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Summer has arrived with a molten thud here on America’s North Coast. It’s time to retire to my porch and recline under an umbrella, sleeping dogs at my feet, to sits and thinks …
Speaking of dogs, what’s up with the sci-fi trend of heartbreaking stories of dogs and their owners in post-apocalyptic worlds? I could barely see Jeff and Goodyear (the dog) driving toward destiny in the Tom Hanks epic Finch. Musta gotten something in my eye.
Speaking of Finch, whoever wrote the screenplay has got to be a huge classic sci-fi geek: The Three Laws of Robotics are brought up in the first 15 minutes of the movie and referenced throughout. Quiz: What famous sci-fi pioneer created the Three Laws of Robotics for which novel? Bonus: What are the laws? Answer toward the end of the column.
It is exceedingly rare for anything new in the dry eye world to be launched and for me to have little or no foreknowledge about it. Such is the case with the new dry eye medication from Alcon, (acoltremon ophthalmic solution 0.003%). Other than press releases and information shared casually at meetings, I am a blank slate. This presents a rare opportunity for me to see how most eye doctors acquire the knowledge necessary to decide whether and how to use a new “thing” by NOT seeking out any special-access learning opportunities and ONLY utilizing what Alcon brings to everyone else. I’ll report in my September anti-inflammatory review column.
By any measure you care to select, Bausch + Lomb responded to the toxic anterior segment syndrome (TASS) outbreak associated with the IOL Envista line in exemplary fashion. TASS is randomly encountered at a consistently low level. B+L responded almost instantly to a very small signal that something was amiss. It made the hard but correct decision to pull the entire enVista line, not just the model affected. Within weeks, the cause of the outbreak was identified, isolated in two lots and mitigated; less than 2 months later, production resumed and enVista IOLs are back. Bravo/brava to all involved.
Shameless suck-up No. 1: Healio | OSN Associate Medical Editor John Hovanesian continues to produce relevant, actionable research in multiple areas of interest to the anterior segment eye doctor. His most recent contribution was presented at the American Society of Cataract and Refractive Surgery meeting and looked at the rapid response seen in moderate to severe dry eye treated with Cequa (cyclosporine ophthalmic solution 0.09%, Sun Pharmaceutical). Statistically significant improvement was seen in higher-order aberrations, tear breakup time and corneal staining at days 7 and 28, upending the contention that cyclosporine A is a slow-acting intervention. Bravo.
Shameless suck-up No. 2: Healio | OSN Section Editor Uday Devgan is arguably the most influential cataract surgeon in the world. Uday’s Cataract Coach video series publishes a new surgical video daily. Every. Single. Day. Despite my, ahem, long tenure as a cataract surgeon, I routinely watch these gems to pick up some of the subtleties Uday and his guest surgeons highlight. Did you know he also has a weekly podcast (shameless plug No. 1: I was a guest earlier this year)? Both are worth a look. Bravo
Shameless suck-up No. 3: While I’m at it, let’s all take a moment to celebrate and send out a big “thank you” to Healio | OSN Chief Medical Editor Dick Lindstrom. At a time when most (all?) folks would be dialing back, Dick added another program director gig to his busy schedule. Once upon a time, I wrote an essay declaring that I wanted to be the next Dick Lindstrom (shameless plug No. 2: Google my personal blog). Dick responded that he wasn’t done being Dick Lindstrom yet, but when he was, I was invited to “get in line!” We are all very lucky that Dick Lindstrom isn’t done being Dick Lindstrom just yet.
Passion may very well be the magic pill that brings health and happiness. Being passionate about something that you do gives you purpose, a reason to get up and go every day. Not only that, but if someone you care about has a passion, you can hitch a ride on the experience. A great example is my darling Better 95% Beth and her 15+-year journey in the equestrian discipline dressage. A total beginner at age 46, Beth is about to embark on a new chapter as a Grand Prix rider. This kind of magic is real!
Let me take a minute to catch you up on the day. At the moment, it is 92° here on the shores of one of our great inland “oceans.” The lake, my muse, is as calm as a bathtub just before the grandchildren jump in. Have you ever seen a bald eagle in the wild? No matter where you are or what you are doing, all you can do is stare in slack-jawed wonder. What a splendid creature.
We should be living in a grand age of refractive surgery. I mean, come on, laser refractive surgery results with LASIK, SMILE or PRK are just off-the-charts great. The vast majority of patients are happy enough with their outcomes to state that they would do it again. In the earliest years of LASIK, I remember complication rates in the 2% to 4% range. Now? Serious complications are in the 0.1% to 0.2% range. If we add the EVO ICL from STAAR and refractive lens exchange to the mix, we can address the vast majority of spectacle independence desires. This should be our message.
Having said that, it is probably time for more of us to be talking in general about neuropathic pain. This is not a LASIK problem. It is a rare problem that occurs across the spectrum of anterior segment practice. The most common cause has to be dry eye disease simply because of the huge number of people affected. The most common surgical procedure associated with neuropathic pain? Despite the voluminous reports on social media, it is not LASIK but cataract surgery. The incidence is likely less than 0.1% in both, but we do more than five times as many cataract surgeries as LASIK procedures each year. Our family has firsthand experience with neuropathic pain. I’ll talk about it in a later column.
Quiz answers: Isaac Asimov, I, Robot. 1. A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2. A robot must obey the orders given it by human beings except where such orders would conflict with the first lLaw. 3. A robot must protect its own existence as long as such protection does not conflict with the first or second law.
I recently wrote about AI in dry eye disease. U.K. surgeon Sheraz Daya recently announced a new anterior segment system that is tailor-made for the introduction of AI into remote eye exams. Surgical robots exist in most surgical specialties; we should expect their arrival in the eye sooner rather than later. For what it’s worth, it’s hard to see why we need anything other than Asimov’s 50+-year-old wisdom when it comes to handling the risks of AI in health care and elsewhere.
Well, that’s an awful lot of thinks for a guy who was mostly planning to just sits a bit. Honestly, it’s a pleasure and a privilege to sit here and think about the world we share. I am happy and grateful for this journey we are on together. Grateful for colleagues like John and Uday and Dick. My dogs were here the whole time, one by my side, the other draped across my feet. Both are sound asleep in the sun.
I think I’ll let them lie.
*Hat tip to the late sports columnist Bill Reynolds whose Saturday musings on New England sports is the inspiration for this month’s column. RIP.
Reference:
Asimov I. Runaround. In: I, Robot. 1950.
For more information:
Darrell E. White, MD, of SkyVision Centers in Westlake, Ohio, can be reached at [email protected].
Dr. Priya Deshmukh
Senior Editor, Health
Dr. Deshmukh is a practicing physician and renowned medical journalist, honored for her investigative reporting on public health. She is dedicated to delivering accurate, evidence-based coverage on health, wellness, and medical innovations.
