,,FACT ,,& ,,FIC;N ,,( ,,H1L?Y ,,VI.N
       ,EYE ,C>E = ,ADULTS & ,*N

      ,,CLYDE ,K4 ,,KIT*51 ,M4,D4

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  ,FUR!R REPRODUC;N OR 4TRIBU;N 9 O!R
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       ,,ISBN-#AJ3 #J-BGE-IICDE-J
     ,,ISBN-#AC3 #IGH-J-BGE-IICDE-J

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     ,BRL ,PAGES P#A-P#F & #AIG-BIH
         ,PR9T ,PAGES #HJ-A#ABB      P#A
























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          ,,SPECIAL ,,SYMBOLS
         ,,US$ ,,9 ,,? ,,VOLUME

@& 7#D1 #ABCDF7 AMP]S& SYMBOL
^C 7#DE1 #AD7 COPY"R SYMBOL
_/ 7#DEF1 #CD7 SLA%
,' 7#F1 #C7 T]M9,N SIGN

    ,MA!MATICAL ,SYMBOLS
@+ 7#D1 #CDF7 PLUS SIGN
@- 7#D1 #CF7 M9US SIGN













                                     P#C
         ,,TRANSCRIB]'S ,,NOTES

  ,! ILLU/R,NS 9 ? BOOK >E ALL S*EMATIC
CROSS-SEC;NS (! EYE OR "PS (! EYE4 ,!Y
>E N NUMB]$ OR O!RWISE ID5TIFI$4 ,CAP;NS
6! ILLU/R,NS >E BRLD ": !Y APPE> 9 PR9T4
  ,]RORS 9 SPELL+1 PUNCTU,N1 GRAMM>1 &
SYNTAX H1 =! MO/ "P1 BE5 TRANSCRIB$ Z !Y
APPE> 9 PR9T4















                                     P#D
                ,,3T5TS
                                   ,PAGE
               ,"P ,,III4
    ,AGE-,RELAT$ ,EYE ,PRO#MS 73T47
#AJ4 ,GLAUCOMA """"""""""""""""""""" #HJ
#AA4 ,MACUL> ,DEG5],N """""""""""""" #HG

               ,"P ,,IV4
           ,SPECIAL ,3SID],NS """""" #IC
#AB4 ,VISUAL ,AIDS """"""""""""""""" #IE
#AC4 ,DIABETES """"""""""""""""""""" #IG
#AD4 ,NEUROLOGIC ,3DI;NS ,A6ECT+
    ,VI.N """""""""""""""""""""""""" #II
  ,CAUSES ( ,SU45 ,VI.N ,LOSS """""" #II
  ,O!R ,NEUROLOGICAL ,PRO#MS """"" A#AJA
#AE4 ,HI/ORY & ,CURR5T ,DEVELOP;TS
    9 ,REFRACTIVE ,SURG]Y """"""""" #AJH
  ,REFRACTIVE ,SURG]Y ,HI/ORY """"" #AJH
  ,TYPES ( ,REFRACTIVE ,SURG]Y """ B#AAJ
  ,PRESBYOPIA ,SURG]Y """""""""""" B#AAE




                                     P#E
























                                     P#F
                  #AJ                #HJ
               ,GLAUCOMA

,ANO!R AGE-RELAT$ -MON EYE PRO#M IS
GLAUCOMA1 A6ECT+ #D P]C5T (! POPUL,N &
9CR1S+ 9 FREQU5CY AF AGE =TY1 ) HI<] IN-
CID;E 9 BLACKS ?AN :ITES4 ,! M -MON TYPE
( GLAUCOMA IS CALL$ 8OP5 ANGLE GLAUCOMA0
& AL DESCRIB$ Z ! 8SN1K ?IEF 9 ! NI<T40
,? IS 2C T 0! "T "O 2COMES AW>E ( VI.N
LOSS DUE 6GLAUCOMA1 ! GLAUCOMA IS USU,Y
ADV.ED1 & UN=TUNATELY ! VI.N _C 2 RECOV-
]$4 ,VI.N PRES]V,N REQUIRES E>LY DETEC;N
& IS "O (! PRIM>Y R1SONS 6RECOMM5D R\T9E
EYE EXAM9,NS = H1L? R1SONS1 E TWO YE>S
AF AGE =TY4
  ,! USUAL SCRE5+ TE/ T SU7E/S GLAUCOMA
IS ! 9TRAOCUL> PRESSURE M1SURE;T4 ,? IS
ONLY "O TE/1 H["E1 & DOES N REPLACE A
-PLETE EYE EXAM9,N4 ,! USUAL RANGE (
8NORMAL0 9TRAOCUL> PRESSURE IS F #AJ-BB
7MILLIMET]S ( M]CURY71 B ? IS AN AV]AGE
RANGE1 & 9 A3URACY DEP5DS ON :O IS DO+ !
TE/1 : ME?OD IS 2+ US$ =! TE/1 & O!R
FACTORS1 S* Z IF ! CORNEA (! EYE    #AIG
IS ?9N] ?AN NORMAL4 ,& EA* 9DI-     A#HJ
VIDUAL IS DI6]5T1 S T :AT IS NORMAL = "S
IS N NECESS>ILY NORMAL = O!RS4 ,"! >E ^?
) PRESSURES ( #BH :O N"E GET GLAUCOMA1 &
"! >E ^? ) PRESSURES ( #AF :O H GLAUCO-
MA4 ,IF ! PRESSURE IS #CJ OR M1 X IS
USU,Y J A MATT] ( "T 2F GLAUCOMA VI.N
LOSS DEVELOPS4 ,SU7E/IVE SIGNS ( GLAUCO-
MA1 9CLUD+ A PRESSURE ABV #BB1 CUPP+ (!
OPTIC N]VE1 OR VI.N LOSS N O!RWISE EX-
PLA9$1 SU7E/ ! NE$ = FUR!R TE/+ = GLAU-
-A4 ,A VISUAL FIELD TE/1 TE/+ P]IPH]AL
VI.N ) -PUT]IZ$ TE*NIQUE1 C DETECT E>LI-
E/ SIGN ( GLAUCOMA4 ,AL NEW OPTIC N]VE
FIB] PHOTOGRAPHIC TE*NIQUES HELP E>LY
DIAGNOSIS & FOLL[-UP4 ,EV5 ) ALL ^! TE/
TE*NIQUES1 ! DIAGNOSIS IS (T5 N EASY4
,TR1T;T PR9CIPLES H V>I$ F L[]+ ALL SUS-
PICI\SLY HI< 9TRAOCUL> PRESSURES1 9
SPITE (! POSSIBIL;Y ( TR1T+ "S :O W N"E
GET GLAUCOMA1 V]SUS REQUIR+ 3FIRM,N (
DIAGNOSIS VIA VISUAL FIELD EXAM & O!R
FACTORS 2F TR1T+4

                                    #AIH
      ,ILLU/R,N3 ,AN >R[ %[S FL[ (   #HA
    AQUE\S FLUID "? ! PUPIL & 96!
    ANT]IOR *AMB] ANGLE TRABECUL> ME%"W
    = DRA9AGE4 ,X AL %[S EXPANSIVE >R[S
    SU7E/+ 9CR1S$ 9TRAOCUL> PRESSURE &!
    RESULT+ CUPP+ (! OPTIC N]VE1 -P>$ 6!
    SMALL CROSS-SEC;N ( RELATIVELY FLAT
    & 8P]FECTLY0 NORMAL OPTIC N]VE4 ,"S
    CUPP+ (! N]VE IS (T5 NORMAL )
    NE>SI<T$;S1 B IS LESS -MONLY NORMAL
    9 F>SI<T$;S4 ,COPY"R ^C #AIHC ,/EPH5
    ,F4 ,GORDON4
  ,VISUAL FIELD 7P]IPH]AL OR SIDE VI.N7
LOSS F GLAUCOMA IS USU,Y N NOT$ 0! PA-
TI5T UNTIL (T5 TOO LATE4 ,P]IPH]AL VI.N
LOSS C 2 9SIDI\S & SN1KY4 ,TYPIC,Y1
GLAUCOMAT\S LOSS ( VI.N MAY 2 T[>D !
NOSE1 ": X MAY N 2 NOTIC$4 ,LOSS ( C5-
TRAL OR R1D+ VI.N MAY N DEVELOP UNTIL Q
LATE 9 ! 41SE1 S T A P]SON MAY 2 A# 6SEE
#BJ_/BJ1 B N 2 A# 6MANEUV] "? A ROOM (
FURNITURE )\T FALL+ D[N4 ,? MAY 2 CALL$
8TUNNEL VI.N10 ?\< "! IS NO S* ?+1 S9CE
"O'S SIDE VI.N EXP&S ) 9CR1S$ 4T.E1 L A
*E]L1D]S MEGAPH"O1 NO MATT] H[      #AII
BAD X IS RE/RICT$4 ,B ! T]M IM-     A#HA
PLIES CORRECTLY PRO#MS 9 MOBIL;Y4
  ,Z "T GOES ON1 OP5 ANGLE GLAUCOMA IS
FELT M & M 6BE A UNIQUE 41SE (! OPTIC
N]VE1 S T "S P H OPTIC N]VES M S5SITIVE
6PRESSURE ?AN O!RS4 ,CUPP+ (! OPTIC N]VE
C SU7E/ GLAUCOMA1 EV5 IF ! EYE PRESSURES
>E RELATIVELY L[4 ,A FLAT OPTIC N]VE IS
EASILY DESCRIB$ Z NORMAL1 B A B[+ BACK-
W>D (! OPTIC N]VE C5TR,Y1 CALL$ CUPP+1
6"S DEGREE C AL 2 NORMAL4 ,:5 ! :OLE OP-
TIC N]VE IS CUPP$1 OR SCOOP$ \ L A BIG
B[L1 ADV.ED GLAUCOMA IS PRETTY OBVI\S4
,V]TIC,Y OVAL CUPS ( SIGNIFICANT SIZE1 Z
-P>$ 6HORIZONT,Y OVAL CUPS1 ESPECI,Y IF
RECORD$ Z 5L>G+ OV] A P]IOD ( "T1 SU7E/
GLAUCOMA4 ,,POAG 7PRIM>Y OP5 ANGLE GLAU-
-A7 MAY 2 "O-EY$ 9 ONSET1 B 9VOLVE;T (
BO? EYES IS HI<LY SUSPECT$ EV5TU,Y4
  ,OP5 ANGLE GLAUCOMA IS DIAGNOS$1 -P>$
6N>R[ ANGLE GLAUCOMA1 0GONIOSCOPY4 ,!
GONIOSCOPE IS A SPECIAL MIRROR$ 3TACT-
L5S-TYPE DEVICE
-------------------------------------#HB
T ALL[S VISUALIZ,N 9 ! ANT]IOR      #BJJ
*AMB] ANGLES1 ! SPACE 2T ! ROOT (   A#HB
! PUPIL =M+ IRIS TISSUE &! P]IPH]AL COR-
NEA4 ,X IS L LOOK+ >.D CORN]S4 ,LATTICE-
LIKE TISSUE CALL$ ME%"W C 2 SE5 IF ! AN-
GLE IS 8OP540 ,! ME%"W FILT]S & ALL[S
DRA9AGE ( AQUE\S FLUID T IS 2+ 3/ANTLY
REPLAC$ & CIRCULAT+ "? ! PUPIL4 ,9 OP5
ANGLES GLAUCOMA1 ! PRO#M SEEMS -P>A# 6A
PLUMB+ PRO#M1 ":BY ! FLUID DOES N DRA9
PROP]LY4 ,!N BACK-UP PRESSURE RESULTS 9
! EYE1 Z IF ! ME%"W IS N LETT+ ! FLUID
FILT] "? PROP]LY1 RESULT+ 9 9CR1S$ 9TRA-
OCUL> BACK PRESSURE4 ,ANO!R -P>ISON IS L
A RU2] TIRE T 2COMES OV]9FLAT$4 ,9 !
CASE (! EYE1 ! RIGID SCL]A PREV5TS
/RET*+1 B ! W1K PO9T IS ! OPTIC N]VE1 &
? IS ": ! DAMAGE O3URS4
  ,! TR1T;T ( *RONIC OP5 ANGLE GLAUCOMA
IS USU,Y EYE DROPS1 : L[] ! 9TRAOCUL>
PRESSURE 0EI DECR1S+ ! AM.T ( AQUE\S
FLUID =M$1 OR 0PROMOT+ BETT] DRA9AGE (!
WAT]LIKE AQUE\S1 OR A -B9,N ( BO?4 ,"!
>E _M EYE DROPS = GLAUCOMA1 NEW "OS AP-
PE>+ (T54 ,SIDE E6ECTS & CO/ MAY A6ECT
*OICE ( DROPS4 ,! E6ECTIVE;S C      #BJA
V>Y P] 9DIVIDUAL1 S T *ANGES MAY    B#HB
NE$ 6BE MADE1 & "S"TS TWO OR ?REE K9DS (
DROPS MAY 2 NEC 6KEEP ! PRESSURE 9 SAFE
RANGES4 ,ONCE TR1T;T IS 2GUN1 X USU,Y
NE$S 6BE 3T9U$ 9DEF9ITELY4 ,PATI5T -PLI-
.E IS REQUIR$1 9CLUD+ FOLL[-UP EXAMS4
,"O IS N A# TO 8FEEL0 IF ! PRESSURE IS
GETT+ HI<]1 UN.S ! PRESSURE RISES RAPID-
LY1 OR IS Q HI<4 ,!N1 ! PA9 IS N 9 ! EYE
XF1 B R 9 ! EYEBR[4
  ,SU3ESS ( TR1T;T IS GAUG$ 0SIGNIFICANT
L[]+ (! EYE PRESSURE1 B BETT] 3FIRM$ 0!
FACT T VISUAL FIELD DEFECTS1 PREVI\SLY
NOT$1 D N WORS54 ,X %D N 2 EXPECT$ T VI-
.N1 9CLUD+ VISUAL FIELD DEFECTS W IM-
PROVE4 ,! MA9 GOAL IS "O ( HOLD+ ! L9E1
S* T FUR!R WORS5+ (! VISUAL FIELD IS N
HAPP5+4 ,O!R FACTORS >E MONITOR+ ! AP-
PE>.E (! OPTIC N]VE1 ! CUPP+1 & N]VE FI-
B] TE/S T AL C DETECT LOSS ( FUNC;N4 ,S
,I TELL PATI5TS N 6EXPECT _! EYES 6SEEM
BETT] :ILE 2+ TR1T$1 S9CE !Y >E UNAW>E
USU,Y (! VISUAL FIELD DEFECT 9 ! F/
PLACE4 ,DON'T EXPECT 6SEE BETT] OR FEEL
L ! EYES FEEL BETT]4 ,DON'T         #BJB
EXPECT 6BE A# 6JUDGE :E!R ! PRES-   C#HB
SURE IS L[]1 Y C'T FEEL X4 ,:AT ! PATI5T
NE$S 6D IS FOLL[ 9/RUC;NS1 TAKE ! M$I-
C9E1 & 2 GD AB FOLL[-UP EXAM9,NS4
  ,TR1T;T ) EYE DROPS IS 3SID]$ PREF]A#
6LAS] OR SURG]Y ME?ODS1 Z L;G Z SU3ESS-
;L1 DUE 6LESS] POT5TIAL -PLIC,NS4 ,LAS]
TR1T;T AM.TS 6MAK+ BURN SPOTS 9 ! ANGUL>
ME%"W1 6PROMOTE BETT] DRA9AGE ( FLUID &
"!=E L[] 9TRAOCUL> PRESSURE4 ,! MA9 COM-
PLIC,N IS T ! E6ECT MAY 2 UNSU3ESS;L1 J
TEMPOR>Y1 OR ONLY "PI,Y SU3ESS;L4 ,NEW]
LAS]S >E AVAILA#1 B L;G-T]M B5EFICIAL
E6ECT REMA9S 6BE SE51 & LAS] TR1T;T HAS
N1 S F>1 REPLAC$ EYE DROPS Z PRIM>Y
TR1T;T4 ,FAC$ )! 9CONV5I;E ( 3T9U$ NE$ =
USE ( EYE DROPS1 "S PATI5TS >E ATTRACT$
6! 8QK FIX0 POT5TIAL
-------------------------------------#HC
( LAS] TRABECULOPLA/Y1 B UN=TUNATELY
CLOSE FOLL[-UP IS REQUIR$ S Z 6N IGNORE
EV5TUAL FAILURE (! PROC$URE4 ,S* PATI5TS
MAY NE$ EYE DROPS AG OR REP1T LAS] TR1T-
;T4
  ,SURGICAL TR1T;T ( GLAUCOMA IS    #BJC
USU,Y RES]V$ = GLAUCOMA PATI5TS     A#HC
^: PRESSURES >E N 3TROLL$ 0EYE DROPS1 OR
LAS] TRABECULOPLA/Y4 ,! SURG]Y PROVIDES
A 8FILT]10 OR SURGIC,Y CR1T$ EXTRA PA?-
WAY =! AQUE\S FLUID 6DRA9 F ! EYE1 S Z
6L[] ! 9TRAOCUL> PRESSURE4 ,SU3ESS IS
-MON1 B N GU>ANTE$4 ,-PLIC,NS 9CLUDE
FAILURE 6FILT]1 9FEC;N1 OR CAT>ACT4 ,IF
A CAT>ACT IS ALR PRES5T1 A -B9,N ( CATA-
RACT SURG]Y & GLAUCOMA FILT]+ PROC$URE
MAY 2 P]=M$4 ,ANO!R POT5TIAL -PLIC,N IS
T :AT MAY ORD9>ILY 2 A SIMPLE 3JUNCTIVI-
TIS MAY SPR1D 69VOLVE ! 9SIDE (! EYE1 &
2COME A M S]I\S 5DOPH?ALMITIS4 ,=TUNATE-
LY1 ? IS A R>E -PLIC,N4
  ,O!R SURGICAL TR1T;T ( GLAUCOMA C IN-
VOLVE AN >TIFICIAL IMPLANT OR VALVE1 :
HELPS REGULATE FLUID DRA9AGE F ! EYE1 (-
T5 ) GRT SU3ESS4 ,5DOCYCLOPHOTOCOAGUL,N
C AL 2 P]=M$1 9VOLV+ LAS] MICROSCOPIC
TR1T;TS ON ! CILI>Y BODY4 ,? IS 3SID]$ Z
OPTIMUM 9 TIM+1 6D DUR+ PHAKOEMULSIFIC,N
9 CAT>ACT SURG]Y1 9 PATI5TS :O >E CON-
TROLL$ 0_! GLAUCOMA M$IC,NS1 9 HOPES (
AVOID+ GLAUCOMA DROPS4              #BJD
  ,! IDEA (A QK FIX = GLAUCOMA IS   B#HC
N NEW1 B N UNIV]S,Y A3EPT$4 ,9 O!R ^WS1
"! >E ^? :O H SD1 LET'S G DIRECTLY 6LAS]
OR SURGICAL 3TROL ( 9TRAOCUL> PRESSURE1
R ?AN ALL ! BO!R ( US+ EYE DROPS4 ,X IS
TRUE T ! CUMULATIVE E6ECTS ( US+ EYE
DROPS 9DEF9ITELY C AM.T 6SIGNIFICANT EX-
P5SE1 S T PROC$URES1 IF !Y "W1 _C SEEM S
EXP5SIVE1 9 ! L;G RUN4 ,? IS ! PRO#M1 2C
! -B9,N ( LACK ( SU3ESS1 REQUIR+ RESUM$
USE ( EYE DROPS ANYWAY1 &! POT5TIAL COM-
PLIC,NS 9CLUD+ CAT>ACTS & 9FEC;N FOLL[+
FILT]+ SURG]Y1 MAKES ! USE ( EYE DROPS N
S EXP5SIVE1 AF ALL4
  ,Z AN 9T]E/+ SIDE /ORY1 ,I ONCE _H A
PATI5T F ,5GL&1 :O 0 REF]R$ :ILE LIV+ "!
6! OPH?ALMIC SURGEON = SUSPICION ( GLAU-
-A4 ,! DOCTOR J HAPP5$ 6BE DO+ 8 8SURG]Y
"D10 & J A4$ H] 6HIS S*$ULE4 ,HE P]=M$
BILAT]AL FILT]+ PROC$URES1 APP>5TLY SUC-
CESS;LLY4 ,%E DID N %[ SIGNS ( GLAUCOMA
:5 ,I EXAM9$ H]1 NOR ANY -PLIC,N F !
SURG]Y4 ,B1 ( C\RSE1 WE D N "K IF %E _H
GLAUCOMA 9 ! F/ PLACE1 S9CE %E DID N H
PROP] TE/+4                         #BJE
  ,ACUTE ANGLE CLOSURE GLAUCOMA     C#HC
IS LESS -MON1 B POT5TI,Y M DRAMATIC 9
CAUSE ( SU45 LOSS ( VI.N4 ,Z 4CLOS$ 0GO-
NIOSCOPY1 IF ! SPACE 2T ! BASE (! IRIS1
! COLOR$ "P1 &! P]IPH]AL CORNEA IS TOO
N>R[1 !N AQUE\S FLUID _C DRA9 PROP]LY1
RESULT+ 9 POT5TI,Y A SU45 RISE 9 9TRAOC-
UL> PRESSURE4 ,! 9CID;E ( N>R[ ANGLES
ANATOMIC,Y IS AB #B P]C5T 9 :ITES1 ":AS
! 9CID;E ( ANGLE CLOSURE GLAUCOMA IS
LESS ?AN #J.A P]C5T4 ,! HI<E/ 9CID;E IS
9 ,ESKIMOS4 ,! POT5TIAL ( ANGLE CLOSURE
GLAUCOMA IS GRTLY 9CR1S$ 9 SMALL1 F>-
SI<T$ EYES4 ,ACUTE ANGLE CLOSURE GLAUCO-
MA ATTACK IS ! USUAL F/ SIGN (! PRO#M4
,PA9 RESULTS1
-------------------------------------#HD
3TR>Y 6M -MON OP5 ANGLE GLAUCOMA1 N 9 !
EYE Z MAY 2 EXPECT$1 B 9 ! EYE BR[ ON T
SIDE1 DUE 6SU45 RISE 9 EYE PRESSURE4
  ,SEQU;E ( EV5TS 9 ACUTE ANGLE CLOSURE
!N C 9CLUDE R$;S (! EYE1 BLURR$ VI.N1
PHOTOS5SITIV;Y1 NAUSEA & VOMIT+4 ,! PU-
PIL 2COMES 5L>G$4 ,O3URR;E ( S* ATTACKS
H HAPP5$ PO/OP]ATIVELY 9 G5]AL      #BJF
SURG]Y1 :5 ATROP9E-L M$IC,NS HAV+   A#HD
PUPIL DILAT+ SIDE E6ECTS H BE5 US$ Z "P
( ANES!SIA1 &! NAUSEA & VOMIT+ SYMPTOMS
(T5 H DIV]T$ ATT5;N F ANGLE CLOSURE
GLAUCOMA ATTACK (! EYE 6"S SORT ( ABDOM-
9AL PRO#M4 ,DILAT+ ! PUPIL C POT5TI,Y
TRI7] AN ATTACK1 B ? DOES N HAPP5 V (T5
9 ! C\RSE ( EYE EXAM9,N4 ,= "O ?+1 IF !
ANT]IOR *AMB] ANGLE LOOKS N>R[1 !N ELEC-
TIVELY X IS DECID$ (T5 N 6DILATE ! PU-
PIL4
  ,COLD M$IC,NS 3TA9+ PUPIL DILAT+ DE-
3GE/ANT DRUGS C PRECIPITATE AN ATTACK1 &
? IS ! R1SON =! W>N+ ON S* PRODUCTS1 IF
"O R1DS ! F9E PR9T4 ,H["E1 ! DI6];E 2T !
DANG] = OP5 ANGLE GLAUCOMA1 ! MO/ -MON
K9D ( GLAUCOMA1 & POT5TIAL ANGLE CLOSURE
GLAUCOMA1 IS N DEF9$ 9 ! W>N+ LABELS4 ,!
AV]AGE OP5 ANGLE GLAUCOMA PATI5T C TAKE
COLD M$IC,NS )\T 3C]N4 ,X C]TA9LY IS AC-
CEPTA# 6"Q YR EYE DOCTOR AB :E!R X IS
ALL "R 6TAKE COLD M$IC,NS ) YR K9D (
GLAUCOMA4
  ,"S"TS "! >E 8M9I ATTACKS0 ( ANGLE
CLOSURE1 "S?+1 IF RECOGNIZ$1 CD     #BJG
PREDICT EV5TUAL MAJOR ATTACK (      B#HD
ANGLE CLOSURE GLAUCOMA4 ,TYPIC,Y1 AN AF-
FECT$ P]SON SAYS T AF WAT*+ ,,TV AT
NI<T1 !Y GET A H1DA*E1 & H 6G 6B$ 2F X
GOES AWAY4 ,IF "Q$1 !Y USU,Y ADMIT T !Y
WAT* ,,TV ) LL OR NO ROOM LI<T &! H1DA*E
IS 9 ! EYEBR[ REGION4 ,"U ^! CIRCUM/.ES1
! PUPILS W 5L>GE 2C ! ROOM IS D>K1 TRIG-
G]+ A SMALL ATTACK ( ANGLE CLOSURE GLAU-
-A1 N S BAD Z 6PREV5T !M FALL+ 6SLEEP4
,! PUPILS NORM,Y 2COME SMALL] 9 SLEEP1 &
! ATTACK C 2 ABORT$4
  ,TR1T;T ( AN ANGLE CLOSURE GLAUCOMA
ATTACK IS USU,Y AN EM]G5CY4 ,DROPS 6CON-
/RICT ! PUPIL 7MIOTICS S* Z PILOC>P9E7
>E US$1 PLUS DIURETIC PILLS L ,DIAMOX1 &
HYP]TONIC SOLU;NS OR,Y TAK5 6DRAW FLUID
F ! EYE4 ,! -B9,N M/ "W RAPIDLY1 & )9 A
FEW M9UTES SIGNS ( IMPROVE;T C 2 DETECT-
$4 ,SELDOM IS EM]G5CY SURG]Y REQUIR$1 &
IF ! PRESSURE IS 3TROLL$ 0M$IC,N1 X MAY
2 BETT] 6AWAIT SIGNS ( LESS 9FLAMM,N1 )9
! NEXT "D OR S4
  ,":AS SURGICAL IRIDECTOMY 0 ONCE 9DI-
CAT$1 N[ LAS] IRIDOTOMY Z AN        #BJH
\TPATI5T C 2 D"O ) LESS TRAUMA &    C#HD
9CONV5I;E 6! PATI5T4 ,3T9U$ TR1T;T ) MI-
OTICS MAY 2 ADVISA# 6AVOID FUR!R AT-
TACKS1 & "S"TS "! IS A -B9,N ( OP5 ANGLE
& N>R[ ANGLE GLAUCOMA1 S* T A4I;NAL
GLAUCOMA DROPS >E REQUIR$4 ,CAT>ACTS
-MONLY RESULT1 FOLL[+ AN ATTACK ( ANGLE
CLOSURE GLAUCOMA1 & MAY =M M RAPIDLY ?AN
AGE-RELAT$-TYPE CAT>ACT4
  ,BILAT]AL SIMULTANE\S ATTACKS ( ANGLE
CLOSURE GLAUCOMA >E =TUNATELY R>E1 B !
UNA6ECT$ EYE IS POT5TI,Y AT RISK 9 ! FU-
TURE1 DUE 6LIKELY
-------------------------------------#HE
ANATOMIC SIMIL>;Y4 ,! *.ES ( AN ANGLE
CLOSURE ATTACK 9 ! O!R EYE >E E/IMAT$ Z
2T #DJ P]C5T & #HJ P]C5T )9 FIVE 6T5
YE>S4 ,PROPHYLACTIC TR1T;T (! O!R EYE1
USU,Y 9 ! =M ( LAS] IRIDOTOMY IS RECOM-
M5D$4 ,A DI6];E ( OP9ION MAY 2 5C.T]$
RELATIVE 6NE$ 6TR1T 8POT5TIAL0 ANGLE
CLOSURE GLAUCOMA1 M1N+ "S"O ^: ANGLES
LOOK N>R[ 5 6H AN ATTACK ( GLAUCOMA4
,_M1 P]H MO/1 S* P WD N"E GET AN ATTACK
( GLAUCOMA1 B 6BE ON ! 8SAFE        #BJI
SIDE10 PROPHYLACTIC TR1T;T ) PI-    A#HE
LOC>P9E 7PUPIL 3/RICT+7 DROPS OR LAS]
IRIDOTOMY MAY 2 ELECT$1 OR A -B9,N ( ^!
TR1T;TS4 ,A PROVOCATIVE TE/1 DILAT+ !
PUPIL 6SEE IF ! PRESSURE GOES UP1 C HELP
DECIDE IF PROPHYLACTIC TR1T;T IS NE$$4
  ,PILOC>P9E IS "O (! ORIG9AL EYE DROPS
= TR1T;T ( GLAUCOMA4 ,Z M5;N$1 X IS N[
US$ MA9LY = N>R[ OR POT5TIAL N>R[ ANGLE
GLAUCOMA4 ,Z A MIOTIC1 ? M1NS T ! PUPIL
IS MADE SMALL]4 ,? IS ESPECI,Y HELP;L 9
N>R[ ANGLES1 Z X 5C\RAGES AQUE\S FLUID
DRA9AGE )\T OB/RUC;N1 09CR1S+ ! SPACE 2T
! IRIS PUPIL =M+ TISSUE &! P]IPH]AL POR-
;NS (! CORNEA4 ,X AL L[]S PRESSURE 9 OP5
ANGLE GLAUCOMA1 B IS LESS US$ CURR5TLY
DUE 6SIDE E6ECTS4 ,^! SIDE E6ECTS 9CLUDE
EYEBR[ A*E :ILE GETT+ US$ 6! MIOTIC
DROPS1 & *ANGE 9 VI.N4 ,2C ! PUPIL IS
SMALL]1 LESS LI<T GETS "?1 & 2C X IS
KEPT SMALL 0! DROPS1 A P]SON HAS A PRO#M
ADAPT+ 6! D>K1 Z 9 NI<T DRIV+1 OR 9 GO+
F \TDOORS 96A MOVIE !AT]4 ,A POSITIVE
SIDE E6ECT1 H["E1 IS T1 2C ! PUPIL IS
SMALL1 A 8P9HOLE0 E6ECT O3URS1 &    #BAJ
P ON MIOTICS >E LESS DEP5D5T ON     B#HE
_! GLASSES4 ,ANO!R SIDE E6ECT DESIRA# TO
"S1 IS T ! EYES APPE> LI<T]1 OR BLU]1 )
SMALL PUPILS1 A FACTOR 3SID]$ ATTRACTIVE
0A FEMALE PATI5T4
  ,"! >E _M K9DS ( EYE DROPS = OP5 ANGLE
GLAUCOMA 3TROL4 ,!Y DI6] 9 AC;N1 A6ECT+
AQUE\S EYE FLUID 9FL[ & \TFL[1 OR BO?4
,!Y ALL H POT5TIAL UNDESIRA# SIDE EF-
FECTS1 ?\< OBVI\SLY N (T5 5 6MAKE !M N
USE;L4 ,N"E!.S1 X IS NEC 6DET]M9E : W "W
BE/ = EA* 9DIVIDUAL1 & TRIAL P]IODS >E
NEC4 ,AM;G ! MO/ -MON >E 2TA-BLOCK]S1 :
>E *1P]1 Q E6ECTIVE Z AN 9ITIAL TR1T;T1
& AVAILA# 9 G5]IC =M4 ,B 2TA-BLOCK]S C
AL 2 A PRO#M = P :O H TR\# ) AS?MA OR
EMPHYSEMA4 ,O!RS 9CLUDE PRO/AGL&9S1 &RO-
G5IC DROPS1 & *OL9E/]ASE 9HIBITORS4
  ,US$ TOPIC,Y1 N M* ( ^! EYE DROPS GETS
96! BLOOD /R1M1 B OBVI\SLY 5 C D S1 &
CAUSE SY/EMIC SIDE E6ECTS4 ,? C 2 M9I-
MIZ$ 0HOLD+ TWO F+]S1 "O ON EA* SIDE (!
NOSE1 2T ! EYES1 9 A P9*+ FA%ION =A FEW
SECONDS AF 9/ILL+ ! DROPS4 ,DO+ ? "R AF
US+ ! EYE DROP HELPS KEEP X F       #BAA
RUNN+ D[N ! NOSE "R AWAY1 ": X      C#HE
MAY 2 RAPIDLY ABSORB$ 96! BLOOD /R1M1 &
AL HELPS ! EYE XF ABSORB ! M$IC,N BETT]4
  ,PATI5TS NE$ 6"U/& T TAK+ ! GLAUCOMA
EYE DROPS = A:ILE DOES N MAKE ! PRO#M G
AWAY1 L TAK+ AN ANTIBIOTIC1 X J HELPS
PREV5T FUR!R DAMAGE 0PROGRES.N ( GLAUCO-
MA4 ,YES1 ? USU,Y M1NS
-------------------------------------#HF
=! RE/ (! PATI5T'S LIFE1 & UN=TUNATELY
:AT M$IC,N SEEMS SATISFACTORY 9ITI,Y MAY
NE$ 6BE REPLAC$ OR A4$ ^U 63T9UE 6ASSURE
SAFE 3TROL 9 ! FUTURE4 ,! /AT$ GOAL IS
6L[] ! PRESSURE AB #BJ P]C5T4 ,NEW] &
BETT] TOPICAL M$IC,NS >E 2+ DEVELOP$4
,UN=TUNATELY1 MO/ NEW M$IC,NS >E N 8G5]-
IC10 & 9SUR.E COV]AGE MAY N PROVIDE PAY-
;T4 ,HOPE;LLY1 ,PLAN ;,D W HELP ,M$IC>E
PATI5TS4
  ,PATI5T -PLI.E1 ! FOLL[+ ( 9/RUC;NS
FAI?;LLY1 C 2 A PRO#M4 ,X IS DI6ICULT TO
REMEMB] 6TAKE EYE DROPS S"EAL "TS A "D1
S T "OS ONCE TAK5 AT B$"T OR F/ ?+ 9 !
MORN+ >E EASI] 6REMEMB]4 ,NEW] M$IC,NS
9CLUDE "S -B9,NS T MAY SIMPLIFY     #BAB
USE1 _M N YET AVAILA# 9 ! ,UNIT$    A#HF
,/ATES4 ,AVAILA# 9 ,CANADA >E S* ?+S Z
,XALACOM 7,XALATAN & TIMOLOL71 ,-BIG5
7,ALPHAGAN & TIMOLOL71 & ,EXTRAVAN
7,TRAVATAN & TIMOLOL74 ,X IS AL DI6ICULT
6PREDICT H[ M* DAMAGE C 2 EXPECT$ 0MISS+
A DROP N[ & !N4 ,"O M/ D ! BE/ "O C1 &
REMEMB] 6TAKE _! M$IC,NS ) !M ON TRIPS1
9CLUD+ 6! HOSPITAL4 ,! HOSPITAL MAY 9SI/
ON GIV+ Y _! [N EYE DROPS1 B !Y W NE$ TO
SEE :AT Y H BE5 TAK+4 ,& 0! WAY1 :5 Y
L1VE ! HOSPITAL1 2 SURE 6ASK =! "PI,Y
US$ BOTTLES ( M$IC9E ! HOSPITAL HAS BE5
GIV+ Y4 ,!Y >E YRS1 S9CE Y PD = !M4
  ,M>IJUANA HAS BE5 REPORT$ Z HAV+ PRES-
SURE L[]+ POT5TIAL1 S* T IS LI/$ Z A
TR1T;T ( GLAUCOMA4 ,H["E1 ,I "K ( NO
OPH?ALMOLOGI/S PRESCRIB+ ? 8M$IC,N40






                                    #BAC
                                    B#HF























                                    #BAD
                  #AA                #HG
            ,MACUL> ,DEG5],N

,MACUL> DEG5],N A6ECTS #B-C P]C5T (!
POPUL,N4 ,X SEEMS 6BE 2COM+ M -MON1 2C X
IS USU,Y AGE RELAT$ & P >E LIV+ L;G]4 ,X
IS -MONLY REF]R$ 6Z ,,AMD1 = AGE-RELAT$
MACUL> DEG5],N4 ,S1 L ! 9CID;E ( CATA-
RACTS & GLAUCOMA1 ! NUMB]S ( AGE-RELAT$
MACUL> DEG5],N PATI5TS W 9CR1SE4 ,H["E1
UNLIKE GLAUCOMA1 ! 9CID;E ( ,,AMD IS
HI<] 9 :ITES ?AN BLACKS4 ,) MACUL> DEG5-
],N ! LOSS ( VI.N IS C5TRAL1 A6ECT+ R1D+
& COLOR VI.N1 B USU,Y N A6ECT+ P]IPH]AL
OR SIDE VI.N4 ,IF -P>+ EYE 6CAM]A ANA-
TOMIC,Y1 ! MACULA IS ! C5TRAL PO9T ( FO-
CUS ON ! RET9A ( LI<T OR IMAGES 5T]+ !
EYE4 ,! MACULA IS -POS$ ( #AJJ P]C5T
C"OS1 ":AS ! P]IPH]AL RET9A IS M -POS$ (
RODS 7USE;L 9 NI<T VI.N74 ,IF "! IS A
8FLAW0 9 ! MACULA1 !N1 L HAV+ A 8FLAW0 9
CAM]A FILM1 & NO MATT] H[ WELL IMAGES >E
FOCUS$ 0! EYE & CORRECTIVE GLASSES1 !
8PICTURES0 DON'T TURN \ "R4
  ,?\< MACUL> DEG5],N IS G5],Y      #BAE
LIMIT$ 6C5TRAL VI.N1 ! 9ABIL;Y TO   A#HG
R1D C 2 S SEV]E Z 6PREV5T PASS+ A DRIV-
]'S TE/1 & EV5 S SEV]E Z 6BE 3SID]$ 8LE-
G,Y BL40 ,? M1NS T A P]SON IS UNA# 6SEE
BETT] ?AN #BJ_/BJJ1 EV5 ) GLASSES4 ,H[-
"E1 -PLETE BL;S IS N EXPECT$1 &! PRO#M
MAY ALW REMA9 MILD4 ,S PROGRES.N (!
PRO#M MAY 2 EXPECT$1 B IS N 9EVITA#4 ,"!
>E EV5 CASES ( SPONTANE\S IMPROVE;T 6"S
DEGREE4 ,,AMD IS SD 6BE ! L1D+ CAUSE (
LEGAL BL;S 9 ! OV] SIXTY-FIVE AGE GR\P4
,H["E1 EV5 IF LEG,Y BL1 ^? ) MACUL> DE-
G5],N PRO#MS >E N ! "OS NE$+ A :ITE
CANE4 ,!Y C 2 EXPECT$ 6BE A# 6GET >.D Z
F> Z MOBIL;Y & N NE$ M* HELP 9 SELF-C>E4
,TYPIC,Y1 !Y >E RELUCTANT 6GIVE UP _!
DRIV]'S LIC5SE1 Z !Y RECOGNIZE LL PRO#MS
9 DRIV+1 DUE 6GD P]IPH]AL VI.N4 ,IF SE-
V]E1 S* P LE>N 6LOOK 6"O SIDE 6SEE BET-
T]1 = EXAMPLE1 6LOOK AT "O'S E> 6BE A#
6SEE ! NOSE4 ,"!=E1 !Y "S"TS SEEM 6N
LOOK O!R P 8IN ! EYE0 :5 TALK+ 6!M4
-------------------------------------#HH
  ,! C5TRAL MACULA IS -POS$ ( #AJJ P]C5T
C"OS1 & IS S S5SITIVE Z 6BE A# TO   #BAF
DI6]5TIATE A #A-DEGREE ANGUL> IN-   A#HH
T]VAL AT #BJ FEET1 H;E #BJ_/BJ VI.N4 ,A
MIXTURE ) 8RODS0 DEVELOPS GRADU,Y AWAY F
! MACULA1 UNTIL1 EV5TU,Y1 9 ! P]IPH]AL
RET9A1 "! >E MA9LY RODS4 ,:AT ? M1NS IS
T LOSS (! C5TRAL OR R1D+ VI.N IS DUE TO
DAMAGE 6! C"OS 9 ! MACULA1 & DAMAGE 6PE-
RIPH]AL OR NI<T VI.N IS DUE 6DAMAGE 6!
RODS1 Z 9 RET9ITIS PIG;TOSA4 ,S "! >E
WORSE ?+S 6HAPP5 6"O'S VI.N ?AN MACUL>
DEG5],N4 ,= "O ?+1 S9CE ,,AMD IS AGE RE-
LAT$1 P ) MACUL> DEG5],N H USU,Y 5JOY$
GD VI.N = MO/ ( _! LIFE1 & !Y AL D N BE-
-E TOT,Y BL4 ,-P>ATIVELY1 ^? ) RET9ITIS
PIG;TOSA MAY H PRO#MS AT AN E>LY AGE1
9VOLV+ LOSS ( NI<T & P]IPH]AL VI.N1 &
MAY EV5TU,Y LOSE _! C5TRAL VI.N AL1 S Z
62COME ALM TOT,Y BL4 ,AL SEV]E GLAUCOMA
C CAUSE M -PLETE BL;S S Z 6BE WORSE 9
-P>ISON4
  ,,AMD MAY -PLICATE ! DIAGNOSIS ( GLAU-
-A OR CAT>ACT E6ECT ON VI.N1 O!R AGE-
RELAT$ POT5TIAL PRO#MS4 ,X MAY 2 DI6I-
CULT 6SEP>ATE "O PRO#M F ! O!R Z 6! P]-
C5TAGE ( E6ECT ON VI.N4 ,? ISSUE    #BAG
IS ESPECI,Y IMPORTANT 9 DET]M9+     B#HH
IF OR :5 CAT>ACT SURG]Y %D 2 P]=M$1 S9CE
M9IMAL IMPROVE;T ( VI.N PO/OP]ATIVELY WD
2 4APPO9T+4 ,IMPROVE;T ( VI.N )A P9HOLE
TE/1 DEMON/RAT+ BETT] VI.N ?AN ) GLASS-
ES1 MAY 2 REASSUR+ T ! PRO#M IS MA9LY
CAT>ACT4 ,ANO!R TE/ IS ! ,AMSL] GRID1 :
IS A PAGE ) SMALL SQU>ES &A DOT 9 ! C5-
T]4 ,) ,,AMD1 ! L9ES >.D ! C5TRAL DOT
2COME CROOK$ & 4TORT$1 &! DOT 9 ! C5T]
MAY 2 ABS5T4 ,"S"TS1 ! E6ECT ( O!R PROB-
LEMS IS N FULLY EVID5T UNTIL AF CAT>ACT
SURG]Y1 & REMOV+ ! CAT>ACT MAY SUBSE-
QU5TLY IMPROVE 9TRAOCUL> EXAM S T O!R
PRO#MS MAY 2 BETT] EVALUAT$4 ,H["E1 UN=-
TUNATELY1 CAT>ACT SURG]Y MAY AL /IMULATE
MACUL> DEG5],N 62COME WORSE1 Z WELL Z
DIABETIC RET9OPA?Y4 ,^! >E FACTORS T
SU7E/ A 3S]VATIVE APPROA* 6CAT>ACT SUR-
G]Y1 ESPECI,Y IF ! CAT>ACT IS N S D5SE Z
6OB/RUCT ADEQUATE EXAM9,N (! RET9A4
  ,"! >E DI6]5T TYPES ( MACUL> DEG5],N1
B MO/ >E AGE RELAT$4 ,H]$IT>Y =MS O3UR &
USU,Y RESULT 9 E>LI] DEVELOP;T (! PRO#M4
,A -MON SITU,N O3URS :5 SPOTS >E    #BAH
VISI# 9 ! 8MACULA0 ^U R\T9E EYE     C#HH
EXAM9,N1 CALL$ DRUS54 ,TOO (T5 ! /ATE;T
IS MADE T A P]SON HAS MACUL> DEG5],N 2C
( ^! SPOTS4 ,H["E1 M1SURA# LOSS ( VI.N
M/ 2 PRES5T 2F MACUL> DEG5],N %D 2 DIAG-
NOS$4 ,! PRES;E ( DRUS5 SPOTS (T5 ANTIC-
IPATES OR REPRES5TS AN E>LY SIGN ( IM-
P5D+ MACUL> DEG5],N1 B VI.N MAY 3T9UE TO
2 NORMAL4 ,ON ! O!R H&1 DIAGNO/IC SIGNS
( MACUL> DEG5],N MAY 2 "S"TS S DI6ICULT
6SEE ^U RET9AL EXAM9,N1 T ?\< MACUL> DE-
G5],N IS SUSPECT$1 SPECIAL TE/S >E RE-
QUIR$1 S* Z FL\RESCE9 ANGIOGRAPHY1 6CON-
FIRM ! DIAGNOSIS4 ,? TE/ MAY AL HELP DE-
T]M9E IF ! TYPE ( MACUL> DEG5],N IS
8WET0 OR 8DRY40
-------------------------------------#HI
  ,! DRY =M A3.TS = AB #IJ P]C5T ( PA-
TI5TS ) ,,AMD4 ,H["E1 ! WET TYPE ( MACU-
L> DEG5],N1 ASSOCIAT$ ) NEOVASCUL>IZ,N1
OR NEW BLOOD VESSEL =M,N1 A3.TS = AB #IJ
P]C5T ( CASES ( SEV]E VI.N LOSS DUE TO
,,AMD4 ,9 G5]AL "! >E FEW TR1T;T ALT]NA-
TIVES =! DRY TYPE1 & _M NEW TR1T;TS >E
N[ AVAILA# =! WET =M ( ,,AMD4 ,S    #BAI
Q (T5 Y MAY HE> AB A NEW TR1T;T =   A#HI
MACUL> DEG5],N 9 ! NEWS1 & ^! >E USU,Y =
! WET =M4 ,! PL5ITUDE HAS RESULT$ DUE 6!
FAILURE ( MO/ PROC$URES 6GIVE M* SU3ESS
9 ! PA/4
  ,A /UDY REC5TLY %[$ T VITAM9S 3TA9+
Z9C & LUTE9 MAY HELP DECR1SE PROGRES.N (
DRY MACUL> DEG5],N1 & >E RECOMM5D$ = ?
R1SON4 ,H["E1 TAK+ S* PILLS MAY N 2 EX-
PECT$ 6AVOID MACUL> DEG5],N 9 ^? DE/9$
6H X1 OR IMPROVE VI.N 9 ^? :O H LO/ VI.N
DUE 6MACUL> DEG5],N4 ,"! >E _M DI6]5T
BR&S 3TA9+ AB ! SAME -B9,NS ( VITAM9S1
Z9C1 & LUTE94 ,NO "O BR& IS \T/&+1 ?\<
"O LABEL1 F ,ALL]GAN1 0 9VOLV$ 9 ! /UDY
F : ALL GET _! 5C\RAGE;T4 ,ALL >E OV]-!-
C.T] DRUGS1 : IS GD = AVAILABIL;Y1 B P]H
BAD 9 T ANY M$ICAL 9SUR.E COV]AGE DOES N
APPLY4 ,ANO!R PRO#M IS T ! UN9=M$ MAY 2
TAK+ ^! M$IC9ES UNNECESS>ILY1 9 AN AT-
TEMPT 6MAKE _! EYES BETT]4
  ,A PATI5T REC5TLY 9=M$ ME T H] RELA-
TIVE 9 ,CANADA IS "UGO+ RHEOPHORESIS =
MACUL> DEG5],N4 ,? APP>5TLY IS A =M (
PLASMAPHORESIS1 ":BY BLOOD IS       #BBJ
DRAWN F A PATI5T1 ! PLASMA IS       B#HI
SEP>AT$1 & C]TA9 PROTE9S & LIPOPROTE9S
>E FILT]$ F ! BLOOD 2F RETURN+ X 96! PA-
TI5T4 ,?\< "S GD RESULTS >E REPORT$1 X
IS ONLY EXP]I;TAL 9 ? C.TRY1 &! FACT T
^! ELE;TS REAPPE> 9 ! BLOOD RAPIDLY
MAKES ? =M ( TR1T;T "QA# 9 !ORY4
  ,TR1T;T ( WET MACUL> DEG5],N IS BE/
P]=M$ 0RET9AL 41SE SPECIALI/S 9 OPH?AL-
MOLOGY4 ,UTILIZ+ A PHOTOGRAPHIC TE*NIQUE
CALL$ FL\RESCE9 ANGIOGRAPHY1 !Y C DET]-
M9E :E!R !Y >E D1L+ )! DRY OR WET =M (
,,AMD4 ,?US !Y C VISUALIZE ! SUBRET9AL
L1K+ ( FLUID & NEW BLOOD VESSEL =M,N1
CALL$ NEOVASCUL>IZ,N1 9 ! WET =M4 ,^!
NEW VESSELS >E DELICATE & UNH1L?Y1 & C
RUPTURE & BLE$ SPONTANE\SLY4 ,? BLE$+
RESULTS 9 SC> =M,N1 DE/ROY+ RET9AL FUNC-
;N4 ,( C\RSE1 9 ! DELICATE MACULA1 ! RE-
SULT C 2 4A/R\S 9 VISUAL E6ECT & 2 SU45
9 ONSET4
  ,DI6]5T APPROA*ES H BE5 TAK5 6TR1T !
WET =M ( MACUL> DEG5],N4 ,UTILIZ+ A LA-
S]1 SPOT TR1T;T ( L1K+ OR POT5TIAL L1KS
F VESSELS C 2 D"O4 ,H["E1 ! LAS]    #BBA
BURN CR1TES A SC>1 & IF ? 9VOLVES   C#HI
! MACULA NE> ! C5T]1 ! VI.N IS REDUC$1
EV5 IF X IS RELATIVELY SU3ESS;L 9 REDUC+
! *.E ( NEW VESSEL =M,N4 ,A NEW] LAS]
TR1T;T IS PHOTO DYNAMIC !RAPY1 : UTILIZ-
ES A M SUP]FICIAL TR1T;T BETT] DIRECT$
6>1S T NE$ TR1T;T4 ,VISUDYNE1 A PHOTOS5-
SITIVE DRUG1 IS 9JECT$ 9TRAV5\SLY1 & !N
A L[1 9S5SITIVE NON!RMAL LAS] IS
-------------------------------------#IJ
US$ 6DE/ROY NEOVASCUL>IZ,N1 ) LL SC>R+4
,RESULTS H BE5 AN IMPROVE;T OV] REGUL>
LAS] TR1T;T1 B (T5 N GD 5\<4
  ,! MO/ DRA/IC SURGICAL TR1T;T IS CALL$
MACUL> TRANSLOC,N4 ,? 9VOLVES MOV+ OR
TRANSLOCAT+ ! RET9A S T ! *OROIDAL NEO-
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WELL ?AN HOP$ & ? =M ( SURG]Y IS US$ =
^? ^: VI.N IS S BAD T !Y >E DESP]ATE TO
REGA9 EV5 A LL VI.N4 ,ANO!R PROC$URE1 N
YET APPROV$ 0! ,FOOD & ,DRUG ,ADM9I/R,N1
IS ! ,,IMT1 OR IMPLANTA# M9IATURE TELE-
SCOPE1 : IS PLAC$ 9 ! L5S CAPSULE AF RE-
MOV+ ! L5S1 9/1D (! 3V5;NAL         #BBB
9TRAOCUL> L5S IMPLANT4 ,? HAS AL-   A#IJ
L[$ IMPROVE;T ( VI.N 9 VOLUNTE]S (A FEW
L9ES ON ! ,SNELL5 *>T1 B "! IS 3C]N AB
APPROVAL1 DUE 6A HI< LOSS ( 5DO!LIAL
CELLS (! CORNEA1 M1N+ P]H SIGNIFICANT
FUTURE -PLIC,NS4
  ,EV5 M REC5T HAS BE5 ! TR1T;T ( WET
MACUL> DEG5],N 0M1NS ( 9JECT+ DRUGS T
4C\RAGE NEOVASCUL>IZ,N1 "S ( : H ORIGI-
NAT$ 9 USE Z ANTIC.ER M$IC,NS4 ,^!
DRUGS1 S* Z MACUG51 AVA/91 & LUC5TIS1 >E
ACTU,Y 9JECT$ "? ! SCL]A 96! VITRE\S (!
EYE4 ,"! H BE5 "S GD RESULTS1 9CLUD+ RE-
PORTS ( IMPROVE;T ( VI.N 9 ! CASE (
AVA/9 & LUC5TIS1 ":AS MACUG5 HAS BE5 M =
MA9T5.E1 6AVOID WORS5+4 8,IMPLANTS0 ( S*
MAT]IALS >E 2+ TRI$ S Z 6AVOID ! NE$ =
S* FREQU5T 9JEC;NS4
  ,! MO/ -MON TYPE ( MACUL> DEG5],N1 !
DRY TYPE1 _C 2 TR1T$ 0LAS]4 ,! PROCESS
SEEMS 6BE M (A LACK ( NUTRI;N OR )]+
AWAY ( CELLS1 RELAT$ 6AGE 9 MO/ "P1 B
C]TA9LY N 9EVITA# 9 ! MAJOR;Y (! AG$4
,LAS] TR1T;T WD ONLY D M DAMAGE 9 AN >EA
T IS Q DELICATE4 ,"S H SU7E/$ T !   #BBC
DRY =M ( MACUL> DEG5],N IS J AN     B#IJ
E>LI] =M (! WET TYPE4 ,MY CL9ICAL OBS]-
V,N SU7E/S T !Y >E TWO DI6]5T PROCESSES1
BO? ) POT5TI,Y 4A/R\S E6ECTS1 B T ! WET
TYPE C>RIES ) X ! ?R1T ( SU45 IRREV]SI#
VI.N LOSS4
  ,! NATURAL C\RSE ( MACUL> DEG5],N IS
62COME WORSE1 B ? IS N 9EVITA#1 & PRO-
GRES.N MAY 2 Q SL[4 ,UN=TUNATELY1 ESPE-
CI,Y 9 ! WET OR NEOVASCUL> TYPE1 "! MAY
2 SU45 WORS5+4 ,"! >E TYPIC,Y 8GD "DS0 &
8BAD "DS0 = ^? ) MACUL> DEG5],N1 & G5]AL
V>I,N ( VI.N1 A6ECT$ 0LI<T+ & "T ( "D4
,5JOY ! 8GD "DS10 IF Y H MACUL> DEG5],N4
,IF ! VI.N GETS WORSE1 X IS N ! PATI5T'S
FAULT F TRY+ 6R1D OR US+ ! EYES TOO M*4
,! BE/ "O C D IS 6SEEK GD PROFES.NAL AD-
VICE4 ,IF A PATI5T WANTS 6EXPLORE ALL
AV5UES1 WE ( C\RSE F/ S5D !M 6A RET9AL
SPECIALI/4 ,R\T9E EXAM9,NS1 E TWO YE>S
AF AGE =TY1 >E RECOMM5D$4 ,IF ! VI.N IS
NORMAL1 !N "! IS NO MACUL> DEG5],N1 EV5
)A FAMILY HI/ORY (! PRO#M4 ,IF ! VI.N IS
N NORMAL1 & ANO!R R1SON _C 2 F.D1 !N A
RET9AL SPECIALI/ MAY 2 3SULT$4      #BBD
,H["E1 EV5 ?\< 3C]N$                C#IJ
-------------------------------------#IA
DUE 6A FAMILY HI/ORY ( MACUL> DEG5],N1 X
IS N NEC OR PRACTICAL = ALL S* P 6BE SE5
0A RET9AL SPECIALI/ =A R\T9E EXAM9,N4
  ,"! >E O!R LESS -MON PRO#MS T C A6ECT
C5TRAL OR R1D+ VI.N1 & : C 2 3FUS$ )
MACUL> DEG5],N1 B MAY 9VOLVE DI6]5T =MS
( TR1T;T4 ,CY/OID MACUL> $EMA IS AN O3A-
.NAL -PLIC,N ( CAT>ACT SURG]Y1 : C 2
TRANSI5T & C 2 TR1T$4 ,A MACUL> 8HOLE0 C
DEVELOP SPONTANE\SLY1 EV5 9 "Y] AGE4 ,!
DEGREE ( VISUAL DEFECT F ? C V>Y1 & SUR-
G]Y MAY 2 RECOMM5D$ 9 SEV]E CASES4 ,MAC-
UL> HOLE IS USU,Y MONOCUL>1 & IS N !
S\RCE (A RET9AL DETA*;T1 L : C RESULT F
HOLES ELSE": 9 ! RET9A4 ,AL1 A MEMBRANE
MAY GR[ OV] ! MACULA1 CALL$ AN EPIRET9AL
MEMBRANE OR CELLOPHANE RET9OPA?Y1 SPON-
TANE\SLY OR Z A RESULT ( 9FLAMM,N 9 !
EYE4 ,TR1T;T DEP5DS ON SEV];Y ( A6ECT ON
VI.N1 & 9VOLVES SURGICAL REMOVAL (! VIT-
RE\S 7VITRECTOMY71 ) PEEL+ ! MEMBRANE (F
! RET9A MICROSCOPIC,Y4 ,-PLETE RECOV]Y
_C 2 GU>ANTE$1 B SPONTANE\S         #BBE
RECOV]Y IS N UN"KN4 ,C5TRAL S]\S    A#IA
RET9OPA?Y A6ECTS "Y MALES1 & IS DESCRIB$
9 ,*APT] #AD4
  ,! H]$IT>Y 9VOLVE;T 9 MACUL> DEG5],N
IS AN >EA ( 9T5SE RESE>*1 ) "S 9T]E/+
RESULTS4 ,! G5ETIC LOCALIZ,N (! PRO#M
RAISES "QS Z 6ETIOLOGY1 & AL "QS AB EV5-
TUAL G5E !RAPY4 ,? C]TA9LY WD 2 A BIG
REW>D 6^? 9VOLV$ 9 S* RESE>*1 B SEEMS TO
2 "S?+ N =ESE5 9 ! NE> FUTURE4














                                    #BBF
               ,,"P ,,IV          #IB-IE
          ,,SPECIAL ,,3SID],NS

                  #AB
             ,VISUAL ,AIDS

,SUBNORMAL VI.N C 2 HELP$ BY 8VISUAL
AIDS40 ,^! >E MA9LY MAGNIFY+ DEVICES1 (-
T5 AID$ 0GD LI<T+4 ,"S GD V>I,NS 9CLUDE
L>GE-SCRE5 MAGNIFY+ ,,TV OR -PUT] MONI-
TORS1 : C 2 US$ 6R1D LRS & BOOKS4 ,"! >E
SPECIAL ME?ODS 6AID 9 WALK+ &! USE (
SEE+-EYE DOGS4 ,SPECIAL C\RSES & AIDS C
HELP 9 SELF-C>E1 COOK+1 & -PUT] USE4 ,!
,BRL ,SOCIETY IS GD = EVALUAT+ P ) AC-
QUIR$ ADULT VI.N LOSS = VISUAL AIDS1 :
IS USU,Y A TRIAL-&-]ROR PROCESS1 & N J
6T1* ,BRL4 ,X IS ACTU,Y Q DI6ICULT = "S-
"O 6LE>N ,BRL IF ! P]SON ONCE _H FAIRLY
GD VI.N1 ESPECI,Y AN ADULT4 ,"! IS A
HUGE DI6];E 2T 2+ 8LEG,Y BL0 F "S?+ L
MACUL> DEG5],N1 :5 USU,Y "O C C>E =
!MVS1 & "S"O ^: VI.N IS S POOR Z 6QUALI-
FY =A SEE+-EYE DOG4
  ,"! IS (T5 3FU.N AB ! LIMIT,N (   #BBG
GLASSES 9 HELP+ ^? ) POOR VI.N4     A#IE
,"O MAY ?9K T X %D 2 POSSI# 6MAKE GLASS-
ES Z /R;G Z A MAGNIFY+ GLASS4 ,H["E1 ! M
! MAGNIFIC,N1 ! CLOS] "O HAS 6HOLD ?+S
6BE 9 FOCUS1 & P DON'T L HOLD+ R1D+ MA-
T]IAL UP 6_! NOSE4 ,USUAL FULL-/R5G?
R1D+ GLASSES1 REQUIR$ 0^? ( U 9 \R SIX-
TIES & 2Y1 & TAK+ 96A3.T T 4T.E VI.N IS
EI GD OR CORRECT$ 0GLASSES1 >E @+#B.E
DIOPT]S4 ,? ALL[S ^? ) NORMAL VI.N 6R1D
SMALL PR9T AT #A_/D MET] OR #AF 9*ES1 &
? IS CLOS] ?AN _M WD L 6H 6HOLD ?+S4 ,=
SUBNORMAL VI.N1 A @+#C MAY 2 TOL]AT$1 )A
FOCAL 4T.E ( #A_/C MET] 7#AC 9*ES71 OR
AT MO/ A @+#D ) AB A #AJ-9* "W+ 4T.E4
,H["E1 M MAGNIFIC,N 6ALL[ SEE+ SMALL
PR9T MAY N 2 TOL]A#1 2C ( HAV+ 6HOLD ?+S
TOO CLOSE4
  ,BL;S F 3G5ITAL R1SONS IS TRAGIC1 B
APP>5TLY N S BAD Z 3G5ITAL D1F;S 9 RE-
T>D+ LE>N+4 ,"! >E1 ( C\RSE1 DEGREES (
VISUAL H&ICAP1 & _M *N ) VISUAL PRO#MS C
GET "? PRIM>Y $UC,N FAIRLY WELL1 ) AS-
SI/.E4 ,! PR9T 9 *N'S BOOKS IS USU,Y
RELATIVELY L>GE1 & ? HELPS4 ,!      #BBH
-PUT] AGE HAS PROBABLY HELP$        B#IE
-------------------------------------#IF
AL1 0PRES5T+ L>G] PR9T4 ,MO/ /ATES H
SPECIAL $UC,N FACILITIES =! BL4 ,9 MY
HOME /ATE ( ,I[A1 "! IS A S*OOL =! BL4
,L>G] /ATES H LOCAL SPECIAL PRIM>Y
S*OOLS ) SPECIAL FACILITIES = ^? )A VI-
SUAL H&ICAP4 ,I 0 IMPRESS$ 0A /ATE;T
MADE 0! S*OOL NURSE AT ! ,I[A ,S*OOL =!
,BL4 ,%E DESCRIB$ A SORT ( CA/E SY/EM
BAS$ ON H[ WELL A * CD SEE4 ,! 8,SI<T
,SAV]S0 7 *N :O _H "S VI.N1 AT L1/ 5 TO
GET >.D4 ,! 8,BRLS0 7 *N ) LL OR NO VI-
.N4 ,2+ A ,SI<T ,SAV] APP>5TLY RESULT$ 9
A L1D]%IP /ATUS1 EA* ,SI<T ,SAV] L1D+ "O
OR TWO ,BRLS1 2T CLASSES1 6_! NEXT AS-
SIGN;T4 ,H["E1 %E PO9T$ \ T ! ,BRLS 7 !
BETT] /UD5TS4 ,!Y A3EPT$ _! PRO#M &
LE>N$ ,BRL S Z 62COME $UCAT$4 ,! ,SI<T
,SAV]S TOO (T5 APP>5TLY TRI$ 6FOOL O!RS1
& Z A RESULT MA9LY !MVS1 96?9K+ T !Y CD
D ! S*OOL "W )\T LE>N+ ,BRL4
  ,TELESCOPIC L5SES >E AVAILA# Z A 4T.E
AID = HELP ) MOVIES OR !AT]4 ,"! >E EV5
S* TELESCOPIC AIDS = DRIV+ A C>1    #BBI
APPROV$ 9 "S /ATES1 B ^! C 2 Q      A#IF
DANG]\S DUE 6RE/RICT$ SIDE VI.N4 ,ANO!R
PRACTICAL PO9T IS T ^? BL9D$1 = :AT"E
R1SON1 / WANT 6WE> _! GLASSES4 ,TRUE1 !
GLASSES MAY 2 ( LL1 IF ANY1 HELP4 ,N"E!-
.S1 BL P :O >E US$ 6WE>+ GLASSES W (T5
WANT 63T9UE 6D S4 ,_! GLASSES NE$ 6BE
UPGRAD$ :5 WORN \1 EV5 IF X IS A MATT] (
DUPLICAT+ :AT !Y H BE5 WE>+4 ,!Y MAY
FEEL ALM NAK$ )\T ! GLASSES1 &! GLASSES
PROBABLY D GIVE "S VISUAL AID 9 C]TA9
CASES4
  ,AM;G ! MO/ DRAMATIC VISUAL AIDS
AVAILA# >E ! ,,TV &! -PUT]1 ":BY PR9T C
2 S 5L>G$ T A P]SON ) LIMIT$ VI.N C R1D
A LR OR PAY BILLS4 ,I H HE>D (A ,MICRO-
S(T PROGRAM CALL$ ,ZOOM ,TEXT1 : C 5L>GE
PR9T1 B M IMPORTANTLY HAS AL A PROGRAM
":BY :AT APPE>S ON ! PR9T$ PAGE C 2 R1D
AL\D1 CALL$ ,DOC 7DOCU;T7 ,R1D]4 ,S* VI-
SUAL AIDS >E R EXP5SIVE B GRTLY APPRECI-
AT$4
  ,"S PATI5TS ASK1 8,WELL1 DOCTOR1 :Y
C'T Y J TRANSPLANT ME A NEW EYE80 ,I RE-
PLY T ! EYE IS L BRA9 TISSUE1 T     #BCJ
WE W 2 A# 6TRANSPLANT EYES AB :5    B#IF
WE 2COME A# 6TRANSPLANT BRA9S1 & T WE H
A RE,Y L;G LI/ ( P :O NE$ A NEW BRA94
,L[-VI.N SPECIALI/S >E AVAILA# AM;G OPH-
?ALMOLOGI/S & OPTOMETRI/S1 :O C "W ) P
VISU,Y 4A#D4


















                                    #BCA
                                    C#IF























                                    #BCB
                  #AC                #IG
               ,DIABETES

,DIABETES MELLITUS IS TYPE ,I IF 9SUL9
IS REQUIR$1 & TYPE ,,II IF 3TROLL$ 0ORAL
M$IC,N OR DIET 7NON-9SUL9-DEP5D5T74 ,9
BO? TYPES1 -PLIC,NS 9VOLV+ ! EYES C OC-
CUR1 ?\< M LIKELY ) TYPE ,I4 ,R>ELY1 B
"S"TS1 EYE EXAM C TRI7] ! DIAGNOSIS4 ,=
EXAMPLE1 2COM+ NE>SI<T$ R RAPIDLY1 :5 N
2+ S 2F1 C 2 DUE 6HI< BLOOD SUG>4 ,!N1
:5 9SUL9 TR1T;T IS UTILIZ$1 FOLL[+ DIAG-
NOSIS1 A %IFT T[>D AN UNUSUAL DEGREE (
F>SI<T$;S C O3UR4 ,C]TA9LY1 :5 ! REFRAC-
TIVE ]ROR OR NE$ = GLASSES IS B\NC+ >.D1
X IS BE/ 6PO/P"O A *ANGE 9 GLASSES UNTIL
! BLOOD SUG> IS /ABILIZ$4 ,I H EV5 SE5
S* A %IFT O3UR FOLL[+ RAPID WEI<T LOSS
9VOLV$ 9 TR1T+ DIABETES1 B G5],Y ! BLOOD
SUG> %IFT CAUS+ A *ANGE 9 VI.N DUE 6NE$
=A *ANGE 9 GLASSES IS RELAT$ 6TYPE ,I1
OR 9SUL9-REQUIR$1 DIABETES4 ,9 T]MS (!
4COV]Y ( DIABETES1 X IS AL "S"TS TRUE T
! 4COV]Y ( PO/]IOR SUBCAPSUL> CAT>ACT 9
A "Y]-?AN-USUAL PATI5T1 C SU7E/     #BCC
LAT5T DIABETES1 Z ,I H EXP]I;ED     A#IG
)A FEW PATI5TS :O 7 TOLD 0ME 6GET TE/$ =
DIABETES4 ,O!RWISE1 ! EYE DOCTOR IS N
USU,Y ! F/ 6DIAGNOSE DIABETES4
  ,! USUAL R1SON 6ADVISE DIABETICS ( ALL
TYPES 6GET ANNUAL EYE EXAM9,NS IS 6LOOK
= :AT IS CALL$ DIABETIC RET9OPA?Y4 ,DIA-
BETIC RET9OPA?Y AM.TS 6/]EOTYPICAL RETI-
NAL HEMORRHAGES & EXUDATES1 OR MACUL>
$EMA4 ,^! H S* A UNIQUE APPE>.E Z 6SU7E/
DIABETES1 )\T A HI/ORY4 ,"! MAY AL 2 A
VITRE\S HEMORRHAGE RESULT+ F DIABETES4
,USU,Y X TAKES SEV5 6T5 YE>S 2F RET9OPA-
?Y O3URS1 & :5 EVID5T SOON]1 X MAY SU7E/
! PATI5T 0 DIABETIC L;G] ?AN SUSPECT$4
,S* RET9OPA?Y C 2 TR1T$ ) LAS] 6AVOID
PROGRESS4 ,=TUNATELY DIABETIC RET9OPA?Y
IS N 9EVITA#4 ,NATUR,Y1 X C 2 ASSUM$ T
GD 3TROL ( DIABETES LESS5S ! *.E ( RETI-
NOPA?Y1 B UN=TUNATELY "! IS NO GU>ANTEE
( IMMUN;Y F RET9OPA?Y 9 DIABETICS4
,TR1T;T ( ASSOCIAT$ HYP]T5.N MAY AL DI-
M9I% *.ES ( DIABETIC RET9OPA?Y4
-------------------------------------#IH
  ,DIABETIC RET9OPA?Y C A3OMPANY    #BCD
O!R EYE 41SES1 & C MAKE X DI6I-     A#IH
CULT 6GAUGE ! SEV];Y ( EA* -PON5T (! VI-
SUAL PRO#M4 ,= EXAMPLE1 DIABETICS GET
9VOLVE;T (! MACULA1 & SPECIAL TE/+ MAY 2
NEC 6EXCLUDE MACUL> DEG5],N ( O!R ORIG94
,AL1 CAT>ACTS >E -MON1 EI ! AGE-RELAT$
V>IETY OR ! TYPE CAUS$ 0DIABETES4 ,! OB-
SCUR+ (! 9SIDE (! EYE DUE 6CAT>ACTS MAY
MAKE X DI6ICULT 6EVALUATE ! DEGREE (
RET9OPA?Y1 Z WELL Z 6P]=M NE$$ LAS]
TR1T;TS4 ,S EV5 IF WE >E N SURE T CATA-
RACT IS ! MA9 CAUSE ( LOSS ( VI.N1 A
BETT] ABIL;Y 6EVALUATE ! RET9A = DIABET-
IC RET9OPA?Y ) CLE>] VIEW FOLL[+ CAT>ACT
EXTRAC;N MAY 2 EXPECT$4 ,-PLICAT+ ! DE-
CI.N = SURG]Y1 H["E1 IS ! "KN FACT T DI-
ABETIC RET9OPA?Y FREQU5TLY TAKES A *ANGE
=! WORSE FOLL[+ CAT>ACT SURG]Y4 ,3SID]+
ALL ! FACTORS1 & PRES5T+ !M 6! PATI5T1
IS "O (! MAJOR JOBS (! OP]AT+ OPH?ALMOL-
OGI/4



                                    #BCE
                                    B#IH























                                    #BCF
                  #AD                #II
   ,NEUROLOGIC ,3DI;NS ,A6ECT+ ,VI.N

,! EYE IS A NEUROS5SORY ORGAN1 AN EXT5.N
(! BRA94 ,X C 2 A6ECT$ 0_M NEUROS5SORY
OR NEUROLOGICAL 41SES4

      ,CAUSES ( ,SU45 ,VI.N ,LOSS

    ,VASCUL> ,O3LU.N
  ,VASCUL> O3LU.N C 2 (! C5TRAL >T]Y OR
VE9 OR BRAN*ES ( ^!4 ,IF C5TRAL1 M1N+ !
MA9 L>GE >T]Y 5T]+ OR ! L>GE VE9 L1V+ !
EYE1 VI.N LOSS IS SEV]E1 &! PROGNOSIS IS
POOR = REGA9+ USE;L VI.N4 ,X IS "S"TS
CALL$ A 8/ROKE0 (! EYE1 PROP]LY SU7E/+ !
FACT T X HAS 6D ) CIRCUL,N (! EYE : C
SU45LY 2 CLOS$ (F1 Z 9 A BRA9-ATTACK-
TYPE /ROKE1 & T FUNC;N MAY N RETURN4 ,(
C\RSE1 X IS LIMIT$ 6! EYE1 S D N PUT ON
A DRIV]'S LIC5SE =M T Y _H A /ROKE FOL-
L[+ S* AN EPISODE1 OR !Y MAY D5Y ! LI-
C5SE EV5 :5 ! O!R EYE SEES WELL4 ,9 C5-
TRAL RET9AL VE9 ?ROMBOSIS1 SECOND>Y
GLAUCOMA MAY DEVELOP )9 N9ETY       #BCG
"DS1 : C 2 PA9;L & DI6ICULT TO      A#II
TR1T4 ,RECOV]Y ( VI.N LOSS MAY O3UR 9
BRAN* VESSEL O3LU.N1 M1N+ T ONLY A BRAN*
(! MA9 VESSEL IS 9VOLV$4 ,"S"TS1 A
PLAQUE ( *OLE/]OL C 2 SE5 BLOCK+ AN >-
T]Y1 & ? SU7E/S C>OTID >T]Y 41SE ON T
SIDE4 ,? F9D+1 ( C\RSE1 IS Q SIGNIFI-
CANT4 ,A /ROKE A6ECT+ ! BRA9 CD O3UR
LAT] S9CE ! PRES;E (! PLAQUE 9 ! EYE
SU7E/S T ANO!R PLAQUE CD 9 ! FUTURE BR1K
(F F ! MA9 C>OTID >T]Y 6BLOCK A VESSEL 9
! BRA94
  ,TRANSI5T VI.N LOSS1 F ABV OR 2L1 Z IF
A W9D[ BL IS DRAWN & !N AG RETRACT$1 IS
CALL$ .AMAUROSIS .FUGAX4 ,? SU7E/S C>OT-
ID >T]Y 41SE & CD W>N ( POT5TIAL VASCUL>
O3LU.N 9 "O EYE1 OR1 Z M5;N$1 EV5 A
/ROKE4 ,IF Y GET S* SYMPTOMS ( TRANSI5T
VI.N LOSS1 Y %D SEE YR EYE DOCTOR4
------------------------------------#AJJ
    ,IS*EMIC ,OPTIC ,NEUROPA?Y
  ,IS*EMIC OPTIC NEUROPA?Y 7,,ION7 IS A
PRO#M O3URR+ USU,Y 9 OLD] P1 ESPECI,Y ^?
) HYP]T5SIVE >T]IOSCL]OTIC VASCUL> 41SE1
OR DIABETICS1 ":BY SU45 LOSS (      #BCH
VI.N C O3UR 6A NOTICEA# DEGREE1    A#AJJ
OR EV5 ALM -PLETE LOSS ( VI.N4 ,X IS
PA9.S & )\T W>N+4 ,TYPIC,Y1 VISUAL FIELD
TE/+ MAY %[ LOSS (! UPP] OR L[] HALF (
VI.N1 B FIELD LOSS MAY V>Y 6EV5 -PLETE
EXT+UI%+ ( VI.N4 ,PROGNOSIS IS POOR =
VISUAL RECOV]Y1 & ?\< WE D N "U/& ! ME*-
ANISM (! LOSS ( VI.N1 WE "K T ! O!R EYE
MAY 2 AT RISK AT "S FUTURE DATE4 ,NON>-
T]ITIC IS*EMIC OPTIC NEUROPA?Y 7,,NAION7
IS ! T]M US$ 6DESCRIBE ,,ION1 Z -P>$ )
TEMPORAL >T]ITIS1 : IS 9FLAMMATORY &1
"!=E1 >T]ITIC4 ,? T]M1 ,,NAION1 IS US$ 9
REF];E 6A 4CUS.N (! SU45 LOSS ( VI.N AS-
SOCIAT$ )! USE ( ,VIAGRA & O!R S* M$I-
C9ES4 ,,NAION USU,Y O3URS )9 A %ORT 9T]-
VAL 7H\RS7 AF US+ S* M$IC,NS1 IF DUE 6S*
USE1 & %D W>N T ! PRO#M MAY O3UR 9 ! O!R
EYE %D "! 2 3T9U$ USE (! M$IC9E4

    ,TEMPORAL ,>T]ITIS
  ,TEMPORAL >T]ITIS IS AL CALL$ CRANIAL
>T]ITIS & CAUSES >T]ITIC OPTIC NEUROPA-
?Y4 ,! SIGNS A6ECT+ ! EYE 9VOLVE SU45
VI.N LOSS ASSOCIAT$ USU,Y )         #BCI
T5D];S (! TEMPORAL >T]Y >EA ON T   B#AJJ
SIDE (! H1D1 & (T5 JAW A*E4 ,"! MAY 2
H1DA*ES AL1 & O!R S]I\S NEUROLOGICAL
-PLIC,NS C FOLL[1 S9CE O!R >T]IES 9 !
BRA9 C 2 9VOLV$4 ,DIAGNOSIS C 2 HI<LY
SU7E/$ 0! ELEVAT$ S$I;T,N RATE ( BLOOD &
3FIRM$ 0A TEMPORAL >T]Y BIOPSY4 ,TEMPO-
RAL >T]ITIS NE$S TR1T;T ) ORAL /]OIDS1
(T5 ON AN EM]G5CY BASIS4 ,"S VISUAL RE-
COV]Y MAY O3UR1 B ! *IEF R1SON = URG5T
TR1T;T IS 6PROTECT ! O!R EYE1 &( C\RSE
6AVOID LIFE-?R1T5+ -PLIC,NS4 ,! R1SON =!
T]M CRANIAL >T]ITIS IS T O!R VESSELS 9 !
BRA9 >E LIKELY 9VOLV$4 ,A S$I;T,N RATE
TE/ ( BLOOD C PREDICT H[ ACTIVE OR SEV]E
IS ! PRO#M & IS US$ Z A SIGN ( SU3ESS (
TR1T;T1 ACUTELY &= L;G-T]M MANAGE;T4 ,!
USE ( ORAL /]OIDS C !N 2 TITRAT$ AC 6!
S$I;T,N RATE1 & IF X %[S SIGNS ( RIS+
AG1 ! ORAL /]OIDS C 2 RESUM$4

    ,OPTIC ,NEURITIS
  ,OPTIC NEURITIS C 2 F V>I\S CAUSES1 B
! MO/ -MON & /RIK+ EXAMPLE IS ASSOCIAT$
) MULTIPLE SCL]OSIS 7,,MS74 ,9      #BDJ
FACT1 ? MAY PRES5T Z ! F/ SYMP-    C#AJJ
TOM ( ,,MS &1 "!=E1 9 "Y] P4 ,VI.N MAY 2
SEV]ELY & SU45LY LO/ B USU,Y AL RECOV]S
9 "P1 OR ALM -PLETELY4 ,USU,Y ONLY "O
EYE IS 9VOLV$ 9 ! 9ITIAL ATTACK4 ,RECOV-
]Y C O3UR SPONTANE\SLY B IS AID$ 0CORTI-
CO/]OID TR1T;T4 ,9TRAV5\S /]OIDS >E PRE-
F]R$ 6ORAL1 HAV+ 6D ) LESS5+ (! POT5TIAL
DEVELOP;T ( O!R SYMPTOMS4 ,TR1T;T & CON-
FIRM,N ( DIAGNOSIS IS
------------------------------------#AJA
BE/ MANAG$ 0A NEUROLOGI/4 ,9 YE>S PA/1
E>LY DIAGNOSIS ( ,,MS 0 "O ( EXCLU.N1
M1N+ T ! SUSPICION IS HI<1 B NO TE/S C
3FIRM4 ,N[ MAGNETIC RESON.E IMAG+
7,,MRI7 TE/S (! BRA9 C DETECT PLAQUES1
SU7E/+ ,,MS Z A POSITIVE DIAGNOSIS4 ,VI-
SUAL FIELD ABNORMALITIES MAY 4APPE>1 )!
ONLY LATE SIGN 2+ PALE;S (! OPTIC N]VE1
"S?+ T MAY 2 OV]LOOK$1 )\T HI/ORY4

    ,VITRE\S ,HEMORRHAGE
  ,VITRE\S HEMORRHAGE IS (T5 SPONTANE\S
& MAY 2 F A CAUSE UN"KN4 ,X IS N A NEU-
ROLOGY PRO#M1 B IS "O (! CAUSES (   #BDA
SU45 LOSS ( VI.N4 ,DEP5D+ ON !     A#AJA
SEV];Y ( HEMORRHAGE1 VI.N MAY 2 CL\D$
"PI,Y1 OR ALM -PLETELY BLACK$ \4 ,H["E1
S* HEMORRHAGE MAY AL 2 "P (A RET9AL TE>
L1D+ 6RET9AL DETA*;T1 OR1 M -MONLY1 A
-PLIC,N ( DIABETES4 ,IF MILD OR UNCOM-
PLICAT$1 ! VITRE\S HEMORRHAGE C SPONTA-
NE\SLY CLE> ) "T4 ,IF SEV]E1 OR IF A3OM-
PANY+ RET9AL DETA*;T1 ! BLOOD C 2 REMOV$
0VITRECTOMY SURG]Y4 ,Z TRUE ( O!R CAUS-
ES1 S* SU45 LOSS ( VI.N DEM&S URG5T EX-
AM9,N 0AN EYE DOCTOR4

       ,O!R ,NEUROLOGICAL ,PRO#MS

  ,"! >E A GRT _M NEUROLOGICAL PRO#MS T
MANIFE/ !MVS 9 EYE SYMPTOMS1 & "H >E A
FEW M4

    ,OPTIC ,N]VE ,PRO#MS
  ,! OPTIC N]VE1 CRANIAL N]VE ,,II1 L
O!R CRANIAL N]VES1 ORIG9ATES DIRECTLY F
! BRA91 Z A =W>D EXT5.N (! BRA94 ,SWELL+
(! OPTIC N]VE C 2 DUE 6PAPILL$EMA1 PAP-
ILLITIS1 OR PSEUDOPAPILL$EMA4       #BDB
,TRUE PAPILL$EMA1 A SWELL+ (!      B#AJA
OPTIC N]VE1 VISI# 9 AN 9TRAOCUL> EYE EX-
AM9,N1 MAY SIGNIFY 9CR1S$ 9TRACRANIAL
PRESSURE F V>I\S CAUSES4 ,= EXAMPLE1 X C
O3UR AF AN 9JURY 9VOLV+ 9TRACRANIAL HEM-
ORRHAGE1 OR A BRA9 TUMOR4 ,X C AL O3UR 9
A M 2NIGN 3DI;N CALL$ PSEUDOTUMOR C]E-
BRI4 ,PAPILLITIS IS A SWELL+ (! OPTIC
N]VE DUE 69FLAMM,N4 ,DI6]5TIAL DIAGNOSIS
9VOLVES ! FACT T VI.N IS USU,Y REDUC$ )
PAPILLITIS1 ":AS X IS (T5 NORMAL ) PAP-
ILL$EMA4 ,AL1 A VISUAL FIELD TE/ W USU,Y
%[ A C5TRAL DEFECT ) PAPILLITIS1 & MAY 2
NORMAL EXCEPT = AN 5L>G$ BL SPOT ) PAP-
ILL$EMA4
  ,"! C 2 A V>I,N (! APPE>.E (! OPTIC
N]VE4 ,= EXAMPLE1 F>SI<T$ P TYPIC,Y H
FLAT 6SLI<TLY SWOLL5-APPE>+ OPTIC N]VES4
,PSEUDO*OKE IS A T]M US$ = SITU,NS ": !
OPTIC N]VE APPE>S SWOLL51 B ACTU,Y IS N4
,"O CAUSE (A PSEUDO*OKE IS DRUS5 (! OP-
TIC N]VE1 2NIGN CY/IC BULGES1 : C CAUSE
SWELL+ (! OPTIC N]VE1 & USU,Y D N A6ECT
VI.N1 ?\< "S SIGN C 2 DEMON/RAT$ 9 VISU-
AL FIELD TE/+4 ,9 ! EXAM1 !         #BDC
APPE>.E ( SPONTANE\S V5\S PULS,N   C#AJA
ON
------------------------------------#AJB
! N]VE C REASSURE T "! IS NO 9CR1S$ IN-
TRACRANIAL PRESSURE4 ,B UN=TUNATELY X IS
N UNI=M T A PULS,N (! VE9 IS NORM,Y
PRES5T1 & X WD TAKE 9=M,N F A =M] EXAM
6PROVE T ! PULS,N _H BE5 *ANG$ F SPONTA-
NE\S PULS,N 6NO PULS,N4
  ,! OPTIC N]VE IS PROBABLY MO/ -MONLY
9VOLV$ 9 OP5-ANGLE GLAUCOMA1 ":1 9 REC5T
!ORY1 ! MA9 PRO#M (! 41SE SU7E/S UNUSUAL
S5SITIV;Y (! OPTIC N]VE 69TRAOCUL> PRES-
SURE4 ,! RESULT IS ! OPPOSITE ( SWELL+ (
! N]VE2 ! OPTIC N]VE ACTU,Y 2COMES
8CUPP$0 OR EXCAVAT$4 ,"H AL1 H["E1 "! IS
GRT V>I,N1 : C 2 NORMAL4 ,= EXAMPLE1
3TR>Y 6F>SI<T$ P :O USU,Y H FLAT-APPE>+
OPTIC N]VES1 NE>SI<T$ P USU,Y H "S CUPP+
(! N]VE4 ,*ANGE 9 CUPP+ NOT$ ON REP1T
EXAMS IS Q SIGNIFICANT 9 SU7E/+ ! NE$ =
TE/+ = GLAUCOMA1 EV5 ) L[] 9TRAOCUL>
PRESSURE4
  ,! OPTIC N]VE1 L O!R CRANIAL N]VES1
-ES DIRECTLY F ! BRA94 ,"!=E1       #BDD
CLAIMS MADE1 Z 9 ! PA/1 0*IRO-     A#AJB
PRACTORS1 T SP9AL ADJU/;T C HELP ! EYES1
>E TOT,Y N SUPPORT$ ANATOMIC,Y4

    ,MULTIPLE ,SCL]OSIS 7,,MS7
  ,"S"TS EYE SYMPTOMS >E ! F/ SIGNS (
,,MS2 AB "O-?IRD ( ,,MS PATI5TS PRES5T )
OPTIC NEURITIS Z ! F/ SIGN4 ,AB #EJ P]-
C5T ( ,,MS PATI5TS W DEVELOP OPTIC NEU-
RITIS4 ,SU45 VI.N LOSS 9 A "Y] PATI5T1
TYPIC,Y A WOMAN 9 H] ?IRTIES1 9 "O EYE1
C 2 ! F/ SYMPTOM ( ,,MS1 CALL$ RETROBUL-
B> NEURITIS4 ,X IS CALL$ RETROBULB> 2C !
N]VE SWELL+ IS 2H ! EYE1 & "!=E DOES N
CAUSE VISI# SWELL+ (! N]VE4 ,OCUL> SIGNS
9CLUDE REDUC$ VI.N1 VISUAL FIELD DEFECT1
& :AT IS CALL$ AN A6]5T PUPIL DEFECT 7!
PUPIL DOES N REACT NORM,Y 6LI<T74
  ,SPONTANE\S IMPROVE;T C 2 EXPECT$ F
RETROBULB> NEURITIS DUE 6,,MS1 EV5 RE-
TURN 6NORMAL VI.N & RETURN 6NORMAL VISU-
AL FIELD TE/ 9 AB #HE P]C5T ( PATI5TS4
,! ONLY LA/+ SIGN MAY 2 A SLI<T PALE;S (
! OPTIC N]VE APPE>.E4 ,! USE ( /]OIDS
MAY SPE$ UP RECOV]Y1 B REC5T        #BDE
REPORTS SU7E/ T S* TR1T;T MAY      B#AJB
L1D 6O!R SYMPTOMS M QKLY ?AN IF SPONTA-
NE\S IMPROVE;T IS ALL[$ 6HAPP54 ,X IS
HELP;L =A NEUROLOGI/ 6MAKE ? DECI.N1 &
69T]PRET O!R TE/S S* Z AN ,,MRI4 ,AN
,,MRI C HELP E/ABLI% DIAGNOSIS ( E>LY
,,MS4 ,LAT]1 9 MO/ CASES UN=TUNATELY1
O!R SIGNS ( ,,MS C APPE> 63FIRM ! DIAG-
NOSIS4 ,A NEUROLOGI/ MAY USE IMMUNOMUDU-
LATORY AG5TS SPECIFIC = ,,MS 6REDUCE !
NUMB] & SEV];Y ( EV5TUAL EPISODES4

    ,D\# ,VI.N 7,DIPLOPIA7
  ,D\# VI.N MAY N 2 F A S]I\S CAUSE1 ES-
PECI,Y IF ( L;G DUR,N & 3TROLLA# 0PRISMS
9 GLASSES4 ,H["E1 IMAGES CLOSE TGR >E M*
M ANNOY+ ?AN IMAGES M SEP>AT$ S Z 65A#
63C5TRATE ON J "O (! IMAGES ) LESS 3FU-
.N4 ,NEUROLOGICAL CAUSES >E MULTIPLE1
9CLUD+ /ROKE1 ,,MS1 OR MYAS!NIA GRAVIS4
,(T5 ! CAUSE IS
------------------------------------#AJC
DUE TO 8IS*EMIA10 OR CAUSE UN"KN1 FOLL[$
0SPONTANE\S RECOV]Y4 ,! CAUSE ( IS*EMIA
CD 2 DIABETES1 HYP]T5.N1            #BDF
>T]IOSCL]OSIS1 OR A CAUSE -MONLY   A#AJC
UN"KN4

    ,SIX? ,N]VE ,PALSY
  ,! SIX? N]VE1 ! ABDUC5S N]VE1 HAS !
L;GE/ 9TRACRANIAL C\RSE1 & IS MO/ -MONLY
A6ECT$ 0AN 9TRACRANIAL 9JURY S* Z BLUNT
H1D TRAUMA4 ,X AL C 2 9VOLV$ 9 SPONTANE-
\S "PIAL P>ALYSIS ( S-CALL$ IS*EMIC
CAUSE 7M1N+ CAUSE UN"KN71 M -MONLY ) AD-
VANC+ AGE4 ,S9CE ! SIX? N]VE 5]VATES !
LAT]AL RECTUS MUSCLE1 ! "O T PULLS ! EYE
T[>D ! E>1 "PIAL OR TOTAL P>ALYSIS RE-
SULTS 9 ! PATI5T 2+ CROSS-EY$4 ,DIPLOPIA
IS LOOK+ M 6! SIDE (! A6ECT$ N]VE &
LESS1 OR P]H N AT ALL1 6! O!R SIDE4 ,?
RESULTS 9 A H1D TURN 6AVOID D\# VI.N4
,S9CE DIPLOPIA IS GRT] 6"O SIDE1 PRISMS
9 GLASSES >E N S HELP;L4 ,H["E1 ! TEMP-
T,N 6COV] OR PAT* "O EYE %D 2 AVOID$1 IF
! H1D TURN AVOIDS DIPLOPIA4 ,? IS 2C
SPONTANE\S RECOV]Y IS ! GRTE/ EXPECT,N1
& PAT*+ "O EYE W DELAY RECOV]Y4
  ,? IS A SITU,N AL ": PHYSICAL !RAPY1 L
EYE EX]CISES1 MAY TAKE FALSE        #BDG
CR$IT = RECOV]Y1 :5 SPONTANE\S     B#AJC
RECOV]Y IS 6BE EXPECT$ ANYWAY4 ,ACTU,Y1
! EYE MUSCLES 3TROLL+ EYE MOVE;T >E #AJJ
"TS /R;G] ?AN NE$$ =! JOB4 ,H["E1 COOR-
D9,N /IMULAT$ 0N]VE IMPULSE IS ( PRIM>Y
IMPORT.E 9 AVOID+ DIPLOPIA & PROMOT+ /]-
EOPTIC VI.N4 ,X PROBABLY WD TAKE MON?S (
TOTAL P>ALYSIS 2F ! RECTUS MUSCLES RO-
TAT+ ! EYE WD %[ SIGNIFICANT SIGNS ( AT-
ROPHY 7W1K;S74 ,SURG]Y C 2 D"O1 B OBVI-
\SLY A L;G DELAY %D O3UR 2F MAK+ ? DECI-
.N1 DUE 6HI< EXPECT,N ( IMPROVE;T 9 MO/
CASES4

    ,F\R? ,N]VE ,PALSY
  ,! F\R? CRANIAL N]VE IS CALL$ ! TRO*-
LE> N]VE1 & X 9N]VATES ! SUP]IOR OBLIQUE
MUSCLE4 ,! SUP]IOR OBLIQUE MUSCLE MAY 2
A6ECT$ 09JURY1 ESPECI,Y IF 6! >EA (! OR-
BIT T[>D ! NOSE1 ": ! MUSCLE IS 9S]T$4
,ACUTE E?MOID S9USITIS 9 *N C AL CAUSE
PALSY1 : IS PROBABLY M ME*ANICAL ?AN DUE
6N]VE 9VOLVE;T4 ,!N 9 OLD] ADULTS1 SPON-
TANE\S PALSY (! SUP]IOR OBLIQUE MUSCLE C
O3UR DUE 6! F\R? N]VE PALSY1 & L    #BDH
! SIX? N]VE1 X C H AN 8IS*EMIC0    C#AJC
TYPE CAUSE4 ,9 ALL CASES1 SPONTANE\S RE-
COV]Y C 2 EXPECT$1 ESPECI,Y 9 ! IS*EMIC
V>IETY4 ,DIPLOPIA &A H1D TILT >E SYMP-
TOMS1 B IF FU.N OR B9OCUL> VI.N C 2 OB-
TA9$ 0A H1D TILT1 X IS BE/ N 6PAT* OR
COV] ! EYE4 ,X MO/ C]TA9LY WD N BE1 Z
MAY 2 9DICAT$ 0PHYSICAL !RAPI/S1 A GD
IDEA 6COV] ! GD EYE 9 AN ATTEMPT TO
8/R5G!N ! W1K EYE40 ,? IS 2C ! PRO#M IS
N (A 8W1K MUSCLE0 B IS ACTU,Y A TEMPOR>Y
NEUROLOGICAL PRO#M4 ,RECOV]Y IS HA/5$ BY
ALL[+ ! EYES 6"W TGR B9OCUL>LY1 ESPECI,Y
IF A H1D TILT IS SU3ESS;L 9
------------------------------------#AJD
AVOID+ DIPLOPIA4 ,S9CE ! D\# VI.N *ANG-
ES1 DEP5D+ ON : WAY ! EYES LOOK1 PRISMS
9 GLASSES >E N HELP;L4

    ,?IRD ,N]VE ,PALSY
  ,! ?IRD CRANIAL N]VE IS CALL$ ! OCULO-
MOTOR N]VE1 & X 5]VATES ?REE MUSCLES T
MOVE ! EYE1 ! ELEVAT+ MUSCLE (! UPP]
EYELID1 CALL$ ! LEVATOR MUSCLE1 PLUS !
PUPIL &! FOCUS+ MUSCLES4            #BDI
,DIABETES IS "O (! MO/ -MON        A#AJD
CAUSES ( SPONTANE\S ?IRD N]VE PALSY1 &
CAUSE UN"KN IS / HI< ON ! LI/4 ,A /ROKE
C AL CAUSE ?IRD N]VE PALSY1 Z "P (! M
G5]ALIZ$ /ROKE OR Z AN ISOLAT$ F9D+4
,SPONTANE\S RECOV]Y IS AG MO/ LIKELY4
,DIPLOPIA IS Q ANNOY+1 &! UPP] EYELID W
DROOP 7PTOSIS7 UNTIL ! -PLETE ?IRD N]VE
PALSY IS RESOLV$4 ,9 A WAY1 DROOP+ (!
EYELID HELPS AVOID D\# VI.N1 & 0! "T !
PTOSIS CLE>S1 ! T5D5CY = D\# VI.N HAS (-
T5 AL IMPROV$4 ,IF ! PUPIL IS N 9VOLV$1
!N DIABETES IS ! MO/ LIKELY CAUSE 7"PIAL
N]VE PALSY ) PUPILL>Y SP>+74 ,A H1D TURN
OR TILT IS LESS LIKELY 6HELP AVOID DI-
PLOPIA4 ,IF PAT*+ OR O3LU.N ( GLASSES IS
US$1 0ALL M1NS D N COV] ! UN9VOLV$ EYE4
,=C+ ! 9VOLV$ EYE 6BE US$ W N HA/5 RE-
COV]Y B W ONLY MAKE A P]SON M MIS]A#4
  ,"S O!R CAUSES ( DIPLOPIA 9CLUDE ?Y-
ROID EYE 41SE & MYAS!NIA GRAVIS4 ,?YROID
EYE 41SE MAY 2 ASSOCIAT$ ) EXOPH?ALMOS &
A6ECT "O EYE M ?AN ! O!R4 ,DUR+ ! 9FLAM-
MATORY PHASE ! MUSCLES SWELL1 B MAY SC>
D[N LAT]1 ) D\# VI.N MA9LY 9        #BEJ
UPW>D GAZE4 ,"S"TS X IS EV5TU,Y    B#AJD
NEC 6REL1SE OR RECESS ! TI<T5$ 9F]IOR
RECTUS SURGIC,Y4 ,MYAS!NIA IS M LIKELY
6BE ASSOCIAT$ ) PTOSIS &) O!R SY/EMIC
SIGNS S* Z EASY FATIGABIL;Y (! >MS OR
LEGS4

    ,TRIGEM9AL ,NEURALGIA 7,TIC ,D\L\-
    REUX7
  ,! TRIGEM9AL N]VE1 OR ! FIF? CRANIAL
N]VE1 IS A S5SORY N]VE1 9VOLV+ ! EYE &
FACIAL TISSUES >.D ! EYE4 ,X HAS ?REE
DIVI.NS3 SUP]IOR 7OPH?ALMIC71 MI4LE
7MAXILL>Y71 & L[] 7M&IBUL>74 ,X C 2 IN-
VOLV$ 9 NEUROLOGICAL PRO#MS RESULT+ F
/ROKE1 TUMOR1 OR 9JURY1 B ! MO/ -MON IN-
VOLVE;T IS 9 REG>DS 6:AT IS CALL$ TRI-
GEM9AL NEURALGIA4 ,TRIGEM9AL NEURALGIA
7TIC D\L\REUX7 IS A SEV]E H1DA*E LOCAL-
IZ$ 6! FACE1 9CLUD+ ! >EA >.D ! EYE4
,TR1T;T C 9VOLVE SURG]Y (! G5ICULATE
GANGLION1 : C RELIEVE ! PA91 B MAY L1VE
! EYE NUMB1 AL;G ) "P (! FACE4 ,NUMB;S (
! EYE C RESULT 9 :AT WD ORD9>ILY 2 MILD
9JURY OR 9FEC;N1 DEVELOP+ 96A       #BEA
S]I\S -PLIC,N4 ,! 9FRAORBITAL      C#AJD
BRAN* S]VES ! *EEK1 2L ! L[] EYELID1 & C
2 A FACTOR 9 ! DIAGNOSIS ( ORBITAL FLOOR
FRACTURE :5 NUMB;S IS ASSOCIAT$ ) TRAUMA
9 ! >EA4 ,NUMB;S (! SK9 >EA 2L ! EYE1 AF
A FI/ 9JURY CAUS+ A BLACK EYE1 = EXAM-
PLE1 SU7E/S T ! FLOOR (! ORBIT HAS BE5
FRACTUR$1 EV5 2F ;,X-RAY 3FIRM,N4
------------------------------------#AJE
    ,BELL'S ,PALSY
  ,BELL'S PALSY 9VOLVES ! SEV5? CRANIAL
N]VE1 AL CALL$ ! FACIAL N]VE4 ,A SPONTA-
NE\S ONSET ( ,BELL'S PALSY IS USUAL1 B !
FACIAL N]VE MAY AL 2 9VOLV$ 9 A M G5]AL-
IZ$ /ROKE4 ,2C "O SIDE (! FACE IS P>A-
LYZ$1 6V>Y+ DEGREE1 A P]SON HAS TR\#
RAIS+ ! EYEBR[1 BL9K+ OR CLOS+ ! EYE
NORM,Y1 OR SMIL+ DUE 6SA7+ (! M\?1 REP-
RES5T+ 9VOLVE;T (! ?REE MA9 BRAN*ES (!
FACIAL N]VE4 ,SPONTANE\S IMPROVE;T IS TO
2 EXPECT$ ) ,BELL'S PALSY1 B X MAY TAKE
S"EAL MON?S1 & RECOV]Y MAY N 2 -PLETE4
  ,9ITI,Y1 ! MO/ POT5TIAL S]I\S -PLIC,N
IS RELAT$ 6N 2+ A# 6CLOSE ! EYE = PRO-
TEC;N1 ESPECI,Y DUR+ SLEEP4 ,A      #BEB
SPECIAL TE*NIQUE ( CLOS+ ! EYE1    A#AJE
) TAPE1 AT B$"T MAY 2 NE$$ = A:ILE4 ,IF
! PRO#M IS SEV]E1 OR PROL;G$1 X MAY 2
NEC 6SEW ! EYELIDS TGR LAT],Y1 CALL$ T>-
SORRHAPHY4 ,? C 2 D"O 9 S* A WAY T ! EYE
C / SEE "? ! LID OP5+ PRES5T T[>D !
NOSE1 &! CLOSURE C 2 REOP5$ IF RECOV]Y
LAT] O3URS4 ,LUBRICANTS S* Z >TIFICIAL
TE>S & O9T;TS C HELP PROTECT ! CORNEA F
DRY+4 ,M]ELY COV]+ ! EYE ) AN EYE PAT*
OR LOOSE DRESS+ MAY D M H>M ?AN GD4
,SPECIAL TAP+ TE*NIQUES C 2 9/RUCT$ 0AN
EYE DOCTOR1 Z WELL Z A WAY ( HELP+ TO
CLOSE ! EYE 0TRAC;N ON ! \TSIDE CORN]
7CAN?US7 (! EYELIDS4
  ,RECOV]Y C 2 -PLICAT$ 0:AT IS CALL$
AB]RANT REG5],N (! FACIAL N]VE1 M1N+ T
REG5],N C 2 MISDIRECT$4 ,? C RESULT 9
BL9K+ OR DROOP+ (! UPP] EYELID :5 *EW+
OR TALK+1 OR 8CROCODILE0 TE>S4 ,APP>5TLY
A CROCODILE HAS TE>+ (! EYES :5 *EW+1 &
AB]RANT REG5],N (! SEV5? N]VE 9 HUMANS
MAY CAUSE ! SAME SIGN1 2C ! MOTOR N]VE
6! LACRIMAL GL& IS AL A FUNC;N (! FACIAL
N]VE4                               #BEC
    ,C]EBRAL ,VASCUL> ,A3ID5T      B#AJE
    7,,CVA7
  ,,CVA IS A C]EBRAL VASCUL> A3ID5T1 OR
A 8/ROKE10 & C CAUSE D\# VI.N DUE 6P>AL-
YSIS (! ?IRD 7OCULOMOTOR71 F\R? 7TRO*LE-
>71 FIF? 7FACIAL71 & SIX? 7ABDUC5S7
N]VES1 OR FACIAL P>ALYSIS ASSOCIAT$ )!
9VOLVE;T (! SEV5? N]VE4 ,S* OCUL> N]VE
9VOLVE;T MAY (T5 2 ASSOCIAT$ ) P>ALYSIS
( "O SIDE (! BODY & O!R PRO#MS4 ,9 S*
CASES1 Z ) PROGNOSIS = O!R C]EBRAL DEFI-
CITS1 "! MAY OR MAY N 2 RECOV]Y4 ,9 A4I-
;N1 "! MAY 2 LOSS (A QU>T] OR HALF (!
SIDE VI.N1 EI 6! LEFT OR 6! "R1 B A6ECT+
BO? EYES4 ,? IS CALL$ HOMONYM\S HEMIAN-
OPSIA1 OR QUADRANOPSIA1 DEP5D+ ON :E!R
HALF OR A QU>T] (! VI.N IS 9VOLV$ 9 EA*
EYE4 ,"S"TS1 ! LOSS ( P]IPH]AL VI.N IS !
ONLY NEUROLOGICAL DEFICIT1 & !N X IS (T5
CALL$ A 8SIL5T /ROKE40 ,? IS 2C1 S9CE "!
IS NO P>ALYSIS OR O!R SIGN ( /ROKE1 !
LOSS ( SIDE VI.N IS "S"TS N NOTIC$ 9I-
TI,Y4 ,SPONTANE\S RECOV]Y C O3UR1 B _C 2
GU>ANTE$4 ,PHYSICAL !RAPI/S "S"TS REF]
6! PRO#M Z 8"R-                     #BED
OR LEFT-SID$ NEGLECT10 Z IF ! PE-   #AJF
RIPH]AL VI.N PRO#M C 2 IMPROV$ 0=C$ AT-
T5;N 6T SIDE4 ,ON ! 3TR>Y1 ^? ) ? PRO#M
%D 2 ALL[$ 6H ! ,,TV1 D9N]1 & 3V]S,N
-PANIONS LOCAT$ ON ! SIDE ON : !Y SEE
BETT]1 LEFT OR "R1 & N ! O!R WAY >.D S Z
6EXA7]ATE ! PRO#M4 ,CR$IT = IMPROVE;T1
:5 X O3URS1 %D N 2 FALSELY GIV5 6=C+ "O
6PAY ATT5;N 6! 8DEFICIT40 ,H["E1 ^? )
P]SI/5T HOMONYM\S HEMIANOPSIA %D N 2 AL-
L[$ 6DRIVE A C>1 EV5 ?\< !Y MAY ADJU/
WELL 6! PRO#M 0TURN+ _! H1D4

    ,MYAS!NIA ,GRAVIS
  ,MYAS!NIA GRAVIS IS A PRO#M T AL C
MANIFE/ EYE SYMPTOMS1 "S"TS Z ! 9ITIAL
PRO#M4 ,DROOP+ (! EYELID1 OR PTOSIS1 (T5
O3URS1 P]H ONLY :5 TIR$1 9ITI,Y4 ,AL D\#
VI.N C 2 9T]MITT5T Z AN E>LY SIGN4 ,^!
PRO#MS MAY WORS51 ESPECI,Y ) EX]CISE1 &
2COME M P]MAN5T4 ,REMIS.NS O3UR & C 2
9FLU;ED 0TR1T;T4 ,DIAGNOSIS C 2 3FIRM$
0,T5SILON OR ICE TE/+4 ,PLAC+ ICE OV] !
A6ECT$ MUSCLES MAY ELIM9ATE D\# VI.N4
,REMOVAL (! ?YMUS GL& (T5 HELPS4    #BEE
    ,H1DA*E                        A#AJF
  ,H1DA*ES >E A -MON R1SON 6SEEK EYE EX-
AM9,N = LOGICAL R1SONS4 ,"! >E DI6]5T
K9DS ( H1DA*ES1 S* Z MIGRA9E1 T5.N1 SI-
NUS1 CLU/]1 & O!R NEUROLOGICAL V>IETIES4
,"! IS A NATURAL 3C]N T ! NE$ = GLASSES1
OR EYE 41SE1 C 2 A TRI7]+ CAUSE = H1D-
A*ES4 ,AN EYE EXAM C 2 USE;L 6HELP 9
F9D+ ! CAUSE ( H1DA*ES1 S* Z :5 "! IS
EVID;E ( PAPILL$EMA1 OR SWELL+ (! OPTIC
N]VE1 : C 2 CAUS$ 09CR1S$ 9TRACRANIAL
PRESSURE4 ,H["E1 X IS EXTREMELY UNCOMMON
T ! NE$ = GLASSES1 OR 8EYE /RA910 IS A
SIGNIFICANT CAUSE ( H1DA*ES4 ,C]TA9LY1
SIGNIFICANT NE$ = VISUAL CORREC;N NE$S
TR1T;T4 ,H["E1 PROL;G$ R1D+ &! USE (
-PUT]S H SPAWN$ ! IDEA T SPECIAL TR1T;TS
OR EYEGLASSES >E 9DICAT$1 )\T SCI5TIFIC
EVID;E T S* USES (! EYES >E H>M;L4 ,L
O!R PHYSICAL ACTIV;Y1 X C 2 EXPECT$ T
EXP&$ EXP]I;E MAY RESULT 9 8GETT+ 9
%APE10 S T SYMPTOMS SU7E/+ FATIGUE MAY
DIM9I%4 ,9 ! M1N"T1 S* ACTIVITIES MAY 2
3SID]$ OCUL> GYMNA/ICS1 : >E N H>M;L 6!
EYES4 ,RE/1 & EXP]I;E1 W PROBABLY   #BEF
SOLVE MO/ S* PRO#MS4               B#AJF
  ,^! >E "S SPECIAL TYPES ( H1DA*ES3

#A4 ,T5.N H1DA*ES >E BLAM$ ON /RESS1 &
  AM;G ! ALLEG$ CAUSES MAY 2 PROL;G$
  -PUT] USE1 9CORRECT PO/URE1 & SLEEP
  PRO#MS4 ,^! H1DA*ES C 2 FRONTAL1 ABV !
  EYES1 OR SPR1D 6! BACK (! NECK4 ,EPI-
  SODES C 2 PROL;G$ S* T ! CAUSE NE$S TO
  2 9VE/IGAT$4
#B4 ,S9US H1DA*ES CAUSE PA9 >.D ! EYES1
  ABV ! EYES1 OR 2H OR 2L ! EYES4 ,O!R
  SYMPTOMS S* Z ^? (A COLD OR SORE ?ROAT
  MAY PROL;G ! H1DA*E UNTIL ! S9USITIS
  CLE>S4
------------------------------------#AJG
#C4 ,CLU/] H1DA*ES C 2 SEV]E & V REPETI-
  TIVE1 LOCALIZ$ >.D "O EYE4 ,!Y MAY LA/
  = #CJ-FJ M9UTES1 RECURR+ = WEEKS OR
  MON?S4 ,!N !Y MAY SPONTANE\SLY /OP =
  MON?S OR YE>S4
#D4 ,MIGRA9E H1DA*ES >E USU,Y ON "O SIDE
  (! H1D1 MOD]ATE 6SEV]E1 & (T5 ASSOCI-
  AT$ ) NAUSEA1 5 6BE CALL$ 8SICK H1D-
  A*ES10 ":BY "O T5DS 6WANT 6LAY    #BEG
  D[N4 ,:5 A VISUAL PRODROME IS    A#AJG
  9VOLV$1 X IS CALL$ CLASSICAL MIGRA9E4
  ,T+L+ OR NUMB;S (! H&S OR FEET MAY OC-
  CUR4 ,9 WOM51 HORM"OS >E (T5 ! TRI7]
  ME*ANISM DUE 6*ANGE1 S* Z 9 PREM5/RUAL
  "TS4
#E4 ,H1DA*ES DUE 6EYE PRO#MS W USU,Y 2
  A3OMPANI$ 0LOCAL SIGNS ( EYE IRRIT,N1
  S* Z R$;S OR 4*>GE1 =EIGN BODY S5S,N1
  S5SITIV;Y 6LI<T1 DROOP+ (! EYELID1 OR
  PA9 LOCALIZ$ 6! EYEBR[4 ,IF ! H1DA*E
  IS DUE 6AN ATTACK ( ANGLE CLOSURE
  GLAUCOMA1 "! MAY 2 ASSOCIAT$ NAUSEA &
  VOMIT+1 R$;S ( "O EYE ) AN 5L>G$ PU-
  PIL1 & LOCALIZ,N (! H1DA*E AT ! EYE-
  BR[4

    ,C5TRAL ,S]\S ,RET9OPA?Y 7,*ORIORET-
    9OPA?Y7
  ,C5TRAL S]\S RET9OPA?Y 7,,CSR7 IS A
3DI;N 9VOLV+ LOSS ( VI.N 6A V>IA# DE-
GREE1 DUE 6SWELL+ (! MACULA4 ,? SYNDROME
MA9LY 9VOLVES "Y] M51 AGE TW5TY 6=TY-
FIVE1 9 "O EYE4 ,/]EOTYPIC,Y1 ^! M5 >E
H>D"W+ &(! OV]A*IEV] TYPES1 &!      #BEH
R1SON+ Z 6:Y AN ACTUAL SWELL+ (!   B#AJG
MACULA IS ASSOCIAT$ IS N EXPLA9A#4 ,I 0
TOLD T ! TR1T;T ( ? 3DI;N AT ! ,MAYO
CL9IC 0 PH5OB>BITAL YE>S AGO4
  ,! BE/ NEWS IS T SPONTANE\S RECOV]Y IS
EXPECT$ )\T TR1T;T1 OR *ANGE 9 LIFE
/YLE1 USU,Y )9 ?REE 6F\R MON?S4 ,AT "O
"T LAS] TR1T;T 0 (F]$ 6^? 9 A HURRY 6GET
BETT]1 B X IS N[ OBVI\S T ! BE/ RESULTS
-E F DO+ NO?+4 ,USE ( ,DIAMOX MAY HA/5 !
DECR1SE ( SWELL+ (! MACULA4 ,/]OIDS >E
3TRA9DICAT$ S9CE USE ( S* C ACTU,Y 2 A
R1SON = DEVELOP+ S* A PRO#M1 & EV5 NOSE
SPRAYS4
  ,VI.N C -PLETELY RETURN 6NORMAL1 ?\<
"! MAY 2 RESIDUAL SLI<T 4TOR;N DEMON/RA#
ON ! AMSL] GRID TE/1 &A T9Y YELL[ SPOT 9
! MACULA MAY P]SI/4 ,O3URR;E 9 FEMALES
IS LESS -MON1 & RECURR;ES C HAPP54





                                    #BEI
                                   C#AJG























                                    #BFJ
                  #AE               #AJH
     ,HI/ORY & ,CURR5T ,DEVELOP;TS
         9 ,REFRACTIVE ,SURG]Y

      ,REFRACTIVE ,SURG]Y ,HI/ORY

,REFRACTIVE SURG]Y HAS ATTRACT$ TREM5D\S
9T]E/ & EXCITE;T1 F XS ORIG94 ,9T]E/ 0 S
GRT T M>KET+ JUMP$ AH1D ( SCI5TIFIC RE-
SE>*1 & ?\< "! H BE5 GRT /RIDES 9 NEW &
BETT] PROC$URES1 ? IS PROBABLY / TRUE4
,Z HAS BE5 ! CASE ) _M (! NEW SURGICAL
PROC$URES1 S* Z 9TRAOCUL> L5S 7,,IOL7
IMPLANTS1 ! 9NOVATORS 7 ^? 9 PRIVATE
PRACTICE1 N UNIV]S;Y PROGRAMS ": RESE>*
PROJECTS MAY 2 EXPECT$ 6ORIG9ATE4 ,_M (!
ORIG9AL REFRACTIVE SURGEONS 7 D>+1 9NO-
VATIVE1 & 9V5TIVE1 B 7 N NECESS>ILY HELD
9 HI< REG>D 0_! PROFES.NAL PE]S & 7 "S-
"TS REF]R$ 6Z 8C[BOYS40 ,) "T1 & NEW]
TE*NIQUES1 _M M RESPECT$ OPH?ALMIC SUR-
GEONS H 2COME 9VOLV$1 &! APPROA* 6RE-
FRACTIVE SURG]Y HAS 2COME M 3S]VATIVELY
A3EPTA#4
  ,E>LY REFRACTIVE SURG]Y M>KET+    #BFA
SU7E/$ T ! PROC$URE WD 2COME S     A#AJH
-MON T E EYE DOCTOR1 ON E CORN]1 WD H A
LAS] 6D ! JOB4 ,9 ACTUAL;Y1 ! TE*NOLOGY
HAS BE5 S EXP5SIVE & *ANG+ T ONLY A FEW
EYE SURGEONS H 8SPECIALIZ$0 9 REFRACTIVE
SURG]Y4 ,EV5 S1 ! NUMB] ( REFRACTIVE
SURGEONS HAS N BE5 9SU6ICI5T =! DEM&1
RESULT+ 9 H1VY PRICE-CUTT+ ADV]TIS+4 ,S*
ADV]TIS+ T5DS 6IRRITATE ! AV]AGE OPH?AL-
MOLOGI/1 = E?ICAL R1SONS1 & 2C ! TE*-
NIQUE ( REFRACTIVE SURG]Y DOES N APPROA*
! DI6ICULTY ( MO/ OPH?ALMIC SURG]Y1 "NLY
CAT>ACT SURG]Y4 ,"O SURGEON1 EXP]I;ED 9
BO? CAT>ACT & LASIK SURG]Y1 RAT$ ! LASIK
SURG]Y ON A LEVEL ( DI6ICULTY AT Z A
?REE IF RAT+ ! CAT>ACT SURG]Y Z A T54
  ,ANO!R OBJEC;N 6ADV]TIS+ IS ! MISL1D+
IMPRES.NS LEFT ) PATI5TS4 ,"O MAY GET !
IMPRES.N T GLASSES W N"E 2 NE$$ AG1 4RE-
G>D+ ! IMP]FECT RESULT1 &! NATURAL PROC-
ESS ( PRESBYOPIA4 ,?US1 A P]FECT 4T.E
RESULT W N ELIM9ATE ! NE$ = R1D+ GLASS-
ES1 AN EXPECT$ EV5TUAL;Y4 ,AL1 ! UN9=M$
MAY GET ! IMPRES.N F
                                    #BFB
ADV]TISE;TS T VI.N MAY 2COME SUP]   #AJI
& BETT] ?AN 2F3 #BJ_/BJ OR BETT]4 ,(
C\RSE1 ? REF]S 6! IMPROVE;T 9 UNCORRECT$
4T.E VI.N1 )\T GLASSES1 & DOES N REV1L T
VI.N C 9 NO WAY 2COME BETT] ?AN PREVI\S-
LY POSSI# ) CORRECT GLASSES OR 3TACT
L5SES4 ,ON ! O!R H&1 DUE TO 8AB]R,NS0
RESULT+ F LASIK1 ! BE/ CORRECT$ VI.N MAY
ACTU,Y 2 WORSE4 ,?US1 ?\< ! UNCORRECT$
VISUAL ACU;Y MAY SEEM REM>KABLY BETT]1 Z
F #BJ_/DJJ 6#BJ_/CJ = 4T.E1 ! BE/ COR-
RECT$ VI.N MAY H DROPP$ F #BJ_/BJ TO
#BJ_/CJ1 ?\< ? IS =TUNATELY UNCOMMON4
  ,"O (! MANUFACTUR]S ( REFRACTIVE SUR-
G]Y MAT]IALS HAS DESCRIB$ ! PROCESS Z
8VAN;Y SURG]Y40 ,? WELL DESCRIBES !
GOAL3 6REDUCE OR ELIM9ATE ! USE ( GLASS-
ES4 ,L COSMETIC PLA/IC SURG]Y1 ! PROCE-
DURE IS N COV]$ 0H1L? 9SUR.E4 ,B L COS-
METIC PLA/IC SURG]Y1 ! REW>DS MAY 2 WELL
WOR? ! 9VE/;T 6A LOT ( P4 ,A 4CUS.N (!
OP;NS W FOLL[4 ,9 SPITE ( SKEPTICS1 !
SU3ESS ( REFRACTIVE SURG]Y HAS 2COME S
-MON T ! EXPECT,NS ( PATI5TS >E 9CR1S+LY
DI6ICULT 6SATISFY4 ,IF ! RESULT     #BFC
IS N ABSOLUTELY P]FECT1 ! PA-      A#AJI
TI5TS >E 9CL9$ 6ASK =A REP1T 85H.E;T0
PROC$URE4
  ,! 3CEPT ( REFRACTIVE SURG]Y IS RELA-
TIVELY NEW1 9 PRACTICE1 IF N 9 DESIRE4
,NOT+ T SC>S (! CORNEA CAUS$ FLATT5+1
&_/OR A/IGMATISM1 EXP]I;TS 7 P]=M$1 UN=-
TUNATELY USU,Y ON HUMANS1 9 ,JAPAN & !N
,RUSSIA4 ,Z M5;N$ "U 8,ANATOMY (! ,EYE10
! CORNEA1 ! CURV$ W9D[ 9 FRONT (! PUPIL
IS ACTU,Y A GRT] FACTOR 9 FOCUS+ LI<T
ONTO ! RET9A ?AN ! L5S (! EYE4 ,! CORNEA
_C *ANGE XS %APE 6ALL[ BETT] FOCUS+1 L !
L5S C1 B ! %APE (! CORNEA C 2 ALT]$4
,NE>SI<T$ EYES >E L>G] ?AN AV]AGE OR H A
CORNEA M CURV$ ?AN AV]AGE OR A -B9,N (
BO?4 ,WE _C %R9K ! EYE1 B WE C FLATT5 !
CORNEA1 AN IDEA T SPAWN$ ! IDEA ( RE-
FRACTIVE SURG]Y4 ,9ITI,Y ? 0 ) 8RADIAL
K]ATOTOMY0 & !N LAS] TR1T;TS4
  ,RADIAL K]ATOTOMY 0 PROBABLY ! ORIG9AL
REFRACTIVE SURG]Y PROC$URE 7T IS IF Y
EXCLUDE ! 9TRODUC;N ( 9TRAOCUL> L5SES 9
CAT>ACT SURG]Y74 ,? TE*NIQUE 9VOLVES
MAK+ DEEP 9CI.NS1 L CUTT+ SEG;TS    #BFD
(A PIE1 9 F\R 6EI<T 9CI.NS RADI-   B#AJI
AT+ F A C5TRAL #D-F MM Z"O ( CLE> COR-
NEA1 DEP5D+ ON ! NE$$ RESULT = CORRECT+
! DEGREE ( MYOPIA4 ,HORIZONTAL 9CI.NS 9
! MIDP]IPH]Y 7 US$ 6CORRECT A/IGMATISM4
,0MOD]N /&>DS1 ? RADIAL K]ATOTOMY SURG]Y
0 PRETTY M* 80GUESS & 0GO%10 B ! E>LY
RESULTS 7 (T5 Q EXCIT+ = NE>SI<T$ P4
,UN=TUNATELY1 E>LY MODIFIC,NS 6A*IEVE
EV5 M P]FECT RESULTS 7 (T5 P]=M$1 (T5
TOO E>LY1 2F ! L;G-T]M RESULTS %[$ T AC-
TU,Y TOO M* _H BE5 P]=M$ 9ITI,Y4 ,PREMA-
TURE 5?USIASM = RESULTS TOO (T5 5D$ 9
LAT] LA;T = :AT IS CALL$ 8HYP]OPIC
%IFT10 M1N+ ! CORNEA FLATT5$ EV5 M ) "T4
,HAV+ SWIT*$ F 2+ NE>SI<T$ 62+ F>SI<T$1
? (T5 RESULT$ 9 PREMATURE R1D+ PRO#MS &
EV5TU,Y POOR VI.N AT ALL 4T.ES1 )\T
GLASSES4 ,IMPROVE;TS RESULT$
------------------------------------#AAJ
F EXP]I;E S* T ! RESULTS CD 2 BETT] CON-
TROLL$4 ,H["E1 NEW] & BETT] REFRACTIVE
PROC$URES DEVELOP$1 S T1 6MY K1 RADIAL
K]ATOTOMY IS NO L;G] P]=M$4 ,ANO!R L;G-
T]M -PLIC,N IS ! ADV]SE E6ECT (     #BFE
RADIAL K]ATOTOMY ON ! EVALU,N (    A#AAJ
9TRAOCUL> IMPLANT CALCUL,NS IF CAT>ACT
SURG]Y 2COMES NEC4 ,X IS 9T]E/+ T ^? :O
H _H RADIAL K]ATOTOMY >E N S CRITICAL (
_! SURGEONS1 Z IF !Y BETT] "U/& T !Y 7
TAK+ A *.E1 & X J DIDN'T "W \4
  ,FOLL[+ RADIAL K]ATOTOMY CAME ! LAS]
PROC$URES4 ,Z M5;N$1 FLATT5+ (! CORNEA
REDUCES MYOPIA 7NE>SI<T$;S74 ,FLATT5+ !
SURFACE )A LAS]1 Z ) PHOTOREFRACTIVE K]-
ATECTOMY 7,,PRK71 9VOLVES DE/ROY+ ! EPI-
!LIUM1 MAK+ ! EYE PA9;L = "DS UNTIL !
EPI!LIUM C REGR[4 ,:5 LASIK DEVELOP$1 X
M1NT AVOID+ ! PA9 0MAK+ A FLAP (! COR-
NEA1 2N ! SURFACE EPI!LIUM1 & !N APPLY+
! LAS] TR1T;T 6DEEP] CORN1L TISSUE4 ,!
FLAP !N IS ALL[$ 6FALL BACK 9 PLACE &
S1L XF )\T SUTURES4 ,! PROC$URE IS S
AMAZ+LY PA9.S1 &! RESULT S GD 9/ANTLY1 T
! R\T9E HAS 2COME 6D BO? EYES TGR4 ,TO
OV]COME HYP]OPIA 7F>SI<T$;S7 X IS DESIR-
A# 69CR1SE ! R.D;S (! CORNEA1 "S?+ N
POSSI# ) RADIAL K]ATOTOMY1 & M DI6ICULT1
B POSSI#1 ) LASIK4 ,A/IGMATISM AL C 2
CORRECT$4 ,FUR!R NEW DEVELOP;TS     #BFF
9CLUDE ! ABIL;Y 6CR1TE ! CORN1L    B#AAJ
FLAP )! LAS] AL1 MAK+ ! SURGICAL "P (!
USE ( METALLIC CUTT+ 9/RU;TS UNNEC4 ,O!R
ADV.E;TS 9CLUDE IMPROV$ LAS]S & M1SUR+
DEVICES S T RESULTS C 2 M PREDICTA#4
,WAVE ,FRONT TE*NOLOGY CLAIMS 6BE A# TO
IMPROVE ON VISUAL AB]R,NS S* T VI.N IS
ACTU,Y IMPROV$1 OV] PREOP]ATIVE ABILI-
TIES1 & EV5 IF N LIKELY 6BE TRUE1 %D AT
L1/ IMPROVE ! RESULTS ( REFRACTIVE SUR-
G]Y4

      ,TYPES ( ,REFRACTIVE ,SURG]Y

    ,,PRK 7,PHOTO ,REFRACTIVE ,K]ATECTO-
    MY7
  ,N[ "S REF] 6? Z ADV.ED SURFACE ABL,N
7,,ASA74 ,? IS ! ORIG9AL LAS] SURG]Y =
RE%AP+ ! CORNEA4 ,TE*NOLOGY ALL[S *ANG+
! %APE (! CORNEA ) LAS]1 6FLATT5 C5TR,Y
6CORRECT NE>SI<T$;S & ALT] ! %APE 6COR-
RECT A/IGMATISM4 ,! RESULTS >E PREDICTA-
#1 B ! E>LY /AGES >E -PLICAT$ 0PA94 ,RE-
MOVAL (! EPI!LIAL SURFACE (! EYE CR1TES
"O MASSIVELY 8SCRAT*$ CORNEA10 &    #BFG
S9CE ! CORNEA IS EXTREMELY S5SI-   C#AAJ
TIVE1 ! EYE IS S PA9;L T ONLY "O EYE IS
USU,Y TR1T$ AT A "T4 ,! EPI!LIAL COV]
REGR[S S* T ! FUNC;N (! EYE IS N ALT]$4
,! NEWE/ ME?ODS ( PA9 RELIEF &! USE (
!RAPEUTIC 3TACT L5SES H REJUV5AT$ 9T]E/
9 ? ORIG9AL LAS] PROC$URE4 ,X IS E/IMAT$
T OPH?ALMIC SURGEONS >E N[ DO+ AB #BJ-CJ
P]C5T ,,PRK N[4 ,! MILIT>Y PREF]S ? TYPE
TR1T;T = _! PILOTS1 = SAFETY R1SONS4
,RADIAL K]ATOTOMY1 = EXAMPLE1 0 N ALL[$
=! POLICE OR MILIT>Y DUE 6! FACT T X
W1K5$ ! EYE 9 CASES ( 9JURY1 S* Z A BL[
6! EYE4 ,,PRK
------------------------------------#AAA
IS RECOMM5D$ = ?9N] CORN1S1 R ?AN LASIK4
,9DIC,NS3 MILD OR MOD]ATE DEGREES ( MYO-
PIA & A/IGMATISM4

    ,LASIK
  ,LAS] 9 SITU K]ATOMILEUSIS 7,LASIK7
HAS L$ 6! MO/ RAPID 9CR1SE 9 9T]E/ 9 RE-
FRACTIVE SURG]Y4 ,X HAS A3.T$ =! HI<E/
VOLUME ( REFRACTIVE SURG]Y4 ,! IMM IM-
PACT ( ,LASIK IS DUE 6! FACT T X    #BFH
IS RELATIVELY PA9.S1 & BO? EYES    A#AAA
C 2 D"O 9ITI,Y4 ,! LACK ( PA9 IS DUE 6!
FACT T ! EPI!LIAL SURFACE COV]+ IS N
SCRAP$ AWAY4 ,A ?9 FLAP ( SUP]FICIAL
CORNEA IS LIFT$ SURGIC,Y 7OR1 M REC5TLY1
0LAS]71 ! LAS] TR1T;T APPLI$ 6! B$ (!
CORNEA EXPOS$1 &! FLAP REPOSI;N$4 ,X
TAKES AB #AJ M9UTES P] EYE1 &! VISUAL
IMPROVE;T IS RELATIVELY 9/ANT4 ,L;G-T]M
RESULTS H BE5 GD1 )\T ! -PLIC,NS EXP]I-
;ED ) RADIAL K]ATOTOMY4 ,-PLIC,NS C OC-
CUR1 9CLUD+ 9FEC;N & PRO#MS )! FLAP (
CORN1L TISSUE1 B >E N -MON4 ,HALOS >.D
LI<TS C O3UR ) ^? ) L>GE PUPILS4 ,9NOVA-
;NS 9 TE*NOLOGY H MADE RESULTS M PRE-
DICTA# & M P]FECT4 ,9DIC,NS >E = MILD OR
MOD]ATE DEGREES ( MYOPIA 7NE>SI<T$;S74
,F>SI<T$;S & A/IGMATISM C AL 2 TR1T$1 6A
"S:AT LESS] DEGREE4
      ,ILLU/R,N3 ,? ILLU/R,N %[S A FLAP
    ( CORNEA LAID BACK1 ) LAS] APPLI$ 6!
    DEEP] /ROMAL B$4 ,!N X %[S ! CORNEA
    IS RELATIVELY FLATT] ONCE ! FLAP IS
    PUT BACK 9 PLACE4 ,PL1SE "U/& T !
    ILLU/R,N IS MADE 6EXA7]ATE      #BFI
    :AT HAPP5S1 ! AM.TS ( TISSUE   B#AAA
    2+ M MICROSCOPIC 9 ACTUAL PRACTICE4
    ,COPY"R ^C #AIID ,/EPH5 ,F4 ,GORDON4
  ,LIMIT,NS 9VOLVE EXTREME MYOPIA1 ?9
CORN1S1 & L>GE PUPILS4 ,"S REFRACTIVE
SURGEONS REGRET ! WAY LASIK 0 PU%$ 2Y
SAFE LIMITS 9 TRY+ 6CORRECT HI< DEGREES
( MYOPIA1 9 ! E>LY /AGES ( USE R ?AN
AWAIT L;G-T]M RESULTS4 ,A NEW 9NOV,N
CALL$ ,9TRALASE UTILIZES 8ALL LAS]10
------------------------------------#AAB
M1N+ A LAS] IS US$ 6FA%ION ! FLAP1 R ?AN
A /EEL MICROK]ATOME4 ,9 A4I;N 6M A3URA-
CY1 X MAY 2 POSSI# 6"W ON ?9N] CORN1S4
,O!R 9NOVATIVE ADV.ES 9CLUDE TE*NOLOGY
ALL[+ GRT] A3URACY IF A PATI5T DOES N
HOLD -PLETELY /1 OR IF CORN1L AB]R,NS >E
PRES5T4 ,9 SPITE ( ALL ^! IMPROVE;TS1 !
9CID;E ( LASIK SURG]Y REPORTABLY HAS
FLATT5$ S9CE #BJJA1 3TR>Y 6AN EXPECT$
9CR1S$ 9T]E/4

    ,LAS]-,ASSI/$ ,SUBEPI!LIAL
    ,K]ATECTOMY 7,LASEK7 OR ,EPI-,LASIK
  ,? NEW] V>I,N ( ,LASIK 9VOLVES    #BGJ
A ?9N] FLAP 9CLUD+ J EPI!LIUM4     A#AAB
,"!=E ! PA9 FACTOR IS / PRES5T 6A DE-
GREE1 B CORN1L ?ICK;S IS LESS (A PRO#M4
,9 ,LASEK1 ! EPI!LIUM IS REMOV$ 9 A
%EET1 AF TR1T;T ) ALCOHOL4 ,) ,EPI-
LASIK1 ! EPI!LIAL FLAP IS RAIS$ 0A SPE-
CIAL K]ATOME-L 9/RU;T4 ,AL;G ) ,,PRK1 !
EV5TUAL RESULTS VISU,Y MAY ACTU,Y IM-
PROVE ON ,LASIK RESULTS1 B OV]ALL 9DICA-
;NS >E AB ! SAME1 )A ?9 CORNEA & L>GE
PUPILS 2+ LESS (A 3TRA9DIC,N4 ,"S >GUE T
? IS N A SIGNIFICANT IMPROVE;T OV] ,,PRK
9 ! L;G T]M4

    ,9TRA/ROMAL ,CORN1L ,R+ 7,9TAC7
  ,! MA9 ADVANTAGE ( ? PROC$URE IS T X
IS REV]SI#4 ,A ?9 R+ ( PLA/IC MAT]IAL IS
PLAC$ 9 ! SUP]FICIAL CORN1L SUBEPI!LIAL
TISSUE1 : FLATT5S ! C5TRAL CORNEA4 ,X
"WS MA9LY ON L[] DEGREES ( MYOPIA4 ,! R+
C 2 REMOV$1 RE/OR+ ! ORIG9AL CORN1L
%APE4 ,ANO!R 9DIC,N C 2 K]ATOCONUS1 A
CORN1L 41SE 9VOLV+ 9CR1S$ C5TRAL CURVA-
TURE4 ,? IS N A PREF]R$ PROC$URE 0MO/
REFRACTIVE SURGEONS4                #BGA
    ,3DUCTIVE ,K]ATOPLA/Y 7,,CK7   B#AAB
  ,? PROC$URE IS DESIGN$ 6APP1L 6! PRES-
BYOPIC GR\P1 ^? EMMETROPIC = 4T.E1 & ES-
PECI,Y ^? HYP]OPIC = 4T.E4 ,X IS ,,FDA
APPROV$ 9 MONOVI.N =M1 M1N+ T "O EYE IS
= R1D+ &! O!R = 4T.E VI.N4 ,9/1D ( LAS]1
RADIO FREQU5CY 5]GY IS US$ 9 A CIRCUL>
PATT]N ON ! MIDP]IPH]Y (! CORNEA1 CR1T+
PUNCTURELIKE BURNS4 ,? H1T REAC;N CAUSES
A C5TRAL PUCK]+1 OR /EEP5+1 S Z 62COME
R.D]1 ?US 2COM+ RELATIVELY MYOPIC 7LESS
HYP]OPIC74 ,NO SC>S RESULT1 & 9 FACT !
RESULTS >E N EXPECT$ 6BE P]MAN5T4 ,RE-
TR1T;T IS POSSI#4 ,! MONOVI.N IDEA C 2
US$ Z 9 O!R =MS ( REFRACTIVE SURG]Y1 B X
IS USE;L 6"K 9 ADV.E IF A P]SON W TOL]-
ATE MONOVI.N4 ,! RESULTS C 2 SIMULAT$ BY
TRIAL ( 3TACT L5SES PREOP]ATIVELY4 ,!
RESULTS MAY 2 Q SATISFACTORY B _C 2 EX-
PECT$ 6BE Z GD VISU,Y Z ) GLASSES1 ESPE-
CI,Y ) 9CR1S+ AGE4 ,IF ! 8BETT] EYE0
M1NT = 4T.E IS #J.GE DIOPT]S OR UP 6#C
DIOPT]S F>SI<T$1 !N BO? EYES C 2 TR1T$4
,Z 9 MONOVI.N ) 3TACT L5SES1 "! IS A
LIMIT 6A3EPTA# B9OCUL>;Y1 M1N+ T    #BGB
! 8R1D+ EYE0 PROBABLY WD N GIVE    C#AAB
SATISFACTORY VI.N = ALL NE$S 2Y ! AGE (
MID 6LATE FIFTIES4 ,! REC5T
------------------------------------#AAC
TR5D T[>D 8LI<T-T\*0 TE*NIQUES HAS GIV5
BETT] & EV5 M LA/+ E6ECTS4

    ,PHAKIC ,,IOL,'S
  ,? IS AN 9VASIVE SURGICAL PROC$URE 9 :
AN 9TRAOCUL> L5S IS 9S]T$ 96! EYE1 EI 9
FRONT OR 2H ! PUPIL1 B L1V+ ! NORMAL L5S
(! EYE 9 PLACE4 ,X IS 9DICAT$ = M EX-
TREME DEGREES ( MYOPIA 7NE>SI<T$;S71 =
EXAMPLE1 #AB 6#BJ DIOPT]S1 OR = EXTREME
HYP]OPIA 7F>SI<T$;S74 ,LIMIT+ FACTORS
9CLUDE ! CO/ ( 9TRAOCUL> SURG]Y1 & POT5-
TIAL -PLIC,NS1 S* Z CAT>ACT1 9FEC;N1 OR
ANY (! R>E -PLIC,NS 9VOLV+ 9TRAOCUL>
SURG]Y1 9CLUD+ POSSI# LOSS (! EYE4 ,!
,,IOL C 2 REMOV$1 = EX*ANGE1 OR :5 CATA-
RACT SURG]Y 2COMES NEC4 ,A CORN1L TE/
CALL$ AN 5DO!LIAL CELL C.T C 2 D"O
PREOP]ATIVELY 6M1SURE ! H1L? (! CORNEA &
GIVE AN IDEA ( H[ ANY FUR!R 9TRAOCUL>
SURG]Y MAY 2 TOL]AT$4               #BGC
    ,A3OMMODATIVE ,,IOL,'S         A#AAC
  ,? APPROA* REPRES5TS ! NEWE/1 ! MO/
EXTREME1 & P]H ! PROC$URE )! GRTE/ FU-
TURE 9 REFRACTIVE SURG]Y4 ,:AT IS NEW IS
T 9TRAOCUL> L5S IMPLANTS >E DESIGN$ TO
*ANGE FOCUS S* T AN OP]AT$ EYE MAY 2 EX-
PECT$ 6SEE BO? = 4T.E1 & CLOS]1 ) *ANGES
( A3OMMOD,N "S:AT L ! FOCUS+ ABIL;Y ( AN
EYE 2F PRESBYOPIA O3URS4 ,/&>D CAT>ACT
SURG]Y RESULT+ 9 APHAKIA ALW L1VES ! EYE
9 A /ATE ( RELATIVE FIX$ FOCUS2 9 O!R
^WS1 GLASSES >E REQUIR$ 6P]FECT 4T.E &
CLOSE VI.N3 APHAKIK BIFOCAL SPECTACLES4
,:5 9TRAOCUL> L5SES 7 DEVIS$1 ! EYE 0 AL
LEFT 9 RELATIVE FIX$ FOCUS4 ,IF P]FECT =
4T.E1 ! EYE NE$$ HELP = CLOSE VI.N4 ,?1
H["E1 0 PROBABLY SIMIL> 6! SITU,N 2F
SURG]Y1 IF ! CAT>ACT PATI5T 0 (! USUAL
S5IOR /AGE ( AGE4

    ,PSEUDO-A3OMMODATIVE ,,IOL,'S
  ,^! >E IMPLANTS T >E MULTIFOCAL1 L A
BIFOCAL1 B USU,Y 9VOLV+ 3C5TRIC >1S (
DI6]5T REFRAC;N4 ,! ,>RAY L5S HAS BE5 9
USE1 & NEW L5SES1 S* Z ! ,RE,/OR    #BGD
& ,RE,ZOOM L5SES1 >E BIG IM-       B#AAC
PROVE;TS4 ,! DESIGN ( ^! L5SES IS SIMIL>
6T TRI$ ) 3TACT L5SES1 : 7 N V SU3ESS;L4

    ,9TRACORN1L ,9LAY
  ,? IS A PROC$URE N YET ,,FDA APPROV$1
9VOLV+ ! CRE,N (A LAMELL> CORN1L FLAP
FOLL[$ 0! 9S];N ( AN 9LAY L5S1 C5T]$ OV]
! PUPIL4 ,X IS 2+ (F]$ 6HYP]OPES OR MY-
OPES1 B N RECOMM5D$ ) M* A/IGMATISM1 OR
TOO FLAT OR ?9 CORN1S4 ,IF APPROV$1 X
HAS ! ADVANTAGE T X MAY 2 D"O 9 ! DOC-
TOR'S (FICE1 & MAY AL 2 P]=M$
------------------------------------#AAD
) AN ASPH]IC 9LAY1 : PROVIDES ANO!R SO-
LU;N 6PRESBYOPIA 0(F]+ NE>-VI.N CORREC;N
Z WELL4 ,SUPPOS$LY ! 9LAY MAY 2 REPLAC$
OR REMOV$1 B POT5TIAL HAZ>DS (! PROC$URE
MAKE "S SKEPTICAL4

    ,MULTIFOCAL ,LASIK
  ,? IS 2+ D"O EXP]I;T,Y1 & !ORETIC,Y (-
F]S ! SAME ADVANTAGES Z PSEUDOA3OMMODA-
TIVE ,,IOL,'S4 ,LIMIT,NS W 2 9 REG>D TO
4SATISFAC;N ) RESULTS VISU,Y1       #BGE
PLUS ! EXPECT$ HALOS & REDUC$      A#AAD
3TRA/ PRO#MS 9 VI.N4 ,AL1 "! IS ! "Q (
REV]SIBIL;Y (! PROC$URE4

  ,:AT %D Y D8 ,: PROC$URE %D Y H D"O8
,WELL1 ,I 2LIEVE Y %D 2 GIV5 OP;NS1 & YR
PRIM>Y EYE DOCTOR %D HELP Y DECIDE4 ,=
MO/ P1 ! OP;N ( WE>+ GLASSES1 Z NE$$1 IS
PROBABLY / ! BE/4 ,A REFRACTIVE SURGEON
HAS SD T IF A P]SON IS US$ 6GD VI.N )
GLASSES1 BIFOCALS1 OR TRIFOCALS1 T !Y %D
PROBABLY N H ! A3OMMODATIVE ,,IOL 9/1D (
! 3V5;NAL ,,IOL AT ! "T ( CAT>ACT SUR-
G]Y1 2C !Y MAY N 2 SATISFI$ )! VISUAL
RESULT4
  ,^? WE>+ 3TACT L5SES H ! OP;N ( MONO-
VI.N :5 !Y 2COME PRESBYOPIC1 & ? GIVES
!M OPPORTUN;Y 6DECIDE IF !Y MAY WANT
MONOVI.N OP;NS ) LAT] REFRACTIVE SURG]Y1
OR CAT>ACT SURG]Y4 ,^? :O >E MILDLY NE>-
SI<T$ %D PROBABLY N EV5 3SID] REFRACTIVE
SURG]Y4 ,6BE A# 6R1D )\T GLASSES AT A
R1SONA# 4T.E IS "S?+ 6BE *]I%$ 9 LAT]
YE>S1 & "Y P NE$ 6BE TOLD ? .) .EMPHA-
SIS3 ,:AT ,I M1N 0? IS1 ^? LESS     #BGF
?AN #C DIOPT]S NE>SI<T$4 ,? IS     B#AAD
AM;G ! HI<E/ ( PO/OP]ATIVE -PLA9TS AM;G
MYOPES3 T "O _C SEE Z WELL UP CLOSE ANY-
MORE EV5 ?\< ? 0 M5;N$ 9 ! PREOP]ATIVE
EXAM4
  ,Z F> Z TIM+ IS 3C]N$1 X IS A MATT] (
N TOO E>LY & N TOO LATE4 ,A "Y P]SON MAY
MAKE ! MISTAKE ( HAV+ LASIK TOO E>LY1 2F
_! EYES H /OPP$ *ANG+1 & !N 2COME M NE>-
SI<T$ LAT]4 ,MO/ P H R1*$ ? /AGE 0! MID
TW5TIES4 ,H["E1 IF A "Y P]SON WAITS TOO
L;G1 !N ! P]IOD ( 8P]FECT VI.N0 IS %ORT-
5$1 2F PRESBYOPIA SETS IN4
  ,AM;G ! EXP]TS1 "S GUIDEL9ES H BE5
SET4 ,F @-#A TO @-#H DIOPT]S NE>SI<T$;S1
A =M ( ,LASIK IS PREF]R$4 ,F @-#H TO
@-#AB DIOPT]S1 X IS AB EQUAL 2T ,LASIK &
PHAKIC ,,IOL,'S1 & F @-#AB TO @-#BJ DI-
OPT]S1 PHAKIC ,,IOL,'S >E RECOMM5D$ = S*
HI< DEGREES ( NE>SI<T$;S 7MYOPIA74 ,=
F>SI<T$;S1 ! RANGES V>Y4 ,! RESULTS (
LASIK >E LIMIT$ = F>SI<T$;S1 PROBABLY
6LESS ?AN #C DIOPT]S4 ,,CK C 2 GD1 &!
FACT T ! RESULTS >E (T5 N P]MAN5T MAY 2
AN ADVANTAGE1 BO? = 5H.E;TS1 &=     #BGG
FUR!R DEVELOP;TS S* Z CAT>ACT      C#AAD
SURG]Y4 ,= HI<] DEGREES ( F>SI<T$;S 7HY-
P]OPIA7 PHAKIC ,,IOL,'S OR A3OMMODATIVE
,,IOL,'S WD 2 NEC4
  ,:AT >E ! D[NSIDES1 OR ! -PLIC,NS8
,CO/ IS "O POT5TIAL PRO#M1 & ?\< P D N
WANT 6SP5D ANY M =A PROC$URE ?AN
------------------------------------#AAE
NEC1 WE >E AL ! BE/ 6REMEMB] ! OLD /ATE-
;T AB GETT+ :AT WE PAY =4 ,! SURGEON TO
:OM ,I REF] *>GES F 4#D1JJJ 64#E1JJJ =
BILAT]AL PROC$URES S* Z ,LASIK & ,,CK4
,PHAKIC ,,IOL,'S 79TRAOCUL> L5S IM-
PLANTS7 >E R\<LY D\# 9 CO/4 ,REMEMB]1
9SUR.E IS N LIKELY 6BE ( ANY HELP4 ,!
BI7E/ -PLIC,N IS PROBABLY N 2+ Q SATIS-
FI$ )! RESULT4 ,! MO/ -MON -PLA9TS C5T]
>.D N 2+ P]FECT = 4T.E1 & !N Z M5;N$1 "!
>E ^? NE>SI<T$ :O J DID N Q "U/& T !Y W
NO L;G] SEE UP CLOSE Z WELL Z !Y DID 2F
SURG]Y4 ,4T.E IMP]FEC;NS C 2 IMPROV$ BY
T\*UP 5H.E;T PROC$URES 9 ,LASIK1 ONCE OR
EV5 TWICE4 ,H["E1 6UNDO A LASIK PROC$URE
S Z 6SEE BETT] = CLOSE IS N PRACTICAL4
,HALOS >.D LI<TS1 AT L1/            #BGH
TEMPOR>ILY1 >E A -MON -PLA9T       A#AAE
FOLL[+ ,LASIK1 ESPECI,Y IF "O HAS L>GE
PUPILS NORM,Y1 & ? IS :Y PUPIL M1SURE;T
IS IMPORTANT PREOP]ATIVELY4 ,PHAKIC
,,IOL,'S C 2 REPLAC$1 B CAT>ACT & CORN1L
-PLIC,NS MAY O3UR1 ?+S ALR ( 3C]N FOLL[+
! PRIM>Y PROC$URE4 ,TRY+ 6REPLACE AN AC-
-MODATIVE ,,IOL WD 2 EV5 RISKI]4 ,REVI.N
AGREE;TS %D 2 REV1L$ PREOP]ATIVELY4
  ,I REC5TLY RCVD A PROMO;N ANN\NCE;T F
A REFRACTIVE SURGEON DESCRIB+ A NEW
PHAKIC ,,IOL1 A L5S 9S]T$ 9 FRONT (!
NORMAL L5S = NE>SI<T$ P4 ,A FEE (
4#D1EJJ P] EYE 0 QUOT$1 9CLUD+ \TPATI5T
FACILITIES & ANES!SIA1 CO/ (! L5S1 PO/-
OP]ATIVE LASIK 5H.E;T IF NEC 7L = A/IG-
MATISM71 & 4#EJJ /IP5D =! PATI5T'S CO-
MANAGE;T1 %D ? 2 ELECT$4 ,? %[S H[ S*
AGREE;TS >E PRES5T$4

          ,PRESBYOPIA ,SURG]Y

  ,PRESBYOPIA IS DEF9$ Z AGE RELAT$ LOSS
( FOCUS+ ABIL;Y 6SEE UP CLOSE1 NE> VI.N4
,ONSET IS GRADUAL1 &! EMMETROPE1    #BGI
"O ^: EYES >E NATUR,Y 9 FOCUS )-   B#AAE
\T FOCUS+ AT A 4T.E1 NOTES 2G9N+ PRO#MS
0! MID-=TIES1 & PROGRESSIVELY ) 9CR1S$
AGE4
  ,! CAUSE ( PRESBYOPIA IS DEBAT$1 B MO/
AGREE ! PRO#M IS A RESULT (! AG+ PROCESS
(! NORMAL L5S (! EYE4 ,H>D5+ OR SCL]OSIS
(! L5S MAT]IAL1 N W1K;S (! EYE MUSCLES1
MAKES X RELATIVELY PROGRESSIVELY UNRE-
SPONSIVE 6EF=TS ( FOCUS+ MUSCLES (! EYE4
  ,H[ C PRESBYOPIA 2 PREV5T$8 ,WELL1
DON'T GET ANY OLD]1 HEH HEH4 ,REC5TLY
CLAIMS H BE5 MADE T ANTIOXIDANTS 9 L1FY
VEGETA#S MAY HELP1 & "! IS A /UDY 2+ P]-
=M$ UTILIZ+ EYE DROPS 3TA9+ ANTIOXI-
DANTS4 ,AL D>K SUNGLASSES H BE5 PROPOS$1
SU7E/+ T SUN EXPOSURE IS A CAUSE4 ,H["E1
NO DIET1 EX]CISE1 M$IC9E1 OR MODIFIC,N (
LIFE /YLE HAS BE5 SCI5TIFIC,Y PROV5 6BE
HELP;L4
  ,MANAGE;T OR TR1T;T (! PRO#M IS USU,Y
9 ! =M ( PROP] SPECTACLES1 OR EYE GLASS-
ES ( SU6ICI5T FOCUS+ P[] 6SATISFY "O'S
BE/ VISUAL POT5TIAL4 ,"S G 6! DRUG /ORE
& TRY \ :AT IS AVAILA# UNTIL !Y     #BHJ
FEEL !Y H SOLV$ ! PRO#M4 ,O!RS J   C#AAE
IGNORE ! PRO#M & LIMIT VISUAL ACTIV;Y4
,& "S >E EV5 WILL+ 6TRY SURGICAL M1NS TO
------------------------------------#AAF
AVOID GLASSES4 ,S"EAL OP;NS >E ACTU,Y
AVAILA#1 S* Z 3TACT L5SES & LAS] PROCE-
DURES4 ,^! 9CLUDE MONOVI.N OR BIFOCAL
3TACT L5SES1 LAS] TR1T;TS (! CORNEA TO
CR1TE MONOVI.N OR MULTIFOCAL SOLU;NS1
RADIO WAVE CORN1L TR1T;T CALL$ ,,CK1 &
N[ AL ! 9TRAOCUL> SURGICAL APPROA*4
  ,! SURGICAL MANAGE;T ( PRESBYOPIA IS !
NEWE/ APPROA* ATTRACT+ ATT5;N DIRECT$ 6!
3SUM]4 ,! E>LIE/ SURG]Y 0 DIRECT$ 6!
CILI>Y BODY1 ! TISSUE 2H ! IRIS1 ! COL-
OR$ "P (! EYE1 : GIVES SUPPORT 6! L5S (!
EYE4 ,W$GE 9S]TS 96! CILI>Y BODY H BE5
TRI$1 B RESULTS H N BE5 5C\RAG+4 ,M RE-
C5TLY1 SURG]Y HAS BE5 DIRECT$ 6REMOV+ !
L5S (! EYE & REPLAC+ X )A SPECIAL >TIFI-
CIAL L5S 9 AN ATTEMPT 6RE/ORE ! FUNC;N
(A "Y]1 NATURAL L5S4 ,YES1 ? C M1N DO+ A
CAT>ACT OP],N1 EV5 IF Y D N H A CAT>ACT1
: IS CALL$ CLE> L5S EXTRAC;N4 ,X IS N S
EXTREME1 ( C\RSE1 IF Y D H A        #BHA
CAT>ACT1 & A3OMMODATIVE ,,IOL,'S   A#AAF
H BE5 APPROV$ 0! ,,FDA Z AN ALT]NATIVE =
^? :O NE$ CAT>ACT SURG]Y4 ,! RESULT IS
!N CALL$ PSEUDOPHAKIK PRESBYOPIA CORREC-
;N 7,,PPC71 Z -P>$ 6PSEUDOPHAKIA1 ! T]M
APPLI$ 6! 3DI;N (! EYE AF 3V5;NAL ,,IOL
SURG]Y4
  ,RESULTS H BE5 GD 5 S* T 9T]E/ IS DE-
VELOP+ AM;G ^? :O WANT 6AVOID GLASSES Z
M* Z POSSI#4 ,3V5;NAL 9TRAOCUL> IMPLANTS
US$ 9 CAT>ACT SURG]Y C 2 SELECT$ 6(F] GD
4T.E VI.N1 (T5 S* T 4T.E GLASSES >E NO
L;G] NE$$4 ,H["E1 ! 3V5;NAL ,,IOL IS N
MULTIFOCAL1 S R1D+ GLASSES >E REQUIR$4
,IF D1L+ ) CAT>ACT PATI5TS1 X IS Q AP-
P1L+ 6BE A# 6SEE AF SURG]Y1 )\T GLASSES1
?\< X IS TRUE T MO/ CAT>ACT PATI5TS >E
OLD 5 T !Y H ALR LE>N$ 6LIVE ) GLASSES4
,REFRACTIVE SURG]Y PATI5TS :O >E 9T]E/$
9 GETT+ RID ( ?ICK 4T.E GLASSES M/ D1L )
! FACT T GLASSES WD 2 EV5TU,Y NE$$ =
R1D+1 ONCE !Y 2COME PRESBYOPIC4 ,!Y ?US
MI<T FEEL T _! GLASSES-FREE GOAL WD 2
-PROMIS$4 ,! LURE ( 2+ A# 6SEE AT ALL
4T.ES1 )\T GLASSES1 MAY ATTRACT     #BHB
S* REFRACTIVE SURG]Y PATI5TS TO    B#AAF
PRESBYOPIA SURG]Y4
  ,! L>GE/ GR\P POT5TI,Y ELIGI# = PRES-
BYOPIA SURG]Y WD 2 ! EMMETROPES1 #DJ P]-
C5T (! TOTAL POPUL,N1 :O NATUR,Y SEE J
F9E UNTIL _! >MS GET TOO %ORT 9 _! =-
TIES4 ,! EMMETROPIC GR\P IS E/IMAT$ Z
#EE MILLION 9 ! ,UNIT$ ,/ATES1 #DD MIL-
LION ( :OM >E NATUR,Y T WAY1 & O!RS
A*IEV+ ?1 FOLL[+ REFRACTIVE OR CAT>ACT
SURG]Y4 ,^? M>KET+ WAYS ( AVOID+ GLASSES
>E NATUR,Y ATTRACT$ 6? L>GE GR\P ( POT5-
TIAL CLI5TS4
  ,TR1T;T ( PRESBYOPIA C 2 APPROA*$ 9
DI6]5T WAYS4 ,Z M5;N$1 REFRACTIVE SURG]Y
USU,Y 9VOLVES *ANG+ ! CURVATURE (! COR-
NEA1 ! CLE> W9D[ TISSUE 9 FRONT (! PU-
PIL4 ,? IS USU,Y D"O )A LAS] ^! "DS1 B
"! IS A NEW TE*NIQUE ( 9S]T+ A WAF]-?9
R1D+ L5S 96! C5T] (! CORNEA4 ,! BI7E/
NEW TR5D ?\< 9VOLVES REMOV+ ! NATURAL
L5S1 2H ! PUPIL1 & REPLAC+ X EI ) AN
,,IOL1 : MOVES S Z 6SIMULATE ! FOCUS+
ABIL;Y (! NORMAL L5S 7?US
                                    #BHC
%[+ T ! FOCUS+ MUSCLES / "W71 OR    #AAG
)A MULTIFOCAL L5S4 ,MULTIFOCAL L5SES >E
N ALL "O P[]4 ,= EXAMPLE1 ! C5TRAL "P
MAY 2 = CLOSE VI.N &! P]IPH]AL "P = 4T.E
VI.N4 ,MULTIFOCAL ,,IOL,'S >E "!=E N
TRUE A3OMMODATIVE L5SES1 B >E PSEUDOAC-
-MODATIVE 9 _! AC;N4
  ,M>KET ANALYSIS HAS PREDICT$ _M P 6BE
9T]E/$ 9 PRESBYOPIC SURG]Y4 ,CO/1 (
C\RSE1 IS A LIMIT+ FACTOR4 ,A HI< P]C5T-
AGE ( P HAV+ _H 9TRAOCUL> PRESBYOPIA
SURG]Y1 P]H #HJ-IJ P]C5T1 SAY !Y C FUNC-
;N )\T GLASSES MO/ (! "T4 ,PATI5T SELEC-
;N IS1 ( C\RSE1 IMPORTANT IF EXPECT+ GD
RESULTS4 ,X HAS BE5 SD1 H["E1 T ^? PA-
TI5TS :O H BE5 WE>+ GLASSES MO/ (! "T1 (
A MULTIFOCAL NATURE1 S* Z BIFOCALS OR
TRIFOCALS1 ..MAY N 2 SATISFI$ )! VISUAL
RESULT ( PRESBYOPIA .SURG]Y4 ,H["E1 P :O
H BE5 AVOID+ GLASSES 0USE ( 3TACT L5SES1
OR PLA9 NEGLECT1 W PROBABLY 2 MO/ SATIS-
FI$4 ,AL1 ^? = :OM CO/ IS N A DET]R5T1 &
:O H BE5 AVOID+ GLASSES1 MAY 2 GD C&I-
DATES4
  ,Z F> Z CO/ IS 3C]N$1 ( C\RSE     #BHD
9SUR.E DOES N COV] PRESBYOPIA      A#AAG
SURG]Y1 M* ! SAME Z COSMETIC SURG]Y4
,:AT IS A BIG SURPRISE1 H["E1 IS T ,M$I-
C>E HAS AGRE$ 6ALL[ A =M ( BAL.E BILL+ =
CAT>ACT SURG]Y1 "S?+ X N"E ALL[$ 2F4
,SURGEONS >E ALL[$ 6BILL ,M$IC>E =! CAT-
>ACT SURG]Y1 & !Y W PAY _! USUAL FEE4 ,!
SURGEONS >E AL ALL[$ 6!N BILL ! PATI5TS
= 8PRESBYOPIA SURG]Y0 7A T]M ,I P]SON,Y
H A PRO#M )71 : ALL[S ! SURGEONS 6COL-
LECT DIRECTLY F ! PATI5TS ! EXTRA CO/ (!
SPECIAL 9TRAOCUL> IMPLANT &! A4I;NAL
SURGICAL FEE4 ,SECOND>Y 9SUR.E1 FOLL[+ !
L1D ( ,M$IC>E Z USUAL1 WD 2 EXPECT$ 6PAY
! USUAL AM.T X PAYS = CAT>ACT SURG]Y1 B
N =! A4I;NAL PRESBYOPIA SURG]Y4
  ,! A4I;NAL AM.T *>G$ ! PATI5T MAY V>Y1
B IS >.D 4#B1HJJ P] EYE 7A RANGE ( QUO-
T,NS F 4#A1AJJ 64#C1BJJ74 ,? MAY SEEM L
N S BAD A D1L = ^? :O G 6! EXTREME TO
AVOID GLASSES1 AT ANY CO/1 B N S* A GD
D1L =! ELD]LY CAT>ACT PATI5T :O IS US$
6,M$IC>E COV]+ "EY?+4 ,X IS EXPECT$ T
MO/ ELD]LY PATI5TS W 3T9UE 6H 3V5;NAL
9TRAOCUL> L5S IMPLANTS1 2C !Y       #BHE
WANT ,M$IC>E 6PAY = "EY?+4         B#AAG

    ,PRESBYOPIA ,SURG]Y ,ALT]NATIVES
    ,MONOVI.N ,LASIK
  ,? IS ! MO/ -MON &! MO/ PROV5 APPROA*
6PROVID+ BO? 4T.E & NE> VI.N4 ,C]TA9LY1
EXP]I;E ) 3TACT L5SES HAS %[N ? 6BE Q
SU3ESS;L1 & FRANKLY M SU3ESS;L ?AN AT-
TEMPTS AT BIFOCAL & O!R MULTIFOCAL 3TACT
L5SES4 ,X "WS WELL ) MYOPES F @-#A TO
@-#H1 HYP]OPES F @+#B.E TO @+#C1 & ^? )
LESS ?AN #C DIOPT]S ( A/IGMATISM4 ,X IS
N RECOMM5D$ = A?LETES1 PILOTS1 OR TRUCK
DRIV]S1 OR ANY"O :O 9SI/S ON N HAV+ 6WE>
GLASSES AT ANY "T = ANY?+4 ,PATI5TS C 2
TOLD T ! MONOVI.N C 2 REV]S$ IF !Y PREF]
B9OCUL>;Y =
------------------------------------#AAH
4T.E1 B X IS PREF]A# 6H TE/$ ! A3EPT.E (
MONOVI.N PREOP]ATIVELY4 ,EV5 S1 X HAS
BE5 NOT$ T P T5D 6BE M CRITICAL & DEM&+
( P]FEC;N AF SURG]Y4

    ,A3OMMODATIVE ,,IOL 7,L5S ,EXTRAC;N7
  ,Z M5;N$1 ? 9VOLVES REMOV+ !      #BHF
NORMAL L5S (! EYE & REPLAC+ X )    A#AAH
AN ,,IOL1 ! DI6];E 2+ T ! L5S 9S]T$ HAS
! ABIL;Y 6*ANGE %APE 9 A WAY 6SIMULATE
NORMAL FOCUS+ OR A3OMMOD,N4 ,! MO/ WELL
"KN ( S* A L5S IS ! ,CRY/AL5S 7,EYEON-
ICS74 ,O!R L5SES >E 2+ US$1 & M >E 9 !
EXP]I;TAL /AGES1 S* Z 2+ A# 6REPLACE !
GEL-L NORMAL L5S MAT]IAL )A SYN!TIC GEL
AL A# 6*ANGE %APE Z DOES ! NORMAL Y\?;L
L5S (! EYE4 ,O!R NEW A3OMMODATIVE
,,IOL,'S >E 9 ! W+S S* Z ! ,SAF>AZI
7,B@&,L7 & ,SM>T ,,IOL 7,M$5NIUM71 & M
>E -+ 9 S* Z ! ,SYN*RONY ,DUAL ,OPTIC
,,IOL 7,VISIOG571 ! ,KELLAN ,TETRA,FLEX
7,L5/EC71 ! ,NU,L5S 7,H]ZELIYA1 ,ISRA-
EL71 &! LI<T ,ADJU/A# ,,IOL 7,CALH\N
,VI.N74

    ,MULTIFOCAL ,,IOL 7,L5S ,EXTRAC;N7
  ,"! >E _M S* L5SES1 9CLUD+ ! ,RE,/OR
7,ALCON71 ,>RAY 7,,AMO71 ,RE,ZOOM
7,,AMO71 & ,TECNIS 7,,AMO74 ,"S S* L5SES
>E BETT] = CLOSE VI.N 7,RE/OR7 ?AN O!RS2
"S >E BETT] = 9T]M$IATE VISUAL NE$S
7,REZOOM74 ,= ^! R1SONS1 "S         #BHG
SURGEONS SU7E/ A -B9,N ( "O TYPE   B#AAH
( L5S 9 "O EYE1 & ANO!R 9 ! SECOND EYE4
,-PLIC,NS 9CLUDE DI6ICULTY 9 ADJU/+ TO
MULTIFOCAL IMAGES1 GL>E1 HALOS1 & DIM9-
I%$ CL>;Y ( VI.N4 ,^! -PLIC,NS H %[N A
LESS5+ DEGREE ( PRO#MS ) NEW] MULTIFOCAL
L5SES4

    ,PHAKIC ,MULTIFOCAL ,,IOL
  ,? 9VOLVES 9S];N ( AN 9TRAOCUL> IM-
PLANT 9 FRONT (! NORMAL L5S (! EYE1 Z C
2 D"O = HI< DEGREES ( HYP]OPIA OR MYOPIA
B AL AVAILA# = L[] DEGREES ( HYP]OPIA OR
MYOPIA1 S Z 6BE A# 6AL PROVIDE ! ABIL;Y
6SEE UP CLOSE4 ,! D[NSIDE 9CLUDES ! FACT
T ? IS AN 9TRAOCUL> SURGICAL PROC$URE1 )
SIMIL> POT5TIAL -PLIC,NS & 9CR1S$ CO/4
,AL1 "! IS ! EXPECT,N ( CAUS+ A CAT>ACT1
?\< ONLY REPORT$ 9 #D P]C5T1 & ?US RE-
QUIR+ ANO!R OP],N LAT]4

    ,SCL]AL ,SURG]Y
  ,? IS A LESS]-"KN B DI6]5T APPROA* TO
SOLV+ ! PRO#MS ( PRESBYOPIA4 ,ADVANTAGES
9CLUDE N HAV+ 64TURB ! CLE>         #BHH
CORNEA OR P]=M 9TRAOCUL> SURG]Y4   C#AAH

A4 ,ANT]IOR ,CILI>Y ,SCL]OTOMY--? PROCE-
  DURE SPUN (F ! NOT,N T IF RADIAL K]A-
  TOTOMY 9CI.NS 7 C>RI$ ACR ! LIMBUS1 !
  JUNC;N (! CORNEA
------------------------------------#AAI
  )! ADJAC5T SCL]A 7"!BY OV] ! CILI>Y
  BODY TISSUE71 T PRESBYOPIA SYMPTOMS 7
  LESS NOTICEA#4 ,S* 9CI.NS1 :5 MADE TO
  HELP REDUCE PRESBYOPIA SYMPTOMS1 H "S-
  "TS BE5 -PLICAT$ 0ANT]IOR SEG;T IS*E-
  MIA 7POOR BLOOD SUPPLY 6! >EA71 OR M
  -MONLY 0POOR VISUAL RESULTS4
B4 ,LAS] PRESBYOPIA REV]SAL 7,,LAPR7
  UTILIZES 9FRAR$ LAS] TISSUE ABL,N TO
  CR1TE RADIAL 9CI.NS T REMOVE A GROOVE
  ( SCL]AL TISSUE OV]LY+ ! CILI>Y BODY4
  ,? HAS BE5 APPROV$ 9 ,EUROPE B N YET 9
  ! ,UNIT$ ,/ATES4
C4 ,SCL]AL ,EXPAN.N ,B&S 7,,SEB7 PROCE-
  DURE1 AL "KN Z ! ,SCL]AL ,SPAC+ ,PRO-
  C$URE 7,,SSP71 9VOLVES CR1T+ RADIAL
  ANT]IOR CILI>Y BODY 9CI.NS &A SCL]AL
  TUNNEL 2T PAIRS ( 9CI.NS1 &       #BHI
  PLAC+ AN IMPLANT 96"O (! SCL]-   A#AAI
  AL TUNNELS4 ,-PLIC,NS 9CLUDE 9E6EC-
  TIVE;S & SCL]AL PROLAPSE 7H]NI,N (
  DEEP] TISSUES74

    ,3DUCTIVE ,K]ATOPLA/Y 7,,CK7
  ,= ? PROC$URE RADIO FREQU5CY 5]GY IS
APPLI$ 6! CORN1L /ROMA 79T]M$IATE LAY]7
0M1NS (A PROBE TIP 9S]T$ 96! P]IPH]AL
CORNEA AT #H 6#CB TR1T;T PO9TS 6PRODUCE
A 3TRACT+ E6ECT T 9CR1SES ! CURVATURE (!
C5TRAL CORNEA4 ,X IS BE/ 6TR1T @+#A.E
DIOPT]S OR LESS HYP]OPIA =A L;G T]M (
GRT] ?AN "O YE>1 Z L;G Z "! IS M9IMAL
A/IGMATISM4
  ,! PROC$URE IS 3SID]$ V SAFE B N Z EF-
FECTIVE OR A3URATE Z LASIK1 & X TAKES M
"T4 ,-PLIC,NS 9CLUDE TRANSI5T A/IGMATISM
& TEMPOR>Y E6ECT1 RESULT+ 9 ! NE$ 6RE-
TR1T 9 "O YE>1 OR SELECT ANO!R PROC$URE4
,H["E1 ! LATE/ RESULTS ) 8LI<T T\*0 H
BE5 A BIT M 5C\RAG+ REG>DS DUR,N4 ,X IS
3SID]$ LESS IMPORTANT 9 ! FUTURE ( RE-
FRACTIVE SURG]Y &( 8UNC]TA9 ADVANTAGE40
                                    #BIJ
    ,MULTIFOCAL ,LASIK             B#AAI
  ,9 ? PRESBYOPIC LASIK PROC$URE ! ABL,N
PROFILE HAS BE5 MODIFI$ 6CR1TE AN ASPH]-
IC CURVATURE (! CORN1L B$ S Z 6CR1TE
BETT] NE> VI.N1 AL;G ) GD 4T.E VI.N4
,PATI5TS NE$ 6BE 9=M$ T 4T.E VI.N W 2
TEMPOR>ILY BLURR$1 :ILE NE> VI.N W 2
IMMLY GD4 ,UTILIZ+ "S MONOVI.N HELPS
L;G-T]M RESULT1 & 5H.E;T IS AVAILA# TWO
6?REE YE>S LAT]4 8,PRESBY-,LASIK0 PA-
TI5TS ( HYP]OPIC TYPE1 PLUS ^? :O >E
PSEUDOPHAKIK 7ALR _H CAT>ACT SURG]Y71 >E
AM;G ! MO/ PL1S$ PO/ TR1T;T4 ,PRO#MS IN-
CLUDE ! FACT T "! MAY DEVELOP A LOSS (
BE/-CORRECT$ VI.N1 "O OR TWO L9ES ON !
,SNELL5 *>T1 &! DUR,N ( POSITIVE E6ECT
LA/S FIVE 6SEV5 YE>S4

    ,9TRACORN1L ,9LAY
  ,AN ASPH]IC 9LAY IS PLAC$ "U A LAMELL>
FLAP (! CORNEA & C5T]$ OV] ! PUPIL1 S* Z
! ,RE,VI.N ,,IOL1 BE/ = HYP]OPES1 #A-F
DIOPT]S1 ) L[ A/IGMATISM4 ,X IS 8M LA/+0
?AN ,,CK1 B N YET ,,FDA APPROV$4
                                    #BIA
  ,S :O %D H PRESBYOPIA SURG]Y8     #ABJ
,CURR5TLY1 ! BI7E/ M>KET IS = ^? ) CATA-
RACTS & ^? :O C AF=D ! EXTRA CO/1 P]H
#BE-CJ P]C5T ( ^? ) CAT>ACTS4 ,! BIG PO-
T5TIAL M>KET IS AM;G ^? :O D N H CATA-
RACTS B WANT 6SEE )\T GLASSES4 ,IF Y >E
"S"O :O REQUIRES /R;G EYEGLASSES1 Y MAY
2 BETT] MOTIVAT$4 ,!N "! >E ^? :O H BE5
AVOID+ GLASSES & N[ C SEE T !Y >E GO+ TO
NE$ GLASSES1 B >E WILL+ 6G 6GRT EXP5SE
63T9UE 6AVOID GLASSES4 ,S* P >E T>GET$
0! PRESBYOPIC SURG]Y 9DU/RY4
  ,! MOVA# "P IMPLANT GIVES V>IA# FOCUS1
L ! ORIG9AL L5S1 B 6A LIMIT$ DEGREE1 S*
T X MAY N 2 SATISFACTORY = V SMALL PR9T
OR ?+S HELD V CLOSE4 ,"O MULTIFOCAL L5S
IS GD = 4T.E &= SMALL PR9T B N S GD AT
9T]M$IATE 4T.ES1 L =A -PUT]4 ,ANO!R MUL-
TIFOCAL L5S GIVES GD 9T]M$IATE VI.N1 B
IS N S GD = SMALL PR9T UP CLOS]4
  ,:5 4CUSS+ ! E6ECTS ( DI6]5T 9TRAOCUL>
L5SES1 ,DR4 ,WM4 ,W4 ,MALONEY REPORTS 9
.,OCUL> .,SURGICAL .,NEWS1 ! ,MAY #A1
#BJJF1 ISSUE1 T "! >E FIVE Z"OS ( FOCUS
63SID]4 ,Z"O #A IS = NE>-VI.N       #BIB
ABIL;Y 6SEE NEWSPR9T & SEW+2       A#ABJ
,Z"O #B IS = ?+S S* Z -PUT]S OR M5US2
,Z"O #C IS = 9DOOR ,,TV1 COOK+1 & EAT+2
,Z"O #D IS = "D"T DRIV+1 GOLF1 OR T5NIS2
& ,Z"O #E IS = NI<T"T DRIV+1 MOVIES1 &
!AT]4 ,N"O (! AVAILA# PRESBYOPIA COR-
RECT+ ,,IOL,'S C DELIV] GD VI.N 9 ALL
FIVE Z"OS4 ,^! ,,IOL,'S CURR5TLY 9CLUDE
F\R ALT]NATIVES3 ,CRY/AL5S 7,EYEONICS71
,RE,ZOOM 7,ADV.ED ,M$ICAL ,OPTICS71 ,RE-
,/OR 7,ALCON71 & 3V5;NAL ,,IOL,'S4 ,TO
A*IEVE ! DESIR$ E6ECTS = CLOSE "W1 A =M
( B9OCUL> 8BL5D+0 IS SU7E/$1 MAK+ "O OR
BO? EYES A BIT NE>SI<T$1 ESPECI,Y IF
,Z"O #E NI<T-DRIV+ REQUIRE;TS >E N S IM-
PORTANT1 & CD 2 SOLV$ )A R>ELY NE$$ PAIR
( DRIV+ GLASSES4
  ,"U ! CIRCUM/.ES1 "S SU7E/ US+ "O TYPE
( L5S 9 "O EYE & ANO!R 9 ! SECOND EYE TO
TAKE ADVANTAGE (! BE/ ( EA* L5S4 ,H["E1
MO/ SURGEONS 2LIEVE T X IS BE/ 6USE !
SAME L5S 9 BO? EYES & SU7E/ A %ORT 9T]-
VAL 2T DO+ ! EYES1 S* Z ?REE WEEKS4 ,:Y
D BO? EYES ) MULTIFOCAL L5SES1 )A %ORT
9T]VAL 2T SURG]IES8 ,"O R1SON IS    #BIC
T X IS NEC =! BRA9 6ADJU/ 6!       B#ABJ
MULTIPLE IMAGES 9 ORD] 6SELECT ! CORRECT
IMAGE1 & X IS PROBABLY EASI] IF BO? EYES
H ! SAME NE$S 7PRO#MS74 ,H[ DOES X D ?8
,X REM9DS ME (! /ORY AB ?REE GUYS >GU+
AB ! MO/ IMPORTANT 9V5;N 9 ! _W4 ,"O SD
! AIRPLANE1 ANO!R SD ! SPACECRAFT1 &!
?IRD SD ! !RMOS4 ,:Y ! !RMOS1 HE 0 ASK$1
& HE SD 8,WELL1 :5 Y PUT "S?+ COLD 9 X1
X /AYS COLD1 & :5 Y PUT "S?+ HOT 9 X1 X
/AYS HOT40 ,:5 QU]I$ Z 6:AT 0 S SPECIAL
AB T1 HE REPLI$1 8,WELL1 H[ D X "K80 ,)
MULTIFOCAL L5SES1 ! BRA9 NE$S TO 8"K10 &
APP>5TLY X 8D10 DEMON/RAT+ TREM5D\S
ABIL;Y (! BRA9 6ADJU/4
  ,:AT IF ! BRA9 DOES N ADAPT8 ,SYMPTOMS
( DYSPHOTOPSIA >E DESCRIB$ ) MULTIFOCAL
L5SES1 9CLUD+ REFLEC;NS1 TEMPORAL D>K;S
OR VISUAL FIELD DEFECT1 UNSETTL+ VI.N
>C1 GL>E1 & C5TRAL FLA% & HALOS4 ,!
SOLU;N1 IS
------------------------------------#ABA
USU,Y WAIT+ =! SYMPTOMS 6G AWAY P] 8NEU-
RAL ADAPT,N10 : MAY TAKE N9E MON?S OR M4
,B IF A PATI5T _C TOL]ATE !         #BID
SYMPTOMS1 ! MULTIFOCAL L5S C 2     A#ABA
REPLAC$ ) AN A3OMMODATIVE ,,IOL1 S* Z
,CRY/AL5S1 OR 0A 3V5;NAL MONOFOCAL IM-
PLANT4 ,DR4 ,MALONEY /ATES 9 .,OCUL>
.,NEWS1 ,OCTOB] #A1 #BJJF1 ISSUE1 T
PSEUDOPHAKIA MONOVI.N IS DI6]5T ?AN CON-
TACT L5S MONOVI.N1 & X TAKES ! BRA9 ONLY
"O OR TWO "DS 6ADJU/1 EV5 )\T PREOP]A-
TIVE TE/+4
  ,-PLIC,NS ( 9TRAOCUL> PRESBYOPIA SUR-
G]Y C 9CLUDE ANY?+ T C G WR;G ) 9TRAOCU-
L> SURG]Y1 9CLUD+ 9FEC;N1 RET9AL DETA*-
;T1 MACUL> SWELL+1 CORN1L DECOMP5S,N1 &
O!R CAUSES ( LOSS ( VI.N4 ,) R\T9E CATA-
RACT SURG]Y1 ^! -PLIC,NS >E N[ =TUNATELY
R>E1 &! SAME MI<T 2 EXPECT$ = PRESBYOPIA
SURG]Y4 ,! BI7E/ -PLIC,NS WD 2 FAILURE
6A*IEVE ! VISUAL RESULTS EXPECT$1 B ? C
2 LESS5$ 0PATI5T SELEC;N & $UC,N4 ,AN
UN"KN =! "Y] PATI5T1 9 _! =TIES OR FIF-
TIES1 IS IF LAT] 9 LIFE !Y MAY DEVELOP
MACUL> DEG5],N & 2 H&ICAPP$ 0HAV+ A MUL-
TIFOCAL ,,IOL : MAKES ! SYMPTOMS WORSE1
OR IF GLAUCOMA W DEVELOP & DI6ICULTY 9
EVALUAT+ ! VISUAL FIELD TE/S W      #BIE
RESULT F HAV+ A MULTIFOCAL ,,IOL   B#ABA
9 PLACE4 ,AL1 ^? :O H _H ,LASIK MAY F9D
T A4I;NAL AB]R,NS CR1T$ 0! MULTIFOCAL
L5S MAY 2 M 9TOL]A#4
  ,S PRESBYOPIA SURG]Y IS N )\T R1SON =
3C]N1 Z %D 2 OBS]V$ ) ANY SURG]Y4 ,X IS
TRUE T AN UNSATISFACTORY RESULT C 2 COR-
RECT$ 0REMOVAL & REPLACE;T (! 9TRAOCUL>
IMPLANT4 ,H["E1 ? C 2 M DI6ICULT ?AN !
ORIG9AL SURG]Y1 &! -PLIC,N RATE 9CR1SES4
,X IS BE/ 6C>E;LLY SELECT PATI5TS Z 6_!
EXPECT,NS1 GIVE !M DETAIL$ PREOP]ATIVE
9=M,N1 & !N AVOID REOP],NS IF POSSI#4 ,X
IS N L RETURN+ A %IRT 6,NORD/ROMS 6GET
"O T FITS BETT]4
  ,": %D Y G 6GET PRESBYOPIC SURG]Y8 ,N
ALL CAT>ACT SURGEONS P]=M PRESBYOPIC
SURG]Y4 ,"S OPH?ALMIC SURGEONS CURR5TLY
DECL9E 2C ( SKEPTICISM AB 9DIC,NS &_/OR
EXPECT$ RESULTS1 OR DI6ICULTY ANSW]+ !
"Q F A PATI5T Z 6:E!R !Y WD H ! SURG]Y
!MVS4 ,?\< ANY GD CAT>ACT SURGEON C
PROBABLY D PRESBYOPIC SURG]Y1 "S L5S
MANUFACTUR]S REQUIRE T AN OPH?ALMOLOGI/
M/ TAKE _! SPECIAL TRA9+ C\RSE &    #BIF
2 C]TIFI$ 0!M 2F !Y W ALL[ !       C#ABA
OPH?ALMIC SURGEON 6BUY _! L5S4
  ,_M REFRACTIVE SURGEONS ADV]TISE1 "S?+
DOCTORS DID N USE 6D PRIOR 6DEREGUL,N 9
! #AIGJ;S1 B : HAS 2COME M -MON 9 -PETI-
;N ) O!R HI<-VOLUME SURGEONS4 ,HI<-
VOLUME SURGEONS >E AL LIKELY 65C\RAGE &
ATTRACT REF]RALS4 ,? BR+S UP ! SUBJECT (
COMANAGE;T1 M1N+ T ! REF]R+ DOCTOR1 Q (-
T5 AN OPTOMETRI/1 ASSUMES ! PO/OP]ATIVE
C>E1 ) APPROVAL & SUPPORT (! SURGEON4 ,Z
M5;N$1 ? IS AN AUTOMATIC R\T9E ) LASIK-
TYPE REFRACTIVE SURG]Y1 B ! ABIL;Y ( AN
OPTOMETRI/ 6ASSUME PO/OP]ATIVE CAT>ACT
C>E HAS BE5 A S\RCE ( 4PUTE 2T OPH?AL-
MOLOGY & OPTOMETRY L1D]%IP GR\PS4 ,ANO!R
RELAT$ ISSUE IS T1 S9CE ,M$IC>E IS IN-
VOLV$ 9 PAY+ FEES1
------------------------------------#ABB
: 9CLUDE A FOLL[-UP ( AB N9ETY "DS1 X
NE$S 6BE E/ABLI%$ PREOP]ATIVELY Z 6:AT
FEES ! PATI5T MAY 2 EXPECT$ 6BE *>G$
PO/OP]ATIVELY1 SAY 0! REF]R+ DOCTOR1
RELATIVE 6! FOLL[-UP (! PRESBYOPIA SUR-
GICAL "P (! PROC$URE4               #BIG
  ,PRESBYOPIA SURG]Y IS C]TA9LY    A#ABB
NEW & EXCIT+4 ,DR4 ,WM4 ,W4 ,M4 ,MALONEY
DESCRIBES PRESBYOPIA CORREC;N Z ! MO/
IMPORTANT 9NOV,N 9 OPH?ALMIC SURG]Y S9CE
PHACOEMULSIFIC,N 7SMALL-9CI.N CAT>ACT
SURG]Y74 ,S9CE "! 0 AN 9CR1SE 9 ! USE (
PHACOEMULSIFIC,N1 F #I P]C5T 6#IE P]C5T
2T #AIHE & #AIIE1 "! MAY AL 2 A M>K$ IN-
CR1SE ( USAGE ( ? NEWE/ 9NOVATIVE PROCE-
DURE 9 ! FUTURE4 ,?\< "! >E R1SONS =
3C]N & SKEPTICISM1 ! IDEA HAS OBVI\S M]-
IT1 & NEW] BETT] IMPLANTS >E 9 ! "WS4 ,S
WAIT+ A:ILE 2F DECID+ AB HAV+ ? SURG]Y
IS N A BAD IDEA4 ,H["E1 IF GR&MA -ES
HOME AF CAT>ACT SURG]Y & C SEE BETT] )\T
GLASSES ?AN ANY"O ELSE 9 ! FAMILY1 "S
J1L\SY MAY /IMULATE AC;N4







                                    #BIH