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Accommodation is a function of the eye which has long been overlooked in eye surgery because we just have not had the technology to do anything about it. The term accommodation refers to the ability of the eye to change focus from things that are very far away, like when we are driving, to things that are very close up and small, like reading or threading a needle.

If you have used a camera before, you have probably been aware of hearing the auto focus feature or noticed the lens move as the camera adjusts to the distance of the main objects in your picture. If it did not do so, the picture would appear blurred. Your eye has the same auto focus feature which allows us to keep the main objects in sharp focus regardless of their distance.

However, as we age, the lens in our eye begins to harden and loses this auto focus capability. Eventually, everybody begins to wear reading glasses or bifocals because of this aging effect called presbyopia. Over the years, people have tried to figure out how to eliminate presbyopia surgically, but there is no perfect way to do so.

Only recently have new developments in intraocular implants given us the ability to truly mimic accommodation as it occurs in the youthful eye. Most notably, the crystalens intraocular implant has been used very successfully in cataract surgery in elderly people. This surgery using the crystalens not only improves the patients distance vision by removing the cloudy lens (cataract) but it also gives improved near/reading vision.

The crystalens is a premium lens implant that has the ability to move in a certain way after it is placed inside the eye which is similar to the auto focus of a camera. With careful preoperative measurement,
calculation, and planning, this surgery can improve distance vision while reducing the need for reading glasses or bifocals.

When we do Lasik surgery, however, we do not have the ability to implant a new lens inside of the eye. Lasik surgery is done on the cornea which is the outer surface or clear dome shaped structure at the front of your eye. In this case, your normal lens remains intact and if you have reached the age where your lens has stiffened, it will remain so.

I often have patients that want some flexibility in terms of still being able to read after Lasik surgery and we do what we can to maximize their reading without significantly compromising their Lasik outcome for distance vision. Many surgeons do a monovision correction on their Lasik patients. Monovision is the practice of leaving the non-dominant eye nearsighted while fully correcting the dominant eye for distance. The concept goes as far back as the monocle, the one-eyed lenses seen worn in the 19th and early 20th century especially in Germany.

Often, in my opinion, surgeons will overdo the monovision effect and leave the patient too nearsighted. Although it gives very good reading vision, the large difference between the two eyes often creates problems with depth perception or dizziness. Also the compromise in distance vision becomes very noticeable to the patient and the brain is not adequately able to fuse or coordinate the different images from the two eyes.

I have had a much higher degree of success using a mini-monovision technique where I leave only a small amount of residual nearsightedness in the non-dominant eye. With this technique, I target good intermediate distance vision rather than close reading/threading-a-needle vision. The residual correction is probably only -1/2 to -1 diopters at most for these patients. This allows much better distance vision and good intermediate vision and some close reading ability. In general, in the modern world, most of our close work is done at the computer distance.

Mini-monovision accomplishes this goal and reduces confusion between the two eyes or loss of depth perception. Ultimately, my goal is to maximize the patients distance vision while giving them the ability to work on a computer, see their cell phone or watch, and read a menu. More extensive small print reading like sitting down to read the newspaper or a novel would probably require reading glasses. For most people, this set-up eliminates the use of glasses for over 90 percent of their day.

Surgical options for correction of accommodation have come a long way in recent times and continue to develop. If you have questions about accommodating intraocular lenses for cataract surgery, or about options when considering Lasik surgery, discuss them with your surgeon (not just a technician) prior to proceeding.

Dr. John Suson MD is an ophthalmologist and a clinical instructor at the Medical College of Wisconsin. Currently, Dr. Suson is in private practice with his sister at their “Suson Eye Specialists” clinic. For more information, visit http://www.supereyes.com

Individuals who have suffered serious injuries and side effects from the medication Levaquin could soon have access to what could potentially be the most important litigation against the drug’s manufacturers and distributors. In an announcement that may set the precedent for future legal action regarding Levaquin, the law firm of Carey and Danis made public their fillings of four lawsuits naming Johnson and Johnson and Ortho-McNeil Pharmaceutical Inc., as well as Walgreen Co., one of the largest distributors of the drug, as defendants. The civil suits, filed to represent twenty plantiffs, allege that Johnson and Johnson and Ortho-McNeil knew about the severe risk of tendonitis and possible tendon rupture, especially in patients over 60, and yet continued marketing the drug as a safe and efficacious treatment option for several different types of infections; these included lung, sinus, skin and urinary tract infections.

Levaquin belongs to a family of drugs known as quinolones. Specifically, it is classified as a fluoroquinolone, a group of medications used as antibiotics for serious infections where other antibiotics may have proved ineffective. However, while there are acceptable and necessary applications for these medications, these medications can have serious side effects. This is especially true of Levaquin (and similarly, Cipro) which has shown to present a potentially debilitating risk of sincere tendonitis and even tendon rupture. Many cases have been reported of the Achilles tendon rupturing in patients taking Levaquin, causing permanent disability.

The lawsuit asserts that Johnson and Johnson and Ortho-McNeil had knowledge of these side effects years before cases began surfacing, yet they continued to market the drug as a safe and viable alternative. Additionally, the lawsuits allege that the two companies manipulated study data in order to circumvent potentially damning evidence against the drug and that the companies minimized the risks to patients when marketing the drug to physicians. The suit charges Johnson and Johnson and Ortho-McNeil with negligence, breach of warranties, and violations of the Illinois Consumer Fraud Act, just to name a few.

Levaquin has been under intense scrutiny for almost a decade; in 2001, the Food and Drug Administration (FDA) instituted initial warning on possible tendon ruptures in patients taking Levaquin. Again in 2004 the FDA issued warnings on Levaquin, expanding the risk of potential tendon rupture from an isolated incident with the Achilles tendon to other tendons in the body, as well as adding the risk of rupture for a period of time after taking the medication. Through 2007 and 2008, the FDA instituted a requirement for the packing of Levaquin, requiring an extended side effect list to be present with the medication as well as giving the drug the FDA’s strongest warning label, the Black Box label. The FDA has been quoted recently saying that Levaquin, “poses a serious and significant public health concern.”

Individuals seeking information regarding levaquin side effects are encouraged to visit http://levaquin.legalview.info/ where they can find access to a wide range of resources regarding levaquin.

Breast implant surgery like any other surgical operation is something that should be thought about and taken under careful consideration. Many women elect to receive breast implants for many reasons.

Here are 5 of the most common reasons for having Breast Implant Surgery:

-Sagging Due to Aging or Pregnancy
Gravity induced aging and pregnancy are two most oft given reasons for women to go for breast augmentation. Pregnancy can have major effects in your cup size-from smaller or regular to fuller to dis-proportioned. It can very unflattering once they loses their firmness.

-Reconstructive or Repair
Losing a breast to any malignant illness or an accident can be devastating. For women who suffer from breast cancer or under go a mastectomy this is an unfortunate reality.

-Self Esteem and Confidence
Many women feel that having the perfect body will make them feel better. This is one of the most common reasons many women opt for breast implants because they many envy others that have larger breasts.

-Body Proportion
Many women feel that the their body type of shape is not in proportion to the size of their breasts. This is also one of the most common reasons many women opt for breast reduction surgery.

-Different Sizes or Shapes
This is very similar to the last reason in that is deals with size. Breast asymmetry is a very normal finding in many women. Sometimes women feel uncomfortable or self conscious if there is a very noticeable difference in size or shape. This can cause them to shy away from tight and revealing clothing.

Fortunately over the past 30 years breast implants and techniques have evolved into improved breast procedures. Breast augmentation enhances the size and shape of a women’s breast by either placing the implant on top of or underneath the pectoralis muscle. This procedure can improve the self esteem of a woman who for her own reasons feels her breast size is too small or misshaped.

By having breast implant surgery many women gain their confidence and see themselves in a new light. Although there may be benefits to these cosmetic procedures they are not always for everyone. It is always best to consult a board certified plastic surgeon who specializes breast implant surgery and the pre-operative and post-operative care.

The reason for an extensive consultation is that it takes time to educate the patient about breast implant surgery. Most patients have consulted the internet prior to making their first visit to a surgeon. Some have learned about breast surgery from friends who have had augmentation mammaplasty. Exceptional results from breast augmentation can only be achieved when a surgeon and his patient are willing to invest the time to talk about and plan the procedure.

Dave Stringham, the President of LookingYourBest.com offers information on plastic surgery in Boise, Idaho and plastic surgery procedures including breast augmentation, breast reconstruction, breast lift and breast implants.

http://www.sorensenbass.com

Across America, candidates for cosmetic procedures are asking about IV sedation and whether it is preferable to general anesthetic.

The numbers released by the American Society for Aesthetic Plastic Surgery (ASAPS) show a meteoric rise in cosmetic and plastic surgery between 1997 and 2008, so it should come as no surprise that more and more men and women are asking about the methods used to alleviate pain during surgery. We rely on surgeons and anesthesiologists to know the latest and best methods for sparing us pain while under the knife, and it seems that more than a few doctors are expressing their preference for what some call twilight sleep surgery.

Unlike twilight sleep childbirth, which used an injection of morphine and scopolamine but caused negative side effects for both mother and child, intravenous sedation uses an IV application of a sedative combined to relax the patient with a local anesthetic for pain management. The name and the intent to alleviate pain are about the only commonalities between the two.

As surgery goes, one of the fundamental differences between general anesthesia and IV sedation is that the latter allows patients to be relatively alert, even for fairly invasive work. While at first the thought of being awake while a surgeon cuts, pokes and sews may seem like the stuff of horror movies, consider the fact that being “completely under” does not guarantee protection from pain. There have been cases where patients have experienced pain under general anesthesia but were simply unable to communicate their distress. With IV sedation, doctor and patient can maintain a flow of information.

Another difference is that the patient retains control of his or her own breathing under twilight sleep, as opposed to the endotrachial tube used by the anesthesiologist to take over that function for general anesthetic. Certain potential complications which arise specifically from the tube are, of course, avoided with IV sedation, and recovery time in general is shorter as well. As stated on Medscape.com, procedures that used to require an overnight hospital stay can now be performed without the hospital in certified outpatient locations.

Dr. Manjit Brar, a Vancouver, Washington, plastic surgeon of over 35 years’ experience, “prefers twilight sleep anesthesia…because patients are less likely to get sick, patients can be asked to sit upright during surgery [to verify that work performed will have the desired effect], and he can communicate with patients if necessary.” As Dr. Brar’s web site, doctorbrar.com, states, “Patients usually leave within three hours of arrival at our facility.”

Intravenous sedation is not for everyone. Surely some patients will simply not be comfortable being alert and aware of surgical procedures being performed on them. IV sedation is also still a relatively new technique, making it a good idea to ensure that the attending physicians have as much experience with it as possible. In the end, perhaps the most important thing is to ensure that both the patient and the doctor are comfortable with the decisions being made.

Dave Stringham, the President of LookingYourBest.com offers information on plastic surgery and plastic surgery procedures including breast augmentation, breast reconstruction, breast lift, and breast implants.

http://www.doctorbrar.com/

Kansas might be facing a dental shortage over the next 3 to 5 years, some sources report. The Kansas Department of Health and Environment also seems to be in agreement with this statement.

Currently, 91 of the state’s 115 counties are listed as having serious issues with shortages in the dentistal industry. Kansas Department of Health and Environment (KDHE) director Dr. Katherine Weno feels that the dental workforce is getting older, and that finding young, viable replacements, is becoming harder and harder. Dental recruitment in Kansas in not what it once was. “We do not have a dental school in Kansas, so we do have a ready pipeline of dentists that come into the state every year. We have to recruit dentists from out of state,” said Weno.

Most of the states graduates, Weno explained, go on to the University of Missouri-Kansas City School of Dentistry. “Trying to recruit them back to rural counties if they are not from rural areas is particularly difficult, so that is why we have a lot of issues with work force shortages in rural counties in western Kansas,” she said, indicating that the major issues are in less populated parts of KS.

Other findings in the report show that the average age of a Kansas dentist is 50, and, the older dentists tend to practice in less densely populated areas. It appears as though only 25% of dentists who graduate from urban high schools practice dentistry or orthodontics in a rural setting. Furthermore, most dentists who do practice in KS, claim that it is simply because of their family ties and the low cost of living within the state’s boundaries. The Office of Local and Rural Health indicated that 57 Kansas counties don’t have enough dentists who accept Medicare, or, help to treat low income patients.

Julie Branstrom, Executive President of the Douglas County Dental Clinic, aims to serve low income residents. “I think our county would be in bigger trouble if the clinic wasn’t here,” said Branstrom. “If the clinic wasn’t serving Medicaid patients, I honestly don’t know where people would go because I can count on one hand the number of dentists in Lawrence that take Medicaid.” Through August of this year, the clinic had over 4,000 appointments; a nine percent increase over the previous year. They have also seen an increase in the number of uninsured patients who seek treatment at the lowest price level – a staggering 26% of all dental patients.

Kansas State Health Officer, Dr. Jason Eberhart-Phillips, is concerned by these findings, also. He believes that poor oral health is connected to a wealth of chronic diseases such as cardiovascular disease and diabetes.

As of now, the KDHE is planning to assemble a dental work force cabinet, which will work in assisting new dentists, and, recruiting new ones to ultimately enter the field of dentistry or orthodontics. They recently learned that they will be awarded a grant worth $355,153 in federal funding to create an oral health professional recruitment program. They hope to now be able to offer high school students a true incentive to graduate, go to dental school, and practice in the less populate areas of Kansas.

Paul Guenther is a Website & SEO Analyst for the Dental Corporation of America. Read more about the shortage of dentists in Kansas: http://dentalcorp.com/dental/index.php/2009/09/shortage-dentists-kansas/ . Learn more about orthodontic and dental practices: http://dentalcorp.com/dental/