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Icon Health Publications - The 2002 Official Patients Sourcebook on Myopia- A Revised and Updated Directory for the Internet Age (2002)

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THE 2002 OFFICIAL
PATIENT?S SOURCEBOOK
on
J AMES N. P ARKER , M.D.
AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications
ICON Group International, Inc.
4370 La Jolla Village Drive, 4th Floor
San Diego, CA 92122 USA
Copyright �02 by ICON Group International, Inc.
Copyright �02 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it
may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without written permission from the publisher.
Printed in the United States of America.
Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle
Editor(s): James Parker, M.D., Philip Parker, Ph.D.
Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for
consultation with your physician. All matters regarding your health require medical supervision. As new medical or
scientific information becomes available from academic and clinical research, recommended treatments and drug therapies
may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date
and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or
implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in
accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation,
in close consultation with a qualified physician. The reader is advised to always check product information (package inserts)
for changes and new information regarding dose and contraindications before taking any drug or pharmacological product.
Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements,
alternative therapies, complementary therapies and medicines, and integrative medical treatments.
Cataloging-in-Publication Data
Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient?s Sourcebook on Myopia: Revised and Updated for the Internet Age/James N. Parker and
Philip M. Parker, editors
p.
cm.
Includes bibliographical references, glossary and index.
ISBN: 0-597-83244-7
1. Myopia-Popular works. I. Title.
iii
Disclaimer
This publication is not intended to be used for the diagnosis or treatment of a health
problem or as a substitute for consultation with licensed medical professionals. It is sold
with the understanding that the publisher, editors, and authors are not engaging in the
rendering of medical, psychological, financial, legal, or other professional services.
References to any entity, product, service, or source of information that may be contained in
this publication should not be considered an endorsement, either direct or implied, by the
publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are
not responsible for the content of any Web pages nor publications referenced in this
publication.
Copyright Notice
If a physician wishes to copy limited passages from this sourcebook for patient use, this
right is automatically granted without written permission from ICON Group International,
Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With
exception to the above, copying our publications in whole or in part, for whatever reason, is
a violation of copyright laws and can lead to penalties and fines. Should you want to copy
tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of
our publications for internal use, press releases, and academic research. Such reproduction
requires confirmed permission from ICON Group International Inc. The disclaimer above
must accompany all reproductions, in whole or in part, of this sourcebook.
iv
Dedication
To the healthcare professionals dedicating their time and efforts to the study of myopia.
Acknowledgements
The collective knowledge generated from academic and applied research summarized in
various references has been critical in the creation of this sourcebook which is best viewed
as a comprehensive compilation and collection of information prepared by various official
agencies which directly or indirectly are dedicated to myopia. All of the Official Patient?s
Sourcebooks draw from various agencies and institutions associated with the United States
Department of Health and Human Services, and in particular, the Office of the Secretary of
Health and Human Services (OS), the Administration for Children and Families (ACF), the
Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ),
the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease
Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare
Financing Administration (HCFA), the Health Resources and Services Administration
(HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health
(NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health
Services Administration (SAMHSA). In addition to these sources, information gathered
from the National Library of Medicine, the United States Patent Office, the European Union,
and their related organizations has been invaluable in the creation of this sourcebook. Some
of the work represented was financially supported by the Research and Development
Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are
owed to Tiffany LaRochelle for her excellent editorial support.
v
About the Editors
James N. Parker, M.D.
Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the
University of California, Riverside and his M.D. from the University of California, San
Diego. In addition to authoring numerous research publications, he has lectured at various
academic institutions. Dr. Parker is the medical editor for the Official Patient?s Sourcebook
series published by ICON Health Publications.
Philip M. Parker, Ph.D.
Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at
INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the
University of California, San Diego and has taught courses at Harvard University, the Hong
Kong University of Science and Technology, the Massachusetts Institute of Technology,
Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient?s
Sourcebook series published by ICON Health Publications.
vi
About ICON Health Publications
In addition to myopia, Official Patient?s Sourcebooks are available for the following related
topics:
�
The Official Patient's Sourcebook on Age-related Macular Degeneration
�
The Official Patient's Sourcebook on Astigmatism
�
The Official Patient's Sourcebook on Blepharitis
�
The Official Patient's Sourcebook on Cataract Surgery
�
The Official Patient's Sourcebook on Cataracts
�
The Official Patient's Sourcebook on Conjunctivitis
�
The Official Patient's Sourcebook on Corneal Transplant Surgery
�
The Official Patient's Sourcebook on Diabetic Retinopathy
�
The Official Patient's Sourcebook on Dry Eye
�
The Official Patient's Sourcebook on Fuchs' Dystrophy
�
The Official Patient's Sourcebook on Glaucoma
�
The Official Patient's Sourcebook on Hyperopia
�
The Official Patient's Sourcebook on Iridocorneal Endothelial Syndrome
�
The Official Patient's Sourcebook on Keratitis
�
The Official Patient's Sourcebook on Keratoconus
�
The Official Patient's Sourcebook on Lasik Surgery
�
The Official Patient's Sourcebook on Lattice Dystrophy
�
The Official Patient's Sourcebook on Macular Holes
�
The Official Patient's Sourcebook on Map-dot-fingerprint Dystrophy
�
The Official Patient's Sourcebook on Ocular Herpes
�
The Official Patient's Sourcebook on Ocular Histoplasmosis Syndrome
�
The Official Patient's Sourcebook on Presbyopia
�
The Official Patient's Sourcebook on Pterygium
�
The Official Patient's Sourcebook on Retinal Detachment
To discover more about ICON Health Publications, simply check with your preferred online
booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of
our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts:
ICON Group International, Inc.
4370 La Jolla Village Drive, Fourth Floor
San Diego, CA 92122 USA
Fax: 858-546-4341
Web site: www.icongrouponline.com/health
Contents vii
Table of Contents
INTRODUCTION ................................................................................................................. 1
Overview ................................................................................................................................. 1
Organization ......................................................................................................................... 3
Scope .......................................................................................................................................... 3
Moving Forward................................................................................................................. 4
PART I: THE ESSENTIALS ..................................................................... 7
CHAPTER 1. THE ESSENTIALS ON MYOPIA: GUIDELINES ........ 9
Overview ................................................................................................................................. 9
What Is the Cornea? ....................................................................................................... 11
What Is the Function of the Cornea? ................................................................... 13
What Are Refractive Errors? .................................................................................... 13
What Is Myopia? .............................................................................................................. 14
How Is Myopia Treated? ............................................................................................. 14
What Is LASIK? ............................................................................................................... 15
When Is LASIK Not for Me? .................................................................................... 17
What Are the Risks and How to Find the Right Doctor? ........................ 19
Additional Risks ............................................................................................................... 20
Finding the Right Doctor ............................................................................................ 22
What Should I Expect before, during, and after Surgery? ...................... 23
LASIK Surgery Checklist ............................................................................................ 27
FDA-Approved Lasers for LASIK.......................................................................... 30
FDA-Approved Lasers for PRK and Other Refractive Surgeries ....... 31
Other Resources ................................................................................................................ 32
More Guideline Sources ............................................................................................... 34
Vocabulary Builder ......................................................................................................... 37
CHAPTER 2. SEEKING GUIDANCE ................................................................. 41
Overview ............................................................................................................................... 41
Associations and Myopia ............................................................................................ 41
Finding More Associations ........................................................................................ 43
Finding an Eye Care Professional .......................................................................... 45
Selecting Your Doctor ................................................................................................... 47
Working with Your Doctor ........................................................................................ 47
Broader Health-Related Resources......................................................................... 49
Vocabulary Builder ......................................................................................................... 49
CHAPTER 3. CLINICAL TRIALS AND MYOPIA .................................... 51
viii Contents
Overview ............................................................................................................................... 51
Recent Trials on Myopia ............................................................................................. 54
Benefits and Risks ............................................................................................................ 57
Keeping Current on Clinical Trials ...................................................................... 60
General References .......................................................................................................... 61
Vocabulary Builder ......................................................................................................... 62
PART II: ADDITIONAL RESOURCES AND
ADVANCED MATERIAL ....................................................................... 63
CHAPTER 4. STUDIES ON MYOPIA ................................................................ 65
Overview ............................................................................................................................... 65
The Combined Health Information Database .................................................. 65
Federally-Funded Research on Myopia............................................................... 66
The National Library of Medicine: PubMed .................................................... 80
Vocabulary Builder ......................................................................................................... 90
CHAPTER 5. PATENTS ON MYOPIA .............................................................. 95
Overview ............................................................................................................................... 95
Patents on Myopia .......................................................................................................... 96
Patent Applications on Myopia............................................................................. 108
Keeping Current ............................................................................................................. 108
Vocabulary Builder ....................................................................................................... 109
CHAPTER 6. BOOKS ON MYOPIA .................................................................. 111
Overview ............................................................................................................................. 111
The National Library of Medicine Book Index.............................................. 111
Chapters on Myopia ..................................................................................................... 115
General Home References .......................................................................................... 117
Vocabulary Builder ....................................................................................................... 118
CHAPTER 7. MULTIMEDIA ON MYOPIA................................................. 121
Overview ............................................................................................................................. 121
Bibliography: Multimedia on Myopia ............................................................... 121
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ....... 125
Overview ............................................................................................................................. 125
NIH Guidelines ............................................................................................................... 125
NIH Databases ................................................................................................................ 126
Other Commercial Databases ................................................................................. 129
The Genome Project and Myopia ......................................................................... 130
Specialized References ................................................................................................. 135
Contents
ix
Vocabulary Builder ....................................................................................................... 137
CHAPTER 9. DISSERTATIONS ON MYOPIA........................................... 139
Overview ............................................................................................................................. 139
Dissertations on Myopia ........................................................................................... 139
Keeping Current ............................................................................................................. 141
PART III. APPENDICES .......................................................................... 143
APPENDIX A. RESEARCHING YOUR MEDICATIONS .................. 145
Overview ............................................................................................................................. 145
Your Medications: The Basics ................................................................................ 145
Learning More about Your Medications.......................................................... 147
Commercial Databases ................................................................................................ 148
Contraindications and Interactions (Hidden Dangers) .......................... 150
A Final Warning ............................................................................................................ 150
General References ........................................................................................................ 151
Vocabulary Builder ....................................................................................................... 152
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ........ 153
Overview ............................................................................................................................. 153
What Is CAM? ................................................................................................................ 153
What Are the Domains of Alternative Medicine?...................................... 154
Can Alternatives Affect My Treatment? ......................................................... 157
Finding CAM References on Myopia ................................................................ 158
Additional Web Resources ........................................................................................ 167
General References ........................................................................................................ 169
APPENDIX C. RESEARCHING NUTRITION ........................................... 173
Overview ............................................................................................................................. 173
Food and Nutrition: General Principles ........................................................... 173
Finding Studies on Myopia ..................................................................................... 178
Federal Resources on Nutrition............................................................................. 182
Additional Web Resources ........................................................................................ 182
Vocabulary Builder ....................................................................................................... 184
APPENDIX D. FINDING MEDICAL LIBRARIES ................................... 187
Overview ............................................................................................................................. 187
Preparation ........................................................................................................................ 187
Finding a Local Medical Library .......................................................................... 188
Medical Libraries Open to the Public ................................................................ 188
APPENDIX E. YOUR RIGHTS AND INSURANCE ............................... 195
x
Contents
Overview ............................................................................................................................. 195
Your Rights as a Patient ............................................................................................ 195
Patient Responsibilities .............................................................................................. 199
Choosing an Insurance Plan ................................................................................... 200
Medicare and Medicaid .............................................................................................. 202
Financial Aid for Eye Care ....................................................................................... 205
NORD?s Medication Assistance Programs ................................................... 207
Additional Resources ................................................................................................... 207
ONLINE GLOSSARIES............................................................................. 209
Online Dictionary Directories ............................................................................... 210
MYOPIA GLOSSARY .................................................................................. 213
General Dictionaries and Glossaries .................................................................. 223
INDEX ................................................................................................................................... 225
Introduction
1
INTRODUCTION
Overview
Dr. C. Everett Koop, former U.S. Surgeon General, once said, ?The best
prescription is knowledge.?1 The Agency for Healthcare Research and
Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view
and recommends that every patient incorporate education into the treatment
process. According to the AHRQ:
Finding out more about your condition is a good place to start. By
contacting groups that support your condition, visiting your local
library, and searching on the Internet, you can find good information
to help guide your treatment decisions. Some information may be
hard to find?especially if you don't know where to look.2
As the AHRQ mentions, finding the right information is not an obvious task.
Though many physicians and public officials had thought that the
emergence of the Internet would do much to assist patients in obtaining
reliable information, in March 2001 the National Institutes of Health issued
the following warning:
The number of Web sites offering health-related resources grows
every day. Many sites provide valuable information, while others may
have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com.
The Agency for Healthcare Research and Quality (AHRQ):
http://www.ahcpr.gov/consumer/diaginfo.htm.
3 From the NIH, National Cancer Institute (NCI):
http://cancertrials.nci.nih.gov/beyond/evaluating.html.
1
2
2
Myopia
Since the late 1990s, physicians have seen a general increase in patient
Internet usage rates. Patients frequently enter their doctor's offices with
printed Web pages of home remedies in the guise of latest medical research.
This scenario is so common that doctors often spend more time dispelling
misleading information than guiding patients through sound therapies. The
Official Patient?s Sourcebook on Myopia has been created for patients who have
decided to make education and research an integral part of the treatment
process. The pages that follow will tell you where and how to look for
information covering virtually all topics related to myopia, from the
essentials to the most advanced areas of research.
The title of this book includes the word ?official.? This reflects the fact that
the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced
to give you some of the latest official information available to date on
myopia.
Given patients? increasing sophistication in using the Internet, abundant
references to reliable Internet-based resources are provided throughout this
sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the
Internet. E-book and electronic versions of this sourcebook are fully
interactive with each of the Internet sites mentioned (clicking on a hyperlink
automatically opens your browser to the site indicated). Hard copy users of
this sourcebook can type cited Web addresses directly into their browsers to
obtain access to the corresponding sites. Since we are working with ICON
Health Publications, hard copy Sourcebooks are frequently updated and
printed on demand to ensure that the information provided is current.
In addition to extensive references accessible via the Internet, every chapter
presents a ?Vocabulary Builder.? Many health guides offer glossaries of
technical or uncommon terms in an appendix. In editing this sourcebook, we
have decided to place a smaller glossary within each chapter that covers
terms used in that chapter. Given the technical nature of some chapters, you
may need to revisit many sections. Building one?s vocabulary of medical
terms in such a gradual manner has been shown to improve the learning
process.
We must emphasize that no sourcebook on myopia should affirm that a
specific diagnostic procedure or treatment discussed in a research study,
patent, or doctoral dissertation is ?correct? or your best option. This
sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and
healthcare providers.
Organization
This sourcebook is organized into three parts. Part I explores basic
techniques to researching myopia (e.g. finding guidelines on diagnosis,
treatments, and prognosis), followed by a number of topics, including
information on how to get in touch with organizations, associations, or other
patient networks dedicated to myopia. It also gives you sources of
information that can help you find a doctor in your local area specializing in
treating myopia. Collectively, the material presented in Part I is a complete
primer on basic research topics for patients with myopia.
Part II moves on to advanced research dedicated to myopia. Part II is
intended for those willing to invest many hours of hard work and study. It is
here that we direct you to the latest scientific and applied research on
myopia. When possible, contact names, links via the Internet, and summaries
are provided. It is in Part II where the vocabulary process becomes
important as authors publishing advanced research frequently use highly
specialized language. In general, every attempt is made to recommend ?freeto-use? options.
Part III provides appendices of useful background reading for all patients
with myopia or related disorders. The appendices are dedicated to more
pragmatic issues faced by many patients with myopia. Accessing materials
via medical libraries may be the only option for some readers, so a guide is
provided for finding local medical libraries which are open to the public.
Part III, therefore, focuses on advice that goes beyond the biological and
scientific issues facing patients with myopia.
Scope
While this sourcebook covers myopia, your doctor, research publications,
and specialists may refer to your condition using a variety of terms.
Therefore, you should understand that myopia is often considered a
synonym or a condition closely related to the following:
�
Nearsightedness
�
Shortsightedness
4
Myopia
In addition to synonyms and related conditions, physicians may refer to
myopia using certain coding systems. The International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most
commonly used system of classification for the world's illnesses. Your
physician may use this coding system as an administrative or tracking tool.
The following classification is commonly used for myopia:4
�
360.21 progressive high (degenerative) myopia
�
367.1 myopia
For the purposes of this sourcebook, we have attempted to be as inclusive as
possible, looking for official information for all of the synonyms relevant to
myopia. You may find it useful to refer to synonyms when accessing
databases or interacting with healthcare professionals and medical librarians.
Moving Forward
Since the 1980s, the world has seen a proliferation of healthcare guides
covering most illnesses. Some are written by patients or their family
members. These generally take a layperson's approach to understanding and
coping with an illness or disorder. They can be uplifting, encouraging, and
highly supportive. Other guides are authored by physicians or other
healthcare providers who have a more clinical outlook. Each of these two
styles of guide has its purpose and can be quite useful.
As editors, we have chosen a third route. We have chosen to expose you to
as many sources of official and peer-reviewed information as practical, for
the purpose of educating you about basic and advanced knowledge as
recognized by medical science today. You can think of this sourcebook as
your personal Internet age reference librarian.
Why ?Internet age?? All too often, patients diagnosed with myopia will log
on to the Internet, type words into a search engine, and receive several Web
site listings which are mostly irrelevant or redundant. These patients are left
to wonder where the relevant information is, and how to obtain it. Since only
the smallest fraction of information dealing with myopia is even indexed in
4 This list is based on the official version of the World Health Organization's 9th Revision,
International Classification of Diseases (ICD-9). According to the National Technical
Information Service, ?ICD-9CM extensions, interpretations, modifications, addenda, or
errata other than those approved by the U.S. Public Health Service and the Health Care
Financing Administration are not to be considered official and should not be utilized.
Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.?
Introduction
5
search engines, a non-systematic approach often leads to frustration and
disappointment. With this sourcebook, we hope to direct you to the
information you need that you would not likely find using popular Web
directories. Beyond Web listings, in many cases we will reproduce brief
summaries or abstracts of available reference materials. These abstracts often
contain distilled information on topics of discussion.
While we focus on the more scientific aspects of myopia, there is, of course,
the emotional side to consider. Later in the sourcebook, we provide a chapter
dedicated to helping you find peer groups and associations that can provide
additional support beyond research produced by medical science. We hope
that the choices we have made give you the most options available in
moving forward. In this way, we wish you the best in your efforts to
incorporate this educational approach into your treatment plan.
The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I
Part I has been edited to give you access to what we feel are ?the essentials?
on myopia. The essentials of a disease typically include the definition or
description of the disease, a discussion of who it affects, the signs or
symptoms associated with the disease, tests or diagnostic procedures that
might be specific to the disease, and treatments for the disease. Your doctor
or healthcare provider may have already explained the essentials of myopia
to you or even given you a pamphlet or brochure describing myopia. Now
you are searching for more in-depth information. As editors, we have
decided, nevertheless, to include a discussion on where to find essential
information that can complement what your doctor has already told you. In
this section we recommend a process, not a particular Web site or reference
book. The process ensures that, as you search the Web, you gain background
information in such a way as to maximize your understanding.
Guidelines
9
CHAPTER 1. THE ESSENTIALS ON MYOPIA: GUIDELINES
Overview
Official agencies, as well as federally-funded institutions supported by
national grants, frequently publish a variety of guidelines on myopia. These
are typically called ?Fact Sheets? or ?Guidelines.? They can take the form of
a brochure, information kit, pamphlet, or flyer. Often they are only a few
pages in length. The great advantage of guidelines over other sources is that
they are often written with the patient in mind. Since new guidelines on
myopia can appear at any moment and be published by a number of sources,
the best approach to finding guidelines is to systematically scan the Internetbased services that post them.
The National Institutes of Health (NIH)5
The National Institutes of Health (NIH) is the first place to search for
relatively current patient guidelines and fact sheets on myopia. Originally
founded in 1887, the NIH is one of the world's foremost medical research
centers and the federal focal point for medical research in the United States.
At any given time, the NIH supports some 35,000 research grants at
universities, medical schools, and other research and training institutions,
both nationally and internationally. The rosters of those who have conducted
research or who have received NIH support over the years include the
world's most illustrious scientists and physicians. Among them are 97
scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Myopia
There is no guarantee that any one Institute will have a guideline on a
specific disease, though the National Institutes of Health collectively publish
over 600 guidelines for both common and rare diseases. The best way to
access NIH guidelines is via the Internet. Although the NIH is organized into
many different Institutes and Offices, the following is a list of key Web sites
where you are most likely to find NIH clinical guidelines and publications
dealing with myopia and associated conditions:
�
Office of the Director (OD); guidelines consolidated across agencies
available at http://www.nih.gov/health/consumer/conkey.htm
�
National Eye Institute (NEI); guidelines available at
http://www.nei.nih.gov/publications/publications.htm
�
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M.,
Inc.) with guidelines available at
http://www.nlm.nih.gov/medlineplus/healthtopics.html
Among those listed above, the National Eye Institute is especially
noteworthy. Established by Congress in 1968 to protect and prolong the
vision of the American people, the National Eye Institute (NEI), one of the
Federal government's National Institutes of Health (NIH), conducts and
supports research that helps prevent and treat eye diseases and other
disorders of vision.6 Vision research is supported by the NEI through
approximately 1600 research grants and training awards made to scientists at
more than 250 medical centers, hospitals, universities, and other institutions
across the country and around the world. The NEI also conducts laboratory
and patient-oriented research at its own facilities located on the NIH campus
in Bethesda, Maryland. This research leads to sight-saving treatments,
reduces visual impairment and blindness, and improves the quality of life
for people of all ages. NEI-supported research has advanced our knowledge
of how the eye functions in health and disease. Another part of the NEI
mission is to conduct public and professional education programs that help
prevent blindness, reduce visual impairment, and increase awareness of
services and devices that are available for people with low vision.
Throughout the sourcebook, some of the text has been ?adapted? from various official or
governmental sources. Adapted signifies ?reproduced? or ?reproduced with minor editorial
adjustments.?
This
paragraph
has
been
adapted
from
the
NEI:
http://www.nei.nih.gov/about/mission.htm; the NEI has also established the National Eye
Health Education Program (NEHEP), a partnership of about 60 professional, civic, and
voluntary organizations and government agencies concerned with eye health. The program
represents a natural extension of the NEI's support of vision research -- a final step in the
research continuum, where results are disseminated to health professionals, patients, and
the public. Other NEI public education activities include a traveling exhibit, which have
been viewed by more than 3.8 million people nationwide; and a school curriculum on vision
for grades 4-8.
6
Guidelines 11
The National Institutes of Health has recently published the following
guideline for myopia:
What Is the Cornea?7
The cornea is the eye's outermost layer. It is the clear, dome-shaped surface
that covers the front of the eye.
Although the cornea is clear and seems to lack substance, it is actually a
highly organized group of cells and proteins. Unlike most tissues in the
body, the cornea contains no blood vessels to nourish or protect it against
infection. Instead, the cornea receives its nourishment from the tears and
aqueous humor that fills the chamber behind it. The cornea must remain
transparent to refract light properly, and the presence of even the tiniest
blood vessels can interfere with this process. To see well, all layers of the
cornea must be free of any cloudy or opaque areas.
The corneal tissue is arranged in five basic layers, each having an important
function. These five layers are:
�
Epithelium - The epithelium is the cornea's outermost region, comprising
about 10 percent of the tissue's thickness. The epithelium functions
primarily to: (1) Block the passage of foreign material, such as dust,
Adapted from the National Eye Institute:
http://www.nei.nih.gov/health/cornealdisease/index.htm.
7
12 Myopia
water, and bacteria, into the eye and other layers of the cornea; and (2)
Provide a smooth surface that absorbs oxygen and cell nutrients from
tears, then distributes these nutrients to the rest of the cornea. The
epithelium is filled with thousands of tiny nerve endings that make the
cornea extremely sensitive to pain when rubbed or scratched. The part of
the epithelium that serves as the foundation on which the epithelial cells
anchor and organize themselves is called the basement membrane.
�
Bowman's Layer - Lying directly below the basement membrane of the
epithelium is a transparent sheet of tissue known as Bowman's layer. It is
composed of strong layered protein fibers called collagen. Once injured,
Bowman's layer can form a scar as it heals. If these scars are large and
centrally located, some vision loss can occur.
�
Stroma - Beneath Bowman's layer is the stroma, which comprises about
90 percent of the cornea's thickness. It consists primarily of water (78
percent) and collagen (16 percent), and does not contain any blood
vessels. Collagen gives the cornea its strength, elasticity, and form. The
collagen's unique shape, arrangement, and spacing are essential in
producing the cornea's light-conducting transparency.
�
Descemet's Membrane - Under the stroma is Descemet's membrane, a
thin but strong sheet of tissue that serves as a protective barrier against
infection and injuries. Descemet's membrane is composed of collagen
fibers (different from those of the stroma) and is made by the endothelial
cells that lie below it. Descemet's membrane is regenerated readily after
injury.
�
Endothelium - The endothelium is the extremely thin, innermost layer of
the cornea. Endothelial cells are essential in keeping the cornea clear.
Normally, fluid leaks slowly from inside the eye into the middle corneal
layer (stroma). The endothelium's primary task is to pump this excess
fluid out of the stroma. Without this pumping action, the stroma would
swell with water, become hazy, and ultimately opaque. In a healthy eye,
a perfect balance is maintained between the fluid moving into the cornea
and fluid being pumped out of the cornea. Once endothelium cells are
destroyed by disease or trauma, they are lost forever. If too many
endothelial cells are destroyed, corneal edema and blindness ensue, with
corneal transplantation the only available therapy.
Guidelines 13
What Is the Function of the Cornea?
Because the cornea is as smooth and clear as glass but is strong and durable,
it helps the eye in two ways:
�
It helps to shield the rest of the eye from germs, dust, and other harmful
matter. The cornea shares this protective task with the eyelids, the eye
socket, tears, and the sclera, or white part of the eye.
�
The cornea acts as the eye's outermost lens. It functions like a window
that controls and focuses the entry of light into the eye. The cornea
contributes between 65-75 percent of the eye's total focusing power.
When light strikes the cornea, it bends--or refracts--the incoming light onto
the lens. The lens further refocuses that light onto the retina, a layer of light
sensing cells lining the back of the eye that starts the translation of light into
vision. For you to see clearly, light rays must be focused by the cornea and
lens to fall precisely on the retina. The retina converts the light rays into
impulses that are sent through the optic nerve to the brain, which interprets
them as images.
The refractive process is similar to the way a camera takes a picture. The
cornea and lens in the eye act as the camera lens. The retina is similar to the
film. If the image is not focused properly, the film (or retina) receives a
blurry image.
The cornea also serves as a filter, screening out some of the most damaging
ultraviolet (UV) wavelengths in sunlight. Without this protection, the lens
and the retina would be highly susceptible to injury from UV radiation.
What Are Refractive Errors?
About 120 million people in the United States wear eyeglasses or contact
lenses to correct nearsightedness, farsightedness, or astigmatism. These
vision disorders--called refractive errors-- affect the cornea and are the most
common of all vision problems in this country. Refractive errors occur when
the curve of the cornea is irregularly shaped (too steep or too flat). When the
cornea is of normal shape and curvature, it bends, or refracts, light on the
retina with precision. However, when the curve of the cornea is irregularly
shaped, the cornea bends light imperfectly on the retina. This affects good
vision. The refractive process is similar to the way a camera takes a picture.
The cornea and lens in your eye act as the camera lens. The retina is similar
14 Myopia
to the film. If the image is not focused properly, the film (or retina) receives a
blurry image. The image that your retina ?sees? then goes to your brain,
which tells you what the image is.
What Is Myopia?
When the cornea is curved too much, or if the eye is too long, faraway
objects will appear blurry because they are focused in front of the retina. This
is called myopia, or nearsightedness. Myopia affects over 25 percent of all
adult Americans.8
Two-thirds of Americans with myopia also have astigmatism. Astigmatism
is a condition in which the uneven curvature of the cornea blurs and distorts
both distant and near objects. A normal cornea is round, with even curves
from side to side and top to bottom. With astigmatism, the cornea is shaped
more like the back of a spoon, curved more in one direction than in another.
This causes light rays to have more than one focal point and focus on two
separate areas of the retina, distorting the visual image.
How Is Myopia Treated?
Myopia is frequently corrected by concave-lensed eyeglasses or with contact
lenses for older children and adults. Although these are safe and effective
methods for treating refractive errors, refractive surgeries are becoming an
increasingly popular option for some patients.
LASIK eye surgery, in particular, has become an option for patients with
myopia. The United States Food and Drug Administration (FDA) is the
official government agency that approves medical devices and procedures.
Before undergoing LASIK eye surgery, you should consider the following
discussion prepared by the FDA.
8 Hyperopia, or farsightedness, is the opposite of myopia. Distant objects are clear, and
close-up objects appear blurry. With hyperopia, images focus on a point beyond the retina.
Hyperopia results from an eye that is too short.
Guidelines 15
What Is LASIK?9
LASIK is a surgical procedure intended to reduce a person's dependency on
glasses or contact lenses. LASIK stands for Laser-Assisted In Situ
Keratomileusis and is a procedure that permanently changes the shape of the
cornea, the clear covering of the front of the eye, using an excimer laser. A
knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left
at one end of this flap. The flap is folded back revealing the stroma, the
middlesection of the cornea. Pulses from a computer-controlled laser
vaporize a portion of the stroma and the flap is replaced.
The Eye and Vision Errors
The cornea is a part of the eye that helps focus light to create an image on the
retina. It works in much the same way that the lens of a camera focuses light
to create an image on film. The bending and focusing of light is also known
as refraction. Usually the shape of the cornea and the eye are not perfect and
the image on the retina is out-of-focus (blurred) or distorted. These
imperfections in the focusing power of the eye are called refractive errors.
There are three primary types of refractive errors: myopia, hyperopia and
astigmatism. Persons with myopia, or nearsightedness, have more difficulty
seeing distant objects as clearly as near objects. Persons with hyperopia, or
farsightedness, have more difficulty seeing near objects as clearly as distant
objects. Astigmatism is a distortion of the image on the retina caused by
irregularities in the cornea or lens of the eye. Combinations of myopia and
astigmatism or hyperopia and astigmatism are common. Glasses or contact
lenses are designed to compensate for the eye's imperfections. Surgical
procedures aimed at improving the focusing power of the eye are called
refractive surgery. In LASIK surgery, precise and controlled removal of
9The
discussion below has been adapted from the FDA:
http://www.fda.gov/cdrh/lasik/default.htm.
16 Myopia
corneal tissue by a special laser reshapes the cornea changing its focusing
power.
Other Types of Refractive Surgery
Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other
refractive surgeries used to reshape the cornea. In RK, a very sharp knife is
used to cut slits in the cornea changing its shape. PRK was the first surgical
procedure developed to reshape the cornea, by sculpting, using a laser.
Later, LASIK was developed. The same type of laser is used for LASIK and
PRK. Often the exact same laser is used for the two types of surgery. The
major difference between the two surgeries is the way that the stroma, the
middle layer of the cornea, is exposed before it is vaporized with the laser. In
PRK, the top layer of the cornea, called the epithelium, is scraped away to
expose the stromal layer underneath. In LASIK, a flap is cut in the stromal
layer and the flap is folded back.
Another type of refractive surgery is thermokeratoplasty in which heat is
used to reshape the cornea. The source of the heat can be a laser, but it is a
different kind of laser than is used for LASIK and PRK. Other refractive
devices include corneal ring segments that are inserted into the stroma and
special contact lenses that temporarily reshape the cornea (orthokeratology).
What the FDA Regulates
In the United States, the Food and Drug Administration (FDA) regulates the
sale of medical devices such as the lasers used for LASIK. Before a medical
device can be legally sold in the U.S., the person or company that wants to
sell the device must seek approval from the FDA. To gain approval, they
must present evidence that the device is reasonably safe and effective for a
particular use, the ?indication.? Once the FDA has approved a medical
device, a doctor may decide to use that device for other indications if the
doctor feels it is in the best interest of a patient. The use of an approved
device for other than its FDA-approved indication is called ?off-label use.?
The FDA does not regulate the practice of medicine.
The FDA does not have the authority to:
�
Regulate a doctor's practice. In other words, FDA does not tell doctors
what to do when running their business or what they can or cannot tell
their patients.
Guidelines 17
�
Set the amount a doctor can charge for LASIK eye surgery.
�
?Insist? the patient information booklet from the laser manufacturer be
provided to the potential patient.
�
Make recommendations for individual doctors, clinics, or eye centers.
FDA does not maintain nor have access to any such list of doctors
performing LASIK eye surgery.
�
Conduct or provide a rating system on any medical device it regulates.
The first refractive laser systems approved by FDA were excimer lasers for
use in PRK to treat myopia and later to treat astigmatism. However, doctors
began using these lasers for LASIK (not just PRK), and to treat other
refractive errors (not just myopia). Over the last several years, LASIK has
become the main surgery doctors use to treat myopia in the United States.
More recently, some laser manufacturers have gained FDA approval for
laser systems for LASIK to treat myopia, hyperopia and astigmatism and for
PRK to treat hyperopia and astigmatism.
See the section on FDA-approved lasers for more details on which lasers
have received FDA approval and the specific indications and treatment
ranges for which they were approved.
When Is LASIK Not for Me?
You are probably NOT a good candidate for refractive surgery if:
�
You are not a risk taker. Certain complications are unavoidable in a
percentage of patients, and there are no long-term data available for
current procedures.
�
It will jeopardize your career. Some jobs prohibit certain refractive
procedures. Be sure to check with your employer/professional
society/military service before undergoing any procedure.
�
Cost is an issue. Most medical insurance will not pay for refractive
surgery. Although the cost is coming down, it is still significant.
�
You required a change in your contact lens or glasses prescription in
the past year. This is called refractive instability. Patients who are:
- In their early 20s or younger,
- Whose hormones are fluctuating due to disease such as diabetes,
- Who are pregnant or breastfeeding, or
18 Myopia
- Who are taking medications such as steroids that cause fluctuations in
vision, are more likely to have refractive instability and probably should
not have a refractive procedure.
�
You have a disease or are on medications that may affect wound
healing. Certain conditions, such as autoimmune diseases (e.g., lupus,
rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes,
and some medications (e.g., retinoic acid and steroids) may prevent
proper healing after a refractive procedure.
�
You actively participate in contact sports. You participate in boxing,
wrestling, martial arts or other activities in which blows to the face and
eyes are a normal occurrence.
�
You are not an adult. Currently, no lasers are approved for LASIK on
persons under the age of 18.
Contraindications
The safety and effectiveness of refractive procedures has not been
determined in patients with some diseases. Do NOT have LASIK surgery if
you have a history of any of the following:
�
Herpes simplex or Herpes zoster (shingles) involving the eye area.
�
Glaucoma, glaucoma suspect, or ocular hypertension.
�
Eye diseases, such as uveitis/iritis (inflammations of the eye) and
blepharitis (inflammation of the eyelids with crusting of the eyelashes).
�
Eye injuries or previous eye surgeries.
�
Keratoconus.
Other Risk Factors
Your doctor should screen you for the following conditions or indicators of
risk:
�
Large pupils. Make sure this evaluation is done in a dark room. Younger
patients and patients on certain medications may be prone to having
large pupils under dim lighting conditions. This can cause symptoms
such as glare, halos, starbursts, and ghost images (double vision) after
surgery. In some patients these symptoms may be debilitating. For
example, a patient may no longer be able to drive a car at night or in
certain weather conditions, such as fog.
Guidelines 19
�
Thin Corneas. The cornea is the thin clear covering of the eye that is over
the iris, the colored part of the eye. Most refractive procedures change the
eye?s focusing power by reshaping the cornea (for example, by removing
tissue). Performing a refractive procedure on a cornea that is too thin or
has too few cells lining the back surface (endothelial cells) may result in
blinding complications.
�
Previous refractive surgery (e.g., RK, PRK, LASIK). Additional
refractive surgery may not be recommended. The decision to have
additional refractive surgery must be made in consultation with your
doctor after careful consideration of your unique situation.
�
Dry Eyes. LASIK surgery tends to aggravate this condition.
What Are the Risks and How to Find the Right Doctor?
Most patients are very pleased with the results of their refractive surgery.
However, like any other medical procedure, there are risks involved. That's
why it is important for you to understand the limitations and possible
complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh the
risks and benefits based on your own personal value system, and try to
avoid being influenced by friends that have had the procedure or doctors
encouraging you to do so.
�
You may be undertreated or overtreated. Only a certain percent of
patients achieve 20/20 vision without glasses or contacts. You may
require additional treatment, but additional treatment may not be
possible. You may still need glasses or contact lenses after surgery. This
may be true even if you only required a very weak prescription before
surgery. If you used reading glasses before surgery, you will still need
reading glasses after surgery.
�
Results are generally not as good in patients with very small amounts
of astigmatism or very large refractive errors of any type. You should
discuss your expectations with your doctor and realize that you may still
require glasses or contacts after the surgery.
�
Results may not be lasting. The level of improved vision you experience
after surgery may be temporary, especially if you are farsighted or
currently need reading glasses. It is especially important for farsighted
individuals to have a cycloplegic refraction (a vision exam with lenses
after dilating drops) as part of the screening process. Patients whose
manifest refraction (a vision exam with lenses before dilating drops) is
20 Myopia
very different from their cycloplegic refraction are more likely to have
temporary results.
�
Some patients lose vision. Some patients lose lines of vision on the
vision chart that cannot be corrected with glasses, contact lenses, or
surgery as a result of treatment. There is little known about how
refractive procedures affect other aspects of vision, such as contrast
sensitivity (the ability to see objects clearly against a similar background
or in dim lighting conditions). Some studies suggest that patients do not
see as well in situations of low contrast, such as at night or in fog, after
treatment as compared to before treatment. Therefore, patients with low
contrast sensitivity to begin with probably should not have a refractive
procedure. It is important for you to know that not all eye centers test
contrast sensitivity, and that when it is tested, it should be done in a dark
room.
�
Some patients may develop severe dry eye syndrome. As a result of
surgery, your eye may not be able to produce enough tears to keep the
eye moist and comfortable. This condition may be permanent. Intensive
drop therapy and the use of plugs or other procedures may be required.
Additional Risks
Monovision
Monovision is one clinical technique used to deal with the correction of
presbyopia, the gradual loss of the ability of the eye to change focus for
close-up tasks that progresses with age. The intent of monovision is for the
presbyopic patient to use one eye for distance viewing and one eye for near
viewing. This practice was first applied to fit contact lens wearers and more
recently to LASIK and other refractive surgeries. With contact lenses, a
presbyopic patient has one eye fit with a contact lens to correct distance
vision, and the other eye fit with a contact lens to correct near vision. In the
same way, with LASIK, a presbyopic patient has one eye operated on to
correct the distance vision, and the other operated on to correct the near
vision. In other words, the goal of the surgery is for one eye to have vision
worse than 20/20, the commonly referred to goal for LASIK surgical
correction of distance vision. Since one eye is corrected for distance viewing
and the other eye is corrected for near viewing, the two eyes no longer work
together. This results in poorer quality vision and a decrease in depth
perception. These effects of monovision are most noticeable in low lighting
conditions and when performing tasks requiring very sharp vision.
Therefore, you may need to wear glasses or contact lenses to fully correct
Guidelines 21
both eyes for distance or near when performing visually demanding tasks,
such as driving at night, operating dangerous equipment, or performing
occupational tasks requiring very sharp close vision (e.g., reading small print
for long periods of time).
Many patients cannot get used to having one eye blurred at all times. The
difference between monovision with contact lenses and monovision with
LASIK is that you can always take contact lenses out or have them changed
(the treatment is reversible and adjustable) as opposed to LASIK, where the
result of the surgery is not reversible or adjustable. Therefore, if you are
considering monovision with LASIK, make sure you go through a trial
period with contact lenses to see if you can tolerate monovision, before
having the irreversible surgery performed on your eyes. Just before this trial
period starts, find out if you pass your state's driver's license requirements
with monovision, or if you need supplemental glasses to drive.
In addition, you should consider how much your presbyopia is expected to
increase in the future. Ask your doctor when you should expect the results of
your monovision surgery to no longer be enough for you to see near-by
objects clearly without the aid of glasses or contacts, or when a second
surgery might be required to further correct your near vision.
Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or to
have surgery on one eye at a time. Although the convenience of having
surgery on both eyes on the same day is attractive, this practice is riskier
than having two separate surgeries. The second eye may have a higher risk
of developing an inflammation if surgery is done on the same day than if
surgery is performed on separate days. If a malfunction of the laser or
microkeratome occurs causing a complication with the first eye, the second
eye is more likely to also experience the same complication if the surgery is
performed on the same day rather than on separate days.
If you decide to have one eye done at a time, you and your doctor will
decide how long to wait before having surgery on the other eye. If both eyes
are treated at the same time or before one eye has a chance to fully heal, you
and your doctor do not have the advantage of being able to see how the first
eye responds to surgery before the second eye is treated.
Another disadvantage to having surgery on both eyes at the same time is
that the vision in both eyes may be blurred after surgery until the initial
22 Myopia
healing process is over, rather than being able to rely on clear vision in at
least one eye at all times.
Finding the Right Doctor
If you are considering refractive surgery, make sure you:
�
Compare. The levels of risk and benefit vary slightly not only from
procedure to procedure, but from device to device depending on the
manufacturer, and from surgeon to surgeon depending on their level of
experience with a particular procedure.
�
Don't base your decision simply on cost and don't settle for the first eye
center, doctor, or procedure you investigate. Remember that the decisions
you make about your eyes and refractive surgery will affect you for the
rest of your life.
�
Be wary of eye centers that advertise, ?20/20 vision or your money back?
or ?package deals.? There are never any guarantees in medicine.
�
Read. It is important for you to read the patient handbook provided to
your doctor by the manufacturer of the device used to perform the
refractive procedure. Your doctor should provide you with this
handbook and be willing to discuss his/her outcomes (successes as well
as complications) compared to the results of studies outlined in the
handbook.
Even the best screened patients under the care of most skilled surgeons can
experience serious complications.
�
During surgery. Malfunction of a device or other error, such as cutting a
flap of cornea through and through instead of making a hinge during
LASIK surgery, may lead to discontinuation of the procedure or
irreversible damage to the eye.
�
After surgery. Some complications, such as migration of the flap,
inflammation or infection, may require another procedure and/or
intensive treatment with drops. Even with aggressive therapy, such
complications may lead to temporary loss of vision or even irreversible
blindness.
Guidelines 23
Under the care of an experienced doctor, carefully screened candidates with
reasonable expectations and a clear understanding of the risks and
alternatives are likely to be happy with the results of their refractive
procedure.
Advertising
Be cautious about ?slick? advertising and/or deals that sound ?too good to
be true.? Remember, they usually are. There is a lot of competition resulting
in a great deal of advertising and bidding for your business. Do your
homework.
If you want to know more about advertising ethics, do's and don'ts, or want
to report on false advertising, explore the following Web sites:
�
http://www.ftc.gov/bcp/menu-ads.htm
�
http://www.ftc.gov/bcp/menu-health.htm
What Should I Expect before, during, and after Surgery?
What to expect before, during, and after surgery will vary from doctor to
doctor and patient to patient. This section is a compilation of patient
information developed by manufacturers and healthcare professionals, but
cannot replace the dialogue you should have with your doctor. Read this
information carefully and with the checklist, discuss your expectations with
your doctor.
Before Surgery
If you decide to go ahead with LASIK surgery, you will need an initial or
baseline evaluation by your eye doctor to determine if you are a good
candidate. This is what you need to know to prepare for the exam and what
you should expect.
If you wear contact lenses, it is a good idea to stop wearing them before your
baseline evaluation and switch to wearing your glasses full-time. Contact
lenses change the shape of your cornea for up to several weeks after you
have stopped using them depending on the type of contact lenses you wear.
Not leaving your contact lenses out long enough for your cornea to assume
its natural shape before surgery can have negative consequences. These
24 Myopia
consequences include inaccurate measurements and a poor surgical plan,
resulting in poor vision after surgery. These measurements, which determine
how much corneal tissue to remove, may need to be repeated at least a week
after your initial evaluation and before surgery to make sure they have not
changed, especially if you wear RGP or hard lenses. If you wear:
�
Soft contact lenses, you should stop wearing them for 2 weeks before
your initial evaluation.
�
Toric soft lenses or rigid gas permeable (RGP) lenses, you should stop
wearing them for at least 3 weeks before your initial evaluation.
�
Hard lenses, you should stop wearing them for at least 4 weeks before
your initial evaluation.
You should tell your doctor:
�
About your past and present medical and eye conditions
�
About all the medications you are taking, including over-the-counter
medications and any medications you may be allergic to
Your doctor should perform a thorough eye exam and discuss:
�
Whether you are a good candidate
�
What the risks, benefits, and alternatives of the surgery are
�
What you should expect before, during, and after surgery
�
What your responsibilities will be before, during, and after surgery
You should have the opportunity to ask your doctor questions during this
discussion. Give yourself plenty of time to think about the risk/benefit
discussion, to review any informational literature provided by your doctor,
and to have any additional questions answered by your doctor before
deciding to go through with surgery and before signing the informed
consent form.
You should not feel pressured by your doctor, family, friends, or anyone else
to make a decision about having surgery. Carefully consider the pros and
cons.
The day before surgery, you should stop using:
�
Creams
�
Lotions
�
Makeup
Guidelines 25
�
Perfumes
These products as well as debris along the eyelashes may increase the risk of
infection during and after surgery. Your doctor may ask you to scrub your
eyelashes for a period of time before surgery to get rid of residues and debris
along the lashes.
Also before surgery, arrange for transportation to and from your surgery
and your first follow-up visit. On the day of surgery, your doctor may give
you some medicine to make you relax. Because this medicine impairs your
ability to drive and because your vision may be blurry, even if you don't
drive make sure someone can bring you home after surgery.
During Surgery
The surgery should take less than 30 minutes. You will lie on your back in a
reclining chair in an exam room containing the laser system. The laser
system includes a large machine with a microscope attached to it and a
computer screen.
A numbing drop will be placed in your eye, the area around your eye will be
cleaned, and an instrument called a lid speculum will be used to hold your
eyelids open. A ring will be placed on your eye and very high pressures will
be applied to create suction to the cornea. Your vision will dim while the
suction ring is on and you may feel the pressure and experience some
discomfort during this part of the procedure. The microkeratome, a cutting
instrument, is attached to the suction ring. Your doctor will use the blade of
the microkeratome to cut a flap in your cornea.
The microkeratome and the suction ring are then removed. You will be able
to see, but you will experience fluctuating degrees of blurred vision during
the rest of the procedure. The doctor will then lift the flap and fold it back on
its hinge, and dry the exposed tissue.
The laser will be positioned over your eye and you will be asked to stare at a
light. This is not the laser used to remove tissue from the cornea. This light is
to help you keep your eye fixed on one spot once the laser comes on. NOTE:
If you cannot stare at a fixed object for at least 60 seconds, you may not be a
good candidate for this surgery.
When your eye is in the correct position, your doctor will start the laser. At
this point in the surgery, you may become aware of new sounds and smells.
26 Myopia
The pulse of the laser makes a ticking sound. As the laser removes corneal
tissue, some people have reported a smell similar to burning hair. A
computer controls the amount of laser delivered to your eye. Before the start
of surgery, your doctor will have programmed the computer to vaporize a
particular amount of tissue based on the measurements taken at your initial
evaluation. After the pulses of laser energy vaporize the corneal tissue, the
flap is put back into position.
A shield should be placed over your eye at the end of the procedure as
protection, since no stitches are used to hold the flap in place. It is important
for you to wear this shield to prevent you from rubbing your eye and
putting pressure on your eye while you sleep, and to protect your eye from
accidentally being hit or poked until the flap has healed.
After Surgery
Immediately after the procedure, your eye may burn, itch, or feel like there is
something in it. You may experience some discomfort, or in some cases, mild
pain and your doctor may suggest you take a mild pain reliever. Both your
eyes may tear or water. Your vision will probably be hazy or blurry. You will
instinctively want to rub your eye, but don't! Rubbing your eye could
dislodge the flap, requiring further treatment. In addition, you may
experience sensitivity to light, glare, starbursts or haloes around lights, or the
whites of your eye may look red or bloodshot. These symptoms should
improve considerably within the first few days after surgery. You should
plan on taking a few days off from work until these symptoms subside. You
should contact your doctor immediately and not wait for your scheduled
visit, if you experience severe pain, or if your vision or other symptoms get
worse instead of better.
You should see your doctor within the first 24 to 48 hours after surgery and
at regular intervals after that for at least the first six months. At the first
postoperative visit, your doctor will remove the eye shield, test your vision,
and examine your eye. Your doctor may give you one or more types of eye
drops to take at home to help prevent infection and/or inflammation. You
may also be advised to use artificial tears to help lubricate the eye. Do not
resume wearing a contact lens in the operated eye, even if your vision is
blurry.
You should wait one to three days following surgery before beginning any
non-contact sports, depending on the amount of activity required, how you
feel, and your doctor's instructions.
Guidelines 27
To help prevent infection, you may need to wait for up to two weeks after
surgery or until your doctor advises you otherwise before using lotions,
creams, or make-up around the eye. Your doctor may advise you to continue
scrubbing your eyelashes for a period of time after surgery. You should also
avoid swimming and using hot tubs or whirlpools for 1-2 months.
Strenuous contact sports such as boxing, football, karate, etc. should not be
attempted for at least four weeks after surgery. It is important to protect
your eyes from anything that might get in them and from being hit or
bumped.
During the first few months after surgery, your vision may fluctuate:
�
It may take up to three to six months for your vision to stabilize after
surgery.
�
Glare, haloes, difficulty driving at night, and other visual symptoms may
also persist during this stabilization period. If further correction or
enhancement is necessary, you should wait until your eye measurements
are consistent for two consecutive visits at least 3 months apart before reoperation.
�
It is important to realize that although distance vision may improve after
re-operation, it is unlikely that other visual symptoms such as glare or
haloes will improve.
�
It is also important to note that no laser company has presented enough
evidence for the FDA to make conclusions about the safety or
effectiveness of enhancement surgery.
Contact your eye doctor immediately, if you develop any new, unusual or
worsening symptoms at any point after surgery. Such symptoms could
signal a problem that, if not treated early enough, may lead to a loss of
vision.
LASIK Surgery Checklist
Know what makes you a poor candidate:
�
Career impact - does your job prohibit refractive surgery?
�
Cost - can you really afford this procedure?
�
Medical conditions - e.g., do you have an autoimmune disease or other
major illness? Do you have a chronic illness that might slow or alter
healing?
28 Myopia
�
Eye conditions - do you have or have you ever had any problems with
your eyes other than needing glasses or contacts?
�
Medications - do you take steroids or other drugs that might prevent
healing?
�
Stable refraction - has your prescription changed in the last year?
�
High or low refractive error - do you use glasses/contacts only some of
the time? Do you need an unusually strong prescription?
�
Pupil size - are your pupils extra large in dim conditions?
�
Corneal thickness - do you have thin corneas?
Know all the risks and procedure limitations:
�
Overtreatment or undertreatment - are you willing and able to have
more than one surgery to get the desired result?
�
May still need reading glasses - do you have presbyopia?
�
Results may not be lasting - do you think this is the last correction you
will ever need? Do you realize that long-term results are not known?
�
May permanently lose vision - do you know some patients may lose
some vision or experience blindness?
�
Development of visual symptoms - do you know about glare, halos,
starbursts, etc. and that night driving might be difficult?
�
Contrast sensitivity - do you know your vision could be significantly
reduced in dim light conditions?
�
Bilateral treatment - do you know the additional risks of having both
eyes treated at the same time?
�
Patient information - have you read the patient information booklet
about the laser being used for your procedure?
Know how to find the right doctor:
�
Experienced - how many eyes has your doctor performed LASIK surgery
on with the same laser?
�
Equipment - does your doctor use an FDA-approved laser for the
procedure you need?
�
Informative - is your doctor willing to spend the time to answer all your
questions?
Guidelines 29
�
Long-term Care - does your doctor encourage follow-up and
management of you as a patient? Your preop and postop care may be
provided by a doctor other than the surgeon.
�
Be Comfortable - do you feel you know your doctor and are comfortable
with an equal exchange of information?
Know preoperative, operative, and postoperative expectations:
�
No contact lenses prior to evaluation and surgery - can you go for an
extended period of time without wearing contact lenses?
�
Have a thorough exam - have you arranged not to drive or work after the
exam?
�
Read and understand the informed consent - has your doctor given you
an informed consent form to take home and answered all your questions?
�
No makeup before surgery - can you go 24-36 hours without makeup
prior to surgery?
�
Arrange for transportation - can someone drive you home after surgery?
�
Plan to take a few days to recover - can you take time off to take it easy
for a couple of days if necessary?
�
Expect not to see clearly for a few days - do you know you will not see
clearly immediately?
�
Know sights, smells, sounds of surgery - has your doctor made you feel
comfortable with the actual steps of the procedure?
�
Be prepared to take drops/medications- are you willing and able to put
drops in your eyes at regular intervals?
�
Be prepared to wear an eye shield - do you know you need to protect the
eye for a period of time after surgery to avoid injury?
�
Expect some pain/discomfort - do you know how much pain to expect?
�
Know when to seek help - do you understand what problems could
occur and when to seek medical intervention?
�
Know when to expect your vision to stop changing - are you aware that
final results could take months?
�
Make sure your refraction is stable before any further surgery - if you
don't get the desired result, do you know not to have an enhancement
until the prescription stops changing?
30 Myopia
FDA-Approved Lasers for LASIK
Company and
model
Approval
number and
date
Autonomous
Technology
- LADARVision
Patient information
P970043/S5
5/9/00
Myopia less than -9.0D with or
without astigmatism from -0.5 to 3.0D
Bausch & Lomb
Surgical
- Technolas 217a
Patient booklet
(PDF)
P990027
2/23/00
Myopia from -1.0 to -7.0D with or
without astigmatism less than -3.0D
Dishler
P970049
12/16/99
Myopia from -0.5 to -13.0D with or
without astigmatism between -0.5 to 4.0D
Kremer
P970005
7/30/98
Myopia from -1.0 to -15.0D with or
without astigmatism less then -5.0D
Nidek
- EC5000
P970053/S2
4/14/00
Myopia from -1.0 to -14.0D with or
without astigmatism less than 4.0D
Summit
- Apex Plus
P930034/S13 Myopia less than -14.0D with or
10/21/99
without astigmatism from 0.5 to 5.0D
Summit
Autonomous
- LADARVision
P970043/S7
9/22/00
VISX
- Star S2 & S3
P930016/S12 Hyperopia between +0.5 and +5.0D
4/27/01
with or without astigmatism up to
+3.0D
VISX
- Star S2
P990010
11/19/99
Myopia less than -14.0D with or
without astigmatism between -0.5
and -5.0D
VISX
- Star S3
(EyeTracker)
P990010/S1
4/20/00
Same as S2, except with eye tracker
Approved indications
(D = diopters)
Hyperopia less than 6.0D with or
without astigmatism less than -6.0D
Guidelines 31
FDA-Approved Lasers for PRK and Other Refractive Surgeries
Company and model
Approval
number and
date
Approved indications
(D = diopters)
Autonomous Technology
- LADARVision
P970043
11/2/98
PRK; Myopia from -1.0 to -10.0D
with or without astigmatism less
than -4.0D
Bausch & Lomb Surgical
- KERACOR 116
P970056
9/28/99
PRK; Myopia from -1.5 to -7.0D
with or without astigmatism less
than -4.5D
LaserSight
- LaserScan LSX
P980008
11/12/99
PRK; Myopia from -1.0 to -6.0D
with or without astigmatism less
than 1.0D
Nidek
- EC5000
P970053
12/17/98
PRK; Myopia from -0.75 to -13.0D
Nidek
- EC5000
P970053/S1
9/29/99
PRK; Myopia from -1.0 to -8.0D
with or without astigmatism from
-0.5 to -4.0D
Summit
- Apex & Apex Plus
P930034
10/25/95
PRK; Myopia from -1.5 to -7.0D
Summit
- Apex Plus
P930034/S9
3/11/98
PRK; Myopia from -1.0 to -6.0D
with or without astigmatism from
-1.0 to -4.0D
Summit
- Apex Plus
P930034/S12
10/21/99
PRK; Hyperopia from +1.5 to
+4.0D with or without
astigmatism less than -1.0D
Summit Autonomous
- LADARVision
P970043/S8
7/11/00
Name Change Only
Sunrise
- Hyperion
P990078
6/30/00
Laser Thermokeratoplasty (LTK);
Hyperopia from +0.75 to +2.5D
with or without astigmatism less
than 0.75D
32 Myopia
VISX
- Model B & C (Star & Star
S2)
P930016
3/27/96
PRK; Myopia from 0 to -6.0D
VISX
- Model B & C (Star & Star
S2)
P930016/S3
4/24/97
PRK; Myopia from 0 to -6.0D with
or without astigmatism from -0.75
to -4.0D
VISX
- Model B & C (Star & Star
S2)
P930016/S5
1/29/98
PRK; Myopia from 0 to -12.0D
with or without astigmatism from
0 to -4.0D
VISX
- Star S2
P930016/S7
11/2/98
PRK; Hyperopia from +1.0 to
+6.0D
VISX
- Star S2 & S3
P930016/S10
10/18/00
PRK; Hyperopia from +0.5 to
+5.0D with or without
astigmatism +0.5 to +4.0D
VISX
- Star S2 & S3
P930016/S13
3/19/01
Add myopia blend zone; increase
overall ablation zone from 6.5 to
8.0mm
Other Resources10
Links to non-Federal organizations are provided solely as a service to our
users. These links do not constitute an endorsement of these organizations or
their programs by FDA or the federal government. FDA is not responsible
for the content of the Web pages found at these links.
FDA Web Resources
Food and Drug Administration
5600 Fishers Lane (HFE-88)
Rockville, MD 20852
Toll free: 1-888-463-6332
Telephone: (301) 827-4420
www.fda.gov
This section includes information from the FDA:
http://www.ftc.gov/bcp/conline/pubs/health/lasik.htm.
10
Guidelines 33
The FDA oversees the safety of food, cosmetics, medicines, medical
devices, and radiation- emitting products and provides information on
contact lenses, intraocular lenses, refractive surgery, and corneal implants
for myopia.
Additional web resources from the FDA include:
�
FDA CDRH documents regarding Manufacturers and Users of Lasers for
Refractive Surgery; http://www.fda.gov/cdrh/ode/laser.html
�
CDRH directory of contacts for consumer and manufacturer calls;
http://www.fda.gov/cdrh/dsma/dsmastaf.html
�
FDA web site for general consumer information on medical devices and
radiation-emitting
products;
http://www.fda.gov/cdrh/consumer/index.shtml
�
The FDA MEDWATCH site: Safety information on drugs and other
medical products; http://www.fda.gov/medwatch
Web Sites of Professional Opthalmology Societies
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
www.eyenet.org
The AAO works to advance the lifelong learning and professional
interests of ophthalmologists to ensure that the public can obtain the best
possible eye care.
American Society of Cataract and Refractive Surgery
4000 Legato Road, Suite 850
Fairfax, VA 22033
www.ascrs.org
The ASCRS works to raise the standards and skills of anterior segment
surgeons through clinical and practice management education. The
Society also works with patients, government and the medical
community to promote delivery of quality eye care.
International Society of Refractive Surgery
1180 Springs Centre So. Blvd. #116
Altamonte Springs, FL
www.LocateAnEyeDoc.com
The ISRS provides scientific research, knowledge and information to all
individuals who are interested in refractive surgery.
34 Myopia
National Eye Institute
31 Center Drive MSC 2510
Bethesda, MD 20892-2510
301-496-5248
www.nei.nih.gov
The NEI conducts and supports research on eye diseases and vision
disorders, and offers free publications for the general public and patients.
Other Links
�
Hardin MD list of eye diseases & other opthalmological topics:
http://www.lib.uiowa.edu/hardin/md/ophth.html
�
Basic information from the United States Federal Trade Commission
about LASIK surgery:
http://www.ftc.gov/bcp/conline/pubs/health/lasik.htm
More Guideline Sources
The guideline above on myopia is only one example of the kind of material
that you can find online and free of charge. The remainder of this chapter
will direct you to other sources which either publish or can help you find
additional guidelines on topics related to myopia. Many of the guidelines
listed below address topics that may be of particular relevance to your
specific situation or of special interest to only some patients with myopia.
Due to space limitations these sources are listed in a concise manner. Do not
hesitate to consult the following sources by either using the Internet
hyperlink provided, or, in cases where the contact information is provided,
contacting the publisher or author directly.
Topic Pages: MEDLINEplus
For patients wishing to go beyond guidelines published by specific Institutes
of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this
Internet-based system are ?health topic pages.? You can think of a health
topic page as a guide to patient guides. To access this system, log on to
http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you
can either search using the alphabetical index or browse by broad topic
areas.
Guidelines 35
If you do not find topics of interest when browsing health topic pages, then
you can choose to use the advanced search utility of MEDLINEplus at the
following:http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This
utility is similar to the NIH Search Utility, with the exception that it only
includes material linked within the MEDLINEplus system (mostly patientoriented information). It also has the disadvantage of generating
unstructured results. We recommend, therefore, that you use this method
only if you have a very targeted search.
The National Guideline Clearinghouse?
The National Guideline Clearinghouse? offers hundreds of evidence-based
clinical practice guidelines published in the United States and other
countries. You can search their site located at http://www.guideline.gov by
using the keyword ?myopia? or synonyms. The following was recently
posted:
�
Care of the patient with myopia.
Source: American Optometric Association.; 1997 (reviewed 2001); 75
pages
http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00
1224&sSearch_string=myopia
Healthfinder?
Healthfinder? is an additional source sponsored by the U.S. Department of
Health and Human Services which offers links to hundreds of other sites that
contain healthcare information. This Web site is located at
http://www.healthfinder.gov. Again, keyword searches can be used to find
guidelines. The following was recently found in this database:
�
FAQ - About LASIK
Summary: Answers to commonly asked questions about LASIK -- a
surgical procedure used in correcting a wide range of nearsightedness
(myopia), farsightedness (hyperopia) and astigmatism.
Source: LASIK Institute
http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R
ecordID=5299
36 Myopia
�
LASIK Glossary of Terms
Summary: Definitions of medical terms commonly used in eye diseases
treatments and procedures, specifically LASIK -- a surgical procedure
used in correcting a wide range of nearsightedness (myopia),
Source: LASIK Institute
http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R
ecordID=5301
�
LASIK Risk & Complications
Summary: Information that provides patients with an understanding of
the risks and complications of LASIK -- a surgical procedure used in
correcting a wide range of nearsightedness (myopia), farsightedness
Source: LASIK Institute
http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R
ecordID=5300
�
Tips on Selecting a Surgeon for the LASIK Procedure
Summary: This web site presents criteria and suggested reading that will
help you select a surgeon to perform the LASIK procedure -- surgery
used in correcting a wide range of nearsightedness (myopia),
Source: LASIK Institute
http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R
ecordID=5302
The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you
may want to explore the NIH Search Utility. This allows you to search for
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is ?crawled? and indexed on an ongoing basis.
Your search will produce a list of various documents, all of which will relate
in some way to myopia. The drawbacks of this approach are that the
information is not organized by theme and that the references are often a
mix of information for professionals and patients. Nevertheless, a large
number of the listed Web sites provide useful background information. We
can only recommend this route, therefore, for relatively rare or specific
disorders, or when using highly targeted searches. To use the NIH search
utility, visit the following Web page: http://search.nih.gov/index.html.
Guidelines 37
Additional Web Sources
A number of Web sites that often link to government sites are available to
the public. These can also point you in the direction of essential information.
The following is a representative sample:
�
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
�
drkoop.com� http://www.drkoop.com/conditions/ency/index.html
�
Family Village: http://www.familyvillage.wisc.edu/specific.htm
�
Google:
http://directory.google.com/Top/Health/Conditions_and_Diseases/
�
Med Help International: http://www.medhelp.org/HealthTopics/A.html
�
Open Directory Project:
http://dmoz.org/Health/Conditions_and_Diseases/
�
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
�
WebMD襀ealth: http://my.webmd.com/health_topics
Vocabulary Builder
The material in this chapter may have contained a number of unfamiliar
words. The following Vocabulary Builder introduces you to terms used in
this chapter that have not been covered in the previous chapter:
Aqueous: Watery; prepared with water. [EU]
Astigmatism: A condition in which the surface of the cornea is not spherical;
causes a blurred image to be received at the retina. [NIH]
Bacteria: Unicellular prokaryotic microorganisms which generally possess
rigid cell walls, multiply by cell division, and exhibit three principal forms:
round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH]
Bilateral: Having two sides, or pertaining to both sides. [EU]
Blepharitis: Inflammation of the eyelids. [EU]
Cataract: An opacity, partial or complete, of one or both eyes, on or in the
lens or capsule, especially an opacity impairing vision or causing blindness.
The many kinds of cataract are classified by their morphology (size, shape,
location) or etiology (cause and time of occurrence). [EU]
Chronic: Persisting over a long period of time. [EU]
38 Myopia
Collagen: The protein substance of the white fibres (collagenous fibres) of
skin, tendon, bone, cartilage, and all other connective tissue; composed of
molecules of tropocollagen (q.v.), it is converted into gelatin by boiling.
collagenous pertaining to collagen; forming or producing collagen. [EU]
Cornea: The outer, transparent, dome-like structure that covers the iris,
pupil, and anterior chamber; part of eye's focusing system. [NIH]
Diopter: The measurement of refractive error. A negative diopter value
signifies an eye with myopia and positive diopter value signifies an eye with
hyperopia. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular
spaces, most commonly present in subcutaneous tissue. [NIH]
Elasticity: Resistance and recovery from distortion of shape. [NIH]
Endothelium: The inner layer of cells on the inside surface of the cornea.
[NIH]
Epithelium: The outermost layer of cells of the cornea and the eye's first
defense against infection. [NIH]
Farsightedness: The common term for hyperopia. [NIH]
Glare: Scatter from bright light that decreases vision. [NIH]
Halos: Rings around lights due to optical imperfections in or in front of the
eye. [NIH]
Herpes: Any inflammatory skin disease caused by a herpesvirus and
characterized by the formation of clusters of small vesicles. When used
alone, the term may refer to herpes simplex or to herpes zoster. [EU]
Hormones: Chemical substances having a specific regulatory effect on the
activity of a certain organ or organs. The term was originally applied to
substances secreted by various endocrine glands and transported in the
bloodstream to the target organs. It is sometimes extended to include those
substances that are not produced by the endocrine glands but that have
similar effects. [NIH]
Hyperopia: Farsightedness; ability to see distant objects more clearly than
close objects; may be corrected with glasses or contact lenses. [NIH]
Hypertension: Persistently high arterial blood pressure. Various criteria for
its threshold have been suggested, ranging from 140 mm. Hg systolic and 90
mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg
diastolic. Hypertension may have no known cause (essential or idiopathic h.)
or be associated with other primary diseases (secondary h.). [EU]
Inflammation: The body's reaction to trauma, infection, or a foreign
substance, often associated with pain, heat, redness, swelling, and/or loss of
function. [NIH]
Guidelines 39
Intraocular: Within the eye. [EU]
Iris: The colored ring of tissue suspended behind the cornea and
immediately in front of the lens; regulates the amount of light entering the
eye by adjusting the size of the pupil. [NIH]
Iritis: Inflammation of the iris, usually marked by pain, congestion in the
ciliary region, photophobia, contraction of the pupil, and discoloration of the
iris. [EU]
Keratectomy: The surgical removal of corneal tissue. [NIH]
Keratoconus: A disorder characterized by an irregular corneal surface
(cone-shaped) resulting in blurred and distorted images. [NIH]
Keratomileusis: Carving of the cornea to reshape it. [NIH]
Keratotomy: A surgical incision (cut) of the cornea. [NIH]
LASIK: The acronym for laser assisted in situ keratomileusis which refers to
creating a flap in the cornea with a microkeratome and using a laser to
reshape the underlying cornea. [NIH]
Lens: The transparent, double convex (outward curve on both sides)
structure suspended between the aqueous and vitreous; helps to focus light
on the retina. [NIH]
Lupus: A form of cutaneous tuberculosis. It is seen predominantly in
women and typically involves the nasal, buccal, and conjunctival mucosa.
[NIH]
Manifest: Being the part or aspect of a phenomenon that is directly
observable : concretely expressed in behaviour. [EU]
Membrane: A thin layer of tissue which covers a surface, lines a cavity or
divides a space or organ. [EU]
Microkeratome: A surgical device that is affixed to the eye by use of a
vacuum ring. When secured, a very sharp blade cuts a layer of the cornea at
a predetermined depth. [NIH]
Monovision: The purposeful adjustment of one eye for near vision and the
other eye fordistance vision. [NIH]
Myopia: Nearsightedness; ability to see close objects more clearly than
distant objects; may be corrected with glasses or contact lenses. [NIH]
Nearsightedness: The common term for myopia. [NIH]
Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU]
Ophthalmologist: A medical doctor specializing in the diagnosis and
medical or surgical treatment of visual disorders and eye disease. [NIH]
Ophthalmology: A surgical specialty concerned with the structure and
function of the eye and the medical and surgical treatment of its defects and
40 Myopia
diseases. [NIH]
Optic: Of or pertaining to the eye. [EU]
Postoperative: Occurring after a surgical operation. [EU]
Preoperative: Preceding an operation. [EU]
Presbyopia:
The gradual loss of the eye's ability to change focus
(accommodation) for seeing near objects caused by the lens becoming less
elastic; associated with aging; occurs in almost all people over age 45. [NIH]
PRK: The acronym for photorefractive keratectomy which is a procedure
involving the removal of the surface layer of the cornea (epithelium) by
gentle scraping and use of a computer-controlled excimer laser to reshape
the stroma. [NIH]
Proteins: Polymers of amino acids linked by peptide bonds. The specific
sequence of amino acids determines the shape and function of the protein.
[NIH]
Pupil: The adjustable opening at the center of the iris that allows varying
amounts of light to enter the eye. [NIH]
Refraction: A test to determine the best eyeglasses or contact lenses to
correct a refractive error (myopia, hyperopia, or astigmatism). [NIH]
Retina: The light-sensitive layer of tissue that lines the back of the eyeball;
sends visual messages through the optic nerve to the brain. [NIH]
Rheumatoid: Resembling rheumatism. [EU]
Sclera: The tough, white, outer layer (coat) of the eyeball; with the cornea, it
protects the entire eyeball. [NIH]
Stabilization: The creation of a stable state. [EU]
Steroid:
A group name for lipids that contain a hydrogenated
cyclopentanoperhydrophenanthrene ring system. Some of the substances
included in this group are progesterone, adrenocortical hormones, the
gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol),
toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
Stroma: The middle, thickest layer of tissue in the cornea. [NIH]
Suction: The removal of secretions, gas or fluid from hollow or tubular
organs or cavities by means of a tube and a device that acts on negative
pressure. [NIH]
Transplantation: The grafting of tissues taken from the patient's own body
or from another. [EU]
Uveitis: An inflammation of part or all of the uvea, the middle (vascular)
tunic of the eye, and commonly involving the other tunics (the sclera and
cornea, and the retina). [EU]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE
Overview
Some patients are comforted by the knowledge that a number of
organizations dedicate their resources to helping people with myopia. These
associations can become invaluable sources of information and advice. Many
associations offer aftercare support, financial assistance, and other important
services. Furthermore, healthcare research has shown that support groups
often help people to better cope with their conditions.11 In addition to
support groups, your physician can be a valuable source of guidance and
support. Therefore, finding a physician that can work with your unique
situation is a very important aspect of your care.
In this chapter, we direct you to resources that can help you find patient
organizations and medical specialists. We begin by describing how to find
associations and peer groups that can help you better understand and cope
with myopia. The chapter ends with a discussion on how to find a doctor
that is right for you.
Associations and Myopia
As mentioned by the Agency for Healthcare Research and Quality,
sometimes the emotional side of an illness can be as taxing as the physical
side.12 You may have fears or feel overwhelmed by your situation. Everyone
has different ways of dealing with disease or physical injury. Your attitude,
your expectations, and how well you cope with your condition can all
Churches, synagogues, and other houses of worship might also have groups that can offer
you the social support you need.
12 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm.
11
42 Myopia
influence your well-being. This is true for both minor conditions and serious
illnesses. For example, a study on female breast cancer survivors revealed
that women who participated in support groups lived longer and
experienced better quality of life when compared with women who did not
participate. In the support group, women learned coping skills and had the
opportunity to share their feelings with other women in the same situation.
In addition to associations or groups that your doctor might recommend, we
suggest that you consider the following list (if there is a fee for an
association, you may want to check with your insurance provider to find out
if the cost will be covered):
�
International Myopia Prevention Association
Address: 1054 Gravel Hill Road Ligonier, PA 15658
Email: [email protected]
Web Site: http://www.myopia.org
Background: The International Myopia Prevention Association (IMPA)
was founded in 1974 by Donald Rehm to promote the prevention and
control of myopia through public and professional education efforts.
IMPA promotes the concept that acquired myopia is caused by excessive
close work and is not an inherited condition.
Publication(s): The Myopia Myth: The Truth About Nearsightedness and
How to Prevent It; The Facts on Eye Disease; The Prevention of Acquired
Myopia.
Relevant area(s) of interest: Myopia; Visual impairment
�
Prevent Blindness America
Address: Prevent Blindness America 500 East Remington Road,
Schaumberg, IL 60173
Telephone: (847) 843-2020 Toll-free: (800) 331-2020
Fax: (847) 843- 8458
Email: [email protected]
Web Site: http://www.preventblindness.org
Background: Prevent Blindness America is a nonprofit voluntary
organization dedicated to fighting blindness and saving sight.
Established in 1908, Prevent Blindness America and its nationwide
network of affiliates, divisions, and chapters serve millions of people
each year through public and professional education, community and
patient service programs, and research. Consisting of 35,000 volunteers
and 43 chapters, the organization produces educational materials
Seeking Guidance 43
including brochures entitled 'Age-Related Macular Degeneration,' 'Signs
of Possible Eye Trouble in Adults,' and 'Your Child's Sight.' The
organization also produces videos, posters, and brochures. Program
activities include support groups, patient advocacy, referrals, and a tollfree help line.
Relevant area(s) of interest: Cataracts, Conjunctivitis, Diabetic
Retinopathy, Dry Eye, Glaucoma, Hyperopia, Keratoconus, Myopia,
Presbyopia, Retinal Detachment
Finding More Associations
There are a number of directories that list additional medical associations
that you may find useful. While not all of these directories will provide
different information than what is listed above, by consulting all of them,
you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC)
The National Health Information Center (NHIC) offers a free referral service
to help people find organizations that provide information about myopia.
For
more
information,
see
the
NHIC?s
Web
site
at
http://www.health.gov/NHIC/ or contact an information specialist by calling
1-800-336-4797.
DIRLINE
A comprehensive source of information on associations is the DIRLINE
database maintained by the National Library of Medicine. The database
comprises some 10,000 records of organizations, research centers, and
government institutes and associations which primarily focus on health and
biomedicine. DIRLINE is available via the Internet at the following Web site:
http://dirline.nlm.nih.gov/. Simply type in ?myopia? (or a synonym) or the
name of a topic, and the site will list information contained in the database
on all relevant organizations.
44 Myopia
The Combined Health Information Database
Another comprehensive source of information on healthcare associations is
the Combined Health Information Database. Using the ?Detailed Search?
option, you will need to limit your search to ?Organizations? and ?myopia?.
Type
the
following
hyperlink
into
your
Web
browser:
http://chid.nih.gov/detail/detail.html. To find associations, use the drop
boxes at the bottom of the search page where ?You may refine your search
by.? For publication date, select ?All Years.? Then, select your preferred
language and the format option ?Organization Resource Sheet.? By making
these selections and typing in ?myopia? (or synonyms) into the ?For these
words:? box, you will only receive results on organizations dealing with
myopia. You should check back periodically with this database since it is
updated every 3 months.
The National Organization for Rare Disorders, Inc.
The National Organization for Rare Disorders, Inc. has prepared a Web site
that provides, at no charge, lists of associations organized by specific
diseases. You can access this database at the following Web site:
http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option
called ?Organizational Database (ODB)? and type ?myopia? (or a synonym)
in the search box.
Online Support Groups
In addition to support groups, commercial Internet service providers offer
forums and chat rooms for people with different illnesses and conditions.
WebMD�, for example, offers such as service at their Web site:
http://boards.webmd.com/roundtable. These online self-help communities
can help you connect with a network of people whose concerns are similar to
yours. Online support groups are places where people can talk informally. If
you read about a novel approach, consult with your doctor or other
healthcare providers, as the treatments or discoveries you hear about may
not be scientifically proven to be safe and effective.
Seeking Guidance 45
Finding an Eye Care Professional13
The National Eye Institute does not provide referrals nor recommend
specific eye care professionals. However, you may wish to consider the
following ways of finding a professional to provide your eye care. You can:
�
Ask family members and friends about eye care professionals they use.
�
Ask your family doctor for the name of a local eye care specialist.
�
Call the department of ophthalmology or optometry at a nearby hospital
or university medical center.
�
Contact a state or county association of ophthalmologists or optometrists.
These groups, usually called academies or societies, may have lists of eye
care professionals with specific information on specialty and experience.
�
Contact your insurance company or health plan to learn whether it has a
list of eye care professionals that are covered under your plan.
�
At a bookstore or library, check on available journals and books about
choosing physicians and medical treatments. Here are some examples:
-
Most large libraries have the reference set The ABMS Compendium of
Certified Medical Professionals, which lists board-certified
ophthalmologists, each with a small amount of biographical
information. A library reference specialist can also help you identify
other books on finding healthcare professionals or help you seek
additional information about local eye physicians using the Internet.
Each year, usually in August, the magazine U.S. News and World
Report features an article that rates hospitals in the United States.
For more specific information, the following sources may prove useful:
-
�
The American Academy of Ophthalmology coordinates an online listing
called Find an Ophthalmologist that contains information on member
ophthalmologists practicing in the United States and abroad. This service
is designed to help the general public locate ophthalmologists within a
specific region. Web site: http://www.eyenet.org/.
�
The International Society of Refractive Surgery maintains a
comprehensive directory of surgeons around the world who are currently
performing refractive surgery. Telephone: (407) 786-7446. E-mail:
[email protected] Web site: http://www.isrs.org.
�
The Blue Book of Optometrists and the Red Book of Ophthalmologists,
now available online, can be used to find doctors in the U.S., Puerto Rico,
13
This section has been adapted from http://www.nei.nih.gov/health/findprofessional.htm.
46 Myopia
and Canada. This resource is helpful when you know the doctor's name,
but need contact information. Web site: http://www.eyefind.com/.
�
Administrators in Medicine and the Association of State Medical Board
Executive Directors have launched DocFinder, an online database that
helps consumers learn whether any malpractice actions have been taken
against a particular doctor. The site provides links to the licensing boards
in the participating states. Web site: http://www.docboard.org/.
�
The American Association of Eye and Ear Hospitals (AAEEH) is
comprised of the premier centers for specialized eye and ear procedures
in the world. Association members are major referral centers that offer
some of the most innovative teaching programs, and routinely treat the
most severely ill eye and ear patients. Telephone: (202) 347-1993. Web
site: http://www.aaeeh.org/locations.html.
Additional steps you can take to locate doctors include the following:
�
Check with the associations listed earlier in this chapter.
�
Information on doctors in some states is available on the Internet at
http://www.docboard.org. This Web site is run by ?Administrators in
Medicine,? a group of state medical board directors.
�
The American Board of Medical Specialties can tell you if your doctor is
board certified. ?Certified? means that the doctor has completed a
training program in a specialty and has passed an exam, or ?board,? to
assess his or her knowledge, skills, and experience to provide quality
patient care in that specialty. Primary care doctors may also be certified
as
specialists.
The
AMBS
Web
site
is
located
at
14
http://www.abms.org/newsearch.asp. You can also contact the ABMS
by phone at 1-866-ASK-ABMS.
�
You can call the American Medical Association (AMA) at 800-665-2882
for information on training, specialties, and board certification for many
licensed doctors in the United States. This information also can be found
in ?Physician Select? at the AMA's Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to
the Web site of the National Organization for Rare Disorders (NORD) at
http://www.rarediseases.org/. NORD maintains a database of doctors with
expertise in various rare diseases. The Metabolic Information Network
(MIN), 800-945-2188, also maintains a database of physicians with expertise
in various metabolic diseases.
While board certification is a good measure of a doctor's knowledge, it is possible to
receive quality care from doctors who are not board certified.
14
Seeking Guidance 47
Selecting Your Doctor15
When you have compiled a list of prospective doctors, call each of their
offices. First, ask if the doctor accepts your health insurance plan and if he or
she is taking new patients. If the doctor is not covered by your plan, ask
yourself if you are prepared to pay the extra costs. The next step is to
schedule a visit with your chosen physician. During the first visit you will
have the opportunity to evaluate your doctor and to find out if you feel
comfortable with him or her. Ask yourself, did the doctor:
�
Give me a chance to ask questions about myopia?
�
Really listen to my questions?
�
Answer in terms I understood?
�
Show respect for me?
�
Ask me questions?
�
Make me feel comfortable?
�
Address the health problem(s) I came with?
�
Ask me my preferences about different kinds of treatments for myopia?
�
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But
remember, it might take time for the relationship to develop. It takes more
than one visit for you and your doctor to get to know each other.
Working with Your Doctor16
Research has shown that patients who have good relationships with their
doctors tend to be more satisfied with their care and have better results. Here
are some tips to help you and your doctor become partners:
�
You know important things about your symptoms and your health
history. Tell your doctor what you think he or she needs to know.
�
It is important to tell your doctor personal information, even if it makes
you feel embarrassed or uncomfortable.
15 This
section has been adapted from the AHRQ:
www.ahrq.gov/consumer/qntascii/qntdr.htm.
16 This section has been adapted from the AHRQ:
www.ahrq.gov/consumer/qntascii/qntdr.htm.
48 Myopia
�
Bring a ?health history? list with you (and keep it up to date).
�
Always bring any medications you are currently taking with you to the
appointment, or you can bring a list of your medications including
dosage and frequency information. Talk about any allergies or reactions
you have had to your medications.
�
Tell your doctor about any natural or alternative medicines you are
taking.
�
Bring other medical information, such as x-ray films, test results, and
medical records.
�
Ask questions. If you don't, your doctor will assume that you understood
everything that was said.
�
Write down your questions before your visit. List the most important
ones first to make sure that they are addressed.
�
Consider bringing a friend with you to the appointment to help you ask
questions. This person can also help you understand and/or remember
the answers.
�
Ask your doctor to draw pictures if you think that this would help you
understand.
�
Take notes. Some doctors do not mind if you bring a tape recorder to help
you remember things, but always ask first.
�
Let your doctor know if you need more time. If there is not time that day,
perhaps you can speak to a nurse or physician assistant on staff or
schedule a telephone appointment.
�
Take information home. Ask for written instructions. Your doctor may
also have brochures and audio and videotapes that can help you.
�
After leaving the doctor's office, take responsibility for your care. If you
have questions, call. If your symptoms get worse or if you have problems
with your medication, call. If you had tests and do not hear from your
doctor, call for your test results. If your doctor recommended that you
have certain tests, schedule an appointment to get them done. If your
doctor said you should see an additional specialist, make an
appointment.
By following these steps, you will enhance the relationship you will have
with your physician.
Seeking Guidance 49
Broader Health-Related Resources
In addition to the references above, the NIH has set up guidance Web sites
that can help patients find healthcare professionals. These include:17
�
Caregivers:
http://www.nlm.nih.gov/medlineplus/caregivers.html
�
Choosing a Doctor or Healthcare Service:
http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv
ice.html
�
Hospitals and Health Facilities:
http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder
The following vocabulary builder provides definitions of words used in this
chapter that have not been defined in previous chapters:
Conjunctivitis: Inflammation of the conjunctiva, generally consisting of
conjunctival hyperaemia associated with a discharge. [EU]
Optometrist: A primary eye care provider who diagnoses, manages, and
treats disorders of the visual system and eye diseases. [NIH]
Optometry: The professional practice of primary eye and vision care that
includes the measurement of visual refractive power and the correction of
visual defects with lenses or glasses. [NIH]
Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (=
degenerative, noninflammatory condition of the retina). [EU]
You can access this information at:
http://www.nlm.nih.gov/medlineplus/healthsystem.html.
17
Clinical Trials 51
CHAPTER 3. CLINICAL TRIALS AND MYOPIA
Overview
Very few medical conditions have a single treatment. The basic treatment
guidelines that your physician has discussed with you, or those that you
have found using the techniques discussed in Chapter 1, may provide you
with all that you will require. For some patients, current treatments can be
enhanced with new or innovative techniques currently under investigation.
In this chapter, we will describe how clinical trials work and show you how
to keep informed of trials concerning myopia.
What Is a Clinical Trial?18
Clinical trials involve the participation of people in medical research. Most
medical research begins with studies in test tubes and on animals.
Treatments that show promise in these early studies may then be tried with
people. The only sure way to find out whether a new treatment is safe,
effective, and better than other treatments for myopia is to try it on patients
in a clinical trial.
What Kinds of Clinical Trials Are There?
Clinical trials are carried out in three phases:
The discussion in this chapter has been adapted from the NIH and the NEI:
www.nei.nih.gov/netrials/ctivr.htm.
18
52 Myopia
�
Phase I. Researchers first conduct Phase I trials with small numbers of
patients and healthy volunteers. If the new treatment is a medication,
researchers also try to determine how much of it can be given safely.
�
Phase II. Researchers conduct Phase II trials in small numbers of patients
to find out the effect of a new treatment on myopia.
�
Phase III. Finally, researchers conduct Phase III trials to find out how
new treatments for myopia compare with standard treatments already
being used. Phase III trials also help to determine if new treatments have
any side effects. These trials--which may involve hundreds, perhaps
thousands, of people--can also compare new treatments with no
treatment.
How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals,
universities, and doctors' offices across the United States. The ?principal
investigator? is the researcher in charge of the study at each facility
participating in the clinical trial. Most clinical trial researchers are medical
doctors, academic researchers, and specialists. The ?clinic coordinator?
knows all about how the study works and makes all the arrangements for
your visits.
All doctors and researchers who take part in the study on myopia carefully
follow a detailed treatment plan called a protocol. This plan fully explains
how the doctors will treat you in the study. The ?protocol? ensures that all
patients are treated in the same way, no matter where they receive care.
Clinical trials are controlled. This means that researchers compare the effects
of the new treatment with those of the standard treatment. In some cases,
when no standard treatment exists, the new treatment is compared with no
treatment. Patients who receive the new treatment are in the treatment
group. Patients who receive a standard treatment or no treatment are in the
?control? group. In some clinical trials, patients in the treatment group get a
new medication while those in the control group get a placebo. A placebo is
a harmless substance, a ?dummy? pill, that has no effect on myopia. In other
clinical trials, where a new surgery or device (not a medicine) is being tested,
patients in the control group may receive a ?sham treatment.? This
treatment, like a placebo, has no effect on myopia and does not harm
patients.
Researchers assign patients ?randomly? to the treatment or control group.
This is like flipping a coin to decide which patients are in each group. If you
Clinical Trials 53
choose to participate in a clinical trial, you will not know which group you
will be appointed to. The chance of any patient getting the new treatment is
about 50 percent. You cannot request to receive the new treatment instead of
the placebo or sham treatment. Often, you will not know until the study is
over whether you have been in the treatment group or the control group.
This is called a ?masked? study. In some trials, neither doctors nor patients
know who is getting which treatment. This is called a ?double masked?
study. These types of trials help to ensure that the perceptions of the patients
or doctors will not affect the study results.
Natural History Studies
Unlike clinical trials in which patient volunteers may receive new
treatments, natural history studies provide important information to
researchers on how myopia develops over time. A natural history study
follows patient volunteers to see how factors such as age, sex, race, or family
history might make some people more or less at risk for myopia. A natural
history study may also tell researchers if diet, lifestyle, or occupation affects
how a disease or disorder develops and progresses. Results from these
studies provide information that helps answer questions such as: How fast
will a disease or disorder usually progress? How bad will the condition
become? Will treatment be needed?
What Is Expected of Patients in a Clinical Trial?
Not everyone can take part in a clinical trial for a specific disease or disorder.
Each study enrolls patients with certain features or eligibility criteria. These
criteria may include the type and stage of disease or disorder, as well as, the
age and previous treatment history of the patient. You or your doctor can
contact the sponsoring organization to find out more about specific clinical
trials and their eligibility criteria. If you are interested in joining a clinical
trial, your doctor must contact one of the trial's investigators and provide
details about your diagnosis and medical history.
If you participate in a clinical trial, you may be required to have a number of
medical tests. You may also need to take medications and/or undergo
surgery. Depending upon the treatment and the examination procedure, you
may be required to receive inpatient hospital care. Or, you may have to
return to the medical facility for follow-up examinations. These exams help
find out how well the treatment is working. Follow-up studies can take
months or years. However, the success of the clinical trial often depends on
54 Myopia
learning what happens to patients over a long period of time. Only patients
who continue to return for follow-up examinations can provide this
important long-term information.
Recent Trials on Myopia
The National Institutes of Health and other organizations sponsor trials on
various diseases and disorders. Because funding for research goes to the
medical areas that show promising research opportunities, it is not possible
for the NIH or others to sponsor clinical trials for every disease and disorder
at all times. The following lists recent trials dedicated to myopia.19 If the trial
listed by the NIH is still recruiting, you may be eligible. If it is no longer
recruiting or has been completed, then you can contact the sponsors to learn
more about the study and, if published, the results. Further information on
the trial is available at the Web site indicated. Please note that some trials
may no longer be recruiting patients or are otherwise closed. Before
contacting sponsors of a clinical trial, consult with your physician who can
help you determine if you might benefit from participation.
�
The Collaborative Longitudinal Evaluation of Ethnicity and Refractive
Error (CLEERE) Study
Condition(s): Myopia
Study Status: This study is currently recruiting patients.
Sponsor(s): National Eye Institute (NEI)
Purpose - Excerpt: To compare and contrast normal eye growth, ocular
component development, and refractive error development in Hispanic,
African-American, and Asian schoolchildren with what happens in
Caucasian children from the Orinda Longitudinal Study of Myopia. To
investigate risk factors for the development of myopia. To conduct DNAbased studies on nearsighted children and their families.
Study Type: Observational
Contact(s): see Web site below
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00000169
�
A Trial of Bifocals in Myopic Children With Esophoria
Condition(s): Myopia; Strabismus; Esophoria
Study Status: This study is no longer recruiting patients.
Sponsor(s): National Eye Institute (NEI)
19
These are listed at www.ClinicalTrials.gov.
Clinical Trials 55
Purpose - Excerpt: To test the hypothesis that correction with bifocal
spectacle lenses rather than single-vision lenses will slow the progression
of myopia in children with near-point esophoria. The primary outcome
variable is cycloplegic refraction as measured with an automated
refractor. Axial length is measured with ultrasound in order to test the
corollary hypothesis that use of bifocals will slow ocular growth in these
myopic children. We will also examine the amount of close work
performed by subjects and the degree of parental myopia as factors that
may influence myopia progression.
Phase(s): Phase III
Study Type: Interventional
Contact(s): Oklahoma; The Office of Billie Walsh, O.D, Tulsa, Oklahoma,
United States; Oklahoma; Tahlequah College of Optometry, Northeastern
State University, Tahlequah, Oklahoma, United States
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00000128
�
Correction of Myopia Evaluation Trial (COMET)
Condition(s): Myopia
Study Status: This study is no longer recruiting patients.
Sponsor(s): National Eye Institute (NEI)
Purpose - Excerpt: To evaluate whether progressive addition lenses
(PALs) slow the rate of progression of juvenile-onset myopia
(nearsightedness) when compared with single vision lenses, as measured
by cycloplegic autorefraction. An additional outcome measure is axial
length, as measured by A-scan ultrasonography. To describe the natural
history of juvenile-onset myopia in a group of children receiving
conventional treatment (single vision lenses).
Phase(s): Phase III
Study Type: Interventional
Contact(s): see Web site below
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00000113
�
The Contact Lens and Myopia Progression (CLAMP) Study
Condition(s): Myopia
Study Status: This study is no longer recruiting patients.
Sponsor(s): National Eye Institute (NEI)
Purpose - Excerpt: To examine the effects of rigid gas permeable contact
lenses on the progression of myopia (nearsightedness) in children To
56 Myopia
determine what changes in the eyes cause certain eyes to progress in
nearsightedness more slowly
Study Type: Observational
Contact(s): Ohio; The Ohio State University College of Optometry,
Columbus, Ohio, 43210, United States; Jeffery J Walline, OD,MS 614-2926603 [email protected]
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00009529
�
Prospective Evaluation of Radial Keratotomy (PERK) Study
Condition(s): Myopia
Study Status: This study is completed.
Sponsor(s): National Eye Institute (NEI)
Purpose - Excerpt: To determine whether radial keratotomy is effective in
reducing myopia. To detect complications of the surgery. To discover
patient characteristics and surgical factors affecting the results. To
determine the long-term safety and efficacy of the procedure.
Phase(s): Phase III
Study Type: Interventional
Contact(s): see Web site below
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00000129
�
The Berkeley Orthokeratology Study
Condition(s): Astigmatism; Myopia
Study Status: This study is completed.
Sponsor(s): National Eye Institute (NEI)
Purpose - Excerpt: To evaluate the relative efficacy of orthokeratology,
primarily by assessment of changes in central corneal thickness,
astigmatism, visual acuity, endothelial cell density, and corneal
curvature. To evaluate the relative safety of orthokeratology, primarily by
assessment of changes in central corneal thickness, astigmatism, visual
acuity, endothelial cell density, induced corneal edema, and epithelial
staining. To assess the duration of any orthokeratology treatment effect.
To study the mechanisms by which refractive error and visual acuity
changes occur, in particular the contribution that comes from changes in
corneal curvature and shape. To determine whether there were any
predisposing ocular factors that could be used to predict which subjects
will experience changes or complications.
Phase(s): Phase III
Clinical Trials 57
Study Type: Interventional
Contact(s): see Web site below
Web Site: http://clinicaltrials.gov/ct/gui/c/w1b/show/NCT00000123
Benefits and Risks20
What Are the Benefits of Participating in a Clinical Trial?
If you are interested in a clinical trial, it is important to realize that your
participation can bring many benefits to you and society at large:
�
A new treatment could be more effective than the current treatment for
myopia. Although only half of the participants in a clinical trial receive
the experimental treatment, if the new treatment is proved to be more
effective and safer than the current treatment, then those patients who
did not receive the new treatment during the clinical trial may be among
the first to benefit from it when the study is over.
�
If the treatment is effective, then it may improve health or prevent
diseases or disorders.
�
Clinical trial patients receive the highest quality of medical care. Experts
watch them closely during the study and may continue to follow them
after the study is over.
�
People who take part in trials contribute to scientific discoveries that may
help other people with myopia. In cases where certain diseases or
disorders run in families, your participation may lead to better care or
prevention for your family members.
The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an
?informed consent.? This document explains a clinical trial's risks and
benefits, the researcher?s expectations of you, and your rights as a patient.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes
of Health:
http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291.
20
58 Myopia
What Are the Risks?
Clinical trials may involve risks as well as benefits. Whether or not a new
treatment will work cannot be known ahead of time. There is always a
chance that a new treatment may not work better than a standard treatment.
There is also the possibility that it may be harmful. The treatment you
receive may cause side effects that are serious enough to require medical
attention.
How Is Patient Safety Protected?
Clinical trials can raise fears of the unknown. Understanding the safeguards
that protect patients can ease some of these fears. Before a clinical trial
begins, researchers must get approval from their hospital's Institutional
Review Board (IRB), an advisory group that makes sure a clinical trial is
designed to protect patient safety. During a clinical trial, doctors will closely
watch you to see if the treatment is working and if you are experiencing any
side effects. All the results are carefully recorded and reviewed. In many
cases, experts from the Data and Safety Monitoring Committee carefully
monitor each clinical trial and can recommend that a study be stopped at any
time. You will only be asked to take part in a clinical trial as a volunteer
giving informed consent.
What Are a Patient's Rights in a Clinical Trial?
If you are eligible for a clinical trial, you will be given information to help
you decide whether or not you want to participate. As a patient, you have
the right to:
�
Information on all known risks and benefits of the treatments in the
study.
�
Know how the researchers plan to carry out the study, for how long, and
where.
�
Know what is expected of you.
�
Know any costs involved for you or your insurance provider.
�
Know before any of your medical or personal information is shared with
other researchers involved in the clinical trial.
�
Talk openly with doctors and ask any questions.
Clinical Trials 59
After you join a clinical trial, you have the right to:
�
Leave the study at any time. Participation is strictly voluntary. However,
you should not enroll if you do not plan to complete the study.
�
Receive any new information about the new treatment.
�
Continue to ask questions and get answers.
�
Maintain your privacy. Your name will not appear in any reports based
on the study.
�
Know whether you participated in the treatment group or the control
group (once the study has been completed).
What about Costs?
In some clinical trials, the research facility pays for treatment costs and other
associated expenses. You or your insurance provider may have to pay for
costs that are considered standard care. These things may include inpatient
hospital care, laboratory and other tests, and medical procedures. You also
may need to pay for travel between your home and the clinic. You should
find out about costs before committing to participation in the trial. If you
have health insurance, find out exactly what it will cover. If you don't have
health insurance, or if your insurance company will not cover your costs,
talk to the clinic staff about other options for covering the cost of your care.
What Should You Ask before Deciding to Join a Clinical Trial?
Questions you should ask when thinking about joining a clinical trial include
the following:
�
What is the purpose of the clinical trial?
�
What are the standard treatments for myopia? Why do researchers think
the new treatment may be better? What is likely to happen to me with or
without the new treatment?
�
What tests and treatments will I need? Will I need surgery? Medication?
Hospitalization?
�
How long will the treatment last? How often will I have to come back for
follow-up exams?
�
What are the treatment's possible benefits to my condition? What are the
short- and long-term risks? What are the possible side effects?
60 Myopia
�
Will the treatment be uncomfortable? Will it make me feel sick? If so, for
how long?
�
How will my health be monitored?
�
Where will I need to go for the clinical trial? How will I get there?
�
How much will it cost to be in the study? What costs are covered by the
study? How much will my health insurance cover?
�
Will I be able to see my own doctor? Who will be in charge of my care?
�
Will taking part in the study affect my daily life? Do I have time to
participate?
�
How do I feel about taking part in a clinical trial? Are there family
members or friends who may benefit from my contributions to new
medical knowledge?
Keeping Current on Clinical Trials
Various government agencies maintain databases on trials. The U.S. National
Institutes of Health, through the National Library of Medicine, has
developed ClinicalTrials.gov to provide patients, family members, and
physicians with current information about clinical research across the
broadest number of diseases and conditions.
The site was launched in February 2000 and currently contains
approximately 5,700 clinical studies in over 59,000 locations worldwide, with
most studies being conducted in the United States. ClinicalTrials.gov
receives about 2 million hits per month and hosts approximately 5,400
visitors daily. To access this database, simply go to their Web site
(www.clinicaltrials.gov) and search by ?myopia? (or synonyms).
While ClinicalTrials.gov is the most comprehensive listing of NIH-supported
clinical trials available, not all trials are in the database. The database is
updated regularly, so clinical trials are continually being added. The
following is a list of specialty databases affiliated with the National Institutes
of Health that offer additional information on trials:
�
For clinical studies at the Warren Grant Magnuson Clinical Center
located in Bethesda, Maryland, visit their Web site:
http://clinicalstudies.info.nih.gov/
Clinical Trials 61
�
For clinical studies conducted at the Bayview Campus in Baltimore,
Maryland, visit their Web site:
http://www.jhbmc.jhu.edu/studies/index.html
�
For eye-related trials, visit and search the Web page of the National Eye
Institute: http://www.nei.nih.gov/neitrials/index.htm
General References
The following references describe clinical trials and experimental medical
research. They have been selected to ensure that they are likely to be
available from your local or online bookseller or university medical library.
These references are usually written for healthcare professionals, so you may
consider consulting with a librarian or bookseller who might recommend a
particular reference. The following includes some of the most readily
available references (sorted alphabetically by title; hyperlinks provide
rankings, information and reviews at Amazon.com):
�
A Guide to Patient Recruitment : Today's Best Practices & Proven
Strategies by Diana L. Anderson; Paperback - 350 pages (2001),
CenterWatch, Inc.; ISBN: 1930624115;
http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
�
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S.,
OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub;
ISBN: 0763715697;
http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
�
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch;
Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935;
http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
�
The Complete Guide to Informed Consent in Clinical Trials by Terry
Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information
Services, Inc.; ISBN: 0970153309;
http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
�
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999),
John Wiley & Sons; ISBN: 0471985961;
http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
�
Extending Medicare Reimbursement in Clinical Trials by Institute of
Medicine Staff (Editor), et al; Paperback 1st edition (2000), National
Academy Press; ISBN: 0309068886;
http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
62 Myopia
�
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001),
Remedica Pub Ltd; ISBN: 1901346293;
http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder
The following vocabulary builder gives definitions of words used in this
chapter that have not been defined in previous chapters:
Acuity: Clearness, or sharpness of vision. [NIH]
Progressive:
Advancing; going forward; going from bad to worse;
increasing in scope or severity. [EU]
Strabismus: Deviation of the eye which the patient cannot overcome. The
visual axes assume a position relative to each other different from that
required by the physiological conditions. The various forms of strabismus
are spoken of as tropias, their direction being indicated by the appropriate
prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia.
Called also cast, heterotropia, manifest deviation, and squint. [EU]
Ultrasonography: The visualization of deep structures of the body by
recording the reflections of echoes of pulses of ultrasonic waves directed into
the tissues. Use of ultrasound for imaging or diagnostic purposes employs
frequencies ranging from 1.6 to 10 megahertz. [NIH]
63
PART II: ADDITIONAL RESOURCES AND
ADVANCED MATERIAL
ABOUT PART II
In Part II, we introduce you to additional resources and advanced research
on myopia. All too often, patients who conduct their own research are
overwhelmed by the difficulty in finding and organizing information. The
purpose of the following chapters is to provide you an organized and
structured format to help you find additional information resources on
myopia. In Part II, as in Part I, our objective is not to interpret the latest
advances on myopia or render an opinion. Rather, our goal is to give you
access to original research and to increase your awareness of sources you
may not have already considered. In this way, you will come across the
advanced materials often referred to in pamphlets, books, or other general
works. Once again, some of this material is technical in nature, so
consultation with a professional familiar with myopia is suggested.
Studies 65
CHAPTER 4. STUDIES ON MYOPIA
Overview
Every year, academic studies are published on myopia or related conditions.
Broadly speaking, there are two types of studies. The first are peer reviewed.
Generally, the content of these studies has been reviewed by scientists or
physicians. Peer-reviewed studies are typically published in scientific
journals and are usually available at medical libraries. The second type of
studies is non-peer reviewed. These works include summary articles that do
not use or report scientific results. These often appear in the popular press,
newsletters, or similar periodicals.
In this chapter, we will show you how to locate peer-reviewed references
and studies on myopia. We will begin by discussing research that has been
summarized and is free to view by the public via the Internet. We then show
you how to generate a bibliography on myopia and teach you how to keep
current on new studies as they are published or undertaken by the scientific
community.
The Combined Health Information Database
The Combined Health Information Database summarizes studies across
numerous federal agencies. To limit your investigation to research studies
and myopia, you will need to use the advanced search options. First, go to
http://chid.nih.gov/index.html. From there, select the ?Detailed Search?
option (or go directly to that page with the following hyperlink:
http://chid.nih.gov/detail/detail.html). The trick in extracting studies is
found in the drop boxes at the bottom of the search page where ?You may
refine your search by.? Select the dates and language you prefer, and the
66 Myopia
format option ?Journal Article.? At the top of the search form, select the
number of records you would like to see (we recommend 100) and check the
box to display ?whole records.? We recommend that you type in ?myopia?
(or synonyms) into the ?For these words:? box. Consider using the option
?anywhere in record? to make your search as broad as possible. If you want
to limit the search to only a particular field, such as the title of the journal,
then select this option in the ?Search in these fields? drop box. The following
is a sample of what you can expect from this type of search:
�
Relieving Visual Stress With Massage and Self-Care
Source: Massage Therapy Journal. 37(4): 34-36, 38, 40, 44. Winter 1999.
Summary: This journal article describes an approach to improving vision
through massage and eye movements. According to the author, many
cases of poor eyesight are caused by visual stress, and habitual straining
to see produces muscle tension and contorted posture, which further
contribute to visual problems. Two components of visual stress,
prolonged near-focusing and tasks with high-level cognitive demand,
have been shown to result in myopia. At Meir Schneider's School for SelfHealing in San Francisco, California, massage therapists learn how to
treat these problems using a combination of massage of the face and
upper body, eye and body movement exercises, and other techniques.
This article describes 13 massage techniques Mr. Schneider recommends
to improve or maintain vision. It also provides instructions for self-care
exercises, including palming, sunning, blinking, extending the periphery,
and shifting, which can help reduce visual stress and improve eyesight. It
has 5 references.
Federally-Funded Research on Myopia
The U.S. Government supports a variety of research studies relating to
myopia and associated conditions. These studies are tracked by the Office of
Extramural Research at the National Institutes of Health.21 CRISP
(Computerized Retrieval of Information on Scientific Projects) is a searchable
database of federally-funded biomedical research projects conducted at
universities, hospitals, and other institutions. Visit the CRISP Web site at
http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket.
You
can
21 Healthcare projects are funded by the National Institutes of Health (NIH), Substance
Abuse and Mental Health Services (SAMHSA), Health Resources and Services
Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office
of Assistant Secretary of Health (OASH).
Studies 67
perform targeted searches by various criteria including geography, date, as
well as topics related to myopia and related conditions.
For most of the studies, the agencies reporting into CRISP provide
summaries or abstracts. As opposed to clinical trial research using patients,
many federally-funded studies use animals or simulated models to explore
myopia and related conditions. In some cases, therefore, it may be difficult to
understand how some basic or fundamental research could eventually
translate into medical practice. The following sample is typical of the type of
information found when searching the CRISP database for myopia:
�
Project Title: Accomodation and the Development of Refractive State
Principal Investigator & Institution: Troilo, David B.; Associate Professor;
Biosciences and Disease; New England College of Optometry 424 Beacon
St Boston, Ma 02115
Timing: Fiscal Year 2001; Project Start 1-JUL-1995; Project End 1-MAR2005
Summary: (adapted from applicant's abstract): Myopia (nearsightedness)
is on the rise around the world and in the United States. It affects tens of
millions of Americans and, in progressive forms, is a leading cause of
blindness. Earlier research with humans and experimental animal models
has made it clear that the postnatal development of the eye and refractive
state involves a combination of genetic and visual factors. The rise in
incidence of human myopia has been associated with increases in literacy
and levels of education, although the nature of the relationship is unclear.
Research using animal models has established that visual stimuli related
to retinal defocus regulate eye growth and refractive state. The studies
described in this proposal use various visual manipulations to explore
the temporal integration of visual stimuli that affect eye growth and the
biochemical mechanisms that may underlie these changes. The following
questions are asked: (1) How does the eye temporally integrate different
visual stimuli for the regulation of eye growth? To answer this, the
investigators will contrast the effects of different states of defocus or
deprivation with corrected or clear vision and examine the stimulus
durations necessary to elicit different ocular growth responses. (2) Do
ocular circadian rhythms in IOP, axial length and choroid thickness play
a role in the regulation of ocular growth? Specifically, the investigators
will examine the phase relationships between these different rhythms
during induced changes in ocular growth rate. (3) How do the temporal
pattern and accuracy of accommodation affect the degree of blur
experienced during near work tasks and when viewing through negative
power spectacle lenses? These measures of accommodative behavior will
68 Myopia
then be correlated with the degree of experimental myopia induced. (4)
What are the changes in scleral extracellular matrix during
experimentally induced changes in ocular growth, and how are they
controlled? Using ocular tissues from the other experiments, the
investigators will quantify changes in scleral extracellular components
and correlate them with visually induced increases and decreases in
ocular growth rate. In addition, the possibility that retinoic acid synthesis
by the choroids/RPE plays a role in the signal cascade from retina to
sclera will be explored. This project will bring together several lines of
investigation to help answer important questions relating to how myopia
develops in response to altered visual experience. These studies will
provide new information for understanding the association of near work,
such as reading, and the development of myopia in humans.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Contact Lenses and Myopia (CLAMP) Study
Principal Investigator & Institution: Walline, Jeffrey J.; None; Ohio State
University Columbus, Oh 43210
Timing: Fiscal Year 2000; Project Start 1-DEC-1997; Project End 0-NOV2002
Summary: The Contact Lenses and Myopia Progression (CLAMP) Study
will serve two purposes: 1) it will provide the training mechanism for
Jeffrey J. Walline, O.D. to become a successful independent investigator
and 2) it will evaluate the effect of rigid contact lenses on myopia
progression in children. The CLAMP Study applies itself very well to
furthering Dr. Walline's education and clinical experience. The CLAMP
Study will generate the basis for Dr. Walline's qualifying examinations
and his doctoral thesis, which will focus on his coursework in
Physiological Optics and Preventive Medicine. Dr. Walline will serve as
Principal Investigator and will gain valuable experience in all aspects of
clinical research. He will be responsible for the recruitment, retention,
ocular examination, and contact lens fitting of 110 children, most data
collection, all data input and analysis, and the administrative functions of
the entire study. The training plan, combined with the wide range of
responsibilities in conducting this small-scale study, will produce an
independent clinician-scientist who has learned the trials and tribulations
of clinical research by direct application of his training and by personal
experience. The CLAMP Study will examine the effects of rigid contact
lenses on myopia progression in nearsighted children over a three-year
period and will attempt to determine the mechanism of treatment effect if
one exists. We will conduct a single-masked, randomized clinical trial on
110 children ages 8 to 11 years old who have between -1.00 D and -3.00 D
Studies 69
(spherical component) of myopia in each eye, less than 1.00 D of
astigmatism in both eyes, less than 1.00 D of anisometropia, no ocular or
systemic health problems that may affect vision, and at least 20/20 best
corrected visual acuity in both eyes. All subjects will be given a
comprehensive baseline examination and fitted with rigid contact lenses;
those who meet the minimum requirements for rigid contact lens
adaptation will be randomized to the experimental group (rigid contact
lenses) or to the control group (soft contact lenses). Annual examinations
will be given to all children to determine their myopic progression, and
to measure their ocular components. Their vision correction will be
updated every six months. The CLAMP Study is the ideal scope and size
of study to train Dr. Walline to become an independent investigator and
has the potential to change the standard of care for young children who
become nearsighted.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Correction of Myopia Evaluation Trial (COMET)
Principal Investigator & Institution: Scheiman, Mitchell M.; Pediatrics;
Pennsylvania College of Optometry 8360 Old York Rd Elkins Park, Pa
19027
Timing: Fiscal Year 2000; Project Start 1-MAR-1997; Project End 8-FEB2002
Summary: (Applicant's Abstract) This proposal is for the Pennsylvania
College of Optometry (PCO) to serve as one of four clinical centers in the
Correction of Myopia Evaluation Trial (COMET). COMET is a
prospective, randomized clinical trial designed to assess whether
progressive addition lenses (PAL's) slow the progression of juvenileonset myopia, compared to conventional single vision lenses (SV). Seven
hundred fifty children 6-12 years old with myopia (-1.25 to -4.5 D) in both
eyes, who meet specific inclusion and exclusion criteria will be enrolled.
They will be identified primarily from elementary school vision
screenings and School of Optometry clinical patient records. All eligible
children will be examined at baseline and at six-month intervals for at
least three years to measure changes in refractive error and to update
prescriptions. A standardized, common protocol will be used at all four
centers. The primary outcome measure is progression of myopia, as
measured by cycloplegic autorefraction. An additional outcome measure
is axial elongation as measured by A-scan ultrasonography. These will be
obtained by masked examiners. This application documents the ability of
PCO to screen 7500 children for possible eligibility, to recruit at least 188
children within on academic year, and to retain them for at least three
years. Documentation is also provided that PCO has the personnel,
70 Myopia
equipment, and facilities to conduct the study in accordance with the
COMET Manual of Procedures (MOP). Complete details of the COMET
rationale, design, and methods are contained in the MOP, which is
submitted separately with the Study Chair and Coordinating Center
applications. In addition to PCO, the other clinical centers are located at
Colleges of Optometry in Boston, Houston, and Birmingham, with the
Study Chair in Boston and the Coordinating Center at Stony Brook.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Correction of Myopia Evaluation Trial--Clinical Center
Principal Investigator & Institution: Kurtz, Daniel; None; New England
College of Optometry 424 Beacon St Boston, Ma 02115
Timing: Fiscal Year 2000; Project Start 1-MAR-1997; Project End 8-FEB2002
Summary: (Applicant's Abstract) This proposal is for the New England
College of Optometry (NEWENCO) to serve as a clinical center in the
Correction of Myopia Evaluation Trial (COMET). COMET is a
prospective, randomized clinical trial designed to assess whether
progressive addition lenses (PALs) slow the progression of juvenile-onset
myopia, compared to conventional single vision lenses (SV). Seven
hundred fifty children 6-12 years old with myopia (-1.25 to -4.5 D) in both
eyes, who meet specific inclusion criteria and lack specific exclusion
criteria will be enrolled. They will be identified primarily from
elementary school vision screenings. All eligible children will be
examined at baseline and at six-month intervals for at least three years of
follow up to measure changes in refractive error and to update
prescriptions. A standardized, common protocol will be used at all four
centers. The primary outcome measure is progression of myopia, as
measured by cycloplegic autorefraction. An additional outcome measure
is axial elongation as measured by A-scan ultrasonography. These will be
obtained by masked examiners. This application documents the ability of
NEWENCO to screen about 7700 children for possible eligibility, to
recruit at least 188 children within one academic year and to retain them
for at least three years of follow up. Documentation is also provided that
NEWENCO has the personnel, equipment, and facilities to conduct the
study in accordance with the COMET Manual of Procedures (MOP).
Complete details of the COMET rationale, design, and methods are
contained in the MOP, which is submitted separately with the study chair
and coordinating center applications. In addition to NEWENCO, the
other clinical centers are located at Colleges of Optometry in
Birmingham, Houston, and Philadelphia, with the Study Chair in Boston
and the Coordinating Center at Stony Brook, NY.
Studies 71
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Correction of Myopia Trial--Clinical Center
Principal Investigator & Institution: Manny, Ruth E.; Chair; Clinical
Optometric Sciences; University of Houston-University Park 4800
Calhoun Blvd Houston, Tx 77004
Timing: Fiscal Year 2000; Project Start 1-MAR-1997; Project End 8-FEB2002
Summary: (Applicant's Abstract) This proposal is for the University of
Houston, College of Optometry (UHCO) to serve as one of four clinical
centers in the Correction of Myopia Evaluation Trial (COMET). COMET
is a prospective, randomized clinical trial designed to assess whether
progressive addition lenses (PAL's) slow the progression of juvenileonset myopia, compared to conventional single vision lenses (SV). A total
of four hundred children, 6-12 years of age with myopia (-1.25 to -4.50 D)
in both eyes, who meet specific inclusion and exclusion criteria will be
enrolled in the 4 participating centers. One hundred twelve children will
be identified in Houston. These children will be recruited primarily from
the University Eye Institute (UEI - the Clinic at UHCO). All eligible
children will be examined at baseline and at six-month intervals for at
least three years to measure changes in refractive error and to update
prescriptions. A standardized, common protocol will be used at all four
centers. The primary outcome measure is progression of myopia, as
measured by cycloplegic autorefraction. A additional outcome measure is
axial elongation as measured by A-scan ultrasonography. These outcome
measures will be obtained by masked examiners. This application
documents the ability of UHCO to recruit at least 112 children within one
academic year, and to retain them for at least three years. Documentation
is also provided that UHCO has the personnel, equipment, and facilities
to conduct the study in accordance with the COMET Manual of
Procedures (MOP). Complete details of the COMET rationale, design,
and methods are contained in the MOP, which is submitted separately
with the Study Chair and Coordinating Center applications. In addition
to UHCO, the other clinical centers are located at Colleges of Optometry
in Boston, Birmingham, and Philadelphia, with the Study Chair in Boston
and the Coordinating Center at Stony Brook NY.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
72 Myopia
�
Project Title: Emmetropization and Development of Myopia in
Children
Principal Investigator & Institution: Gwiazda, Jane E.; Associate
Professor; None; New England College of Optometry 424 Beacon St
Boston, Ma 02115
Timing: Fiscal Year 2000; Project Start 1-SEP-1980; Project End 1-JUL-2004
Summary: The primary goal of the proposed research is increased
understanding of the interacting environmental and hereditary factors
which underlie the normal emmetropization process and which may
produce abnormal growth of the eye eventuating in myopia in school-age
children. Emerging from consideration of studies of humans and animals
is the consensus that retinal defocus is a precursor to the development of
myopia. A primary emphasis of the next phase of this research effort is an
investigation of factors that induce retinal defocus in children. Some of
the factors, such as accommodation, have been studied in the last project
period, while others, such as ocular aberrations, are only now being
investigated with the advent of new techniques. Genetics studies will
investigate what factors may be inherited. Results from this multi-faceted
investigation will be combined into an integrated account of
myopization. In the process, risk factors for the development of myopia
will be identified. The main hypothesis driving this research is that
retinal defocus contributes to continued growth of the eye and
consequent myopia in susceptible children. The projects as three specific
aims: Specific Aim 1: To continue to delineate the time course of
development of coordinated accommodation, convergence, and pupillary
constriction, and compare it to the onset, progression, and stabilization of
myopia. Dynamics of accommodation when children are engaged in near
work activities will be investigated, to determine the extent to which
retinal defocus may be experienced under conditions which approximate
their daily close work habits. The hypothesis to be tested is that children
engaged in close work experience retinal defocus that produces myopia.
Specific Aim 2: To investigate the role of ocular aberrations, including
astigmatism, in the etiology of myopia. Aberrations will be measured
under different accommodative demands know to exacerbate
aberrations. The hypothesis to be tested is that aberrations degrade
retinal images and thereby produce myopia. Specific Aim 3: To complete
the collection and ascertainment of a cohort of pedigrees affected by
juvenile onset myopia and to begin genetic studies designed to identify
genes responsible for overall myopia susceptibility and myopia related
specific factors identified in Aims 1 and 2.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
Studies 73
�
Project Title: Genetics Studies of Myopia
Principal Investigator & Institution: Stambolian, Dwight E.; Assoicate
Professor; Ophthalmology; University of Pennsylvania 1 College Hall
Philadelphia, Pa 19104
Timing: Fiscal Year 2000; Project Start 1-AUG-1999; Project End 1-JUL2004
Summary: Myopia is a disorder in which the eye is relatively long for the
power of the cornea and lens resulting in blurred vision. Because myopia
is the most common eye condition in the world, it is an enormous public
health problem with a large economic impact on the population at large.
Its contribution to acquired blindness varies from 3-19% depending on
the study. Although very common, nothing secure is known about its
pathogenesis despite studies of various animal models. A number of
different studies provide compelling evidence indicating that myopia is
inherited. The complexity of the genetics of this disorder requires a broad
based collaborative effort to adequately locate the gene(s) for this
disorder. The goal of this proposal is to contain the loci responsible for
this disorder. Using uniform clinical criteria, pedigrees affected with
myopia will be collected from two separate geographic regions. Blood
samples from suitable families will be collected for DNA extraction
which will be used for genetic mapping. Microsatellite repeat markers
located at 10 cM intervals through the genome will be used for genotype
generation. The genotype data will be utilized to create databases for
linkage analysis. Potential areas suggestive of linkage will be further
examined with additional markers from the potential region. The results
of this investigation will (1) identify specific genetic loci for myopia, (2)
permit an estimate of the relative importance of environmental exposure
on myopia, and (3) provide a more rational framework for the
classification of myopia based on genetic locus. Findings from this study
may also provide further understanding of the pathogenesis of myopia
and may have public health implications if there are some segments of
the population in which preventing environmental exposures may alter
the onset of disease or its further progression. This will have an even
greater relevance if we are successful at defining the refractive
component(s) of the eye which is responsible for the development of
myopia.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Mechanisms of Ocular Development
Principal Investigator & Institution: Norton, Thomas T.; Professor;
Physiological Optics; University of Alabama at Birmingham Uab Station
Birmingham, Al 35294
74 Myopia
Timing: Fiscal Year 2000; Project Start 1-APR-1986; Project End 1-MAR2002
Summary: The goal of this project is to understand the visually-guided
regulation of axial length in juvenile eyes. Evidence from animal models
strongly suggests that visual signals are used to match the developing
eye s length to its optical power to produce eyes that are in good focus
(e.g., the eyes become emmetropic.) Some aspects of the visual images on
the retina, such as the amount of hyperopic defocus, stimulates eyes to
elongate. As young eyes move from hyperopia toward emmetropia, the
visual stimulus for elongation is reduced and the axial elongation rate is
slowed, keeping the retina in the focal plane. Visual/neural control of
scleral extensibility may be a key component in regulating the elongation
rate of mammalian eyes during emmetropization. Our studies in tree
shrews (small mammals closely related to primates) have found that the
extensibility of the sclera is regulated by the visual environment. The
sclera becomes more extensible in eyes with an environmentally-induced
increase in elongation rate and less extensible in eyes with a decreased
elongation rate. A detailed understanding of the spatial location and
temporal pattern of changes within the sclera is needed to 1) determine
how specific changes in scleral components produce changes in
extensibility, and 2) help define the latency and signaling pathway(s) by
which signals of retinal origin reach the sclera via the choroid. There are
two broad objectives for this project period: First, Specific Aim 1 is to
better define the visual stimuli that increase and decrease axial
elongation rate. This will be accomplished by manipulating and
measuring the amount and sign of defocus during the development of
induced myopia. Second, Specific Aims 2 and 3 are to understand in
detail the remodeling of the scleral matrix that controls axial elongation,
learning what changes, where the changes occur and when the changes
occur relative to changes in the visual environment and changes in axial
elongation. Specific Aim 2 is to define and localize the specific changes in
collagen and proteoglycans in the scleral extracellular matrix that occur
during the development of induced myopia and during recovery from an
induced myopia; Specific Aim 3 is to measure the time-course and
latency of changes in scleral fibroblast gene expression for synthesis and
degradation of scleral extracellular matrix during the development of
induced myopia and recovery. The proposed experiments will
significantly advance our understanding of the mammalian
emmetropization mechanism. This, in turn, will help us to learn how
human eyes normally control their elongation, and how interactions with
the visual environment can lead to myopia (nearsightedness) in children.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
Studies 75
�
Project Title: Molecular Genetics of Myopia
Principal Investigator & Institution: Young, Terri L.; Associate Professor;
Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd
Philadelphia, Pa 19104
Timing: Fiscal Year 2000; Project Start 1-AUG-1998; Project End 1-JUL2003
Summary: Dr. Terri Young is a pediatric ophthalmologist and Assistant
Professor of Ophthalmology at the University of Minnesota. This award
will enhance the candidate's potential for success by providing support
for investigations into the molecular genetics of exaggerate eye growth,
or myopia. Myopia, or nearsightedness is a refractive condition of the
eyes with high incidence in the United States and one of the leading
causes of blindness. Severe myopia predisposes the eye to glaucoma,
macular degeneration, and retinal detachment. Genetic and
environmental influences have been implicated, but specific factors
responsible for myopia in humans have not bee identified. Several
studies support the hypothesis that heredity is a major factor. In order to
better understand the molecular genetics of myopia, we propose to
characterize potential genetic factors of myopia through family studies
with genome screening and linkage analysis. The overall goal of this
proposal is to map genes responsible for familial severe myopia.
Currently, 51 families have been recruited with an autosomal dominant
pattern of inheritance of severe myopia (refractive error less than or equal
to -6.00 diopters). Highly informative short tandem repeat
polymorphisms have been utilized to confirm linkage and subsequently
narrow the chromosomal region of interest. Significant linkage (Lod
score= 6.24) has been identified at a locus on chromosome 18 in 8
families. Recently, significant linkage has been identified at a second
locus on chromosome 12 (Lod score = 3.01) in one large multigeneration
family. These potential candidate regions for myopia, as well as others
that may be identified with the genome screen will be examined for
mutations. This project is important to further our understanding of the
molecular genetics of myopia, and may be generalized to enhance out
understanding of the mechanisms of eye growth, whether normal,
diminished, or excessive. Dr. Young's career goal is to flourish as a
clinical scientist, with an established independent laboratory program in
ophthalmic genetics. Dr. Richard king, the proposed sponsor, has
extensive experience in the genetic analysis of complex diseases. The cosponsors in this proposal will provide expertise in molecular genetics,
ophthalmic genetics, and statistical analysis and epidemiology. With the
support of the Mentored Clinical Scientist Development Award, the
candidate will obtain a solid foundation in molecular genetics.
76 Myopia
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Myopia Development in Children
Principal Investigator & Institution: Zadnik, Karla S.; Associate Professor;
None; Ohio State University Columbus, Oh 43210
Timing: Fiscal Year 2000; Project Start 1-JUL-1991; Project End 0-JUN2001
Summary: The Orinda Longitudinal Study of Myopia (OLSM) was
started in 1989 and has investigated normal eye growth and the
development =of myopia in over 1,200 school-aged children to date. In
the next five years of this project, we propose to conduct three parallel
study phases. Phase I will investigate additional factors that may predict
the onset of juvenile myopia (accommodative function, peripheral
refractive error, intraocular pressure, and school achievement). Phase 2
will compare and contrast the optical ocular components and refractive
error profiles of other ethnic groups with the predominantly Caucasian
Orinda database. Phase 3 will initiate DNA- based studies on the
prevalent OLSM myopes and their families to use these phenotypically
well-characterized children and a panel of candidate genes to look for
evidence of genetic factors. In parallel with the candidate gene
association, family material will be used in an allele sharing approach to
identify loci using highly variable, PCR-based markers. In Phase 1 we
will continue to examine Orinda Union School District children in grades
1 through 8 (ages 6 through 14 years) annually. The measurement of
accommodative response, accommodative lag, phoria, response AC/A
ratio, peripheral refractive error, pushup accommodative amplitude, and
intraocular pressure will be added to the existing protocol. Parents of
children in the study will be contacted for their permission to release
school achievement data (Iowa Test of Basic Skills). Phase 2 will add a
major component to assess the influence of ethnicity on normal ocular
and refractive error development. We propose to identify three
participating sites with access to their local school districts that are
predominantly African-American, Hispanic, and Asian, Children in the
school districts associated with these sites will be examined annually
with initial enrollment in all grades from 1 through 8 using the revised
OLSM protocol as described above. Increased prevalence of myopia
among children of myopic parents, twin studies, segregation analysis,
and our own preliminary analyses from OLSM support a genetic
etiologic component for myopia. In phase 3, we will use the phenotypic
characterization of children in the Orinda Longitudinal Study of Myopia
to identify prevalent cases of myopia and their families. These welldefined phenotypic myopes and non-myopic siblings and their parents
Studies 77
will be explored, seeking to develop a panel of candidate genes for
myopia and to conduct an allele sharing analysis in these families.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Regulation of Scleral Growth and Remodelling
Principal Investigator & Institution: Rada, Jody A.; Associate Professor;
Anatomy and Cell Biology; University of North Dakota Grand Forks, Nd
58201
Timing: Fiscal Year 2000; Project Start 1-JAN-1992; Project End 1-JUL2001
Summary: The sclera, a connective tissue consisting of proteoglycans and
collagen, provides the structural integrity that defines the shape and focal
length of the eye. Therefore, alterations in the synthesis, degradation and
net accumulation of these extracellular matrix components are likely to
lead to significant changes in eye shape and severely affect vision. High
myopia is a common condition characterized by excessive lengthening of
the eye, primarily due to elongation of the vitreous chamber. Generally,
myopia develops before puberty, and then stabilizes. If axial elongation
fails to stabilize, an individual has an increased risk of retinal
detachment, glaucoma, and blindness. This proposal examines the
hypothesis that myopia is a connective tissue disorder in which the
scleral extracellular matrix components are inappropriately remodeled.
The objective of this proposal is to characterize the biochemical events
which lead to scleral elongation and to identify regulatory mechanisms
that govern these events. The well established model of myopia in chicks
(form deprivation myopia) will be used to determine whether: 1)
proteoglycan accumulation within the chick sclera is directly responsible
for normal and myopic scleral growth, 2) changes in the fibrous sclera of
form-deprived chick eyes parallel changes observed in myopic
mammalian sclera 3) regional extracellular matrix turnover is mediated
by the regulation of the 72 kDa gelatinase (MMP-2) and its associated
inhibitors (TIMP-1 and TIMP-2) in the normal and form-deprived sclera,
and 4) changes in the visual environment trigger the differential
expression of genes within the eye which regulate scleral growth.
Additionally, we propose to characterize the extracellular matrix of the
human sclera from donors ranging in age from fetal - 90 years, in order to
identify structural and biochemical differences which would predispose
children to the development of myopia. Together, this information will
serve as a basis for understanding the mechanisms by which myopia
develops in chicks as well as in humans. Ultimately, this information may
lead to the development of an anti-myopia therapy in children which
78 Myopia
would slow the progression of myopia by altering scleral metabolism and
growth.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: The Myopia of Adulthood
Principal Investigator & Institution: Bullimore, Mark A.; None; Ohio State
University Columbus, Oh 43210
Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 0-APR2006
Summary: (Applicant's Abstract) Significant myopia progression occurs
in over 40 percent of adults in their thirties. It has been proposed that the
amount of near work performed places an individual at risk. There is also
evidence that characteristics of a patient's accommodation and vergence
system may predispose them to myopic changes. Nonetheless, there has
been no systematic evaluation of the risk factors for adult myopia
progression. We propose a five-year cohort study to determine the risk
factors associated with adult myopia progression. The risk factors to be
evaluated include: a. A greater proportion of time spent performing near
tasks at home and at work. b. Performing near tasks at a closer distance.
c. A higher accommodative convergence/accommodation (AC/A) ratio.
d. A higher accommodative lag. Five hundred myopic subjects between
25 and 35 years of age will be recruited from the faculty and staff of The
Ohio State University. Myopia progression is operationally defined as an
increase in myopia of at least -0.75 D spherical equivalent as determined
by cycloplegic auto-refraction. Subjects will be divided into progressors
and non-progressors for data analysis based on this criterion. Subjects
will be tested annually using the following methods: visual acuity, noncycloplegic
auto-refraction
and
auto-keratometry,
phoria,
accommodative lag, response AC/A ratio, cycloplegic auto-refraction,
videophakometry, and partial coherence interferometry (axial ocular
dimensions). Participants' near work will be assessed using a novel
technique known as the Experience Sampling Method. Subjects carry a
portable electronic pager for two one-week periods and are paged
randomly throughout the day. Each time they are paged, they dial into
an automated telephone survey and report their activity at that time.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Trial of Bifocals in Myopic Children with Esophoria
Principal Investigator & Institution: Fulk, George W.; None; Northeastern
Oklahoma State University Tahlequah, Ok 74464
Studies 79
Timing: Fiscal Year 2000; Project Start 1-JUN-1996; Project End 1-MAY2002
Summary: (Applicant's Abstract) This clinical trial will test the hypothesis
that correcting a specific group of myopic children with bifocals, instead
of with single-vision spectacles, will reduce the rate of myopic
progression. The specific group of myopic children to be included in the
trial are those who show near-point esophoria, a tendency to overconverge while reading. Such children constitute about 30 percent of all
myopic children. Support for the effectiveness of bifocals in esophoric
children comes from three sources: a retrospective study, a secondary
analysis of a clinical trial designed for another purpose, and pilot data
collected by the applicants. These studies suggest that bifocals reduce the
rate of myopic progression by 50 percent in esophoria children. The
proposed study will be the first clinical trial of bifocals in myopic
children with esophoria. Eighty myopic children with near-point
esophoria will be divided randomly into two treatment groups:
correction with single-vision lenses or with bifocal lenses containing a
+1.50 D add. For 30 months, myopia will be measured every 6 months by
means of automated, cycloplegic refraction. The long-term objective of
the study is to find a method of reducing the final amount of myopia in a
significant portion of all myopic persons. About 25 percent of all
Americans are myopic. The correction of myopia and the treatment of
myopia-associated diseases accounts for a significant proportion of health
care costs. Substantial savings could be achieved if this study is
successful. Many children, who are in phase of rapid myopia
progression, would have to change prescriptions less often. Many adults
would have better vision without glasses, thinner lenses, and a lower risk
of retinal detachment.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
�
Project Title: Vision and Etiology of Axial Myopia
Principal Investigator & Institution: Wallmann, Josh; Professor; Biology;
City College of New York 138Th St and Convent Ave New York, Ny
10031
Timing: Fiscal Year 2000; Project Start 1-DEC-1978; Project End 1-MAR2002
Summary: (Investigator's Abstract): This project seeks to contribute to the
understanding of the etiology of myopia, a leading cause of blindness, by
studying the severe myopia produced by deprivation of form vision in
chickens. This animal model has three important features: the visual
deprivation of one part of the retina produces myopia of only that part of
the eye, and the scleral growth can be modulated up or down as
80 Myopia
necessary to compensate for myopia or hyperopia, suggesting that the
eye can sense its refractive error and compensate for it. This has
important implications in understanding how the eye grows and how it
can go awry in clinical myopia.Three sets of experiments are proposed: (i)
To study the cellular basis of myopia and emmetropization, the
bidirectional modulation of scleral growth will be investigated in an in
vitro system as assessed by incorporation of radiolabeled sulfur into in
organ cultures and in dissociated cell cultures. The increase in
proteoglycan synthesis in myopic scleras and cells of myopic eyes, and
the decrease in those of recovering eyes will be studied to determine
whether the modulation is achieved via a growth factor continuously or
transiently released. Conditioned medium experiments will investigate
the experiments will investigate the roles of he retinal pigment
epithelium, choroid and retina as sources of relevant growth factors.
Finally, different known growth factors will be added to the cultures to
determine their effect on scleral growth in vitro. (ii) By in vivo studies,
evidence will be sought that the recognized role of dopamine in the
amelioration in form deprivation myopia represents a specific inhibition
of the deprivation effect by using agonists on partially occluded eyes.In
addition, scleras of tree shrews, which provide a mammalian model for
myopia, will be studied to determine whether the myopia in these
animals is also largely due to enhanced growth of the posterior sclera.
(iii) The nature of the emmetropization process will be explored with
experiments directed at determining the roles of the choroid and sclera in
compensating for myopia or hyperopia.
Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
The National Library of Medicine: PubMed
One of the quickest and most comprehensive ways to find academic studies
in both English and other languages is to use PubMed, maintained by the
National Library of Medicine. The advantage of PubMed over previously
mentioned sources is that it covers a greater number of domestic and foreign
references. It is also free to the public.22 If the publisher has a Web site that
offers full text of its journals, PubMed will provide links to that site, as well
as to sites offering other related data. User registration, a subscription fee, or
PubMed was developed by the National Center for Biotechnology Information (NCBI) at
the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The
PubMed database was developed in conjunction with publishers of biomedical literature as
a search tool for accessing literature citations and linking to full-text journal articles at Web
sites of participating publishers. Publishers that participate in PubMed supply NLM with
their citations electronically prior to or at the time of publication.
22
Studies 81
some other type of fee may be required to access the full text of articles in
some journals.
To generate your own bibliography of studies dealing with myopia, simply
go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type
?myopia? (or synonyms) into the search box, and click ?Go.? The following
is the type of output you can expect from PubMed for ?myopia? (hyperlinks
lead to article summaries):
�
Biofeedback training for myopia control.
Author(s): Trachtman JN, Giambalvo V, Dippner RF.
Source: Optom Vis Sci. 1992 March; 69(3): 252-4. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1520360&dopt=Abstract
�
Induced myopia associated with increased scleral creep in chick and
tree shrew eyes.
Author(s): Phillips JR, Khalaj M, McBrien NA.
Source: Investigative Ophthalmology & Visual Science. 2000 July; 41(8):
2028-34.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10892839&dopt=Abstract
�
Inhibition of myopia development in chicks using himbacine: a role
for M(4) receptors?
Author(s): Cottriall CL, Truong HT, McBrien NA.
Source: Neuroreport. 2001 August 8; 12(11): 2453-6.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11496128&dopt=Abstract
�
Lacquer crack lesions in experimental chick myopia.
Author(s): Hirata A, Negi A.
Source: Graefe's Archive for Clinical and Experimental Ophthalmology =
Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle
Ophthalmologie. 1998 February; 236(2): 138-45.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9498125&dopt=Abstract
�
Lid-suture myopia in tree shrews with retinal ganglion cell blockade.
Author(s): Norton TT, Essinger JA, McBrien NA.
82 Myopia
Source: Visual Neuroscience. 1994 January-February; 11(1): 143-53.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8011577&dopt=Abstract
�
Long-term changes in retinal contrast sensitivity in chicks from frosted
occluders and drugs: relations to myopia?
Author(s): Diether S, Schaeffel F.
Source: Vision Research. 1999 July; 39(15): 2499-510.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10396619&dopt=Abstract
�
Melatonin and deprivation myopia in chickens.
Author(s): Hoffmann M, Schaeffel F.
Source: Neurochemistry International. 1996 January; 28(1): 95-107.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8746769&dopt=Abstract
�
Modulation of scleral DNA synthesis in development of and recovery
from induced axial myopia in the tree shrew.
Author(s): Gentle A, McBrien NA.
Source: Experimental Eye Research. 1999 February; 68(2): 155-63.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10068481&dopt=Abstract
�
Morphological changes of choriocapillaris in experimentally induced
chick myopia.
Author(s): Hirata A, Negi A.
Source: Graefe's Archive for Clinical and Experimental Ophthalmology =
Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle
Ophthalmologie. 1998 February; 236(2): 132-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9498124&dopt=Abstract
�
Morphology of the recovery from form deprivation myopia in the
chick.
Author(s): Liang H, Crewther SG, Crewther DP, Pirie B.
Source: Australian and New Zealand Journal of Ophthalmology. 1996
May; 24(2 Suppl): 41-4. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8811241&dopt=Abstract
Studies 83
�
Myopia in the eye of developing chicks following monocular and
binocular lid closure.
Author(s): Yinon U, Rose L, Shapiro A.
Source: Vision Research. 1980; 20(2): 137-41. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7434574&dopt=Abstract
�
Myopia in the lid-sutured tree shrew (Tupaia glis).
Author(s): Sherman SM, Norton TT, Casagrande VA.
Source: Brain Research. 1977 March 18; 124(1): 154-7. No Abstract
Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=843938&dopt=Abstract
�
Myopia induced in cats deprived of distance vision during
development.
Author(s): Rose L, Yinon U, Belkin M.
Source: Vision Research. 1974 October; 14(10): 1029-32. No Abstract
Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=4432382&dopt=Abstract
�
Myopia.
Author(s): Schaeffel F, Howland HC.
Source: Vision Research. 1995 May; 35(9): 1135-9. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610574&dopt=Abstract
�
Myopia. The nature versus nurture debate goes on.
Author(s): Mutti DO, Zadnik K, Adams AJ.
Source: Investigative Ophthalmology & Visual Science. 1996 May; 37(6):
952-7. Review. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8631638&dopt=Abstract
�
Myopia: what can we do about it clinically?
Author(s): Grosvenor T.
Source: Optom Vis Sci. 1989 July; 66(7): 415-9. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=2671846&dopt=Abstract
84 Myopia
�
New approach in strabismus surgery in high myopia.
Author(s): Krzizok TH, Kaufmann H, Traupe H.
Source: The British Journal of Ophthalmology. 1997 August; 81(8): 625-30.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9349146&dopt=Abstract
�
N-methyl-D-aspartate-induced excitotoxicity causes myopia in hatched
chicks.
Author(s): Fischer AJ, Seltner RL, Stell WK.
Source: Can J Ophthalmol. 1997 October; 32(6): 373-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9363340&dopt=Abstract
�
Nuclear cataract and myopia during hyperbaric oxygen therapy.
Author(s): Palmquist BM, Philipson B, Barr PO.
Source: The British Journal of Ophthalmology. 1984 February; 68(2): 1137.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=6691953&dopt=Abstract
�
Ocular development and visual deprivation myopia in the common
marmoset (Callithrix jacchus).
Author(s): Troilo D, Judge SJ.
Source: Vision Research. 1993 July; 33(10): 1311-24.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8333155&dopt=Abstract
�
Opiate and N-methyl-D-aspartate receptors in form-deprivation
myopia.
Author(s): Fischer AJ, Seltner RL, Stell WK.
Source: Visual Neuroscience. 1998 November-December; 15(6): 1089-96.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9839973&dopt=Abstract
�
Optical correction of induced axial myopia in the tree shrew:
implications for emmetropization.
Author(s): McBrien NA, Gentle A, Cottriall C.
Source: Optom Vis Sci. 1999 June; 76(6): 419-27.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10416937&dopt=Abstract
Studies 85
�
Persistent hyperplastic primary vitreous with myopia: a case study.
Author(s): Steele G, Peters R.
Source: J Am Optom Assoc. 1999 September; 70(9): 593-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10547975&dopt=Abstract
�
Photorefractive keratectomy to correct astigmatism with myopia or
hyperopia.
Author(s): Dausch D, Klein R, Landesz M, Schroder E.
Source: Journal of Cataract and Refractive Surgery. 1994 March; 20 Suppl:
252-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8006796&dopt=Abstract
�
Pirenzepine prevents form deprivation myopia in a dose dependent
manner.
Author(s): Leech EM, Cottriall CL, McBrien NA.
Source: Ophthalmic & Physiological Optics : the Journal of the British
College of Ophthalmic Opticians (Optometrists). 1995 September; 15(5):
351-6.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8524553&dopt=Abstract
�
Prevention of collagen crosslinking increases form-deprivation myopia
in tree shrew.
Author(s): McBrien NA, Norton TT.
Source: Experimental Eye Research. 1994 October; 59(4): 475-86.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7859823&dopt=Abstract
�
Prevention of form-deprivation myopia with pirenzepine: a study of
drug delivery and distribution.
Author(s): Cottriall CL, McBrien NA, Annies R, Leech EM.
Source: Ophthalmic & Physiological Optics : the Journal of the British
College of Ophthalmic Opticians (Optometrists). 1999 July; 19(4): 327-35.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10645389&dopt=Abstract
�
Reduced extracellular matrix in mammalian sclera with induced
myopia.
Author(s): Norton TT, Rada JA.
86 Myopia
Source: Vision Research. 1995 May; 35(9): 1271-81.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610587&dopt=Abstract
�
Reduction in choroidal blood flow occurs in chicks wearing goggles
that induce eye growth toward myopia.
Author(s): Shih YF, Fitzgerald ME, Norton TT, Gamlin PD, Hodos W,
Reiner A.
Source: Current Eye Research. 1993 March; 12(3): 219-27.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8482110&dopt=Abstract
�
Refractive changes in chicks with form-deprivation myopia.
Author(s): Wang F, Chu T, Zhang W.
Source: Yan Ke Xue Bao. 1996 September; 12(3): 138-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9639839&dopt=Abstract
�
Retinal dopamine in the recovery from experimental myopia.
Author(s): Pendrak K, Nguyen T, Lin T, Capehart C, Zhu X, Stone RA.
Source: Current Eye Research. 1997 February; 16(2): 152-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9068946&dopt=Abstract
�
Retinal function with lens-induced myopia compared with formdeprivation myopia in chicks.
Author(s): Fujikado T, Kawasaki Y, Suzuki A, Ohmi G, Tano Y.
Source: Graefe's Archive for Clinical and Experimental Ophthalmology =
Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle
Ophthalmologie. 1997 May; 235(5): 320-4.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9176681&dopt=Abstract
�
Retinoic acid increases in the retina of the chick with form deprivation
myopia.
Author(s): Seko Y, Shimizu M, Tokoro T.
Source: Ophthalmic Research. 1998; 30(6): 361-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9731117&dopt=Abstract
Studies 87
�
Scleral remodeling during the development of and recovery from axial
myopia in the tree shrew.
Author(s): McBrien NA, Lawlor P, Gentle A.
Source: Investigative Ophthalmology & Visual Science. 2000 November;
41(12): 3713-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11053267&dopt=Abstract
�
Sex differences in chick eye growth and experimental myopia.
Author(s): Zhu X, Lin T, Stone RA, Laties AM.
Source: Experimental Eye Research. 1995 August; 61(2): 173-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7556481&dopt=Abstract
�
Steady state mRNA levels in tree shrew sclera with form-deprivation
myopia and during recovery.
Author(s): Siegwart JT Jr, Norton TT.
Source: Investigative Ophthalmology & Visual Science. 2001 May; 42(6):
1153-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11328721&dopt=Abstract
�
Stimulation of dopaminergic amacrine cells by stroboscopic
illumination or fibroblast growth factor (bFGF, FGF-2) injections:
possible roles in prevention of form-deprivation myopia in the chick.
Author(s): Rohrer B, Iuvone PM, Stell WK.
Source: Brain Research. 1995 July 24; 686(2): 169-81.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7583283&dopt=Abstract
�
Stimulus deprivation myopia in human congenital ptosis: a
preliminary report of 50 unilateral cases.
Author(s): Gusek-Schneider GC, Martus P.
Source: Strabismus. 2000 September; 8(3): 169-77.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11035559&dopt=Abstract
�
Stimulus deprivation myopia in human congenital ptosis: a study of 95
patients.
Author(s): Gusek-Schneider GC, Martus P.
88 Myopia
Source: J Pediatr Ophthalmol Strabismus. 2001 November-December;
38(6): 340-8.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11759772&dopt=Abstract
�
Structural and ultrastructural changes to the sclera in a mammalian
model of high myopia.
Author(s): McBrien NA, Cornell LM, Gentle A.
Source: Investigative Ophthalmology & Visual Science. 2001 September;
42(10): 2179-87.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11527928&dopt=Abstract
�
Surgically-induced astigmatism after laser in situ keratomileusis for
spherical myopia.
Author(s): Huang D, Sur S, Seffo F, Meisler DM, Krueger RR.
Source: J Refract Surg. 2000 September-October; 16(5): 515-8.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11019865&dopt=Abstract
�
The amelioration of myopia using biofeedback of accommodation: a
review.
Author(s): Gilmartin B, Gray LS, Winn B.
Source: Ophthalmic & Physiological Optics : the Journal of the British
College of Ophthalmic Opticians (Optometrists). 1991 October; 11(4): 30413. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1771067&dopt=Abstract
�
The development of experimental myopia and ocular component
dimensions in monocularly lid-sutured tree shrews (Tupaia belangeri)
Author(s): McBrien NA, Norton TT.
Source: Vision Research. 1992 May; 32(5): 843-52.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1604853&dopt=Abstract
�
The duration of normal visual exposure necessary to prevent form
deprivation myopia in chicks.
Author(s): Napper GA, Brennan NA, Barrington M, Squires MA, Vessey
GA, Vingrys AJ.
Studies 89
Source: Vision Research. 1995 May; 35(9): 1337-44.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610595&dopt=Abstract
�
The effect of an interrupted daily period of normal visual stimulation
on form deprivation myopia in chicks.
Author(s): Napper GA, Brennan NA, Barrington M, Squires MA, Vessey
GA, Vingrys AJ.
Source: Vision Research. 1997 June; 37(12): 1557-64.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9231222&dopt=Abstract
�
The effect of nitric oxide synthase inhibitor on form-deprivation
myopia.
Author(s): Fujikado T, Kawasaki Y, Fujii J, Taniguchi N, Okada M,
Suzuki A, Ohmi G, Tano Y.
Source: Current Eye Research. 1997 October; 16(10): 992-6.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9330850&dopt=Abstract
�
The effect of vasoactive intestinal peptide on development of form
deprivation myopia in the chick: a pharmacological and
immunocytochemical study.
Author(s): Seltner RL, Stell WK.
Source: Vision Research. 1995 May; 35(9): 1265-70.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610586&dopt=Abstract
�
The effects of blockade of retinal cell action potentials on ocular
growth, emmetropization and form deprivation myopia in young
chicks.
Author(s): McBrien NA, Moghaddam HO, Cottriall CL, Leech EM,
Cornell LM.
Source: Vision Research. 1995 May; 35(9): 1141-52.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610575&dopt=Abstract
�
The M1 muscarinic antagonist pirenzepine reduces myopia and eye
enlargement in the tree shrew.
Author(s): Cottriall CL, McBrien NA.
90 Myopia
Source: Investigative Ophthalmology & Visual Science. 1996 June; 37(7):
1368-79.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8641840&dopt=Abstract
�
The mechanism of lid-suture myopia.
Author(s): Raviola E, Wiesel TN.
Source: Acta Ophthalmol Suppl. 1988; 185: 91-2. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=2853550&dopt=Abstract
Vocabulary Builder
Accommodation: The ability of the eye to change its focus from distant to
near objects; process achieved by the lens changing its shape. [NIH]
Agonist: In anatomy, a prime mover. In pharmacology, a drug that has
affinity for and stimulates physiologic activity at cell receptors normally
stimulated by naturally occurring substances. [EU]
Anisometropia: A condition of an inequality of refractive power of the two
eyes. [NIH]
Anxiety: The unpleasant emotional state consisting of psychophysiological
responses to anticipation of unreal or imagined danger, ostensibly resulting
from unrecognized intrapsychic conflict. Physiological concomitants include
increased heart rate, altered respiration rate, sweating, trembling, weakness,
and fatigue; psychological concomitants include feelings of impending
danger, powerlessness, apprehension, and tension. [EU]
Ascariasis: Infection by nematodes of the genus ASCARIS. Ingestion of
infective eggs causes diarrhea and pneumonitis. Its distribution is more
prevalent in areas of poor sanitation and where human feces are used for
fertilizer. [NIH]
Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium
of the heart. [EU]
Biochemical: Relating to biochemistry; characterized by, produced by, or
involving chemical reactions in living organisms. [EU]
Cardiovascular: Pertaining to the heart and blood vessels. [EU]
Choroid: The layer filled with blood vessels that nourishes the retina; part of
the uvea. [NIH]
Chromosomal: Pertaining to chromosomes. [EU]
Criterion: A standard by which something may be judged. [EU]
Studies 91
Degenerative: Undergoing degeneration : tending to degenerate; having the
character of or involving degeneration; causing or tending to cause
degeneration. [EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are
needed. [EU]
Dysplasia: Abnormality of development; in pathology, alteration in size,
shape, and organization of adult cells. [EU]
Epidemic: Occurring suddenly in numbers clearly in excess of normal
expectancy; said especially of infectious diseases but applied also to any
disease, injury, or other health-related event occurring in such outbreaks. [EU]
Epiphyseal: Pertaining to or of the nature of an epiphysis. [EU]
Extracellular: Outside a cell or cells. [EU]
Extraction: The process or act of pulling or drawing out. [EU]
Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve
cell bodies located outside the central nervous system; occasionally applied
to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia.
3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the
wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a
clear mucinous fluid. [EU]
Gastroenteritis: An acute inflammation of the lining of the stomach and
intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain,
and weakness, which has various causes, including food poisoning due to
infection with such organisms as Escherichia coli, Staphylococcus aureus,
and Salmonella species; consumption of irritating food or drink; or
psychological factors such as anger, stress, and fear. Called also
enterogastritis. [EU]
Genotype: The genetic constitution of the individual; the characterization of
the genes. [NIH]
Habitual: Of the nature of a habit; according to habit; established by or
repeated by force of habit, customary. [EU]
Hepatitis: Inflammation of the liver. [EU]
Heredity: 1. the genetic transmission of a particular quality or trait from
parent to offspring. 2. the genetic constitution of an individual. [EU]
Hyperbaric: Characterized by greater than normal pressure or weight;
applied to gases under greater than atmospheric pressure, as hyperbaric
oxygen, or to a solution of greater specific gravity than another taken as a
standard of reference. [EU]
Hypoplasia: Incomplete development or underdevelopment of an organ or
tissue. [EU]
92 Myopia
Immunization: The induction of immunity. [EU]
Induction: The act or process of inducing or causing to occur, especially the
production of a specific morphogenetic effect in the developing embryo
through the influence of evocators or organizers, or the production of
anaesthesia or unconsciousness by use of appropriate agents. [EU]
Intestinal: Pertaining to the intestine. [EU]
function of a part. [EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass
of matter. [EU]
Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a
greater degree of anaplasia and have the properties of invasion and
metastasis, compared to benign neoplasms. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of
the spinal axis, as the neutral arch. [EU]
Ophthalmic: Pertaining to the eye. [EU]
Opiate: A remedy containing or derived from opium; also any drug that
induces sleep. [EU]
Optician: An expert in the art and science of making and fitting glasses and
may also dispense contact lenses. [NIH]
Oral: Pertaining to the mouth, taken through or applied in the mouth, as an
oral medication or an oral thermometer. [EU]
Pediatrics: A medical specialty concerned with maintaining health and
providing medical care to children from birth to adolescence. [NIH]
Pneumonia: Inflammation of the lungs with consolidation. [EU]
Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes
insipidus. [EU]
Posterior: Situated in back of, or in the back part of, or affecting the back or
dorsal surface of the body. In lower animals, it refers to the caudal end of the
body. [EU]
Postnatal: Occurring after birth, with reference to the newborn. [EU]
Precursor: Something that precedes. In biological processes, a substance
from which another, usually more active or mature substance is formed. In
clinical medicine, a sign or symptom that heralds another. [EU]
Prevalence: The total number of cases of a given disease in a specified
population at a designated time. It is differentiated from incidence, which
refers to the number of new cases in the population at a given time. [NIH]
Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase
Studies 93
pathway. They are extremely potent mediators of a diverse group of
physiological processes. [NIH]
Proteoglycans:
content. [NIH]
Glycoproteins which have a very high polysaccharide
Ptosis: 1. prolapse of an organ or part. 2. drooping of the upper eyelid from
paralysis of the third nerve or from sympathetic innervation. [EU]
Puberty: The period during which the secondary sex characteristics begin to
develop and the capability of sexual reproduction is attained. [EU]
Sanitation:
The development and establishment of environmental
conditions favorable to the health of the public. [NIH]
Sulfur: An element that is a member of the chalcogen family. It has an
atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in
the amino acids cysteine and methionine. [NIH]
Systemic: Pertaining to or affecting the body as a whole. [EU]
Trachoma: A chronic infectious disease of the conjunctiva and cornea,
producing photophobia, pain, and lacrimation, caused by an organism once
thought to be a virus but now classified as a strain of the bacteria Chlamydia
trachomatis. [EU]
Tuberculosis: Any of the infectious diseases of man and other animals
caused by species of mycobacterium. [NIH]
Tupaia: A genus of tree shrews of the family TUPAIIDAE which consists of
about 12 species. One of the most frequently encountered species is T. glis.
Members of this genus inhabit rain forests and secondary growth areas in
southeast Asia. [NIH]
Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]
Vitreous: Glasslike or hyaline; often used alone to designate the vitreous
body of the eye (corpus vitreum). [EU]
Patents 95
CHAPTER 5. PATENTS ON MYOPIA
Overview
You can learn about innovations relating to myopia by reading recent
patents and patent applications. Patents can be physical innovations (e.g.
chemicals, pharmaceuticals, medical equipment) or processes (e.g.
treatments or diagnostic procedures). The United States Patent and
Trademark Office defines a patent as a grant of a property right to the
inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are
intellectual property. For the United States, the term of a new patent is 20
years from the date when the patent application was filed. If the inventor
wishes to receive economic benefits, it is likely that the invention will
become commercially available to patients with myopia within 20 years of
the initial filing. It is important to understand, therefore, that an inventor?s
patent does not indicate that a product or service is or will be commercially
available to patients with myopia. The patent implies only that the inventor
has ?the right to exclude others from making, using, offering for sale, or
selling? the invention in the United States. While this relates to U.S. patents,
similar rules govern foreign patents.
In this chapter, we show you how to locate information on patents and their
inventors. If you find a patent that is particularly interesting to you, contact
the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office:
http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
96 Myopia
Patents on Myopia
By performing a patent search focusing on myopia, you can obtain
information such as the title of the invention, the names of the inventor(s),
the assignee(s) or the company that owns or controls the patent, a short
abstract that summarizes the patent, and a few excerpts from the description
of the patent. The abstract of a patent tends to be more technical in nature,
while the description is often written for the public. Full patent descriptions
contain much more information than is presented here (e.g. claims,
references, figures, diagrams, etc.). We will tell you how to obtain this
information later in the chapter. The following is an example of the type of
information that you can expect to obtain from a patent search on myopia:
�
Myopia lens
Inventor(s): Kris; Dimitrios Jack (South Autralia, AU), Edwards; Simon
John (South Australia, AU), Fisher; Scott Warren (South Australia, AU),
Pavy; Simon John (South Australia, AU), Varnas; Saulius Raymond
(South Australia, AU), Kris; Dimitrios Jack (South Autralia, AU),
Edwards; Simon John (South Australia, AU), Fisher; Scott Warren (South
Australia, AU), Pavy; Simon John (South Australia, AU), Varnas; Saulius
Raymond (South Australia, AU)
Assignee(s): Sola International Holdings, Ltd. (Lonsdale, AU), Sola
International Holdings, Ltd. (Lonsdale, AU)
Patent Number: 6,343,861
Date filed: February 26, 2001
Abstract: A progressive ophthalmic lens element including a lens surface
having an upper viewing zone having a surface to achieve a refracting
power corresponding to distance vision, a lower viewing zone having a
greater surface power than the upper viewing zone to achieve a
refracting power corresponding to near vision, and an intermediate zon
extending across the lens element having a surface power varying from
that of the upper viewing zone to that of the lower viewing zone and
including a corridor of relatively low surface astigmatism, the
progressive ophthalmic lens element including progressive design
elements selected to reduce myopia progression.
Excerpt(s): The present invention relates to a progressive ophthalmic lens
and in particular to a progressive ophthalmic lens designed to reduce the
rate of juvenile myopia progression, and to a process for producing such
lenses. ... The present invention relates to a progressive ophthalmic lens
and in particular to a progressive ophthalmic lens designed to reduce the
rate of juvenile myopia progression, and to a process for producing such
Patents 97
lenses. ... Myopia, or short-sightedness, is a condition of the eye in which
parallel rays of light come to a focus in front of the retina. The condition
is generally corrected utilising a diverging lens. In many countries,
particularly those in the Asian region, the rate of myopia progression is
significant, particularly in children, with a rate between -1.25 Dioptre
(D)/yr to -2.00 D/yr. This results in a very high proportion of the
population with high levels of myopia. Many countries have accordingly
embarked on research programs to determine suitable methods of
reducing the rate of myopia progression, but with limited success. ...
Myopia, or short-sightedness, is a condition of the eye in which parallel
rays of light come to a focus in front of the retina. The condition is
generally corrected utilising a diverging lens. In many countries,
particularly those in the Asian region, the rate of myopia progression is
significant, particularly in children, with a rate between -1.25 Dioptre
(D)/yr to -2.00 D/yr. This results in a very high proportion of the
population with high levels of myopia. Many countries have accordingly
embarked on research programs to determine suitable methods of
reducing the rate of myopia progression, but with limited success. ...
Numerous progressive lenses are known in the prior art. Progressive
lenses have heretofore been designed on the basis that they have
distance, near and intermediate viewing zones. The intermediate zone
joins the near and distance zones in a cosmetically acceptable way, in the
sense that no discontinuities in the lens should be visible to people
observing the lens of the wearer. The design of the intermediate zone is
based on a line called the "eye path" along which the optical power of the
lens increases more or less uniformly. However, progressive lens designs,
whilst in certain cases tailored for wearers suffering from myopia (see
International Patent Application PCT/EP97/00105 to Applicants) have
heretofore not been applied to juvenile wearers, nor to the problem of
juvenile myopia progression. ... Numerous progressive lenses are known
in the prior art. Progressive lenses have heretofore been designed on the
basis that they have distance, near and intermediate viewing zones. The
intermediate zone joins the near and distance zones in a cosmetically
acceptable way, in the sense that no discontinuities in the lens should be
visible to people observing the lens of the wearer. The design of the
intermediate zone is based on a line called the "eye path" along which the
optical power of the lens increases more or less uniformly. However,
progressive lens designs, whilst in certain cases tailored for wearers
suffering from myopia (see International Patent Application
PCT/EP97/00105 to Applicants) have heretofore not been applied to
juvenile wearers, nor to the problem of juvenile myopia progression.
Web site: http://www.delphion.com/details?pn=US06343861__
98 Myopia
�
Corneal contact lens and method for treating myopia
Inventor(s): Stoyan; Nick (3841 Diamante Pl., Encino, CA 91436)
Assignee(s): none reported
Patent Number: 5,191,365
Date filed: August 23, 1991
Abstract: A corneal contact lens for use in treating myopia by controlled
corneal molding. The lens includes a central zone having a central zone
radius of curvature and a tear zone. The tear zone is located
concentrically around the central zone and has a radius of curvature
which is smaller than the central zone. A transition zone is provided
between the central zone and the tear zone wherein the transition zone
has at least one transition ring. The lens may also include a peripheral
zone which is located concentrically around the tear zone wherein the
peripheral zone includes multiple peripheral curves having radii of
curvature equal to or greater than the central zone.
Excerpt(s): The present invention relates generally to corneal contact
lenses and their use in treating myopia. More particularly, the present
invention is directed to corneal contact lenses which are shaped to
provide gradual altering of the patient's cornea during continued wear to
reshape the cornea to reduce the myopic condition. ... Myopia, also
known as nearsightedness, is a condition where the radius of curvature of
the cornea is smaller than normal. Individuals with this condition have
difficulty in focusing on distant objects because the cornea is curved too
sharply to provide adequate focusing. Myopia is a common condition for
which no entirely suitable permanent treatment has been developed. ...
One approach to correcting myopia is through surgical reshaping of the
cornea. However, such surgical procedures have not been entirely proven
and there is some question as to the permanency of the surgically altered
lens shape.
Web site: http://www.delphion.com/details?pn=US05191365__
Patents 99
�
Composition for treatment of progressive myopia
Inventor(s): Avetisov; Eduard S. (ulitsa Ramenki, II, korpus 3, kv. 629,
Moscow, SU), Vinetskaya; Maya I. (I6 Parkovaya ulitsa, 49, korpus I, kv.
8, Moscow, SU), Iomdina; Elena N. (I Parkovaya ulitsa, I/5I, kv. 34,
Moscow, SU), Boltaeva; Zulfia K. (ulitsa Druzhby narodov, 8a, kv. 27,
Tashkent, SU), Khromov; Gennady L. (2-aya Frunzenskaya ulitsa, I0, kv.
I00, Moscow, SU), Dolgopyatova; Antonina A. (ulitsa Karla Marxa, 20,
kv. I78, Moscow, SU), Davydov; Anatoly B. (ulitsa Krasny Kazanets, I9,
korpus I, kv. 283, Moscow, SU), Tarutta; Elena P. (ulitsa Volgina, I9, kv.
28, Moscow, SU), Andreeva; Ljudmila D. (Nagatinskaya naberezhnaya,
34, kv. I89, Moscow, SU), Avetisov; Eduard S. (ulitsa Ramenki, II, korpus
3, kv. 629, Moscow, SU), Vinetskaya; Maya I. (I6 Parkovaya ulitsa, 49,
korpus I, kv. 8, Moscow, SU), Iomdina; Elena N. (I Parkovaya ulitsa, I/5I,
kv. 34, Moscow, SU), Boltaeva; Zulfia K. (ulitsa Druzhby narodov, 8a, kv.
27, Tashkent, SU), Khromov; Gennady L. (2-aya Frunzenskaya ulitsa, I0,
kv. I00, Moscow, SU), Dolgopyatova; Antonina A. (ulitsa Karla Marxa,
20, kv. I78, Moscow, SU), Davydov; Anatoly B. (ulitsa Krasny Kazanets,
I9, korpus I, kv. 283, Moscow, SU), Tarutta; Elena P. (ulitsa Volgina, I9,
kv. 28, Moscow, SU), Andreeva; Ljudmila D. (Nagatinskaya
naberezhnaya, 34, kv. I89, Moscow, SU)
Assignee(s): none reported, none reported
Patent Number: 5,075,105
Date filed: April 23, 1991
Abstract: The invention relates to medicine.A composition for treatment
of progressive myopia is composed of the following constituents, taken in
mass percent:
Excerpt(s): The present invention relates to medicine and more
specifically a composition for treatment of progressive myopia. ... The
present invention relates to medicine and more specifically a composition
for treatment of progressive myopia. ... At present a complex of
therapeutic measures applied against progressive myopia involves
various methods aimed at reinforcing the posterior pole of the eyeball.
Alongside with conventional surgical methods search for new methods
and means for operationless effects upon the sclera aimed at directional
correction of the myopic process proves to be the currently central
problem. ... At present a complex of therapeutic measures applied against
progressive myopia involves various methods aimed at reinforcing the
posterior pole of the eyeball. Alongside with conventional surgical
methods search for new methods and means for operationless effects
upon the sclera aimed at directional correction of the myopic process
proves to be the currently central problem. ... One state-of-the-art
100 Myopia
medicinal agent for treatment of progressive myopia (SU, A, 1,156,680;
Ophthalmological Herald, 1985, Moscow, Meditsina Publishers, vol. 101,
No. 2, pp. 31-36) is known to appear as a foaming gel-like composition,
incorporating a dry mixture of polyvinylpyrrolidone, acrylamidehydrazide, and ethylacrylate, and a dissolving mixture, consisting of
ferrous chloride, cupric citrate, boric acid, hydrochloric acid, and distilled
water, as well as an activator, i.e., a 3-percent hydrogen peroxide that
promotes foaming of the composition. The aforesaid composition is
injected under the Tenon's capsule to establish an elastic foamed gel on
the scleral surface, which while being gradually replaced by the freshly
formed connective tissue, adds to the strength characteristics of the
sclera. However, the studies performed have demonstrated that
formation of a connective capsule on the scleral surface and a process of
its reinforcing occur at a relative slow rate, which is accounted for by a
definite formulation of said composition, whose active components
stimulate the synthesis of collagen and provide for its structural stability.
... One state-of-the-art medicinal agent for treatment of progressive
myopia (SU, A, 1,156,680; Ophthalmological Herald, 1985, Moscow,
Meditsina Publishers, vol. 101, No. 2, pp. 31-36) is known to appear as a
foaming gel-like composition, incorporating a dry mixture of
polyvinylpyrrolidone, acrylamide-hydrazide, and ethylacrylate, and a
dissolving mixture, consisting of ferrous chloride, cupric citrate, boric
acid, hydrochloric acid, and distilled water, as well as an activator, i.e., a
3-percent hydrogen peroxide that promotes foaming of the composition.
The aforesaid composition is injected under the Tenon's capsule to
establish an elastic foamed gel on the scleral surface, which while being
gradually replaced by the freshly formed connective tissue, adds to the
strength characteristics of the sclera. However, the studies performed
have demonstrated that formation of a connective capsule on the scleral
surface and a process of its reinforcing occur at a relative slow rate, which
is accounted for by a definite formulation of said composition, whose
active components stimulate the synthesis of collagen and provide for its
structural stability.
Web site: http://www.delphion.com/details?pn=US05075105__
Patents 101
�
Ophthalmic formulation for treating myopia comprising dopamine
agonist and cyclodextrin
Inventor(s): Lee; Yong-Hee (Daejeon, KR), Choi; Yun-Jeong (Daejeon,
KR), Seo; Mi-Kyeong (Daejeon, KR), Lee; Chang-Ho (Daejeon, KR), Kim;
In-Chull (Daejeon, KR)
Assignee(s): LG Chemical Ltd. (Seoul, KR)
Patent Number: 5,814,638
Date filed: October 2, 1996
Abstract: An ophthalmic formulation for treating myopia, which
comprises a dopamine agonist and cyclodextrin or its derivative in
combination with a pharmaceutically acceptable carrier.
Excerpt(s): The present invention relates to an ophthalmic formulation for
treating myopia, which comprises a dopamine agonist and cyclodextrin
or its derivative in combination with a pharmaceutically acceptable
carrier. ... It has been estimated that about every fourth person on earth
suffers from myopia and that about one-half or more of those are axial
myopia caused by elongation of the eye along the visual axis. At birth,
the human eye is about two-thirds the adult size and is relatively short in
the axial direction. As a consequence, young children tend to be
farsighted. As the eye grows during childhood, there occurs
compensatory fine tuning of the optical properties of the cornea and lens
to the increasing ocular length. Often the entire process takes place
virtually flawlessly and the eye becomes emmetropic. When this fine
tuning process fails, it usually brings about a lengthened eye. As a result,
distant images get focused in front of the plane of the retina and axial
myopia results(Josh Wallman, Retinal Control of Eye Growth and
Refraction, Progress in Retinal Research, 12, 133-153(1993); and R. A.
Stone et al., U.S. Pat. No. 5,284,843, filed on Apr. 10, 1991). ... Hitherto,
many theories have been put forth to explain the development of myopia.
There is now a substantial evidence to link the function of the posterior
part of the eye, especially image quality at the retina and hence the
nervous system, to the postnatal regulation of ocular growth(R. A. Stone
et al., Postnatal Control of Ocular Growth: Dopaminergic Mechanisms,
Ciba Foundation Symposium 155, 45-62(1990)). For example, there is an
evidence that myopia develops in an eye when it is subjected to retinal
image degradation; Josh Wallman has reported that axial myopia can be
experimentally induced in either birds or primates, when the retina is
deprived of formed images, e.g., by suturing eyelids(Progress in Retinal
Research, 12, 133-153(1993)). The experimental myopia induced in
primates such as monkeys precisely mimics human axial myopia. Thus,
102 Myopia
the vision process is apparently involved in the feedback mechanism
which regulates the postnatal ocular growth.
Web site: http://www.delphion.com/details?pn=US05814638__
�
High myopia anterior chamber lens with anti-glare mask
Inventor(s): Kelman; Charles D. (721 Fifth Ave., New York, NY 10022)
Assignee(s): none reported
Patent Number: 5,769,889
Date filed: September 5, 1996
Abstract: A two piece anterior chamber artificial intraocular lens for
treating high myopia conditions by implantation in an eye after
extracapsular removal of the natural eye lens is disclosed. The two-piece
assembly is inserted through a minimum size incision in the eye. The lens
includes a lens body or optic and a separate ring-shaped tension frame
therefor containing light masking means for inhibiting light rays directed
toward the outer edge portions of the lens body from being scattered
thereby toward the retina after the assembled lens has been inserted into
the eye. The lens body or optic is generally circular and conveniently
made of shape retaining plastic. The optic is generally smaller than the
diameter of a pupil dilated for night vision, and is surrounded by a
snugly fitting annular opaque or semi-opaque ring or frame having a Cshaped cross section and a peripherally extending fin of the same
material. The fin is preferably formed of flexible material which is bent
during insertion to allow insertion of the two-piece assembly through a
minimal size corneal incision. The lens is also provided with position
fixation means, such as haptics, which are integrally formed with the lens
body and extend outward in the generally horizontal plane of the lens
body for seating the lens in the eye. The ring-shaped frame is preferably
mated with the lens during manufacturing.
Excerpt(s): Intraocular lenses for high myopia conditions generally have a
thickened peripheral portion. However, as the diameter of the lens is
increased so as to avoid glare conditions, there is a danger that the
thickened peripheral portion will come in contact with the inner surface
of the cornea, resulting in potential injury. Alternatively, the diameter of
the optic or lens body may be reduced in order to avoid the abovementioned peripheral contact. However, in this latter situation, the optic
will be smaller than the pupil in its dilated condition, resulting in glare
caused by the light being reflected from the edge of the smaller diameter
optic. ... It is yet another object of the present invention to provide a two
piece anterior chamber intraocular lens for treating high myopia
Patents 103
conditions, and which does not present the danger of contacting the inner
surface of the cornea, while at the same time not causing any glare. ... The
present invention relates to a two piece anterior chamber intraocular lens,
and more particularly to an artificial intraocular lens for treating high
myopia conditions by implantation in an eye, such as in the anterior
chamber, after extracapsular removal of the natural eye lens. The twopiece assembly is inserted through a minimum size incision in the eye.
The lens includes a lens body or optic and a separate ring-shaped tension
frame therefor containing light masking means for inhibiting light rays
directed toward the outer edge portions of the lens body from being
scattered thereby toward the retina after the assembled lens has been
inserted into the eye.
Web site: http://www.delphion.com/details?pn=US05769889__
�
Method for treating myopia with an aspheric corneal contact lens
Inventor(s): Stoyan; Nick (3841 Diamante Pl., Encino, CA 91436)
Assignee(s): none reported
Patent Number: 5,428,412
Date filed: August 17, 1993
Abstract: Aspheric corneal contact lenses are used to treat myopia by
controlled corneal molding. In one embodiment of the method, the lens
includes an asymmetric central zone which provides multiple focusing
capability to correct both near and far vision. A tear zone is located
concentrically around the central zone. The tear zone is integral with the
central zone and has a radius of curvature which is smaller than the
central zone. The lens also includes a peripheral zone located
concentrically around the tear zone wherein the peripheral zone has a
radius of curvature equal to or greater than the central zone.
Excerpt(s): The present invention relates generally to corneal contact
lenses and their use in treating myopia. More particularly, the present
invention is directed to corneal contact lenses which are shaped to
provide gradual altering of the patient's cornea during continued wear to
reshape the cornea to reduce the myopic condition. ... Myopia, also
known as nearsightedness, is a condition where the radius of curvature of
the cornea is smaller than normal. Individuals with this condition have
difficulty in focusing on distant objects because the cornea the curved too
sharply to provide adequate focusing. Myopia is a common condition for
which no entirely suitable permanent treatment has been developed. ...
One approach to correcting myopia is through surgical reshaping of the
cornea. However, such surgical procedures have not been entirely proven
104 Myopia
and there is some question as to the permanency of the surgically altered
lens shape.
Web site: http://www.delphion.com/details?pn=US05428412__
�
Multiple focus corneal contact lens and method for treating myopia
Inventor(s): Stoyan; Nick (3841 Diamante Pl., Encino, CA 91436)
Assignee(s): none reported
Patent Number: 5,349,395
Date filed: January 26, 1993
Abstract: A multiple focus corneal contact lens for use in treating myopia
by controlled corneal molding. The lens includes an asymmetric central
zone which provides multiple focusing capability to correct both near
and far vision. The tear zone is located concentrically around the central
zone. The tear zone is integral with the central zone and has a radius of
curvature which is smaller than the central zone. The lens also includes a
peripheral zone located concentrically around the tear zone wherein the
peripheral zone has a radius of curvature equal to or greater than the
central zone.
Excerpt(s): The present invention relates generally to corneal contact
lenses and their use in treating myopia. More particularly, the present
invention is directed to corneal contact lenses which are shaped to
provide gradual altering of the patient's cornea during continued wear to
reshape the cornea to reduce the myopic condition. ... Myopia, also
known as nearsightedness, is a condition where the radius of curvature of
the cornea is smaller than normal. Individuals with this condition have
difficulty in focusing on distant objects because the cornea the curved too
sharply to provide adequate focusing. Myopia is a common condition for
which no entirely suitable permanent treatment has been developed. ...
One approach to correcting myopia is through surgical reshaping of the
cornea. However, such surgical procedures have not been entirely proven
and there is some question as to the permanency of the surgically altered
lens shape.
Web site: http://www.delphion.com/details?pn=US05349395__
Patents 105
�
Corneal contact lens and method for treating myopia
Inventor(s): Stoyan; Nick (3841 Diamante Pl., Encino, CA 91436)
Assignee(s): none reported
Patent Number: 5,191,365
Date filed: August 23, 1991
Abstract: A corneal contact lens for use in treating myopia by controlled
corneal molding. The lens includes a central zone having a central zone
radius of curvature and a tear zone. The tear zone is located
concentrically around the central zone and has a radius of curvature
which is smaller than the central zone. A transition zone is provided
between the central zone and the tear zone wherein the transition zone
has at least one transition ring. The lens may also include a peripheral
zone which is located concentrically around the tear zone wherein the
peripheral zone includes multiple peripheral curves having radii of
curvature equal to or greater than the central zone.
Excerpt(s): The present invention relates generally to corneal contact
lenses and their use in treating myopia. More particularly, the present
invention is directed to corneal contact lenses which are shaped to
provide gradual altering of the patient's cornea during continued wear to
reshape the cornea to reduce the myopic condition. ... Myopia, also
known as nearsightedness, is a condition where the radius of curvature of
the cornea is smaller than normal. Individuals with this condition have
difficulty in focusing on distant objects because the cornea is curved too
sharply to provide adequate focusing. Myopia is a common condition for
which no entirely suitable permanent treatment has been developed. ...
One approach to correcting myopia is through surgical reshaping of the
cornea. However, such surgical procedures have not been entirely proven
and there is some question as to the permanency of the surgically altered
lens shape.
Web site: http://www.delphion.com/details?pn=US05191365__
106 Myopia
�
Composition for treatment of progressive myopia
Inventor(s): Avetisov; Eduard S. (ulitsa Ramenki, II, korpus 3, kv. 629,
Moscow, SU), Vinetskaya; Maya I. (I6 Parkovaya ulitsa, 49, korpus I, kv.
8, Moscow, SU), Iomdina; Elena N. (I Parkovaya ulitsa, I/5I, kv. 34,
Moscow, SU), Boltaeva; Zulfia K. (ulitsa Druzhby narodov, 8a, kv. 27,
Tashkent, SU), Khromov; Gennady L. (2-aya Frunzenskaya ulitsa, I0, kv.
I00, Moscow, SU), Dolgopyatova; Antonina A. (ulitsa Karla Marxa, 20,
kv. I78, Moscow, SU), Davydov; Anatoly B. (ulitsa Krasny Kazanets, I9,
korpus I, kv. 283, Moscow, SU), Tarutta; Elena P. (ulitsa Volgina, I9, kv.
28, Moscow, SU), Andreeva; Ljudmila D. (Nagatinskaya naberezhnaya,
34, kv. I89, Moscow, SU)
Assignee(s): none reported
Patent Number: 5,075,105
Date filed: April 23, 1991
Abstract: The invention relates to medicine.A composition for treatment
of progressive myopia is composed of the following constituents, taken in
mass percent:
Excerpt(s): The present invention relates to medicine and more
specifically a composition for treatment of progressive myopia. ... At
present a complex of therapeutic measures applied against progressive
myopia involves various methods aimed at reinforcing the posterior pole
of the eyeball. Alongside with conventional surgical methods search for
new methods and means for operationless effects upon the sclera aimed
at directional correction of the myopic process proves to be the currently
central problem. ... One state-of-the-art medicinal agent for treatment of
progressive myopia (SU, A, 1,156,680; Ophthalmological Herald, 1985,
Moscow, Meditsina Publishers, vol. 101, No. 2, pp. 31-36) is known to
appear as a foaming gel-like composition, incorporating a dry mixture of
polyvinylpyrrolidone, acrylamide-hydrazide, and ethylacrylate, and a
dissolving mixture, consisting of ferrous chloride, cupric citrate, boric
acid, hydrochloric acid, and distilled water, as well as an activator, i.e., a
3-percent hydrogen peroxide that promotes foaming of the composition.
The aforesaid composition is injected under the Tenon's capsule to
establish an elastic foamed gel on the scleral surface, which while being
gradually replaced by the freshly formed connective tissue, adds to the
strength characteristics of the sclera. However, the studies performed
have demonstrated that formation of a connective capsule on the scleral
surface and a process of its reinforcing occur at a relative slow rate, which
is accounted for by a definite formulation of said composition, whose
active components stimulate the synthesis of collagen and provide for its
structural stability.
Patents 107
Web site: http://www.delphion.com/details?pn=US05075105__
�
Method and artificial intraocular lens device for the phakic treatment
of myopia
Inventor(s): Praeger; Donald (41 Yates Blvd., Poughkeepsie, NY 12601)
Assignee(s): none reported
Patent Number: 4,676,792
Date filed: November 10, 1986
Abstract: The placing of an artificial intraocular lens device (IOL) in the
anterior chamber of the eye (in front of the iris) for treating myopia. The
intraocular lens device includes a meniscus style lens which has a plano
anterior surface and a concave posterior surface. The edges of the lens are
rounded off and the peripheral portion of the lens is considerably thicker
than the central portion of the lens. The lens is a minus (negative)
refracting lens. The lens is suspended in the anterior chamber by three or
four carrying angles or haptics having solid footplates at their ends for
anchoring the device in the anatomic angle of the eye. The solid
footplates are sized to prevent tissue overgrowth and resulting synechia
after placement, additionally facilitating subsequent removal of the lens
device from the anterior chamber if necessary. A ridges lens glide is also
provided to facilitate insertion of the lens device into the anterior
chamber during implantation. This lens device is utilized in the phakic
state (the state of the natural lens being retained). With the patient's
natural crystalline lens being retained, the natural crystalline lens is
located in the posterior chamber behind the iris and the artificial
intraocular lens of negative power is located in the anterior chamber in
front of the iris. The presence of the phakic state allows for
accommodation to occur. The intended age range for applicability of the
device is approximately from age 20-50.
Excerpt(s): Presently, the standard technique for the surgical treatment of
myopia is a keratorefractive procedure wherein either the shape of the
cornea is altered or the refractive index of the cornea is surgically altered.
There are many problems associated with this procedure. While many
physicians are trained in keratorefaction, relatively few ever perform
them and then not often. It thus becomes an intimidating procedure
when performed. There are technical difficulties resulting from the
microkeratome, the computer and the cryolathe, and many problems in
learning to use the cryolathe. Additionally, there are possible
complications such as infection, loss of endothelial cells, penetration and
perforation. Moreover, in the best of hands, the predictability rate is only
108 Myopia
about 55 to 65 percent to plus or minus 2 diopters. ... Implantation of an
intraocular lens is a general procedure practiced in one form or another
by probably 90 percent of the present ophthalmologists. It is a procedure
in which they are experienced. Thus, if a successful lens and method for
the phakic treatment of myopia could be developed, the incidence of eyes
that would be lost or damaged in treating myopia would clearly be
reduced. ... Additionally, if a successful lens and method for the phakic
treatment of myopia could be developed, the patients would retain their
power of accommodation. A 20 year old has an average range of
accommodation of about 10 diopters; a 50 year old might have a range of
accommodation of about 2.0 diopters. With most accommodation
occurring in the anterior lens capsule and with the synkinetic reflex of
internal rectus convergence and myosis, a properly vaulted lens would
allow for adequate accommodation.
Web site: http://www.delphion.com/details?pn=US04676792__
Patent Applications on Myopia
As of December 2000, U.S. patent applications are open to public viewing.24
Applications are patent requests which have yet to be granted (the process to
achieve a patent can take several years).
Keeping Current
In order to stay informed about patents and patent applications dealing with
myopia, you can access the U.S. Patent Office archive via the Internet at no
cost to you. This archive is available at the following Web address:
http://www.uspto.gov/main/patents.htm. Under ?Services,? click on ?Search
Patents.? You will see two broad options: (1) Patent Grants, and (2) Patent
Applications. To see a list of granted patents, perform the following steps:
Under ?Patent Grants,? click ?Quick Search.? Then, type ?myopia? (or
synonyms) into the ?Term 1? box. After clicking on the search button, scroll
down to see the various patents which have been granted to date on myopia.
You can also use this procedure to view pending patent applications
concerning myopia. Simply go back to the following Web address:
http://www.uspto.gov/main/patents.htm. Under ?Services,? click on ?Search
Patents.? Select ?Quick Search? under ?Patent Applications.? Then proceed
with the steps listed above.
24
This has been a common practice outside the United States prior to December 2000.
Patents 109
Vocabulary Builder
Acrylamide: A colorless, odorless, highly water soluble vinyl monomer
formed from the hydration of acrylonitrile. It is primarily used in research
laboratories for electrophoresis, chromatography, and electron microscopy
and in the sewage and wastewater treatment industries. [NIH]
Implantation: The insertion or grafting into the body of biological, living,
inert, or radioactive material. [EU]
Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU]
Perforation: 1. the act of boring or piercing through a part. 2. a hole made
through a part or substance. [EU]
Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any
particular involuntary activity. [EU]
Books 111
CHAPTER 6. BOOKS ON MYOPIA
Overview
This chapter provides bibliographic book references relating to myopia. You
have many options to locate books on myopia. The simplest method is to go
to your local bookseller and inquire about titles that they have in stock or can
special order for you. Some patients, however, feel uncomfortable
approaching their local booksellers and prefer online sources (e.g.
www.amazon.com and www.bn.com). In addition to online booksellers,
excellent sources for book titles on myopia include the Combined Health
Information Database and the National Library of Medicine. Once you have
found a title that interests you, visit your local public or medical library to
see if it is available for loan.
The National Library of Medicine Book Index
The National Library of Medicine at the National Institutes of Health has a
massive database of books published on healthcare and biomedicine. Go to
the following Internet site, http://locatorplus.gov/, and then select ?Search
LOCATORplus.? Once you are in the search area, simply type ?myopia? (or
synonyms) into the search box, and select ?books only.? From there, results
can be sorted by publication date, author, or relevance. The following was
recently catalogued by the National Library of Medicine:25
In addition to LOCATORPlus, in collaboration with authors and publishers, the National
Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The
books may be accessed in two ways: (1) by searching directly using any search term or
phrase (in the same way as the bibliographic database PubMed), or (2) by following the
links to PubMed abstracts. Each PubMed abstract has a ?Books? button that displays a
facsimile of the abstract in which some phrases are hypertext links. These phrases are also
25
112 Myopia
�
Accommodation, nearwork, and myopia. Author: Editha Ong, Kenneth
J. Ciuffreda; Year: 1997; Santa Ana, CA: Optometric Extension Program
Foundation, c1997; ISBN: 0943599881 (alk. paper)
http://www.amazon.com/exec/obidos/ASIN/0943599881/icongroupin
terna
�
Art of LASIK. Author: [edited by] Jeffrey J. Machat, Stephen G. Slade,
Louis E. Probst; Year: 1999; Thorofare, NJ: SLACK, Inc., c1999; ISBN:
1556423861 (alk. paper)
http://www.amazon.com/exec/obidos/ASIN/1556423861/icongroupin
terna
�
Atlas of posterior fundus changes in pathologic myopia. Author:
Takashi Tokoro; Year: 1998; Tokyo; New York: Springer, c1998; ISBN:
4431702253 (hard: alk. paper)
http://www.amazon.com/exec/obidos/ASIN/4431702253/icongroupin
terna
�
Care of the patient with myopia: reference guide for clinicians. Author:
prepared by the American Optometric Association, Consensus Panel on
Care of the Patient with Myopia; David A. Goss, principal author ... [et
al.]; Year: 1997; St. Louis, MO: American Optometric Association, [1997?]
�
Clinical management of myopia. Author: Theodore Grosvenor, David
A. Goss; with a foreword by Henry W Hofstetter; Year: 1999; Boston:
Butterworth-Heinemann, c1999; ISBN: 0750670606 (alk. paper)
http://www.amazon.com/exec/obidos/ASIN/0750670606/icongroupin
terna
�
Complex cases with LASIK: advanced techniques and complication
management. Author: [edited by] Louis E. Probst; Year: 2000; Thorofare,
NJ: SLACK, c2000; ISBN: 1556424043
http://www.amazon.com/exec/obidos/ASIN/1556424043/icongroupin
terna
�
Excimer laser in ophthalmology: a state-of-knowledge update. Author:
Conseil d'関aluation des technologies de la sant� du Qu閎ec; Year: 2000;
Montr閍l, Qu閎ec: The Conseil, [2000]; ISBN: 2550370287
�
Excimer laser photorefractive keratectomy: the correction of myopia
and astigmatism; report submitted to the Minister of Health and Social
Services of Qu閎ec. Author: Grosvenor, Theodore P; Year: 1997;
found in the books available at NCBI. Click on hyperlinked results in the list of books in
which the phrase is found. Currently, the majority of the links are between the books and
PubMed. In the future, more links will be created between the books and other types of
information, such as gene and protein sequences and macromolecular structures. See
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
Books 113
Montr閍l, Qu閎ec: Conseil d'関aluation des technologies de la sant� du
Qu閎ec, [1997]; ISBN: 2550326105
�
Excimer laser refractive surgery: practice and principles. Author:
[edited by] Jeffery J. Machat; Year: 1996; Thorofare, NJ: Slack, c1996;
ISBN: 15556422741 (alk. paper)
�
Fourth International Conference on Myopia, March 14, 15, and 16, 1990.
Author: sponsored by the Myopia International Research Foundation,
Inc; Year: 1990; New York, NY, USA: The Foundation, c1990; ISBN:
1879037009
�
Guide to the optometric training of myopia control. Author: Sonja
Collier-Vanhimbeeck; Year: 1997; Santa Ana, CA: Optometric Extension
Program Foundation, c1997; ISBN: 0943599946
http://www.amazon.com/exec/obidos/ASIN/0943599946/icongroupin
terna
�
Help for progressive myopes: the result of forty-six years ophthalmic
research into causes and nutritional management of progressive
myopia. Author: by Stanley C. Evans; Year: 1990; Suffolk: Teecoll
Publications, 1990; ISBN: 0710900279
�
Myopia: prevalence and progression. Author: Working Group on
Myopia Prevalence and Progression, Committee on Vision, Commission
on Behavioral and Social Sciences and Education, National Research
Council; Year: 1989; Washington, D.C.: National Academy Press, 1989;
ISBN: 0309040817
http://www.amazon.com/exec/obidos/ASIN/0309040817/icongroupin
terna
�
Myopia and nearwork. Author: [edited by] Mark Rosenfield, Bernard
Gilmartin; with a foreword by Ernst Goldsmith; Year: 1998; Oxford;
Boston: Butterworth-Heinemann, 1998; ISBN: 0750637846
http://www.amazon.com/exec/obidos/ASIN/0750637846/icongroupin
terna
�
Myopia and the control of eye growth. Author: Waring, George O.,
1941-; Year: 1990; Chichester; New York: Wiley, 1990; ISBN: 0471926922
http://www.amazon.com/exec/obidos/ASIN/0471926922/icongroupin
terna
�
Myopia surgery: anterior and posterior segments. Author: editor, Frank
B. Thompson; Year: 1990; New York: Macmillan Pub. Co., c1990 [1989
printing]; ISBN: 0024206105
http://www.amazon.com/exec/obidos/ASIN/0024206105/icongroupin
terna
114 Myopia
�
Myopia updates: proceedings of the 6th International Conference on
Myopia. Author: T. Tokoro (ed.); Year: 1998; Tokyo; New York: Springer,
c1998; ISBN: 4431701990 (hardcover: alk. paper)
http://www.amazon.com/exec/obidos/ASIN/4431701990/icongroupin
terna
�
Myopia updates II: proceedings of the 7th International Conference on
Myopia, 1998. Author: L.L.-K. Lin, Y.-F. Shih, P.T. Hung (eds); Year:
2000; Tokyo; New York: Springer, c2000; ISBN: 443170275X (soft cover:
alk. paper)
http://www.amazon.com/exec/obidos/ASIN/443170275X/icongroupi
nterna
�
Myopias: basic science and clinical management. Author: Brian J.
Curtin; Year: 1985; Philadelphia: Harper & Row, c1985; ISBN:
0061406724
http://www.amazon.com/exec/obidos/ASIN/0061406724/icongroupin
terna
�
Near sight, treated by atropia: with tables. Author: by Hasket Derby ..;
Year: 1875; New York: [s.n.], 1875
�
Optometric management of nearpoint vision disorders. Author: Martin
H. Birnbaum; Year: 1993; Boston: Butterworth-Heinemann, c1993; ISBN:
075069193X (alk. paper)
http://www.amazon.com/exec/obidos/ASIN/075069193X/icongroupi
nterna
�
Orthokeratology handbook. Author: Todd D. Winkler, Rodger T. Kame;
Year: 1995; Boston: Butterworth-Heinemann, c1995; ISBN: 0750695951
(alk. paper)
http://www.amazon.com/exec/obidos/ASIN/0750695951/icongroupin
terna
�
Personalizing RK. Author: Paul S. Koch, David M. Dillman; Year: 1996;
Thorofare, NJ: Slack, c1996; ISBN: 1556422768
http://www.amazon.com/exec/obidos/ASIN/1556422768/icongroupin
terna
�
Proceedings of the Fifth International Conference on Myopia: Toronto,
June 22, 23, and 24, 1994. Author: Myopia International Research
Foundation, Inc; Year: 1995; New York: The Foundation, c1995
�
Proceedings of the Third International Conference on Myopia. Author:
sponsored by Myopia International Research Foundation. Inc; Year: 1987;
New York, N.Y., U.S.A. (1265 Broadway, New York 10001): The
Foundation, c1987
Books 115
�
Proceedings. Author: Second International Conference on Myopia,
October 28, 29, and 30, 1982; Year: 1983; New York, N.Y.: Myopia
International Research Foundation, c1983
�
Radial keratotomy: surgical techniques. Author: Robert F. Hofmann ...
[et al.]; edited by Donald R. Sanders; Year: 1986; Thorofare, N.J.: Slack,
c1986; ISBN: 0943432987
http://www.amazon.com/exec/obidos/ASIN/0943432987/icongroupin
terna
�
Refractive anomalies: research and clinical applications. Author: edited
by Theodore Grosvenor, Merton C. Flom; with 27 contributors; Year:
1991; Boston: Butterworth-Heinemann, c1991; ISBN: 0409901490 (alk.
paper)
http://www.amazon.com/exec/obidos/ASIN/0409901490/icongroupin
terna
�
Refractive keratotomy for myopia and astigmatism. Author: George O.
Waring III; Year: 1992; St. Louis: Mosby Year Book, c1992; ISBN:
0801653495
http://www.amazon.com/exec/obidos/ASIN/0801653495/icongroupin
terna
�
Refractive lamellar keratoplasty. Author: [edited by] George W.
Rozakis; Year: 1994; Thorofare, NJ: Slack Inc., 1994; ISBN: 1556422296
http://www.amazon.com/exec/obidos/ASIN/1556422296/icongroupin
terna
Chapters on Myopia
Frequently, myopia will be discussed within a book, perhaps within a
specific chapter. In order to find chapters that are specifically dealing with
myopia, an excellent source of abstracts is the Combined Health Information
Database. You will need to limit your search to book chapters and myopia
using the ?Detailed Search? option. Go directly to the following hyperlink:
http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop
boxes at the bottom of the search page where ?You may refine your search
by.? Select the dates and language you prefer, and the format option ?Book
Chapter.? By making these selections and typing in ?myopia? (or synonyms)
into the ?For these words:? box, you will only receive results on chapters in
books. The following is a typical result when searching for book chapters on
myopia:
116 Myopia
�
Genetic Hearing Loss Associated with Eye Disorders
Source: in Gorlin, R.J.; Toriello, H.V.; Cohen, M.M., Jr., eds. Hereditary
Hearing Loss and Its Syndromes. New York, NY: Oxford University
Press. 1995. p. 105-140.
Contact: Available from Oxford University Press. 200 Madison Avenue,
New York, NY 10016. (800) 334-4249 or (212) 679-7300. PRICE: $195.00
plus shipping and handling. ISBN: 0195065522.
Summary: This chapter, from a text on hereditary hearing loss and its
syndromes, discusses genetic hearing loss associated with eye disorders.
Conditions covered include Usher syndrome (retinitis pigmentosis and
sensorineural hearing loss); Alstrom syndrome; Edwards syndrome;
retinitis pigmentosa, nystagmus, hemiplegic migraine, and sensorineural
hearing loss; retinitis pigmentosa, vitiligo, and sensorineural hearing loss;
Hersh syndrome; choroideremia, obesity, and congenital sensorineural
hearing loss; Refsum syndrome; infantile Refsum syndrome; inverse
retinitis pigmentosa, hypogonadism, and sensorineural hearing loss;
miscellaneous disorders of pigmentary retinopathy and sensorineural
hearing loss; myopia and congenital sensorineural hearing loss; Marshall
syndrome; Holmes-Schepens syndrome; Harboyan syndrome; familial
band keratopathy, abnormal calcium metabolism, and hearing loss;
Ehlers-Danlos syndrome, type IV; corneal anesthesia, retinal
abnormalities, mental retardation, unusual facies, and sensorineural
hearing loss; DeHauwere syndrome; Abruzzo-Erickson syndrome;
aniridia and sensorineural hearing loss; congenital total color blindness,
cataracts, hyperinsulinism, and sensorineural hearing loss; total color
blindness, liver degeneration, endocrine dysfunction, and sensorineural
hearing loss; rod-cone dystrophy, renal dysfunction, and sensorineural
hearing loss; OHAHA syndrome; IVIC syndrome; cataracts and
progressive sensorineural hearing loss; Ohdo syndrome; Michels
syndrome; Fraser syndrome; ocular albinism with late-onset
sensorineural hearing loss; Norrie syndrome; Gernet syndrome; Jensen
syndrome; Berk-Tabatznik syndrome; and Mohr-Mageroy syndrome. For
each condition discussed, the author covers the ocular system
involvement, the auditory system, laboratory findings, pathology,
heredity, diagnosis, and prognosis. References are included in each
section. 23 figures. 4 tables. 346 references.
�
Common Refractive Errors (Ametropias) and Deafness
Source: in Johnson, D.D. Deafness and Vision Disorders: Anatomy and
Physiology, Assessment Procedures, Ocular Anomalies, and Educational
Books 117
Implications. Springfield, IL: Charles C. Thomas Publisher, Ltd. 1999. p.
224-264.
Contact: Available from Charles C. Thomas Publisher, Ltd. 2600 South
First Street, Springfield, IL 62794-9265. (800) 258-8980 or (217) 789-8980.
Fax (217) 789-9130. PRICE: $74.95 plus shipping and handling. ISBN:
039806945X.
Summary: Refractive errors are functional optical (eye) defects in which
the parallel light rays from the environment, after passing through the
eye's transparent substances, are not brought to a sharp focus precisely
on the retina when the eye is unaccommodated; hence, the retinal images
are blurred. This chapter on refractive errors (ametropias) is from a
textbook written to help students preparing for work in the field of
deafness to understand and incorporate an awareness of vision disorders
in the deaf population. The information concerning the congenital
anomalies, functional defects, and pathologic ocular conditions most
often found within a deaf student population was obtained from eleven
years of research unobtrusively conducted within the NTID Eye and Ear
Clinic between August 1984 and May 1995 (at the National Technical
Institute for the Deaf, one of the eight colleges of the Rochester Institute
of Technology). This chapter deals specifically with those refractive errors
common in this population: myopia (nearsightedness), hyperopia
(farsightedness), astigmatism, or a combination thereof. For each
condition, the author provides definitions and general comments,
classification issues, etiology, and the statistics for the condition in the
NTID population. Refractive errors were by far the most common ocular
disorders found among NTID deaf students, ranging from approximately
40 percent of the total population of students (n = 3190) entering NTID to
about 85 percent of those 756 students seen in the NTID Eye and Ear
Clinic. 12 tables. 57 references.
General Home References
In addition to references for myopia, you may want a general home medical
guide that spans all aspects of home healthcare. The following list is a recent
sample of such guides (sorted alphabetically by title; hyperlinks provide
rankings, information, and reviews at Amazon.com):
� American College of Physicians Complete Home Medical Guide (with
Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor),
American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom
edition (1999), DK Publishing; ISBN: 0789444127;
http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna
118 Myopia
� The American Medical Association Guide to Home Caregiving by the
American Medical Association (Editor); Paperback - 256 pages 1 edition
(2001), John Wiley & Sons; ISBN: 0471414093;
http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna
� Anatomica : The Complete Home Medical Reference by Peter Forrestal
(Editor); Hardcover (2000), Book Sales; ISBN: 1740480309;
http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna
� The HarperCollins Illustrated Medical Dictionary : The Complete Home
Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition
(2001), Harper Resource; ISBN: 0062736469;
http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna
� Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems
by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition
(December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578;
http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna
� The Merck Manual of Medical Information : Home Edition (Merck
Manual of Medical Information Home Edition (Trade Paper) by Robert
Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages
(2000), Pocket Books; ISBN: 0671027263;
http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder
Albinism: General term for a number of inherited defects of amino acid
metabolism in which there is a deficiency or absence of pigment in the eyes,
skin, or hair. [NIH]
Anesthesia: A state characterized by loss of feeling or sensation. This
depression of nerve function is usually the result of pharmacologic action
and is induced to allow performance of surgery or other painful procedures.
[NIH]
Aniridia: A congenital abnormality in which there is only a rudimentary
iris. This is due to the failure of the optic cup to grow. Aniridia also occurs in
a hereditary form, usually autosomal dominant. [NIH]
Auditory: Pertaining to the sense of hearing. [EU]
Choroideremia: An X chromosome-linked abnormality characterized by
atrophy of the choroid and degeneration of the retinal pigment epithelium
causing night blindness. [NIH]
Dystrophy: Any disorder arising from defective or faulty nutrition,
especially the muscular dystrophies. [EU]
Books 119
Fundus: The interior lining of the eyeball, including the retina, optic disc,
and macula; portion of the inner eye that can be seen during an eye
examination by looking through the pupil. [NIH]
Hypogonadism: A condition resulting from or characterized by abnormally
decreased functional activity of the gonads, with retardation of growth and
sexual development. [EU]
Nystagmus: An involuntary, rapid, rhythmic movement of the eyeball,
which may be horizontal, vertical, rotatory, or mixed, i.e., of two varieties.
[EU]
Vitiligo: A disorder consisting of areas of macular depigmentation,
commonly on extensor aspects of extremities, on the face or neck, and in skin
folds. Age of onset is often in young adulthood and the condition tends to
progress gradually with lesions enlarging and extending until a quiescent
state is reached. [NIH]
Multimedia 121
CHAPTER 7. MULTIMEDIA ON MYOPIA
Overview
Information on myopia can come in a variety of formats. Among multimedia
sources, video productions, slides, audiotapes, and computer databases are
often available. In this chapter, we show you how to keep current on
multimedia sources of information on myopia. We start with sources that
have been summarized by federal agencies, and then show you how to find
bibliographic information catalogued by the National Library of Medicine. If
you see an interesting item, visit your local medical library to check on the
availability of the title.
Bibliography: Multimedia on Myopia
The National Library of Medicine is a rich source of information on
healthcare-related multimedia productions including slides, computer
software, and databases. To access the multimedia database, go to the
following Web site: http://locatorplus.gov/. Select ?Search LOCATORplus.?
Once in the search area, simply type in myopia (or synonyms). Then, in the
option box provided below the search box, select ?Audiovisuals and
Computer Files.? From there, you can choose to sort results by publication
date, author, or relevance. The following multimedia has been indexed on
myopia. For more information, follow the hyperlink indicated:
�
Before we are six : pre-school vision screening. Source: sponsored by
the National Society for the Prevention of Blindness; United States
Productions; Year: 1979; Format: Motion picture; [United States]: United
States Productions, [197-?]
122 Myopia
�
Contact lenses. Source: University of the Witwatersrand Dept. of
Ophthalmology, the Contact Lens Clinic at the Johannesburg General
Hospital; Year: 1970; Format: Motion picture; Johannesburg: The
University; [Jersey City, N. J.: for sale by Conrad Berens International Eye
Film Library, 1970]
�
Evolution in LASIK. Source: produced by Ophthalmology Interactive in
conjunction with ASCRS; Year: 1998; Format: Electronic resource; Boston,
MA: Ophthalmology Interactive, c1998
�
Eye surgery for refractive errors . Year: 1986; Format: Slide; [Columbus,
Ohio]: Center for Continuing Medical Education, the Ohio State
University College of Medicine, [1986]
�
Highlights of the XVIIth Congress of the ESCRS, Vienna '99. Source:
produced by Ophthalmology Interactive in conjunction with the
European Society of Cataract & Refractive Surgeons; Year: 1999; Format:
Electronic resource; Boston, MA: Ophthalmology Interactive, c1999
�
Otolaryngology and refractive surgery : breakthroughs and treatments.
Source: a presentation of Films for the Humanities & Sciences; ITV,
Information Television Network; Year: 2000; Format: Videorecording;
Princeton, N.J.: Films for the Humanities and Sciences, c2000
�
Primary care ophthalmology. Source: American Medical Association;
Year: 1997; Format: Electronic resource; Newton, MA: SilverPlatter
Education, 1997
�
Progressive intercalary staphyloma : 5 year old female with Marfan's
syndrome and high myopia (-2500 sph d.): surgical repair with
preserved human sclera. Source: Morton F. Goldberg; Year: 1969;
Format: Videorecording; [Baltimore]: Goldberg; [Jersey City, N. J.: for
loan by Conrad Berens International Eye Film Library, inc., 196-?]
�
Refractive errors and optical aberrations. Source: produced by Medical
Illustration and Audiovisual Education, Baylor College of Medicine,
Texas Medical Center, Houston, Tex; Year: 1975; Format: Videorecording;
Houston, Tex.: Institute of Ophthalmology, c1975
�
Refractive errors. Source: University of Michigan, Medical Center,
Independent Study Unit, Dept. of Postgraduate Medicine and Health
Professions Education; Year: 1976; Format: Slide; Ann Arbor: The
University: [for loan or sale by its Medical Center, Media Library], c1976
�
Refractive surgery in the new millennium : clinical and practice
management issues. Source: edited by Marguerite B. McDonald;
produced by Ophthalmology Interactive, in cooperation with the
American Society of Cataract and Refractive Surger; Year: 1998; Format:
Electronic resource; Boston, MA: Ophthalmology Interactive, c1998
Multimedia 123
�
Visual defects in man. Source: David J. Gerrick; Year: 1979; Format:
Slide; Lorain, OH: Dayton Lab, c1979
Physician Guidelines and Databases 125
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES
Overview
Doctors and medical researchers rely on a number of information sources to
help patients with their conditions. Many will subscribe to journals or
newsletters published by their professional associations or refer to
specialized textbooks or clinical guides published for the medical profession.
In this chapter, we focus on databases and Internet-based guidelines created
or written for this professional audience.
NIH Guidelines
For the more common diseases, The National Institutes of Health publish
guidelines that are frequently consulted by physicians. Publications are
typically written by one or more of the various NIH Institutes. For physician
guidelines, commonly referred to as ?clinical? or ?professional? guidelines,
you can visit the following Institutes:
�
Office of the Director (OD); guidelines consolidated across agencies
available at http://www.nih.gov/health/consumer/conkey.htm
�
National Institute of General Medical Sciences (NIGMS); fact sheets
available at http://www.nigms.nih.gov/news/facts/
�
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M.,
Inc.) with guidelines:
http://www.nlm.nih.gov/medlineplus/healthtopics.html
�
National Eye Institute (NEI); guidelines available at
http://www.nei.nih.gov/publications/publications.htm
126 Myopia
NIH Databases
In addition to the various Institutes of Health that publish professional
guidelines, the NIH has designed a number of databases for professionals.26
Physician-oriented resources provide a wide variety of information related
to the biomedical and health sciences, both past and present. The format of
these resources varies. Searchable databases, bibliographic citations, full text
articles (when available), archival collections, and images are all available.
The following are referenced by the National Library of Medicine:27
�
Bioethics: Access to published literature on the ethical, legal and public
policy issues surrounding healthcare and biomedical research. This
information is provided in conjunction with the Kennedy Institute of
Ethics located at Georgetown University, Washington, D.C.:
http://www.nlm.nih.gov/databases/databases_bioethics.html
�
HIV/AIDS Resources: Describes various links and databases dedicated
to HIV/AIDS research:
http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
�
NLM Online Exhibitions: Describes ?Exhibitions in the History of
Medicine?: http://www.nlm.nih.gov/exhibition/exhibition.html.
Additional resources for historical scholarship in medicine:
http://www.nlm.nih.gov/hmd/hmd.html
�
Biotechnology Information: Access to public databases. The National
Center for Biotechnology Information conducts research in
computational biology, develops software tools for analyzing genome
data, and disseminates biomedical information for the better
understanding of molecular processes affecting human health and
disease: http://www.ncbi.nlm.nih.gov/
�
Population Information: The National Library of Medicine provides
access to worldwide coverage of population, family planning, and related
health issues, including family planning technology and programs,
fertility, and population law and policy:
http://www.nlm.nih.gov/databases/databases_population.html
�
Cancer Information: Access to caner-oriented databases:
http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the
databases referenced in MEDLINEplus (http://medlineplus.gov/ or
http://www.nlm.nih.gov/medlineplus/databases.html).
27 See http://www.nlm.nih.gov/databases/databases.html.
26
Physician Guidelines and Databases 127
�
Profiles in Science: Offering the archival collections of prominent
twentieth-century biomedical scientists to the public through modern
digital technology: http://www.profiles.nlm.nih.gov/
�
Chemical Information: Provides links to various chemical databases and
references: http://sis.nlm.nih.gov/Chem/ChemMain.html
�
Clinical Alerts: Reports the release of findings from the NIH-funded
clinical trials where such release could significantly affect morbidity and
mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
�
Space Life Sciences: Provides links and information to space-based
research (including NASA):
http://www.nlm.nih.gov/databases/databases_space.html
�
MEDLINE: Bibliographic database covering the fields of medicine,
nursing, dentistry, veterinary medicine, the healthcare system, and the
pre-clinical sciences:
http://www.nlm.nih.gov/databases/databases_medline.html
�
Toxicology and Environmental Health Information (TOXNET):
Databases covering toxicology and environmental health:
http://sis.nlm.nih.gov/Tox/ToxMain.html
�
Visible Human Interface: Anatomically detailed, three-dimensional
representations of normal male and female human bodies:
http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study
and treat myopia, the following are particularly noteworthy.
The NLM Gateway28
The NLM (National Library of Medicine) Gateway is a Web-based system
that lets users search simultaneously in multiple retrieval systems at the U.S.
National Library of Medicine (NLM). It allows users of NLM services to
initiate searches from one Web interface, providing ?one-stop searching? for
many of NLM's information resources or databases.29 One target audience for
the Gateway is the Internet user who is new to NLM's online resources and
does not know what information is available or how best to search for it.
This audience may include physicians and other healthcare providers,
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for
Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the
National Institutes of Health (NIH).
28
29
128 Myopia
researchers, librarians, students, and, increasingly, patients, their families,
and the public.30 To use the NLM Gateway, simply go to the search site at
http://gateway.nlm.nih.gov/gw/Cmd. Type ?myopia? (or synonyms) into
the search box and click ?Search.? The results will be presented in a tabular
form, indicating the number of references in each database category.
Results Summary
Category
Items Found
Journal Articles
8405
Books / Periodicals / Audio Visual
124
Consumer Health
6
Meeting Abstracts
6
Other Collections
1
Total
8542
HSTAT31
HSTAT is a free, Web-based resource that provides access to full-text
documents used in healthcare decision-making.32 HSTAT's audience includes
healthcare providers, health service researchers, policy makers, insurance
companies, consumers, and the information professionals who serve these
groups. HSTAT provides access to a wide variety of publications, including
clinical practice guidelines, quick-reference guides for clinicians, consumer
health brochures, evidence reports and technology assessments from the
Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's
Put Prevention Into Practice.33 Simply search by ?myopia? (or synonyms) at
the following Web site: http://text.nlm.nih.gov.
Other users may find the Gateway useful for an overall search of NLM's information
resources. Some searchers may locate what they need immediately, while others will utilize
the Gateway as an adjunct tool to other NLM search services such as PubMed� and
MEDLINEplus�. The Gateway connects users with multiple NLM retrieval systems while
also providing a search interface for its own collections. These collections include various
types of information that do not logically belong in PubMed, LOCATORplus, or other
established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal
citations). The Gateway will provide access to the information found in an increasing
number of NLM retrieval systems in several phases.
31 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
32 The HSTAT URL is http://hstat.nlm.nih.gov/.
33 Other important documents in HSTAT include: the National Institutes of Health (NIH)
Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS
Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental
Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT)
30
Physician Guidelines and Databases 129
Coffee Break: Tutorials for Biologists34
Some patients may wish to have access to a general healthcare site that takes
a scientific view of the news and covers recent breakthroughs in biology that
may one day assist physicians in developing treatments. To this end, we
recommend ?Coffee Break,? a collection of short reports on recent biological
discoveries. Each report incorporates interactive tutorials that demonstrate
how bioinformatics tools are used as a part of the research process.
Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about
400 words and is usually based on a discovery reported in one or more
articles from recently published, peer-reviewed literature.36 This site has new
articles every few weeks, so it can be considered an online magazine of sorts,
and intended for general background information. You can access the Coffee
Break
Web
site
at
the
following
hyperlink:
http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases
In addition to resources maintained by official agencies, other databases exist
that are commercial ventures addressing medical professionals. Here are a
few examples that may interest you:
�
CliniWeb International: Index and table of contents to selected clinical
information on the Internet; see http://www.ohsu.edu/cliniweb/.
�
Image Engine: Multimedia electronic medical record system that
integrates a wide range of digitized clinical images with textual data
stored in the University of Pittsburgh Medical Center's MARS electronic
Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention
(SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health
Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the
independent, nonfederal Task Force on Community Services Guide to Community Preventive
Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health
Care Commission (MHCC) health technology evaluations.
34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
35 The figure that accompanies each article is frequently supplied by an expert external to
NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that
tells a biological story.
36 After a brief introduction that sets the work described into a broader context, the report
focuses on how a molecular understanding can provide explanations of observed biology
and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext
links that lead to a series of pages that interactively show how NCBI tools and resources are
used in the research process.
130 Myopia
medical
record
system;
see
the
following
Web
http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
site:
�
Medical World Search: Searches full text from thousands of selected
medical sites on the Internet; see http://www.mwsearch.com/.
�
MedWeaver: Prototype system that allows users to search differential
diagnoses for any list of signs and symptoms, to search medical
literature,
and
to
explore
relevant
Web
sites;
see
http://www.med.virginia.edu/~wmd4n/medweaver.html.
�
Metaphrase: Middleware component intended for use by both caregivers
and medical records personnel. It converts the informal language
generally used by caregivers into terms from formal, controlled
vocabularies;
see
the
following
Web
site:
http://www.lexical.com/Metaphrase.html.
The Genome Project and Myopia
With all the discussion in the press about the Human Genome Project, it is
only natural that physicians, researchers, and patients want to know about
how human genes relate to myopia. In the following section, we will discuss
databases and references used by physicians and scientists who work in this
area.
Online Mendelian Inheritance in Man (OMIM)
The Online Mendelian Inheritance in Man (OMIM) database is a catalog of
human genes and genetic disorders authored and edited by Dr. Victor A.
McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was
developed for the World Wide Web by the National Center for
Biotechnology Information (NCBI).37 The database contains textual
information, pictures, and reference information. It also contains copious
links to NCBI's Entrez database of MEDLINE articles and sequence
information.
To
search
the
database,
go
to
http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type ?myopia? (or
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource
for molecular biology information, NCBI creates public databases, conducts research in
computational biology, develops software tools for analyzing genome data, and
disseminates biomedical information--all for the better understanding of molecular
processes affecting human health and disease.
37
Physician Guidelines and Databases 131
synonyms) in the search box, and click ?Submit Search.? If too many results
appear, you can narrow the search by adding the word ?clinical.? Each
report will have additional links to related research and databases. By
following these links, especially the link titled ?Database Links,? you will be
exposed to numerous specialized databases that are largely used by the
scientific community. These databases are overly technical and seldom used
by the general public, but offer an abundance of information. The following
is an example of the results you can obtain from the OMIM for myopia:
�
Aplasia Cutis Congenita, High Myopia, and Cone-rod Dysfunction
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601075
�
Blepharoptosis, Myopia, and Ectopia Lentis
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?110150
�
Camptodactyly, Myopia, and Fibrosis of the Medial Rectus Muscle of
Eye
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?602612
�
Dandy-walker Malformation with Mental Retardation, Macrocephaly,
Myopia, and Brachytelephalangy
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?220219
�
Deafness, Cochlear, with Myopia and Intellectual Impairment
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?221200
�
Diaphragmatic Hernia, Exomphalos, Absent Corpus
Hypertelorism, Myopia, and Sensorineural Deafness
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?222448
�
Epiphyseal Dysplasia of Femoral Head, Myopia, and Deafness
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?226950
�
Epiphyseal Dysplasia, Multiple, with Myopia and Conductive
Deafness
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?132450
�
Microphthalmos with Myopia and Corectopia
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?156900
Callosum,
132 Myopia
�
Myopia 1
Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?310460
Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for
Biotechnology Information of the National Library of Medicine at the
National Institutes of Health. This Web site categorizes each disorder by the
system
of
the
body
associated
with
it.
Go
to
http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to
have a full view of important conditions linked to human genes. Since this
site is regularly updated, you may wish to re-visit it from time to time. The
following systems and associated disorders are addressed:
�
Cancer: Uncontrolled cell division.
Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic
myeloid leukemia, colon cancer, lung cancer, malignant melanoma,
multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor,
pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von
Hippel-Lindau syndrome.
Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html
�
Immune System: Fights invaders.
Examples: Asthma, autoimmune polyglandular syndrome, Crohn's
disease, DiGeorge syndrome, familial Mediterranean fever,
immunodeficiency with Hyper-IgM, severe combined immunodeficiency.
Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
�
Metabolism: Food and energy.
Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease,
Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy,
Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria,
Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease.
Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
�
Nervous System: Mind and body.
Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman
syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor,
Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome,
Spinocerebellar atrophy, Williams syndrome.
Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
Physician Guidelines and Databases 133
�
Signals: Cellular messages.
Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome,
Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg
syndrome, Werner syndrome.
Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
Entrez
Entrez is a search and retrieval system that integrates several linked
databases at the National Center for Biotechnology Information (NCBI).
These databases include nucleotide sequences, protein sequences,
macromolecular structures, whole genomes, and MEDLINE through
PubMed. Entrez provides access to the following databases:
�
PubMed: Biomedical literature (PubMed),
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
�
Nucleotide Sequence Database (Genbank):
Web site:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
�
Protein Sequence Database:
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
�
Structure: Three-dimensional macromolecular structures,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
�
Genome: Complete genome assemblies,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
�
PopSet: Population study data sets,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
�
OMIM: Online Mendelian Inheritance in Man,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
�
Taxonomy: Organisms in GenBank,
Web site:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
�
Books: Online books,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
�
ProbeSet: Gene Expression Omnibus (GEO),
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
�
3D Domains: Domains from Entrez Structure,
Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
134 Myopia
�
NCBI's Protein Sequence Information Survey Results:
Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology
Information,
go
to
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom
e, and then select the database that you would like to search. The databases
available are listed in the drop box next to ?Search.? In the box next to ?for,?
enter ?myopia? (or synonyms) and click ?Go.?
Jablonski's Multiple Congenital Anomaly/Mental Retardation
(MCA/MR) Syndromes Database38
This online resource can be quite useful. It has been developed to facilitate
the identification and differentiation of syndromic entities. Special attention
is given to the type of information that is usually limited or completely
omitted in existing reference sources due to space limitations of the printed
form.
At the following Web site you can also search across syndromes using an
index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html.
You
can
search
by
keywords
at
this
Web
site:
http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.
The Genome Database39
Established at Johns Hopkins University in Baltimore, Maryland in 1990, the
Genome Database (GDB) is the official central repository for genomic
mapping data resulting from the Human Genome Initiative. In the spring of
1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for
Sick Children in Toronto, Ontario assumed the management of GDB. The
Human Genome Initiative is a worldwide research effort focusing on
structural analysis of human DNA to determine the location and sequence of
the estimated 100,000 human genes. In support of this project, GDB stores
and curates data generated by researchers worldwide who are engaged in
the mapping effort of the Human Genome Project (HGP). GDB's mission is
to provide scientists with an encyclopedia of the human genome which is
Adapted from the National Library of Medicine:
http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
39 Adapted from the Genome Database:
http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
38
Physician Guidelines and Databases 135
continually revised and updated to reflect the current state of scientific
knowledge. Although GDB has historically focused on gene mapping, its
focus will broaden as the Genome Project moves from mapping to sequence,
and finally, to functional analysis.
To access the GDB, simply go to the following hyperlink:
http://www.gdb.org/. Search ?All Biological Data? by ?Keyword.? Type
?myopia? (or synonyms) into the search box, and review the results. If more
than one word is used in the search box, then separate each one with the
word ?and? or ?or? (using ?or? might be useful when using synonyms). This
database is extremely technical as it was created for specialists. The articles
are the results which are the most accessible to non-professionals and often
listed under the heading ?Citations.? The contact names are also accessible to
non-professionals.
Specialized References
The following books are specialized references written for professionals
interested in myopia (sorted alphabetically by title, hyperlinks provide
rankings, information, and reviews at Amazon.com):
�
Clinical Ophthalmic Pathology: Test Yourself by John Harry, Gary
Misson; Paperback (January 2004); Butterworth-Heinemann; ISBN:
0750622644;
http://www.amazon.com/exec/obidos/ASIN/007137325X/icongroupinterna
�
Dictionary of Ophthalmology by Michel Millodot, Ph.D., Daniel Laby,
MD; Paperback, 1st edition (January 15, 2002), Butterworth-Heinemann
Medical; ISBN: 0750647973;
http://www.amazon.com/exec/obidos/ASIN/0750647973/icongroupinterna
�
Emergency Ophthalmology by Kenneth C. Chern (Editor); Hardcover
(October 2002), McGraw Hill Text; ISBN: 007137325X;
http://www.amazon.com/exec/obidos/ASIN/007137325X/icongroupinterna
�
The Epidemiology of Eye Disease by Gordon Johnson, et al; Hardcover
(January 1999), Lippincott Williams & Wilkins Publishers; ISBN:
0412643103;
http://www.amazon.com/exec/obidos/ASIN/0412643103/icongroupinterna
�
The Epidemiology of Eye Disease by Gordon Johnson, et al; Paperback 436 pages, 1st edition (March 15, 1998), Lippincott, Williams & Wilkins
Publishers; ISBN: 0412845008;
http://www.amazon.com/exec/obidos/ASIN/0412845008/icongroupinterna
136 Myopia
�
External Eye Disease : A Systematic Approach by Ian A. MacKie;
Hardcover, Illustrated edition (January 1999), Butterworth-Heinemann;
ISBN: 0750617446;
http://www.amazon.com/exec/obidos/ASIN/0750617446/icongroupinterna
�
External Eye Disease (Clinical Ophthalmology Slide Set , Vol 2) by Jack
J. Kanski; Hardcover, Vol 2 (September 1997), Butterworth-Heinemann
Medical; ISBN: 0750626461;
http://www.amazon.com/exec/obidos/ASIN/0750626461/icongroupinterna
�
External Eye Disease (Clinical Ophthalmology Photo CD Set , Vol 2) by
Jack J. Kanski; Unknown Binding (September 1997), ButterworthHeinemann Medical; ISBN: 0750626941;
http://www.amazon.com/exec/obidos/ASIN/0750626941/icongroupinterna
�
The Eye Book: A Complete Guide to Eye Disorders and Health (Large
Print) by Gary H. Cassel, M.D., et al; Paperback - 528 pages, 1st edition
(February 15, 2001), Johns Hopkins University Press; ISBN: 0801865204;
http://www.amazon.com/exec/obidos/ASIN/0801865204/icongroupinterna
�
The Eye: Basic Sciences in Practice by John V. Forrester (Editor), et al;
Hardcover - 447 pages, 2nd edition (January 15, 2002), W B Saunders Co;
ISBN: 0702025410;
http://www.amazon.com/exec/obidos/ASIN/0702025410/icongroupinterna
�
Functional Anatomy and Histology of the Eye by Gordon Ruskell;
Hardcover, Illustrate edition (April 2002), Butterworth-Heinemann; ISBN:
0750637749;
http://www.amazon.com/exec/obidos/ASIN/0750637749/icongroupinterna
�
The Little Eye Book: A Pupil's Guide to Understanding Ophthalmology
by Janice K. Comt Ledford, Roberto Pineda, MD; Paperback - 149 pages,
1st edition (January 15, 2002) Slack, Inc.; ISBN: 1556425600;
http://www.amazon.com/exec/obidos/ASIN/1556425600/icongroupinterna
�
Ophthalmic Pocket Companion by Dean Dornic; Paperback, 6th edition
(March 15, 2002); Butterworth-Heinemann; ISBN: 0750673818;
http://www.amazon.com/exec/obidos/ASIN/0750673818/icongroupinterna
�
Ophthalmology Review Manual by Kenneth C. Chern, Michael E. Zegans
(Editors); Paperback (550 pages), 1st edition (2000); Lippincott, Williams &
Wilkins; ISBN: 0683303643;
http://www.amazon.com/exec/obidos/ASIN/0683303643/icongroupinterna
�
Ophthalmic Research and Epidemiology: Evaluation and Application by
Stanley W. Hatch (Editor), Paperback - 298 pages, 1st edition (1998),
Butterworth-Heinemann Medical; ISBN: 0750699140;
http://www.amazon.com/exec/obidos/ASIN/0750699140/icongroupinterna
Physician Guidelines and Databases 137
�
Ophthalmic Surgery: Principles & Practice by George L. Spaeth;
Hardcover (January 2002), W B Saunders Co; ISBN: 0721669727;
http://www.amazon.com/exec/obidos/ASIN/0721669727/icongroupinterna
�
Review Questions for Treatment and Management of Ocular Disease
(Review Questions) by Gurwood; Paperback (2001), Parthenon Pub
Group; ISBN: 1850707502;
http://www.amazon.com/exec/obidos/ASIN/1850707502/icongroupinterna
�
The Wills Eye Manual: Office and Emergency Room Diagnosis and
Treatment of Eye Disease by Douglas J. Rhee (Editor), et al; Paperback 563 pages, 3rd edition (March 15, 1999), Lippincott, Williams & Wilkins
Publishers; ISBN: 0781716020;
http://www.amazon.com/exec/obidos/ASIN/0781716020/icongroupinterna
Vocabulary Builder
Aplasia: Lack of development of an organ or tissue, or of the cellular
products from an organ or tissue. [EU]
Blepharoptosis: Drooping of the upper lid due to deficient development or
paralysis of the levator palpebrae muscle. [NIH]
Femoral: Pertaining to the femur, or to the thigh. [EU]
Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU]
Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an
abnormal opening. [EU]
Hypertelorism: Abnormal increase in the interorbital distance due to
overdevelopment of the lesser wings of the sphenoid. [NIH]
Malformation: A morphologic defect resulting from an intrinsically
abnormal developmental process. [EU]
Microphthalmos: Congenital or developmental anomaly in which the
eyeballs are abnormally small. [NIH]
Dissertations 139
CHAPTER 9. DISSERTATIONS ON MYOPIA
Overview
University researchers are active in studying almost all known diseases. The
result of research is often published in the form of Doctoral or Master's
dissertations. You should understand, therefore, that applied diagnostic
procedures and/or therapies can take many years to develop after the thesis
that proposed the new technique or approach was written.
In this chapter, we will give you a bibliography on recent dissertations
relating to myopia. You can read about these in more detail using the
Internet or your local medical library. We will also provide you with
information on how to use the Internet to stay current on dissertations.
Dissertations on Myopia
ProQuest Digital Dissertations is the largest archive of academic dissertations
available. From this archive, we have compiled the following list covering
dissertations devoted to myopia. You will see that the information provided
includes the dissertation?s title, its author, and the author?s institution. To
read more about the following, simply use the Internet address indicated.
The following covers recent dissertations dealing with myopia:
�
Assessing Near Work As a Risk for Myopia: the Better Evaluation of
Eye Performance (beep) Study by Jeandervin, Marjorie Kay; Phd from
The Ohio State University, 2000, 219 pages
http://wwwlib.umi.com/dissertations/fullcit/9971575
140 Myopia
�
Corporate Investment with Myopic Noise Traders (investor Myopia) by
Bange, Mary Marguerite, Phd from The University of Wisconsin Madison, 1991, 233 pages
http://wwwlib.umi.com/dissertations/fullcit/9128894
�
Corporate Myopia and Firm Performance: an International Comparison
by Beldona, Sriram, Phd from Temple University, 1994, 113 pages
http://wwwlib.umi.com/dissertations/fullcit/9512805
�
Family Characteristics Related to the Development of Myopia. by
Grigsby, Eugene Howard, Phd from Washington State University, 1979,
90 pages
http://wwwlib.umi.com/dissertations/fullcit/7915127
�
Financial Management and the 1966 Credit Crunch: a Study of
Financial Myopia by Roden, Peyton Foster, Phd from University of
North Texas, 1970, 237 pages
http://wwwlib.umi.com/dissertations/fullcit/7017985
�
Identity, Appearance, and Corrective Lenswear: Predictors of College
Students' Interest in Vision-correcting Myopia Surgery by Stratton,
Terry Dean; Phd from University of Kentucky, 1999, 286 pages
http://wwwlib.umi.com/dissertations/fullcit/9957056
�
Institutional Investor Myopia, Ownership, Earnings, and Returns by
Eames, Michael Joseph, Phd from University of Washington, 1995, 122
pages
http://wwwlib.umi.com/dissertations/fullcit/9609635
�
Myopia and Competitive Reputations in De-escalating Promotional
Competition: Game Theoretic Intuition Versus Naive Decision-making
by Kallianpur, Amy (shanti), Phd from University of Pennsylvania, 1999,
119 pages
http://wwwlib.umi.com/dissertations/fullcit/9926149
�
Peak Load with 'too-high' Metering Costs: Optimal Pricing under
Myopia. by Oliu, Josep, Phd from University of Minnesota, 1978, 201
pages
http://wwwlib.umi.com/dissertations/fullcit/7912059
�
Resolution Preference, Managerial Myopia, and Market Valuation: an
Empirical Test by Ryan, Harley Eulin, Jr., Phd from Georgia State
University, 1994, 104 pages
http://wwwlib.umi.com/dissertations/fullcit/9526899
Dissertations 141
Keeping Current
As previously mentioned, an effective way to stay current on dissertations
dedicated to myopia is to use the database called ProQuest Digital
Dissertations via the Internet, located at the following Web address:
http://wwwlib.umi.com/dissertations. The site allows you to freely access
the last two years of citations and abstracts. Ask your medical librarian if the
library has full and unlimited access to this database. From the library, you
should be able to do more complete searches than with the limited 2-year
access available to the general public.
143
PART III. APPENDICES
ABOUT PART III
Part III is a collection of appendices on general medical topics which may be
of interest to patients with myopia and related conditions.
Researching Your Medications 145
APPENDIX A. RESEARCHING YOUR MEDICATIONS
Overview
There are a number of sources available on new or existing medications
which could be prescribed to patients with myopia. While a number of hard
copy or CD-Rom resources are available to patients and physicians for
research purposes, a more flexible method is to use Internet-based databases.
In this chapter, we will begin with a general overview of medications. We
will then proceed to outline official recommendations on how you should
view your medications. You may also want to research medications that you
are currently taking for other conditions as they may interact with
medications for myopia. Research can give you information on the side
effects, interactions, and limitations of prescription drugs used in the
treatment of myopia. Broadly speaking, there are two sources of information
on approved medications: public sources and private sources. We will
emphasize free-to-use public sources.
Your Medications: The Basics40
The Agency for Health Care Research and Quality has published extremely
useful guidelines on how you can best participate in the medication aspects
of myopia. Taking medicines is not always as simple as swallowing a pill. It
can involve many steps and decisions each day. The AHCRQ recommends
that patients with myopia take part in treatment decisions. Do not be afraid
to ask questions and talk about your concerns. By taking a moment to ask
questions early, you may avoid problems later. Here are some points to
cover each time a new medicine is prescribed:
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
146 Myopia
�
Ask about all parts of your treatment, including diet changes, exercise,
and medicines.
�
Ask about the risks and benefits of each medicine or other treatment you
might receive.
�
Ask how often you or your doctor will check for side effects from a given
medication.
Do not hesitate to ask what is important to you about your medicines. You
may want a medicine with the fewest side effects, or the fewest doses to take
each day. You may care most about cost, or how the medicine might affect
how you live or work. Or, you may want the medicine your doctor believes
will work the best. Telling your doctor will help him or her select the best
treatment for you.
Do not be afraid to ?bother? your doctor with your concerns and questions
about medications for myopia. You can also talk to a nurse or a pharmacist.
They can help you better understand your treatment plan. Feel free to bring
a friend or family member with you when you visit your doctor. Talking
over your options with someone you trust can help you make better choices,
especially if you are not feeling well. Specifically, ask your doctor the
following:
�
The name of the medicine and what it is supposed to do.
�
How and when to take the medicine, how much to take, and for how
long.
�
What food, drinks, other medicines, or activities you should avoid while
taking the medicine.
�
What side effects the medicine may have, and what to do if they occur.
�
If you can get a refill, and how often.
�
About any terms or directions you do not understand.
�
What to do if you miss a dose.
�
If there is written information you can take home (most pharmacies have
information sheets on your prescription medicines; some even offer
large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently
taking (not just those for myopia). This includes prescription medicines and
the medicines that you buy over the counter. Then your doctor can avoid
giving you a new medicine that may not work well with the medications you
take now. When talking to your doctor, you may wish to prepare a list of
Researching Your Medications 147
medicines you currently take, the reason you take them, and how you take
them. Be sure to include the following information for each:
�
Name of medicine
�
Reason taken
�
Dosage
�
Time(s) of day
Also include any over-the-counter medicines, such as:
�
Laxatives
�
Diet pills
�
Vitamins
�
Cold medicine
�
Aspirin or other pain, headache, or fever medicine
�
Cough medicine
�
Allergy relief medicine
�
Antacids
�
Sleeping pills
�
Others (include names)
Learning More about Your Medications
Because of historical investments by various organizations and the
emergence of the Internet, it has become rather simple to learn about the
medications your doctor has recommended for myopia. One such source is
the United States Pharmacopeia. In 1820, eleven physicians met in
Washington, D.C. to establish the first compendium of standard drugs for
the United States. They called this compendium the ?U.S. Pharmacopeia
(USP).? Today, the USP is a non-profit organization consisting of 800
volunteer scientists, eleven elected officials, and 400 representatives of state
associations and colleges of medicine and pharmacy. The USP is located in
Rockville, Maryland, and its home page is located at www.usp.org. The USP
currently provides standards for over 3,700 medications. The resulting USP
DI� Advice for the Patient� can be accessed through the National Library of
Medicine of the National Institutes of Health. The database is partially
148 Myopia
derived from lists of federally approved medications in the Food and Drug
Administration's (FDA) Drug Approvals database.41
While the FDA database is rather large and difficult to navigate, the
Phamacopeia is both user-friendly and free to use. It covers more than 9,000
prescription and over-the-counter medications. To access this database,
simply type the following hyperlink into your Web browser:
http://www.nlm.nih.gov/medlineplus/druginformation.html.
To
view
examples of a given medication (brand names, category, description,
preparation, proper use, precautions, side effects, etc.), simply follow the
hyperlinks indicated within the United States Pharmacopoeia (USP). It is
important
to
read
the
disclaimer
by
the
USP
(http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using
the information provided.
Of course, we as editors cannot be certain as to what medications you are
taking. Therefore, we have compiled a list of medications associated with the
treatment of myopia. Once again, due to space limitations, we only list a
sample of medications and provide hyperlinks to ample documentation (e.g.
typical dosage, side effects, drug-interaction risks, etc.). The following drugs
have been mentioned in the Pharmacopeia and other sources as being
potentially applicable to myopia:
Vitamin D and Related Compounds
�
Systemic - U.S. Brands: Calciferol; Calciferol Drops; Calcijex;
Calderol; DHT; DHT Intensol; Drisdol; Drisdol Drops; Hectorol;
Hytakerol; Rocaltrol; Zemplar
http://www.nlm.nih.gov/medlineplus/druginfo/vitamindandrel
atedcompoundssys202597.html
Commercial Databases
In addition to the medications listed in the USP above, a number of
commercial sites are available by subscription to physicians and their
institutions. You may be able to access these sources from your local medical
library or your doctor's office.
Though cumbersome, the FDA database can be freely browsed at the following site:
www.fda.gov/cder/da/da.htm.
41
Researching Your Medications 149
Reuters Health Drug Database
The Reuters Health Drug Database can be searched by keyword at the
hyperlink: http://www.reutershealth.com/frame2/drug.html. The following
medications are listed in the Reuters' database as associated with myopia
(including those with contraindications):42
�
Acetazolamide
http://www.reutershealth.com/atoz/html/Acetazolamide.htm
�
Ethosuximide
http://www.reutershealth.com/atoz/html/Ethosuximide.htm
�
Pilocarpine
http://www.reutershealth.com/atoz/html/Pilocarpine.htm
Mosby's GenRx
Mosby's GenRx database (also available on CD-Rom and book format)
covers 45,000 drug products including generics and international brands. It
provides prescribing information, drug interactions, and patient information.
Information
can
be
obtained
at
the
following
hyperlink:
http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference
The Physicians Desk Reference database (also available in CD-Rom and book
format) is a full-text drug database. The database is searchable by brand
name, generic name or by indication. It features multiple drug interactions
reports. Information can be obtained at the following hyperlink:
http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites
A number of additional Web sites discuss drug information. As an example,
you may like to look at www.drugs.com which reproduces the information
in the Pharmacopeia as well as commercial information. You may also want
to consider the Web site of the Medical Letter, Inc. which allows users to
download articles on various drugs and therapeutics for a nominal fee:
http://www.medletter.com/.
42
Adapted from A to Z Drug Facts by Facts and Comparisons.
150 Myopia
Contraindications and Interactions (Hidden Dangers)
Some of the medications mentioned in the previous discussions can be
problematic for patients with myopia--not because they are used in the
treatment process, but because of contraindications, or side effects.
Medications with contraindications are those that could react with drugs
used to treat myopia or potentially create deleterious side effects in patients
with myopia. You should ask your physician about any contraindications,
especially as these might apply to other medications that you may be taking
for common ailments.
Drug-drug interactions occur when two or more drugs react with each other.
This drug-drug interaction may cause you to experience an unexpected side
effect. Drug interactions may make your medications less effective, cause
unexpected side effects, or increase the action of a particular drug. Some
drug interactions can even be harmful to you.
Be sure to read the label every time you use a nonprescription or
prescription drug, and take the time to learn about drug interactions. These
precautions may be critical to your health. You can reduce the risk of
potentially harmful drug interactions and side effects with a little bit of
knowledge and common sense.
Drug labels contain important information about ingredients, uses,
warnings, and directions which you should take the time to read and
understand. Labels also include warnings about possible drug interactions.
Further, drug labels may change as new information becomes available. This
is why it's especially important to read the label every time you use a
medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins,
botanicals, minerals and herbals you take as well as the foods you eat. Ask
your pharmacist for the package insert for each prescription drug you take.
The package insert provides more information about potential drug
interactions.
A Final Warning
At some point, you may hear of alternative medications from friends,
relatives, or in the news media. Advertisements may suggest that certain
alternative drugs can produce positive results for patients with myopia.
Exercise caution--some of these drugs may have fraudulent claims, and
Researching Your Medications 151
others may actually hurt you. The Food and Drug Administration (FDA) is
the official U.S. agency charged with discovering which medications are
likely to improve the health of patients with myopia. The FDA warns
patients to watch out for43:
�
Secret formulas (real scientists share what they know)
�
Amazing breakthroughs or miracle cures (real breakthroughs don't
happen very often; when they do, real scientists do not call them amazing
or miracles)
�
Quick, painless, or guaranteed cures
�
If it sounds too good to be true, it probably isn't true.
If you have any questions about any kind of medical treatment, the FDA
may have an office near you. Look for their number in the blue pages of the
phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at
www.fda.gov.
General References
In addition to the resources provided earlier in this chapter, the following
general references describe medications (sorted alphabetically by title;
hyperlinks provide rankings, information and reviews at Amazon.com):
�
Handbook of Drugs In Primary Eyecare by D. Reid Woodard, R. Blair
Woodard; Paperback - 477 pages, 2nd edition (March 13, 1997), McGrawHill Professional Publishing; ISBN: 0838536034;
http://www.amazon.com/exec/obidos/ASIN/0838536034/icongroupinterna
�
O'Connor Davies's Ophthalmic Drugs: Diagnostic and Therapeutic Uses
by P. H. O'Connor Davies, et al; Paperback, 4th edition (June 1998),
Butterworth-Heinemann Medical; ISBN: 0750629665;
http://www.amazon.com/exec/obidos/ASIN/0750629665/icongroupinterna
�
Ophthalmic Drug Facts, 2002 by Jimmie D. Bartlett (Editor), et al;
Paperback - 427 pages, 1st edition (January 15, 2002); Facts & Comparisons;
ISBN: 1574391135;
http://www.amazon.com/exec/obidos/ASIN/1574391135/icongroupinterna
�
Ophthalmic Medications and Pharmacology by Brian Duvall, O.D.,
Robert M. Kershner, MD; Paperback - 118 pages, 1st edition (January 15,
43
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
152 Myopia
1998), Slack, Inc.; ISBN: 1556423284;
http://www.amazon.com/exec/obidos/ASIN/1556423284/icongroupinterna
�
Pocket Companion Clinical Ocular Pharmacology by Bartlett, et al;
Paperback, 4th edition (March 15, 2002), Butterworth-Heinemann; ISBN:
0750673443;
http://www.amazon.com/exec/obidos/ASIN/0750673443/icongroupinterna
�
Textbook of Ocular Pharmacology by Thom J. Zimmerman, Ph.D.
(Editor), et al; Hardcover (September 1997), Lippincott, Williams & Wilkins
Publishers; ISBN: 0781703069;
http://www.amazon.com/exec/obidos/ASIN/0781703069/icongroupinterna
� The Wills Eye Drug Guide by Douglas J. Rhee, Vincent A. Deramo;
Paperback, 2nd edition (May 15, 2001), Lippincott, Williams & Wilkins
Publishers; ISBN: 0781732778;
http://www.amazon.com/exec/obidos/ASIN/0781732778/icongroupinterna
Vocabulary Builder
The following vocabulary builder gives definitions of words used in this
chapter that have not been defined in previous chapters:
Ethosuximide: An anticonvulsant especially useful in the treatment of
absence seizures unaccompanied by other types of seizures. [NIH]
Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic
effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH]
Researching Alternative Medicine 153
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE
Overview
Complementary and alternative medicine (CAM) is one of the most
contentious aspects of modern medical practice. You may have heard of
these treatments on the radio or on television. Maybe you have seen articles
written about these treatments in magazines, newspapers, or books. Perhaps
your friends or doctor have mentioned alternatives.
In this chapter, we will begin by giving you a broad perspective on
complementary and alternative therapies. Next, we will introduce you to
official information sources on CAM relating to myopia. Finally, at the
conclusion of this chapter, we will provide a list of readings on myopia from
various authors. We will begin, however, with the National Center for
Complementary and Alternative Medicine's (NCCAM) overview of
complementary and alternative medicine.
What Is CAM?44
Complementary and alternative medicine (CAM) covers a broad range of
healing philosophies, approaches, and therapies. Generally, it is defined as
those treatments and healthcare practices which are not taught in medical
schools, used in hospitals, or reimbursed by medical insurance companies.
Many CAM therapies are termed ?holistic,? which generally means that the
healthcare practitioner considers the whole person, including physical,
mental, emotional, and spiritual health. Some of these therapies are also
known as ?preventive,? which means that the practitioner educates and
44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
154 Myopia
treats the person to prevent health problems from arising, rather than
treating symptoms after problems have occurred.
People use CAM treatments and therapies in a variety of ways. Therapies are
used alone (often referred to as alternative), in combination with other
alternative therapies, or in addition to conventional treatment (sometimes
referred to as complementary). Complementary and alternative medicine, or
?integrative medicine,? includes a broad range of healing philosophies,
approaches, and therapies. Some approaches are consistent with
physiological principles of Western medicine, while others constitute healing
systems with non-Western origins. While some therapies are far outside the
realm of accepted Western medical theory and practice, others are becoming
established in mainstream medicine.
Complementary and alternative therapies are used in an effort to prevent
illness, reduce stress, prevent or reduce side effects and symptoms, or
control or cure disease. Some commonly used methods of complementary or
alternative therapy include mind/body control interventions such as
visualization and relaxation, manual healing including acupressure and
massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45
The list of CAM practices changes continually. The reason being is that these
new practices and therapies are often proved to be safe and effective, and
therefore become generally accepted as ?mainstream? healthcare practices.
Today, CAM practices may be grouped within five major domains: (1)
alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy
therapies. The individual systems and treatments comprising these
categories are too numerous to list in this sourcebook. Thus, only limited
examples are provided within each.
Alternative Medical Systems
Alternative medical systems involve complete systems of theory and practice
that have evolved independent of, and often prior to, conventional
biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
Researching Alternative Medicine 155
practiced by individual cultures throughout the world, including a number
of venerable Asian approaches.
Traditional oriental medicine emphasizes the balance or disturbances of qi
(pronounced chi) or vital energy in health and disease, respectively.
Traditional oriental medicine consists of a group of techniques and methods
including acupuncture, herbal medicine, oriental massage, and qi gong (a
form of energy therapy). Acupuncture involves stimulating specific
anatomic points in the body for therapeutic purposes, usually by puncturing
the skin with a thin needle.
Ayurveda is India's traditional system of medicine. Ayurvedic medicine
(meaning ?science of life?) is a comprehensive system of medicine that
places equal emphasis on body, mind, and spirit. Ayurveda strives to restore
the innate harmony of the individual. Some of the primary Ayurvedic
treatments include diet, exercise, meditation, herbs, massage, exposure to
sunlight, and controlled breathing.
Other traditional healing systems have been developed by the world?s
indigenous populations. These populations include Native American,
Aboriginal, African, Middle Eastern, Tibetan, and Central and South
American cultures. Homeopathy and naturopathy are also examples of
complete alternative medicine systems.
Homeopathic medicine is an unconventional Western system that is based
on the principle that ?like cures like,? i.e., that the same substance that in
large doses produces the symptoms of an illness, in very minute doses cures
it. Homeopathic health practitioners believe that the more dilute the remedy,
the greater its potency. Therefore, they use small doses of specially prepared
plant extracts and minerals to stimulate the body's defense mechanisms and
healing processes in order to treat illness.
Naturopathic medicine is based on the theory that disease is a manifestation
of alterations in the processes by which the body naturally heals itself and
emphasizes health restoration rather than disease treatment. Naturopathic
physicians employ an array of healing practices, including the following:
diet and clinical nutrition, homeopathy, acupuncture, herbal medicine,
hydrotherapy (the use of water in a range of temperatures and methods of
applications), spinal and soft-tissue manipulation, physical therapies (such
as those involving electrical currents, ultrasound, and light), therapeutic
counseling, and pharmacology.
156 Myopia
Mind-Body Interventions
Mind-body interventions employ a variety of techniques designed to
facilitate the mind's capacity to affect bodily function and symptoms. Only a
select group of mind-body interventions having well-documented theoretical
foundations are considered CAM. For example, patient education and
cognitive-behavioral approaches are now considered ?mainstream.? On the
other hand, complementary and alternative medicine includes meditation,
certain uses of hypnosis, dance, music, and art therapy, as well as prayer and
mental healing.
Biological-Based Therapies
This category of CAM includes natural and biological-based practices,
interventions, and products, many of which overlap with conventional
medicine's use of dietary supplements. This category includes herbal, special
dietary, orthomolecular, and individual biological therapies.
Herbal therapy employs an individual herb or a mixture of herbs for healing
purposes. An herb is a plant or plant part that produces and contains
chemical substances that act upon the body. Special diet therapies, such as
those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to
prevent and/or control illness as well as promote health. Orthomolecular
therapies aim to treat disease with varying concentrations of chemicals such
as magnesium, melatonin, and mega-doses of vitamins. Biological therapies
include, for example, the use of laetrile and shark cartilage to treat cancer
and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods
This category includes methods that are based on manipulation and/or
movement of the body. For example, chiropractors focus on the relationship
between structure and function, primarily pertaining to the spine, and how
that relationship affects the preservation and restoration of health.
Chiropractors use manipulative therapy as an integral treatment tool.
In contrast, osteopaths place particular emphasis on the musculoskeletal
system and practice osteopathic manipulation. Osteopaths believe that all of
the body's systems work together and that disturbances in one system may
have an impact upon function elsewhere in the body. Massage therapists
manipulate the soft tissues of the body to normalize those tissues.
Researching Alternative Medicine 157
Energy Therapies
Energy therapies focus on energy fields originating within the body
(biofields) or those from other sources (electromagnetic fields). Biofield
therapies are intended to affect energy fields (the existence of which is not
yet experimentally proven) that surround and penetrate the human body.
Some forms of energy therapy manipulate biofields by applying pressure
and/or manipulating the body by placing the hands in or through these
fields. Examples include Qi gong, Reiki and Therapeutic Touch.
Qi gong is a component of traditional oriental medicine that combines
movement, meditation, and regulation of breathing to enhance the flow of
vital energy (qi) in the body, improve blood circulation, and enhance
immune function. Reiki, the Japanese word representing Universal Life
Energy, is based on the belief that, by channeling spiritual energy through
the practitioner, the spirit is healed and, in turn, heals the physical body.
Therapeutic Touch is derived from the ancient technique of ?laying-on of
hands.? It is based on the premises that the therapist?s healing force affects
the patient's recovery and that healing is promoted when the body's energies
are in balance. By passing their hands over the patient, these healers identify
energy imbalances.
Bioelectromagnetic-based therapies involve the unconventional use of
electromagnetic fields to treat illnesses or manage pain. These therapies are
often used to treat asthma, cancer, and migraine headaches. Types of
electromagnetic fields which are manipulated in these therapies include
pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment?
A critical issue in pursuing complementary alternatives mentioned thus far
is the risk that these might have undesirable interactions with your medical
treatment. It becomes all the more important to speak with your doctor who
can offer advice on the use of alternatives. Official sources confirm this view.
Though written for women, we find that the National Women?s Health
Information Center?s advice on pursuing alternative medicine is appropriate
for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
158 Myopia
Is It Okay to Want Both Traditional and Alternative Medicine?
Should you wish to explore non-traditional types of treatment, be sure to
discuss all issues concerning treatments and therapies with your healthcare
provider, whether a physician or practitioner of complementary and
alternative medicine. Competent healthcare management requires
knowledge of both conventional and alternative therapies you are taking for
the practitioner to have a complete picture of your treatment plan.
The decision to use complementary and alternative treatments is an
important one. Consider before selecting an alternative therapy, the safety
and effectiveness of the therapy or treatment, the expertise and qualifications
of the healthcare practitioner, and the quality of delivery. These topics
should be considered when selecting any practitioner or therapy.
Finding CAM References on Myopia
Having read the previous discussion, you may be wondering which
complementary or alternative treatments might be appropriate for myopia.
For the remainder of this chapter, we will direct you to a number of official
sources which can assist you in researching studies and publications. Some
of these articles are rather technical, so some patience may be required.
The Combined Health Information Database
For a targeted search, The Combined Health Information Database is a
bibliographic database produced by health-related agencies of the Federal
Government (mostly from the National Institutes of Health). This database is
updated four times a year at the end of January, April, July, and October.
Check the titles, summaries, and availability of CAM-related information by
using the ?Simple Search? option at the following Web site:
http://chid.nih.gov/simple/simple.html. In the drop box at the top, select
?Complementary and Alternative Medicine.? Then type ?myopia? (or
synonyms) in the second search box. We recommend that you select 100
?documents per page? and to check the ?whole records? options. The
following was extracted using this technique:
�
Treatment of Myopia With Ear-Point Pressing and Acupuncture: A
Report of 216 Cases
Source: International Journal of Clinical Acupuncture. 6(1): 105-107. 1995.
Researching Alternative Medicine 159
Summary: This journal article describes the outcomes of 216 children and
young adults with myopia who were treated with acupuncture and earpoint pallet pressure methods. The sample consisted of 124 males and 92
females, ranging in age from 8 to 25 years. The lowest and highest
unaided visual acuities before treatment were 0.03 and 0.9, respectively.
A total of 428 eyes were treated; the total number of treatments ranged
from 5 to 50. Acupuncture was performed once daily, with an interval of
1 day after 6 days of treatment. Ear-point pallet pressure, using Semen
Vaccariae seeds, was self-administered 3 times daily, using 50 pressing
strokes each time. Of the 428 eyes treated, 126 (29.4 percent) were rated as
cured, 144 (33.7 percent) as markedly improved, 144 (33.7 percent) as
improved, and 14 (3.3 percent) as not changed. The author discusses the
therapeutic techniques, and offers suggestions for preventing myopia in
young people.
National Center for Complementary and Alternative Medicine
The National Center for Complementary and Alternative Medicine
(NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has
created a link to the National Library of Medicine's databases to allow
patients to search for articles that specifically relate to myopia and
complementary medicine. To search the database, go to the following Web
site: www.nlm.nih.gov/nccam/camonpubmed.html. Select ?CAM on
PubMed.? Enter ?myopia? (or synonyms) into the search box. Click ?Go.?
The following references provide information on particular aspects of
complementary and alternative medicine (CAM) that are related to myopia:
�
6-Hydroxy dopamine does not affect lens-induced refractive errors but
suppresses deprivation myopia.
Author(s): Schaeffel F, Hagel G, Bartmann M, Kohler K, Zrenner E.
Source: Vision Research. 1994 January; 34(2): 143-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8116274&dopt=Abstract
�
A morphological analysis of experimental myopia in young chickens.
Author(s): Hayes BP, Fitzke FW, Hodos W, Holden AL.
Source: Investigative Ophthalmology & Visual Science. 1986 June; 27(6):
981-91.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=3486857&dopt=Abstract
160 Myopia
�
A role for photoreceptor outer segments in the induction of deprivation
myopia.
Author(s): Liang H, Crewther DP, Crewther SG, Barila AM.
Source: Vision Research. 1995 May; 35(9): 1217-25.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610583&dopt=Abstract
�
Anatomical correlates of experimentally induced myopia.
Author(s): Beresford JA, Crewther SG, Crewther DP.
Source: Australian and New Zealand Journal of Ophthalmology. 1998
May; 26 Suppl 1: S84-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9685033&dopt=Abstract
�
Apomorphine blocks form-deprivation myopia in chickens by a
dopamine D2-receptor mechanism acting in retina or pigmented
epithelium.
Author(s): Rohrer B, Spira AW, Stell WK.
Source: Visual Neuroscience. 1993 May-June; 10(3): 447-53.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8494798&dopt=Abstract
�
Behavioral treatment of myopia: refractive error and acuity changes in
relation to axial length and intraocular pressure.
Author(s): Rosen RC, Schiffman HR, Meyers H.
Source: Am J Optom Physiol Opt. 1984 February; 61(2): 100-5.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=6703003&dopt=Abstract
�
Bilateral experimental myopia in chicks.
Author(s): Sivak JG, Barrie DL, Weerheim JA.
Source: Optom Vis Sci. 1989 December; 66(12): 854-8.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=2626252&dopt=Abstract
�
Biofeedback of accommodation to reduce functional myopia.
Author(s): Trachtman JN, Giambalvo V, Feldman J.
Source: Biofeedback Self Regul. 1981 December; 6(4): 547-62.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7326275&dopt=Abstract
Researching Alternative Medicine 161
�
Biofeedback of accommodation to reduce functional myopia: a case
report.
Author(s): Trachtman JN.
Source: Am J Optom Physiol Opt. 1978 June; 55(6): 400-6.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=736097&dopt=Abstract
�
Biofeedback of accommodation to reduce myopia: a review.
Author(s): Trachtman JN.
Source: Am J Optom Physiol Opt. 1987 August; 64(8): 639-43. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=3310647&dopt=Abstract
�
Biofeedback training for myopia control.
Author(s): Trachtman JN, Giambalvo V, Dippner RF.
Source: Optom Vis Sci. 1992 March; 69(3): 252-4. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1520360&dopt=Abstract
�
Biofeedback training of visual acuity and myopia: a pilot study.
Author(s): Gallaway M, Pearl SM, Winkelstein AM, Scheiman M.
Source: Am J Optom Physiol Opt. 1987 January; 64(1): 62-71.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=3826280&dopt=Abstract
�
Biomechanical considerations of high myopia: Part I--Physiological
characteristics.
Author(s): Bell GR.
Source: J Am Optom Assoc. 1993 May; 64(5): 332-8. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8320416&dopt=Abstract
�
Cataract extraction in pathological myopia.
Author(s): Curtin BJ.
Source: Ophthalmic Surg. 1976 Spring; 7(1): 65-76.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1264420&dopt=Abstract
�
Changes in myopia, visual acuity, and psychological distress after
biofeedback visual training.
Author(s): Angi MR, Caucci S, Pilotto E, Racano E, Rupolo G, Sabbadin E.
162 Myopia
Source: Optom Vis Sci. 1996 January; 73(1): 35-42.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8867680&dopt=Abstract
�
Cochlear deafness, myopia, and intellectual impairment in an Amish
family.
Author(s): Eldridge R, Berlin CI, Money JW, McKusick VA.
Source: Arch Otolaryngol. 1968 July; 88(1): 49-54. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=5660029&dopt=Abstract
�
Cone receptor sensitivity is altered in form deprivation myopia in the
chicken.
Author(s): Westbrook AM, Crewther DP, Crewther SG.
Source: Optom Vis Sci. 1999 May; 76(5): 326-38.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10375250&dopt=Abstract
�
Constant light affects retinal dopamine levels and blocks deprivation
myopia but not lens-induced refractive errors in chickens.
Author(s): Bartmann M, Schaeffel F, Hagel G, Zrenner E.
Source: Visual Neuroscience. 1994 March-April; 11(2): 199-208.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8003448&dopt=Abstract
�
Corneal endothelial response to induced myopia in the chicken.
Author(s): Hirst LW, Bancroft J, Bi JQ, Ohirich S.
Source: Clinical & Experimental Ophthalmology. 2001 August; 29(4): 2447.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11545424&dopt=Abstract
�
Current methods of treating and preventing myopia.
Author(s): Woo GC, Wilson MA.
Source: Optom Vis Sci. 1990 September; 67(9): 719-27. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=2234833&dopt=Abstract
�
Developmental aspects of experimental myopia
susceptibility, recovery and relation to emmetropization.
Author(s): Wallman J, Adams JI.
in
chicks:
Researching Alternative Medicine 163
Source: Vision Research. 1987; 27(7): 1139-63.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=3660666&dopt=Abstract
�
Diurnal growth rhythms in the chicken eye: relation to myopia
development and retinal dopamine levels.
Author(s): Weiss S, Schaeffel F.
Source: Journal of Comparative Physiology. A, Sensory, Neural, and
Behavioral Physiology. 1993 April; 172(3): 263-70.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8510054&dopt=Abstract
�
Dose-dependent effects of 6-hydroxy dopamine on deprivation
myopia, electroretinograms, and dopaminergic amacrine cells in
chickens.
Author(s): Li XX, Schaeffel F, Kohler K, Zrenner E.
Source: Visual Neuroscience. 1992 November; 9(5): 483-92.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1360257&dopt=Abstract
�
Effect of dark-rearing on experimental myopia in monkeys.
Author(s): Raviola E, Wiesel TN.
Source: Investigative Ophthalmology & Visual Science. 1978 June; 17(6):
485-8.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=566258&dopt=Abstract
�
Effects of brief periods of unrestricted vision on the development of
form-deprivation myopia in monkeys.
Author(s): Smith EL 3rd, Hung LF, Kee CS, Qiao Y.
Source: Investigative Ophthalmology & Visual Science. 2002 February;
43(2): 291-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11818369&dopt=Abstract
�
Effects of nicotinic antagonists on ocular growth and experimental
myopia.
Author(s): Stone RA, Sugimoto R, Gill AS, Liu J, Capehart C, Lindstrom
JM.
164 Myopia
Source: Investigative Ophthalmology & Visual Science. 2001 March;
42(3): 557-65.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=11222511&dopt=Abstract
�
ERG of form deprivation myopia and drug induced ametropia in
chicks.
Author(s): Fujikado T, Hosohata J, Omoto T.
Source: Current Eye Research. 1996 January; 15(1): 79-86.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8631207&dopt=Abstract
�
Evaluation of accommotrac biofeedback training for myopia control.
Author(s): Koslowe KC, Spierer A, Rosner M, Belkin M.
Source: Optom Vis Sci. 1991 May; 68(5): 338-43.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=1852394&dopt=Abstract
�
Expansion of the retinal pigment epithelium in experimental myopia.
Author(s): Lin T, Grimes PA, Stone RA.
Source: Vision Research. 1993 September; 33(14): 1881-5.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8249307&dopt=Abstract
�
Experimental animal myopia models are applicable to human juvenileonset myopia.
Author(s): Meyer C, Mueller MF, Duncker GI, Meyer HJ.
Source: Survey of Ophthalmology. 1999 October; 44 Suppl 1: S93-102.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10548121&dopt=Abstract
�
Experimental myopia in chickens induced by corneal astigmatism.
Author(s): Shih YF, Ho TC, Chen MS, Lin LL, Wang PC, Hou PK.
Source: Acta Ophthalmol (Copenh). 1994 October; 72(5): 597-601.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7887158&dopt=Abstract
�
Experimental myopia in Japan.
Author(s): Tokoro T.
Researching Alternative Medicine 165
Source: Acta Ophthalmol Suppl. 1988; 185: 93-4. No Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=2853551&dopt=Abstract
�
Experimentally induced myopia in chicks: morphometric and
biochemical analysis during the first 14 days after hatching.
Author(s): Pickett-Seltner RL, Sivak JG, Pasternak JJ.
Source: Vision Research. 1988; 28(2): 323-8.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=3414019&dopt=Abstract
�
Expression of bFGF and TGF-beta 2 in experimental myopia in chicks.
Author(s): Seko Y, Shimokawa H, Tokoro T.
Source: Investigative Ophthalmology & Visual Science. 1995 May; 36(6):
1183-7.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7730028&dopt=Abstract
�
Flicker parameters are different for suppression of myopia and
hyperopia.
Author(s): Schwahn HN, Schaeffel F.
Source: Vision Research. 1997 October; 37(19): 2661-73.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=9373666&dopt=Abstract
�
Form deprivation myopia in adolescent monkeys.
Author(s): Smith EL 3rd, Bradley DV, Fernandes A, Boothe RG.
Source: Optom Vis Sci. 1999 June; 76(6): 428-32.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10416938&dopt=Abstract
�
Form deprivation myopia in mature common marmosets (Callithrix
jacchus).
Author(s): Troilo D, Nickla DL, Wildsoet CF.
Source: Investigative Ophthalmology & Visual Science. 2000 July; 41(8):
2043-9.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=10892841&dopt=Abstract
�
Form deprivation myopia: elastic properties of sclera.
Author(s): Phillips JR, McBrien NA.
166 Myopia
Source: Ophthalmic & Physiological Optics : the Journal of the British
College of Ophthalmic Opticians (Optometrists). 1995 September; 15(5):
357-62.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8524554&dopt=Abstract
�
Form-deprivation myopia induces activation of scleral matrix
metalloproteinase-2 in tree shrew.
Author(s): Guggenheim JA, McBrien NA.
Source: Investigative Ophthalmology & Visual Science. 1996 June; 37(7):
1380-95.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=8641841&dopt=Abstract
�
Formoguanamine-induced inhibition of deprivation myopia in chick is
accompanied by choroidal thinning while retinal function is retained.
Author(s): Westbrook AM, Crewther SG, Liang H, Beresford JA, Allen M,
Keller I, Crewther DP.
Source: Vision Research. 1995 July; 35(14): 2075-88.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7660611&dopt=Abstract
�
High myopia causing developmental delays and polydipsia in a
preschool child.
Author(s): Rosenberg L, Gross RN.
Source: J Am Optom Assoc. 1981 August; 52(8): 667-9. No Abstract
Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=6172458&dopt=Abstract
�
High myopia following excessive occlusion therapy in the first year of
life.
Author(s): Munoz M, Capo H.
Source: The British Journal of Ophthalmology. 1995 March; 79(3): 297. No
Abstract Available.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7703213&dopt=Abstract
�
How applicable are animal myopia models to human juvenile onset
myopia?
Author(s): Zadnik K, Mutti DO.
Researching Alternative Medicine 167
Source: Vision Research. 1995 May; 35(9): 1283-8. Review.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=
PubMed&list_uids=7610588&dopt=Abstract
Additional Web Resources
A number of additional Web sites offer encyclopedic information covering
CAM and related topics. The following is a representative sample:
�
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
�
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
�
Chinese Medicine: http://www.newcenturynutrition.com/
�
drkoop.com�
http://www.drkoop.com/InteractiveMedicine/IndexC.html
�
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
�
Google: http://directory.google.com/Top/Health/Alternative/
�
Healthnotes: http://www.thedacare.org/healthnotes/
�
Open Directory Project: http://dmoz.org/Health/Alternative/
�
TPN.com: http://www.tnp.com/
�
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
�
WebMD襀ealth: http://my.webmd.com/drugs_and_herbs
�
WellNet: http://www.wellnet.ca/herbsa-c.htm
�
WholeHealthMD.com:
http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to myopia; please note that any
particular subject below may indicate either a therapeutic use, or a
contraindication (potential danger), and does not reflect an official
recommendation:
�
Herbs and Supplements
Antioxidants
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
168 Myopia
Aspirin
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Beta-Carotene
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Bilberry
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Bilberry
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Blueberry
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Carotenoids
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Elderberry
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Flavonoids
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Ginkgo
Researching Alternative Medicine 169
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Glutathione
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Hawthorn
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Lutein
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
�
Related Conditions
Cataracts
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Glaucoma
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
General References
A good place to find general background information on CAM is the
National Library of Medicine. It has prepared within the MEDLINEplus
system an information topic page dedicated to complementary and
alternative medicine. To access this page, go to the MEDLINEplus site at:
www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site
provides a general overview of various topics and can lead to a number of
170 Myopia
general sources. The following additional references describe, in broad
terms, alternative and complementary medicine (sorted alphabetically by
title; hyperlinks provide rankings, information, and reviews at
Amazon.com):
�
Smart Medicine for Your Eyes by Jeffrey Anshel; Paperback - 224 pages
(June 1999), Avery Penguin Putnam; ISBN: 0895298708;
http://www.amazon.com/exec/obidos/ASIN/0895298708/icongroupinterna
�
Natural Eye Care, An Encyclopedia: Complementary Treatments for
Improving and Saving Your Eyes and Saving Your Eyes by Marc
Grossman and Glen Swartwout; Paperback - 196 pages, 1st edition (June
15, 1999), McGraw Hill - NTC; ISBN: 0879837047;
http://www.amazon.com/exec/obidos/ASIN/0879837047/icongroupinterna
� Alternative Medicine for Dummies by James Dillard (Author); Audio
Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659;
http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna
�
Complementary and Alternative Medicine Secrets by W. Kohatsu
(Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400;
http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
�
Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition
(2001), Appleton & Lange; ISBN: 0838516211;
http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
�
Eat, Drink, and Be Healthy: The Harvard Medical School Guide to
Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages
(2001), Simon & Schuster; ISBN: 0684863375;
http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
� Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T.
Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997),
Prima Publishing; ISBN: 0761511571;
http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna
�
Integrative Medicine: An Introduction to the Art & Science of Healing
by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001),
Sounds True; ISBN: 1564558541;
http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
�
New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448
pages, Revised edition (2001), DK Publishing; ISBN: 078948031X;
http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
� Textbook of Complementary and Alternative Medicine by Wayne B.
Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN:
Researching Alternative Medicine 171
0683044370;
http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna
For additional information on complementary and alternative medicine, ask
your doctor or write to:
National Institutes of Health
National Center for Complementary and Alternative Medicine
Clearinghouse
P. O. Box 8218
Silver Spring, MD 20907-8218
Researching Nutrition 173
APPENDIX C. RESEARCHING NUTRITION
Overview
Since the time of Hippocrates, doctors have understood the importance of
diet and nutrition to patients? health and well-being. Since then, they have
accumulated an impressive archive of studies and knowledge dedicated to
this subject. Based on their experience, doctors and healthcare providers may
recommend particular dietary supplements to patients with myopia. Any
dietary recommendation is based on a patient's age, body mass, gender,
lifestyle, eating habits, food preferences, and health condition. It is therefore
likely that different patients with myopia may be given different
recommendations. Some recommendations may be directly related to
myopia, while others may be more related to the patient's general health.
These recommendations, themselves, may differ from what official sources
recommend for the average person.
In this chapter we will begin by briefly reviewing the essentials of diet and
nutrition that will broadly frame more detailed discussions of myopia. We
will then show you how to find studies dedicated specifically to nutrition
and myopia.
Food and Nutrition: General Principles
What Are Essential Foods?
Food is generally viewed by official sources as consisting of six basic
elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and
(6) minerals. Consuming a combination of these elements is considered to be
a healthy diet:
174 Myopia
�
Fluids are essential to human life as 80-percent of the body is composed
of water. Water is lost via urination, sweating, diarrhea, vomiting,
diuretics (drugs that increase urination), caffeine, and physical exertion.
�
Carbohydrates are the main source for human energy (thermoregulation)
and the bulk of typical diets. They are mostly classified as being either
simple or complex. Simple carbohydrates include sugars which are often
consumed in the form of cookies, candies, or cakes. Complex
carbohydrates consist of starches and dietary fibers. Starches are
consumed in the form of pastas, breads, potatoes, rice, and other foods.
Soluble fibers can be eaten in the form of certain vegetables, fruits, oats,
and legumes. Insoluble fibers include brown rice, whole grains, certain
fruits, wheat bran and legumes.
�
Proteins are eaten to build and repair human tissues. Some foods that are
high in protein are also high in fat and calories. Food sources for protein
include nuts, meat, fish, cheese, and other dairy products.
�
Fats are consumed for both energy and the absorption of certain
vitamins. There are many types of fats, with many general publications
recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in
some cases, disease prevention. Most are consumed in your diet (exceptions
being vitamins K and D which are produced by intestinal bacteria and
sunlight on the skin, respectively). Each vitamin and mineral plays a
different role in health. The following outlines essential vitamins:
�
Vitamin A is important to the health of your eyes, hair, bones, and skin;
sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
�
Vitamin B1, also known as thiamine, is important for your nervous
system and energy production; food sources for thiamine include meat,
peas, fortified cereals, bread, and whole grains.
�
Vitamin B2, also known as riboflavin, is important for your nervous
systems and muscles, but is also in involved in the release of proteins
from nutrients; food sources for riboflavin include dairy products, leafy
vegetables, meat, and eggs.
�
Vitamin B3, also known as niacin, is important for healthy skin and helps
the body use energy; food sources for niacin include peas, peanuts, fish,
and whole grains
�
Vitamin B6, also known as pyridoxine, is important for the regulation of
cells in the nervous system and is vital for blood formation; food sources
for pyridoxine include bananas, whole grains, meat, and fish.
Researching Nutrition 175
�
Vitamin B12 is vital for a healthy nervous system and for the growth of
red blood cells in bone marrow; food sources for vitamin B12 include
yeast, milk, fish, eggs, and meat.
�
Vitamin C allows the body's immune system to fight various diseases,
strengthens body tissue, and improves the body's use of iron; food
sources for vitamin C include a wide variety of fruits and vegetables.
�
Vitamin D helps the body absorb calcium which strengthens bones and
teeth; food sources for vitamin D include oily fish and dairy products.
�
Vitamin E can help protect certain organs and tissues from various
degenerative diseases; food sources for vitamin E include margarine,
vegetables, eggs, and fish.
�
Vitamin K is essential for bone formation and blood clotting; common
food sources for vitamin K include leafy green vegetables.
�
Folic Acid maintains healthy cells and blood and, when taken by a
pregnant woman, can prevent her fetus from developing neural tube
defects; food sources for folic acid include nuts, fortified breads, leafy
green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become
toxic if consumed in excess (e.g. vitamin A, D, E and K).
Like vitamins, minerals are chemicals that are required by the body to
remain in good health. Because the human body does not manufacture these
chemicals internally, we obtain them from food and other dietary sources.
The more important minerals include:
�
Calcium is needed for healthy bones, teeth, and muscles, but also helps
the nervous system function; food sources for calcium include dry beans,
peas, eggs, and dairy products.
�
Chromium is helpful in regulating sugar levels in blood; food sources for
chromium include egg yolks, raw sugar, cheese, nuts, beets, whole
grains, and meat.
�
Fluoride is used by the body to help prevent tooth decay and to reinforce
bone strength; sources of fluoride include drinking water and certain
brands of toothpaste.
�
Iodine helps regulate the body's use of energy by synthesizing into the
hormone thyroxine; food sources include leafy green vegetables, nuts,
egg yolks, and red meat.
176 Myopia
�
Iron helps maintain muscles and the formation of red blood cells and
certain proteins; food sources for iron include meat, dairy products, eggs,
and leafy green vegetables.
�
Magnesium is important for the production of DNA, as well as for
healthy teeth, bones, muscles, and nerves; food sources for magnesium
include dried fruit, dark green vegetables, nuts, and seafood.
�
Phosphorous is used by the body to work with calcium to form bones
and teeth; food sources for phosphorous include eggs, meat, cereals, and
dairy products.
�
Selenium primarily helps maintain normal heart and liver functions;
food sources for selenium include wholegrain cereals, fish, meat, and
dairy products.
�
Zinc helps wounds heal, the formation of sperm, and encourage rapid
growth and energy; food sources include dried beans, shellfish, eggs, and
nuts.
The United States government periodically publishes recommended diets
and consumption levels of the various elements of food. Again, your doctor
may encourage deviations from the average official recommendation based
on your specific condition. To learn more about basic dietary guidelines, visit
the Web site: http://www.health.gov/dietaryguidelines/. Based on these
guidelines, many foods are required to list the nutrition levels on the food?s
packaging. Labeling Requirements are listed at the following site maintained
by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government
recommends that consumers become familiar with the following
abbreviations before reading FDA literature:47
�
DVs (Daily Values): A new dietary reference term that will appear on
the food label. It is made up of two sets of references, DRVs and RDIs.
�
DRVs (Daily Reference Values): A set of dietary references that applies
to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and
potassium.
�
RDIs (Reference Daily Intakes): A set of dietary references based on the
Recommended Dietary Allowances for essential vitamins and minerals
and, in selected groups, protein. The name ?RDI? replaces the term ?U.S.
RDA.?
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 177
�
RDAs (Recommended Dietary Allowances): A set of estimated nutrient
allowances established by the National Academy of Sciences. It is
updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?48
Dietary supplements are widely available through many commercial
sources, including health food stores, grocery stores, pharmacies, and by
mail. Dietary supplements are provided in many forms including tablets,
capsules, powders, gel-tabs, extracts, and liquids. Historically in the United
States, the most prevalent type of dietary supplement was a
multivitamin/mineral tablet or capsule that was available in pharmacies,
either by prescription or ?over the counter.? Supplements containing strictly
herbal preparations were less widely available. Currently in the United
States, a wide array of supplement products are available, including vitamin,
mineral, other nutrients, and botanical supplements as well as ingredients
and extracts of animal and plant origin.
The Office of Dietary Supplements (ODS) of the National Institutes of Health
is the official agency of the United States which has the expressed goal of
acquiring ?new knowledge to help prevent, detect, diagnose, and treat
disease and disability, from the rarest genetic disorder to the common
cold.?49 According to the ODS, dietary supplements can have an important
impact on the prevention and management of disease and on the
maintenance of health.50 The ODS notes that considerable research on the
effects of dietary supplements has been conducted in Asia and Europe where
the use of plant products, in particular, has a long tradition. However, the
overwhelming majority of supplements have not been studied scientifically.
To explore the role of dietary supplements in the improvement of health
care, the ODS plans, organizes, and supports conferences, workshops, and
symposia on scientific topics related to dietary supplements. The ODS often
This discussion has been adapted from the NIH:
http://ods.od.nih.gov/whatare/whatare.html.
49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31,
Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920,
Fax: (301) 480-1845, E-mail: [email protected]
50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health
and Education Act defines dietary supplements as ?a product (other than tobacco) intended
to supplement the diet that bears or contains one or more of the following dietary
ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance
for use to supplement the diet by increasing the total dietary intake; or a concentrate,
metabolite, constituent, extract, or combination of any ingredient described above; and
intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not
represented as a conventional food or as a sole item of a meal or the diet.?
48
178 Myopia
works in conjunction with other NIH Institutes and Centers, other
government agencies, professional organizations, and public advocacy
groups.
To learn more about official information on dietary supplements, visit the
ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact:
The Office of Dietary Supplements
National Institutes of Health
Building 31, Room 1B29
31 Center Drive, MSC 2086
Bethesda, Maryland 20892-2086
Tel: (301) 435-2920
Fax: (301) 480-1845
E-mail: [email protected]
Finding Studies on Myopia
The NIH maintains an office dedicated to patient nutrition and diet. The
National Institutes of Health?s Office of Dietary Supplements (ODS) offers a
searchable bibliographic database called the IBIDS (International
Bibliographic Information on Dietary Supplements). The IBIDS contains over
460,000 scientific citations and summaries about dietary supplements and
nutrition as well as references to published international, scientific literature
on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is
available to the public free of charge through the ODS Internet page:
http://ods.od.nih.gov/databases/ibids.html.
After entering the search area, you have three choices: (1) IBIDS Consumer
Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We
recommend that you start with the Consumer Database. While you may not
find references for the topics that are of most interest to you, check back
periodically as this database is frequently updated. More studies can be
found by searching the Full IBIDS Database. Healthcare professionals and
researchers generally use the third option, which lists peer-reviewed
citations. In all cases, we suggest that you take advantage of the ?Advanced
Search? option that allows you to retrieve up to 100 fully explained
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary
Supplements (ODS) at the National Institutes of Health to assist the public, healthcare
providers, educators, and researchers in locating credible, scientific information on dietary
supplements. IBIDS was developed and will be maintained through an interagency
partnership with the Food and Nutrition Information Center of the National Agricultural
Library, U.S. Department of Agriculture.
51
Researching Nutrition 179
references in a comprehensive format. Type ?myopia? (or synonyms) into
the search box. To narrow the search, you can also select the ?Title? field.
The following information is typical of that found when using the ?Full
IBIDS Database? when searching using ?myopia? (or a synonym):
�
112 cases of juvenile myopia treated by auricular acupressure.
Source: Chen, M C J-Tradit-Chin-Med. 1989 September; 9(3): 173 02546272
�
268 cases of myopia treated with injection and pellet pressure at
auriculoacupoints.
Author(s): Clinic of Ningxia Military Region, PLA, Yinchuan.
Source: Yang, C Hu, L Zhu, F Li, L J-Tradit-Chin-Med. 1993 September;
13(3): 196-8 0254-6272
�
A study on the prevention and treatment of myopia with nacre on
chicks.
Author(s): Department of Chemistry, Huazhong University of Science
and Technology, Wuhan 430074, China. [email protected]
Source: Xu, H Huang, K Gao, Q Gao, Z Han, X Pharmacol-Res. 2001 July;
44(1): 1-6 1043-6618
�
Atropine and bifocals can slow the progression of myopia in children.
Author(s): Department of Ophthalmology, Jules Stein Eye Institute,
U.CLA. School of Medicine, Los Angeles, California 90095, USA.
Source: Syniuta, L A Isenberg, S J Binocul-Vis-Strabismus-Q. 2001; 16(3):
203-8 1088-6281
�
Atropine effect on school myopia. A preliminary report.
Author(s): Department of Ophthalmology, Veterans General Hospital,
Taipei, Taiwan.
Source: Kao, S C Lu, H Y Liu, J H Acta-Ophthalmol-Suppl. 1988; 185132-3
�
Atropine reduces experimental myopia and eye enlargement via a
nonaccommodative mechanism.
Author(s): Department of Optometry & Vision Sciences, University
of Wales, College of Cardiff, United Kingdom.
Source: McBrien, N A Moghaddam, H O Reeder, A P Invest-OphthalmolVis-Sci. 1993 January; 34(1): 205-15 0146-0404
�
Avian models of experimental myopia: environmental factors in the
regulation of eye growth.
Author(s): Department of Psychology, University of Maryland, College
Park 20742-4411.
Source: Hodos, W Ciba-Found-Sympage 1990; 155149-56; discussion 1569 0300-5208
180 Myopia
�
Cholinergic amacrine cells are not required for the progression and
atropine-mediated suppression of form-deprivation myopia.
Author(s): Department of Anatomy and Lions' Sight Centre, The
University of Calgary, Faculty of Medicine, 3330 Hospital Dr. N.W.,
Calgary, Alberta, Canada. [email protected]
Source: Fischer, A J Miethke, P Morgan, I G Stell, W K Brain-Res. 1998
May 25; 794(1): 48-60 0006-8993
�
Colchicine causes excessive ocular growth and myopia in chicks.
Author(s): Department of Anatomy, University of Calgary, Faculty of
Medicine, Alberta, Canada. [email protected]
Source: Fischer, A J Morgan, I G Stell, W K Vision-Res. 1999 February;
39(4): 685-97 0042-6989
�
Comparison of the effect of atropine and cyclopentolate on myopia.
Author(s): Department of Ophthalmology, Veterans General Hospital,
Yang-Ming Medical College, Taipei, Taiwan, Republic of China.
Source: Yen, M Y Liu, J H Kao, S C Shiao, C H Ann-Ophthalmol. 1989
May; 21(5): 180-2, 187 0003-4886
�
Decreased proteoglycan synthesis associated with form deprivation
myopia in mature primate eyes.
Author(s): Department of Anatomy and Cell Biology, University of North
Dakota School of Medicine and Health Sciences, Grand Forks 58202-9037,
USA. [email protected]
Source: Rada, J A Nickla, D L Troilo, D Invest-Ophthalmol-Vis-Sci. 2000
July; 41(8): 2050-8 0146-0404
�
Do variations in normal nutrition play a role in the development of
myopia?
Author(s): Department of Optometry and Radiography, Hong Kong
Polytechnic University, Hong Kong.
Source: Edwards, M H Optom-Vis-Sci. 1996 October; 73(10): 638-43 10405488
�
Effects of apomorphine, a dopamine receptor agonist, on ocular
refraction and axial elongation in a primate model of myopia.
Author(s): Department of Pharmacology, Emory University, Atlanta,
Georgia 30322.
Source: Iuvone, P M Tigges, M Stone, R A Lambert, S Laties, A M InvestOphthalmol-Vis-Sci. 1991 April; 32(5): 1674-7 0146-0404
�
Effects of different concentrations of atropine on controlling myopia in
myopic children.
Author(s): Department of Ophthalmology, National Taiwan University
Hospital, Taipei, Republic of China.
Researching Nutrition 181
Source: Shih, Y F Chen, C H Chou, A C Ho, T C Lin, L L Hung, P T JOcul-Pharmacol-Ther. 1999 February; 15(1): 85-90 1080-7683
�
Effects of nitric oxide donors and nitric oxide synthase substrates on
ciliary muscle contracted by carbachol and endothelin for possible use
in myopia prevention.
Author(s): Institute of Ocular Pharmacology and Department of Medical
Pharmacology and Toxicology, Texas A&M University System
Health Science Center, College of Medicine, College Station 77843-1114,
USA.
Source: Beauregard, C Liu, Q Chiou, G C J-Ocul-Pharmacol-Ther. 2001
February; 17(1): 1-9 1080-7683
�
Effects of prostaglandins on form deprivation myopia in the chick.
Author(s): Department of Neuroscience, Uppsala University, Sweden.
Source: Jin, N Stjernschantz, J Acta-Ophthalmol-Scand. 2000 October;
78(5): 495-500 1395-3907
�
Endogenous opiates in the chick retina and their role in formdeprivation myopia.
Author(s): Lions' Sight Centre, Department of Anatomy, Faculty of
Medicine, University of Calgary, Alberta, Canada.
Source: Seltner, R L Rohrer, B Grant, V Stell, W K Vis-Neurosci. 1997 SepOctober; 14(5): 801-9 0952-5238
�
Excimer laser for various degrees of myopia. A new model estimating
the immediate response, the regression, the final response and the time
relationship.
Author(s): Department of Ophthalmology, Rigshospitalet, University of
Copenhagen, Denmark.
Source: Edmund, C Acta-Ophthalmol-Scand. 1998 April; 76(2): 131-7
1395-3907
�
Excimer laser photorefractive keratectomy for myopia: two-year followup.
Author(s): Department of Ophthalmology, Kangnam St. Mary's Hospital,
Catholic University Medical College, Seoul, Korea.
Source: Kim, J H Hahn, T W Lee, Y C Sah, W J J-Cataract-Refract-Surg.
1994 March; 20 Suppl229-33 0886-3350
�
In vivo and in vitro association of retinoic acid with form-deprivation
myopia in the chick.
Author(s): Department of Ophthalmology, School of Medicine, Tokyo
Medical and Dental University, Japan.
Source: Seko, Y Shimokawa, H Tokoro, T Exp-Eye-Res. 1996 October;
63(4): 443-52 0014-4835
182 Myopia
Federal Resources on Nutrition
In addition to the IBIDS, the United States Department of Health and Human
Services (HHS) and the United States Department of Agriculture (USDA)
provide many sources of information on general nutrition and health.
Recommended resources include:
�
healthfinder�, HHS's gateway to health information, including diet and
nutrition:
http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag
e=0
�
The United States Department of Agriculture's Web site dedicated to
nutrition information: www.nutrition.gov
�
The Food and Drug Administration's Web site for federal food safety
information: www.foodsafety.gov
�
The National Action Plan on Overweight and Obesity sponsored by the
United
States
Surgeon
General:
http://www.surgeongeneral.gov/topics/obesity/
�
The Center for Food Safety and Applied Nutrition has an Internet site
sponsored by the Food and Drug Administration and the Department of
Health and Human Services: http://vm.cfsan.fda.gov/
�
Center for Nutrition Policy and Promotion sponsored by the United
States Department of Agriculture: http://www.usda.gov/cnpp/
�
Food and Nutrition Information Center, National Agricultural Library
sponsored by the United States Department of Agriculture:
http://www.nal.usda.gov/fnic/
�
Food and Nutrition Service sponsored by the United States Department
of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources
A number of additional Web sites offer encyclopedic information covering
food and nutrition. The following is a representative sample:
�
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
�
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
�
Google: http://directory.google.com/Top/Health/Nutrition/
�
Healthnotes: http://www.thedacare.org/healthnotes/
Researching Nutrition 183
�
Open Directory Project: http://dmoz.org/Health/Nutrition/
�
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
�
WebMD襀ealth: http://my.webmd.com/nutrition
�
WholeHealthMD.com:
http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to myopia; please note that any
particular subject below may indicate either a therapeutic use, or a
contraindication (potential danger), and does not reflect an official
recommendation:
�
Vitamins
Ascorbic Acid
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Pyridoxine
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
�
Minerals
Alpha-Tocopherol
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Quercetin
Source: Healthnotes, Inc.; www.healthnotes.com
Hyperlink:
http://www.thedacare.org/healthnotes/Concern/Cataracts.htm
Selenium
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
184 Myopia
�
Food and Diet
Berries
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Sugar
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Tea
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Vegetables
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Water
Source: Integrative Medicine Communications; www.onemedicine.com
Hyperlink:
http://www.drkoop.com/interactivemedicine/ConsConditions/Glauco
macc.html
Vocabulary Builder
The following vocabulary builder defines words used in the references in
this chapter that have not been defined in previous chapters:
Capsules: Hard or soft soluble containers used for the oral administration of
medicine. [NIH]
Carbachol: A slowly hydrolyzed cholinergic agonist that acts at both
muscarinic and nicotinic receptors. [NIH]
Researching Nutrition 185
Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
particularly of the pentahydric and hexahydric alcohols. They are so named
because the hydrogen and oxygen are usually in the proportion to form
water, (CH2O)n. The most important carbohydrates are the starches, sugars,
celluloses, and gums. They are classified into mono-, di-, tri-, poly- and
heterosaccharides. [EU]
Cholesterol: The principal sterol of all higher animals, distributed in body
tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
Cholinergic:
Resembling acetylcholine in pharmacological
stimulated by or releasing acetylcholine or a related compound. [EU]
action;
Cyclopentolate: A parasympatholytic anticholinergic used solely to obtain
mydriasis or cycloplegia. [NIH]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
Iodine: A nonmetallic element of the halogen group that is represented by
the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a
nutritionally essential element, especially important in thyroid hormone
synthesis. In solution, it has anti-infective properties and is used topically.
[NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal
and plant tissues. Required by the body for the formation of coenzymes
NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic
properties. [NIH]
Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU]
Potassium: An element that is in the alkali group of metals. It has an atomic
symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation
in the intracellular fluid of muscle and other cells. Potassium ion is a strong
electrolyte and it plays a significant role in the regulation of fluid volume
and maintenance of the water-electrolyte balance. [NIH]
Psychology: The science dealing with the study of mental processes and
behavior in man and animals. [NIH]
Radiography: The making of film records (radiographs) of internal
structures of the body by passage of x-rays or gamma rays through the body
to act on specially sensitized film. [EU]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver,
kidney, heart, and leafy vegetables. The richest natural source is yeast. It
occurs in the free form only in the retina of the eye, in whey, and in urine; its
principal forms in tissues and cells are as FMN and FAD. [NIH]
Selenium: An element with the atomic symbol Se, atomic number 34, and
atomic weight 78.96. It is an essential micronutrient for mammals and other
animals but is toxic in large amounts. Selenium protects intracellular
186 Myopia
structures against oxidative damage. It is an essential component of
glutathione peroxidase. [NIH]
Substrate: A substance upon which an enzyme acts. [EU]
Thermoregulation: Heat regulation. [EU]
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating
effect on thyroid metabolism. [NIH]
Finding Medical Libraries 187
APPENDIX D. FINDING MEDICAL LIBRARIES
Overview
At a medical library you can find medical texts and reference books,
consumer health publications, specialty newspapers and magazines, as well
as medical journals. In this Appendix, we show you how to quickly find a
medical library in your area.
Preparation
Before going to the library, highlight the references mentioned in this
sourcebook that you find interesting. Focus on those items that are not
available via the Internet, and ask the reference librarian for help with your
search. He or she may know of additional resources that could be helpful to
you. Most importantly, your local public library and medical libraries have
Interlibrary Loan programs with the National Library of Medicine (NLM),
one of the largest medical collections in the world. According to the NLM,
most of the literature in the general and historical collections of the National
Library of Medicine is available on interlibrary loan to any library. NLM's
interlibrary loan services are only available to libraries. If you would like to
access NLM medical literature, then visit a library in your area that can
request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
188 Myopia
Finding a Local Medical Library
The quickest method to locate medical libraries is to use the Internet-based
directory published by the National Network of Libraries of Medicine
(NN/LM). This network includes 4626 members and affiliates that provide
many services to librarians, health professionals, and the public. To find a
library in your area, simply visit http://nnlm.gov/members/adv.html or call
1-800-338-7657.
Medical Libraries Open to the Public
In addition to the NN/LM, the National Library of Medicine (NLM) lists a
number of libraries that are generally open to the public and have reference
facilities. The following is the NLM?s list plus hyperlinks to each library Web
site. These Web pages can provide information on hours of operation and
other restrictions. The list below is a small sample of libraries recommended
by the National Library of Medicine (sorted alphabetically by name of the
U.S. state or Canadian province where the library is located):53
�
Alabama: Health InfoNet of Jefferson County (Jefferson County Library
Cooperative, Lister Hill Library of the Health Sciences),
http://www.uab.edu/infonet/
�
Alabama: Richard M. Scrushy Library (American Sports Medicine
Institute), http://www.asmi.org/LIBRARY.HTM
�
Arizona: Samaritan Regional Medical Center: The Learning Center
(Samaritan Health System, Phoenix, Arizona),
http://www.samaritan.edu/library/bannerlibs.htm
�
California: Kris Kelly Health Information Center (St. Joseph Health
System), http://www.humboldt1.com/~kkhic/index.html
�
California: Community Health Library of Los Gatos (Community Health
Library of Los Gatos), http://www.healthlib.org/orgresources.html
�
California: Consumer Health Program and Services (CHIPS) (County of
Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical
Center Library) - Carson, CA,
http://www.colapublib.org/services/chips.html
�
California: Gateway Health Library (Sutter Gould Medical Foundation)
�
California: Health Library (Stanford University Medical Center),
http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 189
�
California: Patient Education Resource Center - Health Information and
Resources (University of California, San Francisco),
http://sfghdean.ucsf.edu/barnett/PERC/default.asp
�
California: Redwood Health Library (Petaluma Health Care District),
http://www.phcd.org/rdwdlib.html
�
California: San Jos� PlaneTree Health Library,
http://planetreesanjose.org/
�
California: Sutter Resource Library (Sutter Hospitals Foundation),
http://go.sutterhealth.org/comm/resc-library/sac-resources.html
�
California: University of California, Davis. Health Sciences Libraries
�
California: ValleyCare Health Library & Ryan Comer Cancer Resource
Center (ValleyCare Health System),
http://www.valleycare.com/library.html
�
California: Washington Community Health Resource Library
(Washington Community Health Resource Library),
http://www.healthlibrary.org/
�
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare),
http://www.exempla.org/conslib.htm
�
Connecticut: Hartford Hospital Health Science Libraries (Hartford
Hospital), http://www.harthosp.org/library/
�
Connecticut: Healthnet: Connecticut Consumer Health Information
Center (University of Connecticut Health Center, Lyman Maynard Stowe
Library), http://library.uchc.edu/departm/hnet/
�
Connecticut: Waterbury Hospital Health Center Library (Waterbury
Hospital), http://www.waterburyhospital.com/library/consumer.shtml
�
Delaware: Consumer Health Library (Christiana Care Health System,
Eugene du Pont Preventive Medicine & Rehabilitation Institute),
http://www.christianacare.org/health_guide/health_guide_pmri_health
_info.cfm
�
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine),
http://www.delamed.org/chls.html
�
Georgia: Family Resource Library (Medical College of Georgia),
http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
�
Georgia: Health Resource Center (Medical Center of Central Georgia),
http://www.mccg.org/hrc/hrchome.asp
�
Hawaii: Hawaii Medical Library: Consumer Health Information Service
(Hawaii Medical Library), http://hml.org/CHIS/
190 Myopia
�
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center),
http://www.nicon.org/DeArmond/index.htm
�
Illinois: Health Learning Center of Northwestern Memorial Hospital
(Northwestern Memorial Hospital, Health Learning Center),
http://www.nmh.org/health_info/hlc.html
�
Illinois: Medical Library (OSF Saint Francis Medical Center),
http://www.osfsaintfrancis.org/general/library/
�
Kentucky: Medical Library - Services for Patients, Families, Students &
the Public (Central Baptist Hospital),
http://www.centralbap.com/education/community/library.htm
�
Kentucky: University of Kentucky - Health Information Library
(University of Kentucky, Chandler Medical Center, Health Information
Library), http://www.mc.uky.edu/PatientEd/
�
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner
Medical Foundation), http://www.ochsner.org/library/
�
Louisiana: Louisiana State University Health Sciences Center Medical
Library-Shreveport, http://lib-sh.lsuhsc.edu/
�
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial
Hospital), http://www.fchn.org/fmh/lib.htm
�
Maine: Gerrish-True Health Sciences Library (Central Maine Medical
Center), http://www.cmmc.org/library/library.html
�
Maine: Hadley Parrot Health Science Library (Eastern Maine
Healthcare), http://www.emh.org/hll/hpl/guide.htm
�
Maine: Maine Medical Center Library (Maine Medical Center),
http://www.mmc.org/library/
�
Maine: Parkview Hospital,
http://www.parkviewhospital.org/communit.htm#Library
�
Maine: Southern Maine Medical Center Health Sciences Library
(Southern Maine Medical Center),
http://www.smmc.org/services/service.php3?choice=10
�
Maine: Stephens Memorial Hospital Health Information Library
(Western Maine Health), http://www.wmhcc.com/hil_frame.html
�
Manitoba, Canada: Consumer & Patient Health Information Service
(University of Manitoba Libraries),
http://www.umanitoba.ca/libraries/units/health/reference/chis.html
�
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre),
http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 191
�
Maryland: Health Information Center at the Wheaton Regional Library
(Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional
Library), http://www.mont.lib.md.us/healthinfo/hic.asp
�
Massachusetts: Baystate Medical Center Library (Baystate Health
System), http://www.baystatehealth.com/1024/
�
Massachusetts: Boston University Medical Center Alumni Medical
Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
�
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell
General Hospital),
http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
�
Massachusetts: Paul E. Woodard Health Sciences Library (New England
Baptist Hospital), http://www.nebh.org/health_lib.asp
�
Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's
Hospital), http://www.southcoast.org/library/
�
Massachusetts: Treadwell Library Consumer Health Reference Center
(Massachusetts General Hospital),
http://www.mgh.harvard.edu/library/chrcindex.html
�
Massachusetts: UMass HealthNet (University of Massachusetts Medical
School), http://healthnet.umassmed.edu/
�
Michigan: Botsford General Hospital Library - Consumer Health
(Botsford General Hospital, Library & Internet Services),
http://www.botsfordlibrary.org/consumer.htm
�
Michigan: Helen DeRoy Medical Library (Providence Hospital and
Medical Centers), http://www.providence-hospital.org/library/
�
Michigan: Marquette General Hospital - Consumer Health Library
(Marquette General Hospital, Health Information Center),
http://www.mgh.org/center.html
�
Michigan: Patient Education Resouce Center - University of Michigan
Cancer Center (University of Michigan Comprehensive Cancer Center),
http://www.cancer.med.umich.edu/learn/leares.htm
�
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information,
http://www.sladen.hfhs.org/library/consumer/index.html
�
Montana: Center for Health Information (St. Patrick Hospital and Health
Sciences Center),
http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
192 Myopia
�
National: Consumer Health Library Directory (Medical Library
Association, Consumer and Patient Health Information Section),
http://caphis.mlanet.org/directory/index.html
�
National: National Network of Libraries of Medicine (National Library of
Medicine) - provides library services for health professionals in the
United States who do not have access to a medical library,
http://nnlm.gov/
�
National: NN/LM List of Libraries Serving the Public (National Network
of Libraries of Medicine), http://nnlm.gov/members/
�
Nevada: Health Science Library, West Charleston Library (Las Vegas
Clark County Library District),
http://www.lvccld.org/special_collections/medical/index.htm
�
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College
Library),
http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld
/
�
New Jersey: Consumer Health Library (Rahway Hospital),
http://www.rahwayhospital.com/library.htm
�
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood
Hospital and Medical Center),
http://www.englewoodhospital.com/links/index.htm
�
New Jersey: Meland Foundation (Englewood Hospital and Medical
Center), http://www.geocities.com/ResearchTriangle/9360/
�
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant,
http://www.nypl.org/branch/health/links.html
�
New York: Health Information Center (Upstate Medical University, State
University of New York), http://www.upstate.edu/library/hic/
�
New York: Health Sciences Library (Long Island Jewish Medical Center),
http://www.lij.edu/library/library.html
�
New York: ViaHealth Medical Library (Rochester General Hospital),
http://www.nyam.org/library/
�
Ohio: Consumer Health Library (Akron General Medical Center, Medical
& Consumer Health Library),
http://www.akrongeneral.org/hwlibrary.htm
�
Oklahoma: Saint Francis Health System Patient/Family Resource Center
(Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 193
�
Oregon: Planetree Health Resource Center (Mid-Columbia Medical
Center), http://www.mcmc.net/phrc/
�
Pennsylvania: Community Health Information Library (Milton S.
Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
�
Pennsylvania: Community Health Resource Library (Geisinger Medical
Center), http://www.geisinger.edu/education/commlib.shtml
�
Pennsylvania: HealthInfo Library (Moses Taylor Hospital),
http://www.mth.org/healthwellness.html
�
Pennsylvania: Hopwood Library (University of Pittsburgh, Health
Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
�
Pennsylvania: Koop Community Health Information Center (College of
Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
�
Pennsylvania: Learning Resources Center - Medical Library
(Susquehanna Health System),
http://www.shscares.org/services/lrc/index.asp
�
Pennsylvania: Medical Library (UPMC Health System),
http://www.upmc.edu/passavant/library.htm
�
Quebec, Canada: Medical Library (Montreal General Hospital),
http://ww2.mcgill.ca/mghlib/
�
South Dakota: Rapid City Regional Hospital - Health Information Center
(Rapid City Regional Hospital, Health Information Center),
http://www.rcrh.org/education/LibraryResourcesConsumers.htm
�
Texas: Houston HealthWays (Houston Academy of Medicine-Texas
Medical Center Library), http://hhw.library.tmc.edu/
�
Texas: Matustik Family Resource Center (Cook Children's Health Care
System), http://www.cookchildrens.com/Matustik_Library.html
�
Washington: Community Health Library (Kittitas Valley Community
Hospital), http://www.kvch.com/
�
Washington: Southwest Washington Medical Center Library (Southwest
Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 195
APPENDIX E. YOUR RIGHTS AND INSURANCE
Overview
Any patient with myopia faces a series of issues related more to the
healthcare industry than to the medical condition itself. This appendix
covers two important topics in this regard: your rights and responsibilities as
a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient
The President?s Advisory Commission on Consumer Protection and Quality
in the Healthcare Industry has created the following summary of your rights
as a patient.54
Information Disclosure
Consumers have the right to receive accurate, easily understood information.
Some consumers require assistance in making informed decisions about
health plans, health professionals, and healthcare facilities. Such information
includes:
�
Health plans. Covered benefits, cost-sharing, and procedures for
resolving complaints, licensure, certification, and accreditation status,
comparable measures of quality and consumer satisfaction, provider
network composition, the procedures that govern access to specialists
and emergency services, and care management information.
54Adapted
from Consumer Bill of Rights and Responsibilities:
http://www.hcqualitycommission.gov/press/cbor.html#head1.
196 Myopia
�
Health professionals. Education, board certification, and recertification,
years of practice, experience performing certain procedures, and
comparable measures of quality and consumer satisfaction.
�
Healthcare facilities. Experience in performing certain procedures and
services, accreditation status, comparable measures of quality, worker,
and consumer satisfaction, and procedures for resolving complaints.
�
Consumer assistance programs. Programs must be carefully structured to
promote consumer confidence and to work cooperatively with health
plans, providers, payers, and regulators. Desirable characteristics of such
programs are sponsorship that ensures accountability to the interests of
consumers and stable, adequate funding.
Choice of Providers and Plans
Consumers have the right to a choice of healthcare providers that is
sufficient to ensure access to appropriate high-quality healthcare. To ensure
such choice, the Commission recommends the following:
�
Provider network adequacy. All health plan networks should provide
access to sufficient numbers and types of providers to assure that all
covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week.
If a health plan has an insufficient number or type of providers to
provide a covered benefit with the appropriate degree of specialization,
the plan should ensure that the consumer obtains the benefit outside the
network at no greater cost than if the benefit were obtained from
participating providers.
�
Women's health services. Women should be able to choose a qualified
provider offered by a plan -- such as gynecologists, certified nurse
midwives, and other qualified healthcare providers -- for the provision of
covered care necessary to provide routine and preventative women's
healthcare services.
�
Access to specialists. Consumers with complex or serious medical
conditions who require frequent specialty care should have direct access
to a qualified specialist of their choice within a plan's network of
providers. Authorizations, when required, should be for an adequate
number of direct access visits under an approved treatment plan.
�
Transitional care. Consumers who are undergoing a course of treatment
for a chronic or disabling condition (or who are in the second or third
trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 197
plans or at a time when a provider is terminated by a plan for other than
cause should be able to continue seeing their current specialty providers
for up to 90 days (or through completion of postpartum care) to allow for
transition of care.
�
Choice of health plans. Public and private group purchasers should,
wherever feasible, offer consumers a choice of high-quality health
insurance plans.
Access to Emergency Services
Consumers have the right to access emergency healthcare services when and
where the need arises. Health plans should provide payment when a
consumer presents to an emergency department with acute symptoms of
sufficient severity--including severe pain--such that a ?prudent layperson?
could reasonably expect the absence of medical attention to result in placing
that consumer's health in serious jeopardy, serious impairment to bodily
functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions
Consumers have the right and responsibility to fully participate in all
decisions related to their healthcare. Consumers who are unable to fully
participate in treatment decisions have the right to be represented by
parents, guardians, family members, or other conservators. Physicians and
other health professionals should:
�
Provide patients with sufficient information and opportunity to decide
among treatment options consistent with the informed consent process.
�
Discuss all treatment options with a patient in a culturally competent
manner, including the option of no treatment at all.
�
Ensure that persons with disabilities have effective communications with
members of the health system in making such decisions.
�
Discuss all current treatments a consumer may be undergoing.
�
Discuss all risks,
nontreatment.
�
Give patients the opportunity to refuse treatment and to express
preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
198 Myopia
�
Discuss the use of advance directives -- both living wills and durable
powers of attorney for healthcare -- with patients and their designated
family members.
�
Abide by the decisions made by their patients and/or their designated
representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should:
�
Disclose to consumers factors -- such as methods of compensation,
ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
�
Assure that provider contracts do not contain any so-called ?gag clauses?
or other contractual mechanisms that restrict healthcare providers' ability
to communicate with and advise patients about medically necessary
treatment options.
�
Be prohibited from penalizing or seeking retribution against healthcare
professionals or other health workers for advocating on behalf of their
patients.
Respect and Nondiscrimination
Consumers have the right to considerate, respectful care from all members of
the healthcare industry at all times and under all circumstances. An
environment of mutual respect is essential to maintain a quality healthcare
system. To assure that right, the Commission recommends the following:
�
Consumers must not be discriminated against in the delivery of
healthcare services consistent with the benefits covered in their policy, or
as required by law, based on race, ethnicity, national origin, religion, sex,
age, mental or physical disability, sexual orientation, genetic information,
or source of payment.
�
Consumers eligible for coverage under the terms and conditions of a
health plan or program, or as required by law, must not be discriminated
against in marketing and enrollment practices based on race, ethnicity,
national origin, religion, sex, age, mental or physical disability, sexual
orientation, genetic information, or source of payment.
Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in
confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 199
healthcare information protected. Consumers also have the right to review
and copy their own medical records and request amendments to their
records.
Complaints and Appeals
Consumers have the right to a fair and efficient process for resolving
differences with their health plans, healthcare providers, and the institutions
that serve them, including a rigorous system of internal review and an
independent system of external review. A free copy of the Patient's Bill of
Rights is available from the American Hospital Association.55
Patient Responsibilities
Treatment is a two-way street between you and your healthcare providers.
To underscore the importance of finance in modern healthcare as well as
your responsibility for the financial aspects of your care, the President?s
Advisory Commission on Consumer Protection and Quality in the
Healthcare Industry has proposed that patients understand the following
?Consumer Responsibilities.?56 In a healthcare system that protects
consumers' rights, it is reasonable to expect and encourage consumers to
assume certain responsibilities. Greater individual involvement by the
consumer in his or her care increases the likelihood of achieving the best
outcome and helps support a quality-oriented, cost-conscious environment.
Such responsibilities include:
�
Take responsibility for maximizing healthy habits such as exercising, not
smoking, and eating a healthy diet.
�
Work collaboratively with healthcare providers in developing and
carrying out agreed-upon treatment plans.
�
Disclose relevant information and clearly communicate wants and needs.
�
Use your health insurance plan's internal complaint and appeal processes
to address your concerns.
�
Avoid knowingly spreading disease.
55 To order your free copy of the Patient's Bill of Rights, telephone 312-422-3000 or visit the
American Hospital Association?s Web site: http://www.aha.org. Click on ?Resource Center,?
go to ?Search? at bottom of page, and then type in ?Patient's Bill of Rights.? The Patient?s
Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number
471124.
56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
200 Myopia
�
Recognize the reality of risks, the limits of the medical science, and the
human fallibility of the healthcare professional.
�
Be aware of a healthcare provider's obligation to be reasonably efficient
and equitable in providing care to other patients and the community.
�
Become knowledgeable about your health plan?s coverage and options
(when available) including all covered benefits, limitations, and
exclusions, rules regarding use of network providers, coverage and
referral rules, appropriate processes to secure additional information, and
the process to appeal coverage decisions.
�
Show respect for other patients and health workers.
�
Make a good-faith effort to meet financial obligations.
�
Abide by administrative and operational procedures of health plans,
healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan
There are a number of official government agencies that help consumers
understand their healthcare insurance choices.57 The U.S. Department of
Labor, in particular, recommends ten ways to make your health benefits
choices work best for you.58
1. Your options are important. There are many different types of health
benefit plans. Find out which one your employer offers, then check out the
plan, or plans, offered. Your employer's human resource office, the health
plan administrator, or your union can provide information to help you
match your needs and preferences with the available plans. The more
information you have, the better your healthcare decisions will be.
2. Reviewing the benefits available. Do the plans offered cover preventive
care, well-baby care, vision or dental care? Are there deductibles? Answers
to these questions can help determine the out-of-pocket expenses you may
face. Matching your needs and those of your family members will result in
the best possible benefits. Cheapest may not always be best. Your goal is
high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web
site:
http://www.ahrq.gov/consumer/qntascii/qnthplan.htm.
58 Adapted from the Department of Labor:
http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html.
57
Your Rights and Insurance 201
3. Look for quality. The quality of healthcare services varies, but quality can
be measured. You should consider the quality of healthcare in deciding
among the healthcare plans or options available to you. Not all health plans,
doctors, hospitals and other providers give the highest quality care.
Fortunately, there is quality information you can use right now to help you
compare your healthcare choices. Find out how you can measure quality.
Consult the U.S. Department of Health and Human Services publication
?Your Guide to Choosing Quality Health Care? on the Internet at
www.ahcpr.gov/consumer.
4. Your plan's summary plan description (SPD) provides a wealth of
information. Your health plan administrator can provide you with a copy of
your plan?s SPD. It outlines your benefits and your legal rights under the
Employee Retirement Income Security Act (ERISA), the federal law that
protects your health benefits. It should contain information about the
coverage of dependents, what services will require a co-pay, and the
circumstances under which your employer can change or terminate a health
benefits plan. Save the SPD and all other health plan brochures and
documents, along with memos or correspondence from your employer
relating to health benefits.
5. Assess your benefit coverage as your family status changes. Marriage,
divorce, childbirth or adoption, and the death of a spouse are all life events
that may signal a need to change your health benefits. You, your spouse and
dependent children may be eligible for a special enrollment period under
provisions of the Health Insurance Portability and Accountability Act
(HIPAA). Even without life-changing events, the information provided by
your employer should tell you how you can change benefits or switch plans,
if more than one plan is offered. If your spouse's employer also offers a
health benefits package, consider coordinating both plans for maximum
coverage.
6. Changing jobs and other life events can affect your health benefits.
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you,
your covered spouse, and your dependent children may be eligible to
purchase extended health coverage under your employer's plan if you lose
your job, change employers, get divorced, or upon occurrence of certain
other events. Coverage can range from 18 to 36 months depending on your
situation. COBRA applies to most employers with 20 or more workers and
requires your plan to notify you of your rights. Most plans require eligible
individuals to make their COBRA election within 60 days of the plan's
notice. Be sure to follow up with your plan sponsor if you don't receive
notice, and make sure you respond within the allotted time.
202 Myopia
7. HIPAA can also help if you are changing jobs, particularly if you have a
medical condition. HIPAA generally limits pre-existing condition exclusions
to a maximum of 12 months (18 months for late enrollees). HIPAA also
requires this maximum period to be reduced by the length of time you had
prior ?creditable coverage.? You should receive a certificate documenting
your prior creditable coverage from your old plan when coverage ends.
8. Plan for retirement. Before you retire, find out what health benefits, if any,
extend to you and your spouse during your retirement years. Consult with
your employer's human resources office, your union, the plan administrator,
and check your SPD. Make sure there is no conflicting information among
these sources about the benefits you will receive or the circumstances under
which they can change or be eliminated. With this information in hand, you
can make other important choices, like finding out if you are eligible for
Medicare and Medigap insurance coverage.
9. Know how to file an appeal if your health benefits claim is denied.
Understand how your plan handles grievances and where to make appeals
of the plan's decisions. Keep records and copies of correspondence. Check
your health benefits package and your SPD to determine who is responsible
for handling problems with benefit claims. Contact PWBA for customer
service assistance if you are unable to obtain a response to your complaint.
10. You can take steps to improve the quality of the healthcare and the
health benefits you receive. Look for and use things like Quality Reports
and Accreditation Reports whenever you can. Quality reports may contain
consumer ratings -- how satisfied consumers are with the doctors in their
plan, for instance-- and clinical performance measures -- how well a
healthcare organization prevents and treats illness. Accreditation reports
provide information on how accredited organizations meet national
standards, and often include clinical performance measures. Look for these
quality measures whenever possible. Consult ?Your Guide to Choosing
Quality Health Care? on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid
Illness strikes both rich and poor families. For low-income families, Medicaid
is available to defer the costs of treatment. The Health Care Financing
Administration (HCFA) administers Medicare, the nation's largest health
insurance program, which covers 39 million Americans. In the following
pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 203
contact information on how to find more in-depth information about
Medicaid.59
Who is Eligible for Medicare?
Generally, you are eligible for Medicare if you or your spouse worked for at
least 10 years in Medicare-covered employment and you are 65 years old
and a citizen or permanent resident of the United States. You might also
qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or
transplant). Here are some simple guidelines:
You can get Part A at age 65 without having to pay premiums if:
�
You are already receiving retirement benefits from Social Security or the
Railroad Retirement Board.
�
You are eligible to receive Social Security or Railroad benefits but have
not yet filed for them.
�
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay
premiums if:
�
You have received Social Security or Railroad Retirement Board disability
benefit for 24 months.
�
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts:
�
Part A (Hospital Insurance). Most people do not have to pay for Part A.
�
Part B (Medical Insurance). Most people pay monthly for Part B.
Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small
facilities that give limited outpatient and inpatient services to people in rural
areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information:
http://www.medicare.gov/Basics/Overview.asp.
59
204 Myopia
Cost: Most people get Part A automatically when they turn age 65. You do
not have to pay a monthly payment called a premium for Part A because you
or a spouse paid Medicare taxes while you were working.
If you (or your spouse) did not pay Medicare taxes while you were working
and you are age 65 or older, you still may be able to buy Part A. If you are
not sure you have Part A, look on your red, white, and blue Medicare card. It
will show ?Hospital Part A? on the lower left corner of the card. You can
also call the Social Security Administration toll free at 1-800-772-1213 or call
your local Social Security office for more information about buying Part A. If
you get benefits from the Railroad Retirement Board, call your local RRB
office or 1-800-808-0772. For more information, call your Fiscal Intermediary
about Part A bills and services. The phone number for the Fiscal
Intermediary office in your area can be obtained from the following Web
site: http://www.medicare.gov/Contacts/home.asp.
Part B (Medical Insurance)
Helps Pay For: Doctors, services, outpatient hospital care, and some other
medical services that Part A does not cover, such as the services of physical
and occupational therapists, and some home healthcare. Part B helps pay for
covered services and supplies when they are medically necessary.
Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month.
In some cases this amount may be higher if you did not choose Part B when
you first became eligible at age 65. The cost of Part B may go up 10% for each
12-month period that you were eligible for Part B but declined coverage,
except in special cases. You will have to pay the extra 10% cost for the rest of
your life.
Enrolling in Part B is your choice. You can sign up for Part B anytime during
a 7-month period that begins 3 months before you turn 65. Visit your local
Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually
taken out of your monthly Social Security, Railroad Retirement, or Civil
Service Retirement payment. If you do not receive any of the above
payments, Medicare sends you a bill for your part B premium every 3
months. You should receive your Medicare premium bill in the mail by the
10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the
Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For
more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 205
phone number for the Medicare carrier in your area can be found at the
following Web site: http://www.medicare.gov/Contacts/home.asp. You may
have choices in how you get your healthcare including the Original
Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare
Private Fee-for-Service Plans.
Medicaid
Medicaid is a joint federal and state program that helps pay medical costs for
some people with low incomes and limited resources. Medicaid programs
vary from state to state. People on Medicaid may also get coverage for
nursing home care and outpatient prescription drugs which are not covered
by Medicare. You can find more information about Medicaid on the
HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm.
States also have programs that pay some or all of Medicare's premiums and
may also pay Medicare deductibles and coinsurance for certain people who
have Medicare and a low income. To qualify, you must have:
�
Part A (Hospital Insurance),
�
Assets, such as bank accounts, stocks, and bonds that are not more than
$4,000 for a single person, or $6,000 for a couple, and
�
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings
Programs
brochure,
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua
ge=English&Type=Pub&PubID=10126. There are also Prescription Drug
Assistance Programs available. Find information on these programs which
offer discounts or free medications to individuals in need at
http://www.medicare.gov/Prescription/Home.asp.
Financial Aid for Eye Care60
Many state and national resources regularly provide aid to people with
vision problems. The National Eye Institute, which supports eye research,
does not help individuals pay for eye care. However, if you are in need of
financial aid to assess or treat an eye problem, you might contact one or
more of the following programs.
60
Adapted from http://www.nei.nih.gov/health/financialaid.htm.
206 Myopia
You may also contact a social worker at a local hospital or other community
agency. Social workers often are knowledgeable about community resources
that can help people facing financial and medical problems.
�
EyeCare America - National Eye Care Project, coordinated by the
American Academy of Ophthalmology (AAO), provides free and lowcost eye exams for U.S. citizens 65 and older who have not had access to
an ophthalmologist in the past three years. Telephone: 1-800-222-EYES.
Web site: http://www.eyenet.org/public/pi/service/necp.html.
�
VISION USA, coordinated by the American Optometric Association
(AOA), provides free eye care to uninsured, low-income workers and
their families. Screening for the program takes place only during January
of each year, with exams provided later in the year. Telephone: 1-800-7664466.
�
Lions Clubs International provides financial assistance to individuals for
eye care through local clubs. There are Lions Clubs in most localities, and
services vary from club to club. Check your telephone book for the
telephone number and address of your local club. The telephone number
for the national office is (630) 571-5466.
�
Celebrate Sight: Do You Know Your Glaucoma Risk? coordinated by
the American Academy of Ophthalmology, is a program offering free
examinations and treatment for glaucoma to people who do not have
medical
insurance.
Telephone:
1-800-391-EYES.
Web
site:
http://www.eyenet.org/public/glaucoma/gl_2001.html
�
Mission Cataract USA, coordinated by the Volunteer Eye Surgeons'
Association, is a program providing free cataract surgery to people of all
ages who have no other means to pay. Surgeries are scheduled annually
on one day, usually in May. Telephone: 1-800-343-7265.
�
Knights Templar Eye Foundation provides assistance for eye surgery for
people who are unable to pay or receive adequate assistance from current
government agencies or similar sources. Mailing address: 5097 North
Elston Avenue, Suite 100, Chicago, IL 60630-2460. Telephone: (773) 2053838.
E-mail:
[email protected]
Web site: http://www.knightstemplar.org/ktef/.
�
Sight for Students, a Vision Service Plan (VSP) program in partnership
with the Entertainment Industry Foundation, provides eye exams and
glasses to children 18 years and younger whose families cannot afford
vision
care.
Telephone:
1-888-290-4964.
Web
site:
http://www.sightforstudents.org/.
Your Rights and Insurance 207
�
New Eyes for the Needy provides vouchers for the purchase of new
prescription eyeglasses. Mailing address: 549 Millburn Avenue, P.O. Box
332, Short Hills, N.J. 07078-0332. Telephone: (973) 376-4903.
�
The Medicine Program assists people to enroll in one or more of the
many patient assistance programs that provide prescription medicine
free-of-charge to those in need. Patients must meet the sponsor's criteria.
The program is conducted in cooperation with the patient's doctor.
Mailing Address: P.O. Box 4182, Poplar Bluff, MO 63902-4182. Telephone:
(573) 996-7300. E-mail: [email protected] Web site:
http://www.themedicineprogram.com
�
Directory of Prescription Drug Patient Assistance Programs 1999-2000,
published by Pharmaceutical Research and Manufacturers of America,
identifies company programs that provide prescription medications free
of charge to physicians for their needy patients. A copy of the directory is
available online at http://www.phrma.org/patients. Telephone: 1-800PMA-INFO.
NORD?s Medication Assistance Programs
Finally, the National Organization for Rare Disorders, Inc. (NORD)
administers medication programs sponsored by humanitarian-minded
pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.61 NORD
programs ensure that certain vital drugs are available ?to those individuals
whose income is too high to qualify for Medicaid but too low to pay for their
prescribed medications.? The program has standards for fairness, equity,
and unbiased eligibility. It currently covers some 14 programs for nine
pharmaceutical companies. NORD also offers early access programs for
investigational new drugs (IND) under the approved ?Treatment INDs?
programs of the Food and Drug Administration (FDA). In these programs, a
limited number of individuals can receive investigational drugs that have yet
to be approved by the FDA. These programs are generally designed for rare
diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources
In addition to the references already listed in this chapter, you may need
more information on health insurance, hospitals, or the healthcare system in
Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
61
208 Myopia
general. The NIH has set up an excellent guidance Web site that addresses
these and other issues. Topics include:62
�
Health Insurance:
http://www.nlm.nih.gov/medlineplus/healthinsurance.html
�
Health Statistics:
http://www.nlm.nih.gov/medlineplus/healthstatistics.html
�
HMO and Managed Care:
http://www.nlm.nih.gov/medlineplus/managedcare.html
�
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
�
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
�
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
�
Nursing Homes and Long-term Care:
http://www.nlm.nih.gov/medlineplus/nursinghomes.html
�
Patient's Rights, Confidentiality, Informed Consent, Ombudsman
Programs, Privacy and Patient Issues:
http://www.nlm.nih.gov/medlineplus/patientissues.html
�
Veteran's Health, Persian Gulf War, Gulf War Syndrome, Agent Orange:
http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at:
http://www.nlm.nih.gov/medlineplus/healthsystem.html.
62
Online Glossaries 209
ONLINE GLOSSARIES
The Internet provides access to a number of free-to-use medical dictionaries
and glossaries. The National Library of Medicine has compiled the following
list of online dictionaries:
�
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical
reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
�
MedicineNet.com Medical Dictionary (MedicineNet, Inc.):
http://www.medterms.com/Script/Main/hp.asp
�
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.):
http://www.intelihealth.com/IH/
�
Multilingual Glossary of Technical and Popular Medical Terms in Eight
European Languages (European Commission) - Danish, Dutch, English,
French, German, Italian, Portuguese, and Spanish:
http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
�
On-line Medical Dictionary (CancerWEB):
http://www.graylab.ac.uk/omd/
�
Technology Glossary (National Library of Medicine) - Health Care
Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
�
Terms and Definitions (Office of Rare Diseases):
http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia
covering every aspect of medicine (licensed from A.D.A.M., Inc.). The
ADAM
Medical
Encyclopedia
Web
site
address
is
http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also
available
on
commercial
Web
sites
such
as
drkoop.com
(http://www.drkoop.com/)
and
Web
MD
(http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics
of interest can be researched by using keywords before continuing
elsewhere, as these basic definitions and concepts will be useful in more
advanced areas of research. You may choose to print various pages
specifically relating to myopia and keep them on file. The NIH, in particular,
suggests that patients with myopia visit the following Web sites in the
ADAM Medical Encyclopedia:
�
Basic Guidelines for Myopia
210 Myopia
Nearsightedness
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/001023.htm
�
Signs & Symptoms for Myopia
Headaches
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm
�
Diagnostics and Tests for Myopia
Refraction test
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/003844.htm
Slit-lamp exam
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/003880.htm
Standard ophthalmic exam
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/003434.htm
Test of color vision
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/003387.htm
�
Background Topics for Myopia
Retina
Web site:
http://www.nlm.nih.gov/medlineplus/ency/article/002291.htm
Online Dictionary Directories
The following are additional online directories compiled by the National
Library of Medicine, including a number of specialized medical dictionaries
and glossaries:
�
Medical Dictionaries & Glossaries (Jim Martindale):
http://www-sci.lib.uci.edu/HSG/Medical.html#DICTION
Online Glossaries 211
�
Medical Dictionaries: Medical & Biological (World Health Organization):
http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
�
MEL-Michigan Electronic Library List of Online Health and Medical
Dictionaries (Michigan Electronic Library):
http://mel.lib.mi.us/health/health-dictionaries.html
�
Patient Education: Glossaries (DMOZ Open Directory Project):
http://dmoz.org/Health/Education/Patient_Education/Glossaries/
�
StudyWeb: Reference: Medical Dictionaries (American Computer
Resources, Inc.): http://www.studyWeb.com/links/675.html
�
Web of Online Dictionaries (Bucknell University):
http://www.yourdictionary.com/diction5.html#medicine
Glossary 213
MYOPIA GLOSSARY
The following is a complete glossary of terms used in this sourcebook. The
definitions are derived from official public sources including the National
Institutes of Health [NIH] and the European Union [EU]. After this glossary, we
list a number of additional hardbound and electronic glossaries and
dictionaries that you may wish to consult.
Accommodation: The ability of the eye to change its focus from distant to
near objects; process achieved by the lens changing its shape. [NIH]
Acrylamide: A colorless, odorless, highly water soluble vinyl monomer
formed from the hydration of acrylonitrile. It is primarily used in research
laboratories for electrophoresis, chromatography, and electron microscopy
and in the sewage and wastewater treatment industries. [NIH]
Acuity: Clearness, or sharpness of vision. [NIH]
Agonist: In anatomy, a prime mover. In pharmacology, a drug that has
affinity for and stimulates physiologic activity at cell receptors normally
stimulated by naturally occurring substances. [EU]
Albinism: General term for a number of inherited defects of amino acid
metabolism in which there is a deficiency or absence of pigment in the eyes,
skin, or hair. [NIH]
Anesthesia: A state characterized by loss of feeling or sensation. This
depression of nerve function is usually the result of pharmacologic action
and is induced to allow performance of surgery or other painful procedures.
[NIH]
Aniridia: A congenital abnormality in which there is only a rudimentary
iris. This is due to the failure of the optic cup to grow. Aniridia also occurs in
a hereditary form, usually autosomal dominant. [NIH]
Anisometropia: A condition of an inequality of refractive power of the two
eyes. [NIH]
Anxiety: The unpleasant emotional state consisting of psychophysiological
responses to anticipation of unreal or imagined danger, ostensibly resulting
from unrecognized intrapsychic conflict. Physiological concomitants include
increased heart rate, altered respiration rate, sweating, trembling, weakness,
and fatigue; psychological concomitants include feelings of impending
danger, powerlessness, apprehension, and tension. [EU]
Aplasia: Lack of development of an organ or tissue, or of the cellular
products from an organ or tissue. [EU]
Aqueous: Watery; prepared with water. [EU]
214 Myopia
Ascariasis: Infection by nematodes of the genus ASCARIS. Ingestion of
infective eggs causes diarrhea and pneumonitis. Its distribution is more
prevalent in areas of poor sanitation and where human feces are used for
fertilizer. [NIH]
Astigmatism: A condition in which the surface of the cornea is not
spherical; causes a blurred image to be received at the retina. [NIH]
Auditory: Pertaining to the sense of hearing. [EU]
Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium
of the heart. [EU]
Bacteria: Unicellular prokaryotic microorganisms which generally possess
rigid cell walls, multiply by cell division, and exhibit three principal forms:
round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH]
Bilateral: Having two sides, or pertaining to both sides. [EU]
Biochemical: Relating to biochemistry; characterized by, produced by, or
involving chemical reactions in living organisms. [EU]
Blepharitis: Inflammation of the eyelids. [EU]
Blepharoptosis: Drooping of the upper lid due to deficient development or
paralysis of the levator palpebrae muscle. [NIH]
Capsules: Hard or soft soluble containers used for the oral administration of
medicine. [NIH]
Carbachol: A slowly hydrolyzed cholinergic agonist that acts at both
muscarinic and nicotinic receptors. [NIH]
Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
particularly of the pentahydric and hexahydric alcohols. They are so named
because the hydrogen and oxygen are usually in the proportion to form
water, (CH2O)n. The most important carbohydrates are the starches, sugars,
celluloses, and gums. They are classified into mono-, di-, tri-, poly- and
heterosaccharides. [EU]
Cardiovascular: Pertaining to the heart and blood vessels. [EU]
Cataract: An opacity, partial or complete, of one or both eyes, on or in the
lens or capsule, especially an opacity impairing vision or causing blindness.
The many kinds of cataract are classified by their morphology (size, shape,
location) or etiology (cause and time of occurrence). [EU]
Cholesterol: The principal sterol of all higher animals, distributed in body
tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
Cholinergic:
Resembling acetylcholine in pharmacological
stimulated by or releasing acetylcholine or a related compound. [EU]
action;
Choroid: The layer filled with blood vessels that nourishes the retina; part of
the uvea. [NIH]
Glossary 215
Choroideremia: An X chromosome-linked abnormality characterized by
atrophy of the choroid and degeneration of the retinal pigment epithelium
causing night blindness. [NIH]
Chromosomal: Pertaining to chromosomes. [EU]
Chronic: Persisting over a long period of time. [EU]
Collagen: The protein substance of the white fibres (collagenous fibres) of
skin, tendon, bone, cartilage, and all other connective tissue; composed of
molecules of tropocollagen (q.v.), it is converted into gelatin by boiling.
collagenous pertaining to collagen; forming or producing collagen. [EU]
Conjunctivitis: Inflammation of the conjunctiva, generally consisting of
conjunctival hyperaemia associated with a discharge. [EU]
Constriction: The act of constricting. [NIH]
Cornea: The outer, transparent, dome-like structure that covers the iris,
pupil, and anterior chamber; part of eye's focusing system. [NIH]
Criterion: A standard by which something may be judged. [EU]
Cyclopentolate: A parasympatholytic anticholinergic used solely to obtain
mydriasis or cycloplegia. [NIH]
Degenerative: Undergoing degeneration : tending to degenerate; having the
character of or involving degeneration; causing or tending to cause
degeneration. [EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are
needed. [EU]
Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
Diopter: The measurement of refractive error. A negative diopter value
signifies an eye with myopia and positive diopter value signifies an eye with
hyperopia. [NIH]
Dysplasia: Abnormality of development; in pathology, alteration in size,
shape, and organization of adult cells. [EU]
Dystrophy: Any disorder arising from defective or faulty nutrition,
especially the muscular dystrophies. [EU]
Edema: Excessive amount of watery fluid accumulated in the intercellular
spaces, most commonly present in subcutaneous tissue. [NIH]
Elasticity: Resistance and recovery from distortion of shape. [NIH]
Endothelium: The inner layer of cells on the inside surface of the cornea.
[NIH]
Epidemic: Occurring suddenly in numbers clearly in excess of normal
expectancy; said especially of infectious diseases but applied also to any
disease, injury, or other health-related event occurring in such outbreaks. [EU]
216 Myopia
Epiphyseal: Pertaining to or of the nature of an epiphysis. [EU]
Epithelium: The outermost layer of cells of the cornea and the eye's first
defense against infection. [NIH]
Ethosuximide: An anticonvulsant especially useful in the treatment of
absence seizures unaccompanied by other types of seizures. [NIH]
Extracellular: Outside a cell or cells. [EU]
Extraction: The process or act of pulling or drawing out. [EU]
Farsightedness: The common term for hyperopia. [NIH]
Femoral: Pertaining to the femur, or to the thigh. [EU]
Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU]
Fundus: The interior lining of the eyeball, including the retina, optic disc,
and macula; portion of the inner eye that can be seen during an eye
examination by looking through the pupil. [NIH]
Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve
cell bodies located outside the central nervous system; occasionally applied
to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia.
3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the
wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a
clear mucinous fluid. [EU]
Gastroenteritis: An acute inflammation of the lining of the stomach and
intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain,
and weakness, which has various causes, including food poisoning due to
infection with such organisms as Escherichia coli, Staphylococcus aureus,
and Salmonella species; consumption of irritating food or drink; or
psychological factors such as anger, stress, and fear. Called also
enterogastritis. [EU]
Genotype: The genetic constitution of the individual; the characterization of
the genes. [NIH]
Habitual: Of the nature of a habit; according to habit; established by or
repeated by force of habit, customary. [EU]
Halos: Rings around lights due to optical imperfections in or in front of the
eye. [NIH]
Hepatitis: Inflammation of the liver. [EU]
Heredity: 1. the genetic transmission of a particular quality or trait from
parent to offspring. 2. the genetic constitution of an individual. [EU]
Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an
abnormal opening. [EU]
Herpes:
Any inflammatory skin disease caused by a herpesvirus and
Glossary 217
characterized by the formation of clusters of small vesicles. When used
alone, the term may refer to herpes simplex or to herpes zoster. [EU]
Hormones: Chemical substances having a specific regulatory effect on the
activity of a certain organ or organs. The term was originally applied to
substances secreted by various endocrine glands and transported in the
bloodstream to the target organs. It is sometimes extended to include those
substances that are not produced by the endocrine glands but that have
similar effects. [NIH]
Hyperbaric: Characterized by greater than normal pressure or weight;
applied to gases under greater than atmospheric pressure, as hyperbaric
oxygen, or to a solution of greater specific gravity than another taken as a
standard of reference. [EU]
Hyperopia: Farsightedness; ability to see distant objects more clearly than
close objects; may be corrected with glasses or contact lenses. [NIH]
Hypertelorism: Abnormal increase in the interorbital distance due to
overdevelopment of the lesser wings of the sphenoid. [NIH]
Hypertension: Persistently high arterial blood pressure. Various criteria for
its threshold have been suggested, ranging from 140 mm. Hg systolic and 90
mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg
diastolic. Hypertension may have no known cause (essential or idiopathic h.)
or be associated with other primary diseases (secondary h.). [EU]
Hypogonadism: A condition resulting from or characterized by abnormally
decreased functional activity of the gonads, with retardation of growth and
sexual development. [EU]
Hypoplasia: Incomplete development or underdevelopment of an organ or
tissue. [EU]
Immunization: The induction of immunity. [EU]
Implantation: The insertion or grafting into the body of biological, living,
inert, or radioactive material. [EU]
Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU]
Induction: The act or process of inducing or causing to occur, especially the
production of a specific morphogenetic effect in the developing embryo
through the influence of evocators or organizers, or the production of
anaesthesia or unconsciousness by use of appropriate agents. [EU]
Inflammation: The body's reaction to trauma, infection, or a foreign
substance, often associated with pain, heat, redness, swelling, and/or loss of
function. [NIH]
Intraocular: Within the eye. [EU]
Iodine: A nonmetallic element of the halogen group that is represented by
218 Myopia
the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a
nutritionally essential element, especially important in thyroid hormone
synthesis. In solution, it has anti-infective properties and is used topically.
[NIH]
Iris: The colored ring of tissue suspended behind the cornea and
immediately in front of the lens; regulates the amount of light entering the
eye by adjusting the size of the pupil. [NIH]
Iritis: Inflammation of the iris, usually marked by pain, congestion in the
ciliary region, photophobia, contraction of the pupil, and discoloration of the
iris. [EU]
Keratectomy: The surgical removal of corneal tissue. [NIH]
Keratoconus: A disorder characterized by an irregular corneal surface
(cone-shaped) resulting in blurred and distorted images. [NIH]
Keratomileusis: Carving of the cornea to reshape it. [NIH]
Keratotomy: A surgical incision (cut) of the cornea. [NIH]
LASIK: The acronym for laser assisted in situ keratomileusis which refers to
creating a flap in the cornea with a microkeratome and using a laser to
reshape the underlying cornea. [NIH]
Lens: The transparent, double convex (outward curve on both sides)
structure suspended between the aqueous and vitreous; helps to focus light
on the retina. [NIH]
Lesion: Any pathological or traumatic discontinuity of tissue or loss of
function of a part. [EU]
Lupus: A form of cutaneous tuberculosis. It is seen predominantly in
women and typically involves the nasal, buccal, and conjunctival mucosa.
[NIH]
Malformation: A morphologic defect resulting from an intrinsically
abnormal developmental process. [EU]
Manifest: Being the part or aspect of a phenomenon that is directly
observable : concretely expressed in behaviour. [EU]
Membrane: A thin layer of tissue which covers a surface, lines a cavity or
divides a space or organ. [EU]
Microkeratome: A surgical device that is affixed to the eye by use of a
vacuum ring. When secured, a very sharp blade cuts a layer of the cornea at
a predetermined depth. [NIH]
Microphthalmos: Congenital or developmental anomaly in which the
eyeballs are abnormally small. [NIH]
Molecular: Of, pertaining to, or composed of molecules : a very small mass
of matter. [EU]
Glossary 219
Monovision: The purposeful adjustment of one eye for near vision and the
other eye fordistance vision. [NIH]
Myopia: Nearsightedness; ability to see close objects more clearly than
distant objects; may be corrected with glasses or contact lenses. [NIH]
Nearsightedness: The common term for myopia. [NIH]
Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a
greater degree of anaplasia and have the properties of invasion and
metastasis, compared to benign neoplasms. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of
the spinal axis, as the neutral arch. [EU]
Niacin: Water-soluble vitamin of the B complex occurring in various animal
and plant tissues. Required by the body for the formation of coenzymes
NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic
properties. [NIH]
Nystagmus: An involuntary, rapid, rhythmic movement of the eyeball,
which may be horizontal, vertical, rotatory, or mixed, i.e., of two varieties.
[EU]
Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU]
Ophthalmic: Pertaining to the eye. [EU]
Ophthalmologist: A medical doctor specializing in the diagnosis and
medical or surgical treatment of visual disorders and eye disease. [NIH]
Ophthalmology: A surgical specialty concerned with the structure and
function of the eye and the medical and surgical treatment of its defects and
diseases. [NIH]
Opiate: A remedy containing or derived from opium; also any drug that
induces sleep. [EU]
Optic: Of or pertaining to the eye. [EU]
Optician: An expert in the art and science of making and fitting glasses and
may also dispense contact lenses. [NIH]
Optometrist: A primary eye care provider who diagnoses, manages, and
treats disorders of the visual system and eye diseases. [NIH]
Optometry: The professional practice of primary eye and vision care that
includes the measurement of visual refractive power and the correction of
visual defects with lenses or glasses. [NIH]
Oral: Pertaining to the mouth, taken through or applied in the mouth, as an
oral medication or an oral thermometer. [EU]
Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU]
Pediatrics:
A medical specialty concerned with maintaining health and
220 Myopia
providing medical care to children from birth to adolescence. [NIH]
Perforation: 1. the act of boring or piercing through a part. 2. a hole made
through a part or substance. [EU]
Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic
effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH]
Pneumonia: Inflammation of the lungs with consolidation. [EU]
Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes
insipidus. [EU]
Posterior: Situated in back of, or in the back part of, or affecting the back or
dorsal surface of the body. In lower animals, it refers to the caudal end of the
body. [EU]
Postnatal: Occurring after birth, with reference to the newborn. [EU]
Postoperative: Occurring after a surgical operation. [EU]
Potassium: An element that is in the alkali group of metals. It has an atomic
symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation
in the intracellular fluid of muscle and other cells. Potassium ion is a strong
electrolyte and it plays a significant role in the regulation of fluid volume
and maintenance of the water-electrolyte balance. [NIH]
Precursor: Something that precedes. In biological processes, a substance
from which another, usually more active or mature substance is formed. In
clinical medicine, a sign or symptom that heralds another. [EU]
Preoperative: Preceding an operation. [EU]
Presbyopia:
The gradual loss of the eye's ability to change focus
(accommodation) for seeing near objects caused by the lens becoming less
elastic; associated with aging; occurs in almost all people over age 45. [NIH]
Prevalence: The total number of cases of a given disease in a specified
population at a designated time. It is differentiated from incidence, which
refers to the number of new cases in the population at a given time. [NIH]
PRK: The acronym for photorefractive keratectomy which is a procedure
involving the removal of the surface layer of the cornea (epithelium) by
gentle scraping and use of a computer-controlled excimer laser to reshape
the stroma. [NIH]
Progressive:
Advancing; going forward; going from bad to worse;
increasing in scope or severity. [EU]
Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase
pathway. They are extremely potent mediators of a diverse group of
physiological processes. [NIH]
Proteins: Polymers of amino acids linked by peptide bonds. The specific
Glossary 221
sequence of amino acids determines the shape and function of the protein.
[NIH]
Proteoglycans:
content. [NIH]
Glycoproteins which have a very high polysaccharide
Psychology: The science dealing with the study of mental processes and
behavior in man and animals. [NIH]
Ptosis: 1. prolapse of an organ or part. 2. drooping of the upper eyelid from
paralysis of the third nerve or from sympathetic innervation. [EU]
Puberty: The period during which the secondary sex characteristics begin to
develop and the capability of sexual reproduction is attained. [EU]
Pupil: The adjustable opening at the center of the iris that allows varying
amounts of light to enter the eye. [NIH]
Radiography: The making of film records (radiographs) of internal
structures of the body by passage of x-rays or gamma rays through the body
to act on specially sensitized film. [EU]
Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any
particular involuntary activity. [EU]
Refraction: A test to determine the best eyeglasses or contact lenses to
correct a refractive error (myopia, hyperopia, or astigmatism). [NIH]
Retina: The light-sensitive layer of tissue that lines the back of the eyeball;
sends visual messages through the optic nerve to the brain. [NIH]
Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (=
degenerative, noninflammatory condition of the retina). [EU]
Rheumatoid: Resembling rheumatism. [EU]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver,
kidney, heart, and leafy vegetables. The richest natural source is yeast. It
occurs in the free form only in the retina of the eye, in whey, and in urine; its
principal forms in tissues and cells are as FMN and FAD. [NIH]
Sanitation:
The development and establishment of environmental
conditions favorable to the health of the public. [NIH]
Sclera: The tough, white, outer layer (coat) of the eyeball; with the cornea, it
protects the entire eyeball. [NIH]
Selenium: An element with the atomic symbol Se, atomic number 34, and
atomic weight 78.96. It is an essential micronutrient for mammals and other
animals but is toxic in large amounts. Selenium protects intracellular
structures against oxidative damage. It is an essential component of
glutathione peroxidase. [NIH]
Stabilization: The creation of a stable state. [EU]
Steroid:
A group name for lipids that contain a hydrogenated
222 Myopia
cyclopentanoperhydrophenanthrene ring system. Some of the substances
included in this group are progesterone, adrenocortical hormones, the
gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol),
toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
Strabismus: Deviation of the eye which the patient cannot overcome. The
visual axes assume a position relative to each other different from that
required by the physiological conditions. The various forms of strabismus
are spoken of as tropias, their direction being indicated by the appropriate
prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia.
Called also cast, heterotropia, manifest deviation, and squint. [EU]
Stroma: The middle, thickest layer of tissue in the cornea. [NIH]
Substrate: A substance upon which an enzyme acts. [EU]
Suction: The removal of secretions, gas or fluid from hollow or tubular
organs or cavities by means of a tube and a device that acts on negative
pressure. [NIH]
Sulfur: An element that is a member of the chalcogen family. It has an
atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in
the amino acids cysteine and methionine. [NIH]
Systemic: Pertaining to or affecting the body as a whole. [EU]
Thermoregulation: Heat regulation. [EU]
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating
effect on thyroid metabolism. [NIH]
Trachoma: A chronic infectious disease of the conjunctiva and cornea,
producing photophobia, pain, and lacrimation, caused by an organism once
thought to be a virus but now classified as a strain of the bacteria Chlamydia
trachomatis. [EU]
Transplantation: The grafting of tissues taken from the patient's own body
or from another. [EU]
Tuberculosis: Any of the infectious diseases of man and other animals
caused by species of mycobacterium. [NIH]
Tupaia: A genus of tree shrews of the family TUPAIIDAE which consists of
about 12 species. One of the most frequently encountered species is T. glis.
Members of this genus inhabit rain forests and secondary growth areas in
southeast Asia. [NIH]
Ultrasonography: The visualization of deep structures of the body by
recording the reflections of echoes of pulses of ultrasonic waves directed into
the tissues. Use of ultrasound for imaging or diagnostic purposes employs
frequencies ranging from 1.6 to 10 megahertz. [NIH]
Uveitis: An inflammation of part or all of the uvea, the middle (vascular)
Glossary 223
tunic of the eye, and commonly involving the other tunics (the sclera and
cornea, and the retina). [EU]
Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]
Vitiligo: A disorder consisting of areas of macular depigmentation,
commonly on extensor aspects of extremities, on the face or neck, and in skin
folds. Age of onset is often in young adulthood and the condition tends to
progress gradually with lesions enlarging and extending until a quiescent
state is reached. [NIH]
Vitreous: Glasslike or hyaline; often used alone to designate the vitreous
body of the eye (corpus vitreum). [EU]
General Dictionaries and Glossaries
While the above glossary is essentially complete, the dictionaries listed here
cover virtually all aspects of medicine, from basic words and phrases to
more advanced terms (sorted alphabetically by title; hyperlinks provide
rankings, information and reviews at Amazon.com):
�
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski
(Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins
Publishers, ISBN: 1560534605,
http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
�
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of
Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg,
M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational
Series, ISBN: 0764112015,
http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
�
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition
(2001), CRC Press-Parthenon Publishers, ISBN: 185070368X,
http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
�
Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland,
et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN:
0721662544,
http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
�
Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th
Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN:
0721694934,
http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
�
Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical
Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B
224 Myopia
Saunders Co, ISBN: 0721682812,
http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna
�
Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical
Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X,
http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
�
Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for
Windows and Macintosh, Individual) by Stedmans, CD-ROM edition
(2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328,
http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
�
Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN:
068340007X,
http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
�
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes
(Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co,
ISBN: 0803606540,
http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 225
INDEX
A
Accommodation....40, 67, 72, 78, 88, 107,
108, 160, 161, 220
Acrylamide...................................100, 106
Acuity.........................56, 69, 78, 160, 161
Agonist.........101, 152, 180, 184, 214, 220
Albinism ...............................................116
Anesthesia...........................................116
Aniridia.................................................116
Anisometropia........................................69
Aqueous ..................................11, 39, 218
Astigmatism .....13, 14, 15, 17, 19, 30, 31,
32, 35, 40, 56, 69, 72, 85, 88, 96, 112,
115, 117, 164, 221
Auditory ...............................................116
Auricular ..............................................179
B
Bacteria ...........................12, 93, 174, 222
Biochemical .............................67, 77, 165
Blepharitis ..............................................18
Blindness ....10, 12, 22, 28, 37, 42, 67, 73,
75, 77, 79, 116, 118, 214, 215
Blinking ..................................................66
C
Capsules..............................................177
Carbachol ............................................181
Carbohydrate.......................................176
Cataract ...........................37, 84, 206, 214
Cholesterol ....................40, 174, 176, 222
Cholinergic...................................184, 214
Choroid ......................67, 74, 80, 118, 215
Choroideremia .....................................116
Chromosomal ........................................75
Chronic ....................27, 93, 132, 196, 222
Collagen ...... 12, 38, 74, 77, 85, 100, 106,
215
Constriction............................................72
Criterion .................................................78
Cyclopentolate.....................................180
D
Degenerative .....................4, 49, 175, 221
Deprivation ..... 67, 77, 79, 82, 84, 85, 86,
87, 88, 89, 159, 160, 162, 163, 164,
165, 166, 180, 181
Diarrhea.................................90, 174, 214
Diopter ...........................................38, 215
Dystrophy ............................................116
E
Edema .............................................12, 56
Elasticity ................................................12
Endothelium...........................................12
Epithelium .... 11, 12, 16, 40, 80, 118, 160,
164, 215, 220
Extracellular ........................ 68, 74, 77, 85
Extraction ...................................... 73, 161
F
Farsightedness ..... 13, 14, 15, 35, 36, 117
Fundus ................................................ 112
G
Ganglion................................................ 81
Genotype .............................................. 73
Glare ........................... 18, 26, 27, 28, 102
H
Habitual................................................. 66
Halos............................................... 18, 28
Heredity......................................... 75, 116
Herpes .......................................... 38, 217
Hormones ............................... 17, 40, 222
Hydrogen .................... 100, 106, 185, 214
Hyperbaric............................... 84, 91, 217
Hypertension......................................... 18
Hypogonadism .................................... 116
I
Implantation ........................ 102, 103, 107
Incision.......................... 39, 102, 103, 218
Induction ............................... 92, 160, 217
Infantile ............................................... 116
Inflammation .... 18, 21, 22, 26, 40, 49, 91,
216, 221, 222
Intestinal........................................ 89, 174
Intraocular ....... 33, 76, 102, 107, 108, 160
Iris ...... 19, 38, 39, 40, 107, 118, 213, 215,
218, 221
Iritis ....................................................... 18
K
Keratectomy............ 40, 85, 112, 181, 220
Keratomileusis ........................ 39, 88, 218
Keratotomy.................................... 56, 115
L
LASIK........................................ 15, 32, 34
Lens .... 13, 15, 17, 20, 26, 37, 39, 40, 68,
73, 86, 90, 96, 98, 101, 102, 103, 104,
105, 107, 108, 159, 162, 213, 214, 218
Lupus .................................................... 18
M
Manifest .................................. 19, 62, 222
Membrane............................................. 12
Microkeratome .... 15, 21, 25, 39, 107, 218
Molecular ...................... 75, 126, 129, 130
Monovision...................................... 20, 21
N
Nasal............................................. 39, 218
226 Myopia
Nearsightedness.....13, 14, 15, 35, 36, 55,
67, 74, 75, 98, 103, 104, 105, 117
Neoplasms.....................................92, 219
Neural ............................................74, 175
Nystagmus...........................................116
O
Ocular ...18, 54, 55, 56, 67, 68, 72, 76, 78,
88, 89, 101, 116, 117, 163, 180
Ophthalmic ..............75, 96, 101, 113, 210
Ophthalmologist.............................75, 206
Ophthalmology ......................45, 112, 122
Optic ...... 13, 40, 102, 118, 119, 213, 216,
221
Optometry..............................................45
Oral ................................92, 184, 214, 219
Overdose .............................................175
P
Perforation ...........................................107
Polydipsia ............................................166
Posterior ..80, 99, 101, 106, 107, 112, 113
Postnatal........................................67, 101
Postoperative...................................26, 29
Potassium............................................176
Precursor ...............................................72
Preoperative ..........................................29
Presbyopia.................................20, 21, 28
Prevalence.....................................76, 113
Progressive...4, 55, 67, 69, 70, 71, 96, 99,
106, 113, 116
Prostaglandins.....................................181
Proteins .................................11, 174, 176
Proteoglycans..................................74, 77
Ptosis .....................................................87
Puberty ..................................................77
Pupil.........38, 39, 102, 119, 215, 216, 218
R
Refraction.. 15, 19, 28, 29, 55, 78, 79, 180
Retina... 13, 14, 15, 37, 39, 40, 49, 68, 74,
79, 86, 90, 97, 101, 102, 103, 117, 119,
160, 181, 185, 214, 216, 218, 221, 223
Retinopathy......................................... 116
Rheumatoid........................................... 18
Riboflavin ............................................ 174
S
Sanitation ...................................... 90, 214
Sclera... 13, 40, 68, 74, 77, 80, 85, 87, 88,
99, 106, 122, 165, 223
Selenium ............................................. 176
Stabilization..................................... 27, 72
Strabismus .............................. 62, 84, 222
Stroma ........................ 12, 15, 16, 40, 220
Suction .................................................. 25
Sulfur..................................................... 80
Surgical .... 15, 16, 20, 24, 35, 36, 39, 40,
56, 98, 99, 103, 104, 105, 106, 107,
115, 122, 218, 219, 220
Systemic ............................................... 69
T
Tears............................. 11, 12, 13, 20, 26
Thermoregulation................................ 174
Thyroxine ............................................ 175
Transplantation ..................................... 12
Tuberculosis.................................. 39, 218
U
Ultrasonography ................. 55, 69, 70, 71
Uveitis ................................................... 18
V
Vasoactive ............................................ 89
Vitiligo ................................................. 116
Vitreous............... 39, 77, 85, 93, 218, 223
Index 227
228 Myopia
Index 229
230 Myopia
as gynecologists, certified nurse
midwives, and other qualified healthcare providers -- for the provision of
covered care necessary to provide routine and preventative women's
healthcare services.
�
Access to specialists. Consumers with complex or serious medical
conditions who require frequent specialty care should have direct access
to a qualified specialist of their choice within a plan's network of
providers. Authorizations, when required, should be for an adequate
number of direct access visits under an approved treatment plan.
�
Transitional care. Consumers who are undergoing a course of treatment
for a chronic or disabling condition (or who are in the second or third
trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 197
plans or at a time when a provider is terminated by a plan for other than
cause should be able to continue seeing their current specialty providers
for up to 90 days (or through completion of postpartum care) to allow for
transition of care.
�
Choice of health plans. Public and private group purchasers should,
wherever feasible, offer consumers a choice of high-quality health
insurance plans.
Access to Emergency Services
Consumers have the right to access emergency healthcare services when and
where the need arises. Health plans should provide payment when a
consumer presents to an emergency department with acute symptoms of
sufficient severity--including severe pain--such that a ?prudent layperson?
could reasonably expect the absence of medical attention to result in placing
that consumer's health in serious jeopardy, serious impairment to bodily
functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions
Consumers have the right and responsibility to fully participate in all
decisions related to their healthcare. Consumers who are unable to fully
participate in treatment decisions have the right to be represented by
parents, guardians, family members, or other conservators. Physicians and
other health professionals should:
�
Provide patients with sufficient information and opportunity to decide
among treatment options consistent with the informed consent process.
�
Discuss all treatment options with a patient in a culturally competent
manner, including the option of no treatment at all.
�
Ensure that persons with disabilities have effective communications with
members of the health system in making such decisions.
�
Discuss all current treatments a consumer may be undergoing.
�
Discuss all risks,
nontreatment.
�
Give patients the opportunity to refuse treatment and to express
preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
198 Myopia
�
Discuss the use of advance directives -- both living wills and durable
powers of attorney for healthcare -- with patients and their designated
family members.
�
Abide by the decisions made by their patients and/or their designated
representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should:
�
Disclose to consumers factors -- such as methods of compensation,
ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
�
Assure that provider contracts do not contain any so-called ?gag clauses?
or other contractual mechanisms that restrict healthcare providers' ability
to communicate with and advise patients about medically necessary
treatment options.
�
Be prohibited from penalizing or seeking retribution against healthcare
professionals or other health workers for advocating on behalf of their
patients.
Respect and Nondiscrimination
Consumers have the right to considerate, respectful care from all members of
the healthcare industry at all times and under all circumstances. An
environment of mutual respect is essential to maintain a quality healthcare
system. To assure that right, the Commission recommends the following:
�
Consumers must not be discriminated against in the delivery of
healthcare services consistent with the benefits covered in their policy, or
as required by law, based on race, ethnicity, national origin, religion, sex,
age, mental or physical disability, sexual orientation, genetic information,
or source of payment.
�
Consumers eligible for coverage under the terms and conditions of a
health plan or program, or as required by law, must not be discriminated
against in marketing and enrollment practices based on race, ethnicity,
national origin, religion, sex, age, mental or physical disability, sexual
orientation, genetic information, or source of payment.
Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in
confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 199
healthcare information protected. Consumers also have the right to review
and copy their own medical records and request amendments to their
records.
Complaints and Appeals
Consumers have the right to a fair and efficient process for resolving
differences with their health plans, healthcare providers, and the institutions
that serve them, including a rigorous system of internal review and an
independent system of external review. A free copy of the Patient's Bill of
Rights is available from the American Hospital Association.55
Patient Responsibilities
Treatment is a two-way street between you and your healthcare providers.
To underscore the impor
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