doctor will take the risk of not doing a biopsy / scanner / MRI / surgery (depending on the case). Because, how would you defend yourself in front of the judge ? This is something we always have in mind.

This is how you end with false positives and over-diagnosis.

Hi, I did not intend to be disrespectful, sorry if you read my message like this.

I mainly intended to underline the fact that we (doctors) were promised a revolution in healthcare (AKA : to disappear) and we ended with diagnostic scores.

However, I gladly admit that I exaggerated and that AI technologies can be helpful in some cases, of course.

I assumed that basic ML was similar to the statistics I already knew, and that deep learning was inherently different. It had to be different, given how people talked about it. It is just an illustration of how the fuss made about AI at this time impacted researcher's minds with no expertise in ML. This is going down, fortunately.