Eye Protection And Correction

Interviewed by Melissa Moniz
Wednesday - December 24, 2008
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By Dr. Dean Hu
Ophthalmologist, chief of the Department of Ophthalmology at Kaiser Permanente Hawaii

Interviewed by Melissa Moniz

Where did you receive your schooling and training?

I graduated from the combined undergraduate and medical program at the University of Michigan. Then I went to the University of Pittsburgh Medical Center for my ophthalmology residency training as well as my fellowship training in cornea and refractive surgery.

How long have you been practicing?

This is my 10th year at Kaiser Permanente.

What is your area of specialty?

Like most of the other ophthalmologists at Kaiser, I cover the full scope of comprehensive ophthalmology, but I also spend a good portion of my time performing surgeries in my sub-specialty area like cornea transplantation, LASIK and other refractive surgeries.

Can you talk a little about the different types of vision correction surgeries, and how it has improved since you first started?

When I was a second-year medical student, I remember sitting in the lecture hall listening to one of the professors talk about some laser that could correct nearsightedness. I thought to myself, ‘Sure, wonder when that will ever happen?’ But by the time I entered my residency training it was already fairly mainstream to use the excimer laser to do PRK, which is a surface laser correction for nearsightedness. That worked well, except that there was quite a bit of discomfort and a fairly long healing and recovery time. Since then, we’ve gone to LASIK, where we create a flap on the surface of the cornea and shape the cornea underneath it. With LASIK, most patients are comfortable and seeing well by the first day after surgery. A newer advance now is to use a laser to create the flap as well, so that has actually improved the safety profile of the procedure. In fact, I chose to have LASIK myself at the end of my fellowship. I’m nine years out from having LASIK and seeing very well, and I’ve been very happy with it.

Are there any precautions or things that people should be aware of before deciding to do the procedure?

There are a number of things, most of which we pick up at the screening exam. Basically, really bad dry eyes, shape abnormalities of the cornea and some people with very high or unusual prescriptions may not be good LASIK candidates.

Is the procedure painful at all?

It’s actually pretty painless. We use numbing drops on the surface. You feel some pressure and some coldness of the drops, but there really isn’t any pain at all. After the surgery, the eyes feel gritty and a bit teary, but by the next day, most patients feel as good as new.

Dr. Hu takes a closer look during a routine eye exam
Dr. Hu takes a closer look during a routine eye exam

How much of your practice is doing surgeries, and how much of it is clinical?

I usually spend about a half day a week in cataract surgery and a half day a week in LASIK surgery. And I also have a half day dedicated to administrative work since becoming chief of the department last year. The rest is patient care time.

Do you have any tips on keeping eyes healthy?

Kaiser Permanente is a huge proponent of preventive care, so for people who smoke, the biggest preventive measure is smoking cessation. Smoking is associated with cataracts and macular degeneration as well as a lot of other diseases not directly related to the eyes. For people with diabetes, we recommend regular screening eye exams to detect diabetic eye problems at their earliest stages. Due to the preventive efforts at Kaiser Permanente, we have maintained a consistently high percentage of our patients who have diabetic eye exams on a regular basis. In general, we also recommend that our patients use good ultraviolet protection. Wear sunglasses and a hat when you’re outside, because excessive ultra-violet exposure can speed cataract development as well as predis-pose to developing a pterygium, which is a fleshy growth that is on the front surface of the eye. UV exposure also plays a role in macular degeneration.

As a kid I always remember my parents telling me not to sit too close to the TV because it’s bad for my eyes. Is there any truth to that?

You’re probably talking about becoming nearsighted and needing glasses. That’s a controversial subject, the development of myopia and refractive errors or focusing problems. Most ophthalmologists feel that it is probably genetically determined for the most part, and we don’t really know that television really affects it, so I generally don’t have a problem if kids sit close.

There is some thought that a lot of close work, like reading and studying, can worsen nearsightedness, but I still recommend reading a lot and studying hard.

How much of having poor eyesight and diseases is genetic and how much is environment?

There is likely a component of both in most conditions. We are finding more and more that many diseases have a genetic component, but to some extent, they can also be affected by one’s environment.

Besides LASIK, have there been other medical advancements that have helped improve the way you treat patients?

Yes, with cornea transplants there’s a relatively new technique that has become popular over the past few years - partial thickness cornea transplantation for certain conditions. That has really improved the recovery time and overall safety. This procedure has actually increased the number of transplants being done nationwide. The downside to that is there was already a somewhat limited donor base for corneas, and this surgery has taxed the donor pool even more. In Hawaii, we have a projected need for 190 corneas for next year, half of which will be harvested locally and half imported from the Mainland. One piece of good news is that now people who have had LASIK or PRK surgery can be cornea donors, where in the past they could not. But donors are always needed. The nice thing about corneas is that since they don’t have any blood vessels or blood flow, you don’t have to do blood typing or tissue matching. And the tissue can stay viable for a longer period of time in its preservative solution.

Is there a way to correct blindness?

It depends on the reason. The leading cause of blindness in the world is cataracts, so people who lose vision from cataracts can certainly be fixed if cataract surgery is available in their part of the world. If it’s due to optic nerve damage, we still don’t have anything yet because you can’t regenerate nerve tissue. Certain other forms of vision loss are also treatable like corneal scars, which can be treated with a transplant. Every now and then people ask about a full-eye transplant. We can’t do a full-eye transplant yet, but a cornea transplant is doable.

What do you see as the future of ophthalmology?

Probably one of the big things that we’re still looking forward to is being able to correct oldage vision. Most everybody starts losing their near vision around age 40 due to a condition called presbyopia. We are still looking for some solution to help people see up close without reading glasses while still maintaining their distance vision. It may be that cataract surgery will be the solution for many people. That’s one of the things Kaiser Permanente has been offering, premium lens implants with cataract surgery. Standard lens implants are single focus for distance, but there are some newer lenses that can improve the near vision to a certain extent in addition to providing distance vision. These lenses work very well, but none is perfect yet. I think at some point there will be a lens implant that will give people excellent vision at distance and near, as well as all points in between, kind of like being young again. That may be the ultimate solution to the problem.

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