Customized Ablation 1 Ive Seen the Future and its CustomCornea!

This Technology Update column is the first of a series of eight articles chronicling the development of Customized Ablation or Wavefront Driven LASIK. This column was published in the June 15th issue of Ocular Surgery News following both the 1999 ASLMS (American Society for Lasers in Medicine and Surgery) and ASCRS (American Society of Cataract and Refractive Surgery) meetings.

I've Seen the Future.....and it's Custom Cornea!

Technology Update

Irving J. Arons
Spectrum Consulting

What if you could more accurately predict and successfully restore a patients vision to 20/20 with refractive surgery. What if, in some cases, you could actually achieve "Ted Williams" type vision (20/16) or better for your patients who would want that. Would you be interested in finding out more?

Since I first heard Marguerite McDonald's presentation on custom cornea at last fall's AAO meeting (1998), I've been intrigued with the idea, and have wanted to know more about how it was going to be accomplished. The idea of not only correcting vision to emmetropia (20/20), but enhancing it to 20/16 or better was exciting and this was only reinforced by the presentations given at a Bausch & Lomb press conference at the AAO, where George Waring declared 20/12 by 2012, now changed to 20/10 by 2010 in current B&L Surgical advertisements! (For more on both of these presentations, see my columns from the AAO in the January 1st issue of OSN.)

Now, after hearing a presentation given by Tim Turner, director of research at Orbtek, on the "Orbscan Corneal Topography Laser-Link System" (at the recent American Society of Lasers in Medicine and Surgery [ASLMS] meeting in Orlando), and especially after viewing a tape of a course given at the recent ASCRS meeting by Marguerite McDonald, Ronald Krueger, Ray Applegate and George Pettit on "Wavefront-Guided Customized Ablations -- Beyond Topography-Assisted Refractive Surgery", sponsored by Autonomous Technology -- now a subsidiary of Summit Technology, I am convinced that topographically-linked ablation, and especially wavefront-guided ablations, are the future of refractive surgery.

As reported last January, several companies have announced that they are in the process of combining corneal topography with their excimer laser systems to be able to perform "custom" ablations. Among those are LaserSight, working with Humphrey-Zeiss and Orbtek; VISX, working with EyeSys Premier and Orbtek, among others; B&L Surgical/Chiron with Technomed and Orbtek; Schwind with Technomed; and Aesculap-Meditec, also with the Orbtek system and possibly Technomed.

In Dr. Turner's presentation, he explained how the first-generation of topographically linked laser ablations, which depend on the capture of topographic information (corneal curvature and elevation) supplied by such placido reflection systems as Computed Anatomy and EyeSys Premier, will probably be the first out of the block, along with the Orbscan slit scanning system. The Orbscan is capable of providing additional information such as the thickness of the cornea and the condition of its rear surface, through what Orbtek calls CIPTA, or Corneal Interactive Programmed Topographic Ablation. However, by combining the Orbscan with ultrasound to determine the ocular axial length and lens thickness, a simulation of the retinal point spread function (PSF) can be determined. Point spread functions can be calculated for any surface or any sequence of surfaces. Thus a PSF can be calculated from anterior corneal data alone, but it may or may not approximate the true retina PSF, depending on the optical importance of the other internal ocular surfaces. However, this does not include local aberration-inducing variations. So, Orbtek has created a simulated next-generation measurement technique called WAVE, or Wavefront Ablation Vision Enhancement. WAVE treats patient vision rather than corneal geometry (elevation and surface curvature), by targeting idealistic post-operative surface topography with the optical PSF optimized. It calculates wavefront aberration by reverse ray tracing of all of the rays emanating from a theoretical point source of light at the fovea and back through a modeled crystalline lens and the measured cornea. Orbscan measurements are used by WAVE to fully characterize the cornea (both anterior and posterior surfaces), and other data (refraction, ultrasonic axial length and lens thickness) are used to model the crystalline lens. These additions aid in the simulation of the true retinal PSF and the ocular wave aberration. When wave aberrations are directly measurable, they can also be included in the WAVE strategy. The WAVE system is still experimental and has not yet been used on any human patients.

The major difference between what Orbtek and Autonomous Technology are attempting to do is in the measurement of aberrations. As noted above, Orbtek uses theoretical measurements and modeling to simulate an aberration pattern, while Autonomous actually measures the total aberration of the eye by shooting a laser pulse onto the retina, through the lens, and obtains an actual aberration pattern of the return waves, thus getting a more accurate pattern of what aberrations are present in the complete optical system.

Autonomous uses a proprietary wavefront sensor to capture the wavefront pattern returning from the laser-induced spot on the retina. It then converts this information into a 3D map of the aberrations to determine what changes are needed in the corneal surface to compensate for the aberrations present in the eye, and to overcome them. Autonomous has built a prototype device, called the CustomCornea Measurement Device, and, under an IRB, has placed it in an ophthalmologist's office in Florida in order to take measurements on patients under a real-life situation, beginning in April. In an in-house study of 103 eyes, including some people with 20/20 or better vision and some with known pathologies, the custom cornea maps provided by a prototype device, appeared to bear out the theory -- emmetropes, as well as those with sharper vision have less aberrations and can be distinguished from those with aberrated vision. In the near future, this information will be programmed into the LadarVision small spot scanning laser system to provide the potentially enhanced vision, possibly reaching the theoretical diffraction limits of the retina of 20/8!

Of course, all of this would not be possible without the extremely accurate tracking system available on the Autonomous laser. Since the accurate placement of the "compensating" ablation pattern is necessary, by linking the wavefront analysis device to the LadarVision tracking laser, the precise pattern of ablation correction can be obtained, centered on the visual axis, and "customcornea" achieved. The company hopes to begin CustomCornea treatments this summer, depending on regulatory approvals and, hopefully, within the next two years, this technology could become a commercial reality.

Editors note: This column was not put online by OSN. The Janury 1st column mentioned, is also not online, but was picked up by a sister publication, OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION, and published in February 1999. (Which is linked.)

ITS ABOUT TIME

Globally there are an estimated 34 million people who are infected with the HIV virus. And since its discovery in the early 80's, more than 35 million people have died of HIV/AIDS, making it one of the most destructive pandemics in history.

According to the United Nations Special Sessions on HIV/AIDS, many of the 36 million people infected with HIV do not know they are carrying the virus. Nor do they know much about the disease. And as a result, more than 2 million people die each year of this disease.

It's not like nothing is being done about it; in fact, a lot of health organizations and foundations have risen up to the aid. But. . .

#ITSABOUTTIME we talked about it

#ITSABOUTTIME more is done about it

#ITSABOUTTIME we spoke to people about it

#ITSABOUTTIME we stopped the stigmatization

#ITSABOUTTIME we broke the fear

#ITSABOUTTIME we took the test

#ITSABOUTTIME we let our children know, cos someday they will grow

#ITSABOUTTIME we preached the gospel of protection with clear intentions

#ITSABOUTTIME we stood for the safety of our future

#ITSABOUTTIME is a month-long HIV/AIDSawareness/online campaign, which kicks off with "Día Mundial del SIDA", tomorrow, the 1st of December, 2015 (World AIDS day).

#ITSABOUTTIME will be running all 30 days of the month of December. We're going to be touching and discussing a lot of aspects/issues regarding the HIV and AIDS.

The (hashtag) #ITSABOUTTIMEis going to be trending over all our social media platforms; whatsapp, facebook, twitter, google+, and BBM/BBM Channel.

It'll be very nice if you do not stay out of this programme.

Should you be interested in participating in the online awareness programme, either as a writer, a partner, sponsor, or contributor, feel free to contact the Medicalmattaz team:

Whatsapp:

·        Saheed Quadri – 08130403603

·        Akande Quadri – 08183213714

·        E-mail: medicalmattaz@gmail.com

Together, we can kick out the bane of #ignorance in our society.

#ITSABOUTTIME

#STAYHEALTHY.

Understanding Holistic Health And Wellness And Its Benefits

By Leticia Jensen

A common topic of late has to do with well-being and living a longer and happier life. In all this, there is the question of how modern medicine treats people, which has many people wondering if there are other solutions. The problem with modern medicine has everything to do with the fact that it is symptoms that are treated and not the root problem. The information below on holistic health and wellness can open up doors to the solutions that many people are seeking, and rightfully so.

With regards to medical doctors, they generally overlook what the core problem really is, and go directly to the symptoms. Holistically, it is the entire body, mind and spirit that are treated, as well as one's mental health and emotions. Simply put, they deal with the individual as a whole.

It is about discovering what causes one's pain, discomfort, and the like. Furthermore, it approaches every aspect of the individual as one entity, unlike modern medicine that promotes surgery or medication without delving deeper. Modern medicine simply covers up symptoms.

It does not ignore any part of the being, because it intertwines all the aspects of an individual. Every part of a person functions depending on every other aspect. That's why holistic healing is a complete approach focusing on everything about the individual.

It is often referred to by other names, like alternative, complementary, or natural health, although these do not necessarily describe properly. One particular type of treatment doesn't necessarily mean that it is holistic. Instead, treating someone holistically requires specific and individual treatments that meet the needs of each individual, with a unique care plan.

Treatments could include a variety of approaches. There could be a nutritional counseling, homeopathy, acupuncture, and many more. Herbs and vitamins supplementation are almost always used, and exercise is always encouraged. They also include detoxification within the body, and one's environment to promote balance and harmony.

But that's not all! It gets the individual involved in his or her own individual care plan. They learned about self-care through awareness and guidance. They are encouraged to make serious lifestyle changes when necessary, for the greatest outcome. In doing so, and they may be able to prevent serious illnesses and diseases from developing. However, and this is very important, these approaches will strengthen the immune system, but there are no guarantees of being disease-free throughout life.

At the same time, it should not avoid anyone from seeking medical advice from medical doctors. Instead, it should be used in combination. The point is that there are alternatives to taking drugs that can be harmful, and always come with numerous side effects that can create a slew of other problems. Treatments and approaches can differ from one practitioner to another, but the goal is always the same, which is to make the individual better overall. Most people take advantage of the simpler way to live, by popping pills but not making any serious changes. To be completely healthy and well, people need to be committed to the effort.

About the Author:

You can visit www.healthyharvesthouse.com for more helpful information about The Importance Of Holistic Health And Wellness.

New Theory About the Purpose of Sleep and Why Its So Important to Get Sound Sleep

by Ram

Sleep by Francisco Goya

According to Ayurveda philosophy, sleep is one of three pillars that endow the body with strength, complexion, and healthy growth, which can continue through the full span of life. The Ayurvedic texts also describe the maladies that can result from poor-quality sleep, including but not limited to misery, emaciation, weakness, brain fog, memory loss, and fatigue. It is believed that good quality sleep is essential for the well-being of any individual as the body utilizes the sleep time to repair itself of damage sustained during the waking hours.

In this hypercompetitive world, many of us complain of a lack of good quality sleep. We’re a world of unhealthy sleepers. If one were to compare the world statistics of insomnia and poor quality sleep, it is interesting to note that the numbers are nearly similar throughout the world. Within the USA, 30 percent of us have trouble falling asleep (insomnia) and 50 percent can sleep but have trouble maintaining sound/quality sleep due to tension, work, stress and/or emotional upheaval. 

Nearly 10 million people in the U.S. use prescription sleep aids. Several recent studies have shown that lack of sleep or a discontinuous sleep during the night may be deleterious for the brain, and may trigger dementia and increase the risk of stroke symptoms. For more on sleep and suitable interventions, check our earlier posts on these topics including: sleep and memory by Nina Sleep, Alzheimer's Disease and Yoga and The Importance of Good Sleep and natural interventions for good sleep 5 Tips for Better Sleep. 

The type of sleep and how we are affected by it is of great interest to sleep researchers. Sleep researchers have provided a number of reasons for why we sleep. Sleep helps to maintain a healthy immune system, balance our appetites, makes us less susceptible to degenerative diseases or infections, improves memory, and enhances cognition. Recent research work points to another interesting fact about why we sleep. Published just a week ago, a pair of papers offers evidence for another theory: Ultrastructural evidence for synaptic scaling across the wake/sleep cycle and Homer1a drives homeostatic scaling-down of excitatory synapses during sleep. 

According to these researchers, sleep helps us to forget some of the things we learn each day. Learning requires new neuronal connections or neuronal branching in our brains, which help neurons to communicate with neighboring neurons quickly and efficiently. Furthermore, these new neuronal branches also store firsthand memories of impressions that we draw in each day through our five senses. However, some of this information is redundant and does not require being stored. For example, you do not need to know what clothes you wore to work on a Thursday couple of weeks ago. Similarly, the people you saw at the airport terminal is not a value for the brain. 

In the first study Ultrastructural evidence for synaptic scaling across the wake/sleep cycle scientists from the University of Wisconsin-Madison proposed that neuronal branches grow so wildly during the day with all our experiential learning that our neuronal circuits actually get “noisy” (in neuroscience, “noisy” refers to the constant bombardment of electrical activity in neurons that can be measured by sophisticated machines). These scientists further added that when we sleep soundly, the brain discards all the unnecessary noise and consolidates only the relevant signals. In one experiment, scientists grew neurons in a lab dish and fed the neurons with a drug that stimulates the excess noise (that is, growth of extra neuronal branches). Twenty four hours later, the neurons had pared backed some of the branches. In a follow up experiment, the scientists surveyed brain tissue slices from mice that slept soundly and compared them to tissue slices from mice that were forced to keep awake. The neuronal branches in the mice that slept were much smaller and far less “noisy” compared to neuronal branches from mice that were forced to stay awake.

The second study Homer1a drives homeostatic scaling-down of excitatory synapses during sleep, led by scientists from Johns Hopkins University, explored the same theory with a different set of experiments. In this case, the researchers created a tiny window through which they could peer into mouse brains. They added a chemical that would light up each time a new neuronal branch developed, suggesting a new learning had triggered electrical activity, resulting in a noise. 

Looking through the window, they found that the chemical lit up very few times in mice that were asleep, suggesting that the brain was discarding all the extra branches resulting in reduced noise. This suggested that sleep turned on the pruning machinery to pare back the excess neuronal branches. More importantly, this sleep-induced pruning of neurons helped in consolidating memories. Mice that were not allowed to sleep ended up with less pruning of the branches, more neuronal noise, and fuzzy memories. Interestingly, the pruning machinery was very specific; it did not prune the well-established old neuronal connections. 

To provide an analogy, I am reminded of what the computer folks always advise us when the computer starts functioning erratically. Before thinking of any expensive repairs, the first thing they do is to switch off the computer and reboot it. The reasoning is that the processor discards and clears the hard drive of all of the unnecessary and not-needed information. So the take-home message is that we do not need to harbor all the information that we encounter briefly on a day-day basis, especially the bad, unpleasant, sad, and negative events. 

Every day we encounter brief negative thoughts/experiences —when we typically experience a brief bout of anger—that do not need to be consolidated. For example, while driving you may have encountered someone who speeded wildly and overtook you without signaling, or maybe your waiter took a long time to bring the lunch order and you got delayed for your next important meeting. These situations need not be stored as it is not helpful—it is a noise that we need to erase by sleeping soundly.

If we cannot discard these negative experiences through sound sleep, these disharmonious memories can keep lurking in the brain for a long time, and create the excess noise through the numerous unwanted neuronal branches and erratic electrical activity that will have deleterious effects on the brain. 

Sleep experts are now busy trying to discover medicines that might precisely target the molecules to induce sleep, ensuring that neuronal branches get properly pruned and all the junk information is purged. However, as yogis we know what works better naturally than medicines: a good sleep. Remember, good sleep is essential for a person’s health and wellbeing and if you are experiencing sleep problems, there is quite a price to pay.

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The Treatment For Sport Injuries And Its Factors

By William West

Many would appreciate the existence of sports. This is where you can take off your stress from work and be competitive in a different level. In this way, you may also develop your body that it would look fit and very flexible. Some people who loves sports wont notice that their body have been developed naturally because of it.

If you happen to be in Wilmington, many individuals are not considering having a great time with sports. Even if it is a fun activity to do sometime, Wilmington sports injuries might happen. This is sad news for any participant. Good thing there is a group that could really focus their help on this kind of situation.

There are various recreational activities to choose from. It would just depend on what kind of things you would like. Most sports would need a ball to play with. This will require the player to certainly be fast and even smart enough to strategize the next move. There are different factors that should be considered as victorious in any game.

There are various parts of the body which are very prone to injuries. The one with joints are the usually target for these unfortunate thing. Sometimes, you'll figure out that your knees, shoulders, elbows and even your feet are the parts the needs much care. This could lead to a minor to serious problem if not prevented.

The doctor can be the best person to call during this can kind of situation. They are well knowledgeable on the things that should be done. If you dont know any doctor on your list, then it will be difficult for you to be treated quickly. You might need to rely with other services which could be very slow to respond.

Various ways of treatment might be necessary to make it back from the original. Usually, surgery will be done to it. Sometimes, it will only matter if its a major one or just minor. This is solely the discretion of the doctor is which one is the best for the patient. They may only know the details but the great decision would still remain to the professional.

If you want to deal in securing your health, then you have to keep everything in standby mode. This simply means that having a sports health assurance would really aid you in being worry free in playing your favorite sport. After the game, you may have a general check up to be sure that all your parts are well maintained and covered.

In everything you do, you must make sure that you get the support from your family and close friends. With this, you'll have a great time enjoying it in another level. Its totally different if you have someone is really very supportive to all your endeavors in life.

With the good motivation to continue enjoying life, everyone will have the opportunity to be more active and prepared for the future. This should be something to look forward to and not to fear of especially with the oldies. Remember that its not yet too late to start caring for your self.

About the Author:

Make sure you check out the following chiropractic clinic to find out about Wilmington sports injuries and how they are treated. For appointments, feel free to visit this website on http://www.optimalperformancechiro.com right now!