Final Project:

Part 1:
Grand Rounds
How much of a difference are the supplements really making? The data seems to go along with
what she says but only after it's shown in such a way (not vs the placebo, vs nothing at all instead) that
it shows much meaningful improvement. Even when the data is supposedly in favor of the
supplements it is a minor improvement (4-10%).
Data contradicts. First it is said that beta-carotene has a positive affect when part of the diet, but
it makes it worse when part of the supplement for smokers. The omega-3 was the same but instead had
no affect at all, good or bad, in any tested concentration.
Surgery
The procedure is quite simple, the use of lasers to reshape the cornea so the light will go into the
pupil without the previous blurring. Allows the light to be focused onto the back of the eye better.
Cost of about $2000 per eye is pretty low considering it fixes the need for glasses or contacts
permanently (unless the patient is young in which case it will change slightly until their 20s).
The patient seems dazed afterward perhaps because he decided to have a sedative as well as the
slight local anesthetic always used. And there in lies the main problem, discomfort or fear of
discomfort in this procedure. While the companies and many post-op patients actually swear by it's
relative comfort even with so many things touching the eye.

Part 2:
Observations
Grand Rounds:
http://videocast.nih.gov/summary.asp?Live=13551&bhcp=1
Emily Chew, MD, NIH
(300) over 50% of eye problems are Macular Degeneration
(420) nutritional tests, zinc has already been proven to be useful
(515) antioxidants and zinc had a 27% reduction in onset of MD.
(620) found that those with high omega 3 and lutein/zeaxanthin had less problems.
Observational study, not to be recommended to patients.
(730) add above to zinc and antioxidant dose.
(1300) no change with any combination with different mixes of medicine vs placebo.
(1420) L/Z at low concentrations is more effective, 26% reduction in onset of MD. Higher
concentrations have less effect
(1630) graph of how taking out beta-carotene helps, but it's little, bias?
(1740) AREDS (zinc/antiox pills) without beta-carotene actually seems to reduce vision loss
after it has already started.
(1850) BC increases risk of lung cancer in smokers, LZ doesn't
(2030) LZ may be appropriate carotenoid substitution for BC in AREDS formulation.
Surgery:
https://www.youtube.com/watch?v=qoH0VHrOM9A
extremely short procedure
(40) cone is used to cut off part of the top of the cornea
(100) computer does all the thinking of when it's ready or not, good or not?

(200) ink rings to show where the flap meets the rest of the eye
(245) lasers then reshape the underlying cornea
(310) use fast shooting water to clean the cornea before putting the flap back
(350) surgery is done, patient can already open his eyes and see
(520) surgeon continues to ask questions, mostly it seems to quell fears had by those thinking of
having the procedure. Is an advertisement most likely.

III.1 Disease State Fundamentals:

A. Normal physiology:
Light enters through the cornea, a sort of protective dome at the front of the eye, then it goes in
through the whole of the pupil. The pupil will dilate or constrict based on how much light is
entering the eye in order to keep the light levels in the eye somewhat static. After the cornea
and some bending there the light then goes through the lens which is immediately behind the
iris and pupil, here is where the image is reversed and inverted. The vitreous humor makes up
most of the eye's volume but is really just there to give the light some room to focus on the
retina where the real work is done. At the retina the light will trigger cones and rods at the back
of the eye which detect light in different ways so we can see a variety of colors and shades.
These light receptors send back the information through the optic nerve and finally to the brain
where the signals are processed and seen by the brain.
B. Pathophysiology:
Disease Function: variations of the same sort of problem which results in blurred vision are
near and farsightedness which is caused by the shortening or lengthening of the eyeball that
occurs over time. This causes the light to not be focused on the back of the eye as well, thus
non-focused vision.
Causal Factors: often these things are going to happen anyway but there have been studies
possible linking eyestrain from detailed work and diabetes to onset of the disease earlier or at
all. Over time as a child ages the eye will change shape making them near or farsighted or have
an astigmatism, this can't be stopped only corrected. The main ways of knowing if a patient
will develop this is if their parents had it.
Disease Progression: it can affect children from ages of 8 till their not children anymore.
After their early 20s if they still don't have problems then they will probably avoid it till they
get old. The disease progresses as the body grows so the earlier they start growing the earlier
the onset of the disease.
C. Understand Clinical Presentation:(Profile the patient state associated with a disease)
Depending on the correction method used the patient can be older or younger, for example kids
can get glasses or contacts at any time but have to be over 18 to have a LASIK procedure.
D. Assess Clinical Outcomes (Elaborate on the morbidity and mortality rates associated with the
disease)
Morbidity: the inability to see well can be a huge detriment to a person's life as so much of
what we do these days has to do with seeing well (driving, using the comp, etc.).
Mortality: no statistics for deaths due to eye disease, too small to warrant studies.

E. Gather Epidemiology Data: (Outline the incidence and prevalence of the disease, as well as
dynamics in the area)
Incidence: 50% of people have visual impairment by age 20.
Prevalence: over 142 million in America have some form of visual impairment
Geographical Target: no tendencies in eye disease with location
F. Economic Impact:
Annual impact of vision problems in the USA is about $51.4 billion
II.2 Treatment Options:
A. Develop an Overview of Treatment Options:
1. Glasses: use a second artificial lens in front of the eye in order to counteract the faulty focusing
of the real lens. Put on frame outside the body in order to be easily removed and added
2. Contacts: same as glasses but uses a lens that can be put directly on the eye and held there for
the whole day. Progress is being made to make it be able to last longer on the eye without
problems as well.
3. Surgery: cut the cornea so it acts as a second lens instead of using an artificial one. Permanent
as the cornea doesn't heal and a one time thing.
B. Evaluate Clinical Treatment Profiles
All available treatments will be decided on by the patient as they have the same affect, only
depends on cost and availability of the different treatment options in order for the patient to
make a choice. The glasses are generally considered the easiest form of correction followed by
contacts, the only problem with these is that the patient will have times that if they don't have
the corrective lens on they wont be able to see.
C. Analyze Economic Treatment Profiles:
1. glasses: averages at $200 for a frame and around $30 for the lens but can be much more if the
buyer is willing to pay more for higher quality stuff. The glasses will also have to be replaced
after they break or when the patient's prescription changes.
2. Contacts: depending on how bad the visual problem is the contacts can have an annual cost
from 200-700 dollars. This is because the contacts have to be replaced every few weeks, this
means that contacts will cost more than glasses over the long term.
3. Surgery: LASIK eye surgery costs about 2000 dollars per eye but it is also a one time payment.
So if the patient ops for contacts it can still be more expensive over 5 years or even less
depending on the quality of contact lens. However it is more expensive than glasses assuming
they don't break them a lot.
D. Utilization Treatment Profiles:
1. glasses: usually not used because of the social objections we have toward glasses they are
generally the cheapest option and used by many older patients after social norms mean nothing.
2. Contacts: most widely used form of visual fixing due to it being seemingly cheaper than surgery
and socially acceptable.
3. Surgery: main reason it isn't used is because of the hate we have for surgery as a country and it
is generally deemed wrong to get surgery for aesthetic reasons in many circles.

Part 3:
Glasses:

LASIK surgery:

5. single vision

11. custom

6. OTC reading glasses

12. bladeless

7. bifocal

13. wavefront tech

8. trifocal

Supplements:

9. progressive

14. zinc

10. adjustable focus

15. antioxidants

Contacts:

16. omega-3

1. soft contact lens

17. lutein/zeaxanthin

2. rigid gas
permeable

18. beta carotene

3. extended wear

Need to fix eye problems

4. disposable

Eye drops:
28. prostaglandins

Lifestyle:

29. beta-blockers

19. reduce time using

computer

30. alpha-adrenergic agonists

31. parasympathomimetics

20. don't use electronics in

dark rooms

32. combination

21. less time straining eyes

PRK:
26. PRK
27. LASEK

Punctal plugs:
22. umbrella
23. tapered
24. reservoir
25. hollow

Part 4:

size of holes accentuated so they can be seen. The holes allow the contact to breath so it can be worn
longer without ill affects, up to a week.
References
http://www.webmd.com/eye-health/lasik-laser-eye-surgery?page=2#2
http://www.lasikcomplications.com/TopTenReasons.htm
http://www.visioneyeinstitute.com.au/article/laser-eye-surgery-permanent/
https://www.youtube.com/watch?v=qoH0VHrOM9A
http://videocast.nih.gov/summary.asp?Live=13551&bhcp=1
http://www.tedmontgomery.com/the_eye/
http://www.hopkinsmedicine.org/wilmer/conditions/nearsight.html
http://www.healthline.com/health/nearsightedness#AnatomyoftheEye2
https://nei.nih.gov/eyedata/adultvision_usa
http://documents.preventblindness.org/publichealth/Impact_of_Vision_Problems.pdf
http://www.cdc.gov/visionhealth/projects/economic_studies.htm
http://member.aarp.org/health/healthy-living/info-11-2013/shopping-for-eyeglasses.html
http://www.allaboutvision.com/contacts/faq/contact-cost.htm
https://en.wikipedia.org/wiki/Glasses