Who is at Risk?
In “Cataract Surgery Riskier for Younger Patients” (News in Review, July/August), the article describes the increased risk of retinal detachments in patients under the age of 50. This information has been presented before and is consistent with other articles.
While the increased risk of retinal detachment is quintupled for those under the age of 50 as compared to the overall risk, it is important to note that this number is misleading since the overall risk includes the under-50-year-old group. If you compare the under-50 group against patients over the age of 70, the risk increases to eight times as much.
Complete informed consent should be obtained from those patients who are considering clear lens extraction for refractive purposes. It should include a statement saying that the risk for retinal detachment may not be an early complication but can extend out to at least 10 years after the surgery.
David S. Rothberg, MD
The Vaseline Routine
Being frustrated by the lack of simple, inexpensive measures for dry eyes, I have developed a routine for dry eye patients using standard Vaseline petroleum jelly at bedtime. This has worked remarkably well for dry eye patients, as well as for those with blepharitis, meibomian gland dysfunction and/or frequent styes.
Before bedtime, thoroughly wet the skin of the lower eyelids with the fingers. Apply a thin coat of Vaseline to the wet skin. Work the Vaseline up to the eyelashes, applying a small amount to the lashes themselves. This will not blur the vision or get into the eye, or get on sheets or pillowcases.
In the morning, the eyelids will be a little sticky and the eyes may feel a little uncomfortable. Use a washcloth or surgical towel with warm water to compress the glands under the lashes. Then use the cloth to gently scrub the eyelashes and eyelids. After cleaning off the excess Vaseline, put a drop of artificial tears in the eyes. The eyes should immediately feel better.
The Vaseline Routine serves as eyelid hygiene and calms the eyelids and eyes. The Vaseline keeps debris off the lashes, which then clean easily. It also prevents trauma from eye rubbing at night, since the patient’s fingers or hands slide on the Vaseline and cannot do serious damage to the eyelid. In addition, the Vaseline allows the lower lashes to fix to the upper lashes and helps to close the eye more effectively at night.
This routine is especially effective at moisturizing the eyes during both night and day. Though the Vaseline is cleaned off in the morning, some always stays on the skin under the lashes, working its way into the eye during the day as the patient blinks, a small amount at a time. This provides continued lubrication throughout the day and reduces the need for artificial tears to a minimum.
Vaseline is not for everyone. However, patients who follow the routine improve markedly in a few weeks. We have experimented with multiple variations of how, where and how often to apply the Vaseline. This routine works the best.
Other patients complaining of intense itching in the medial canthal area can also benefit from this routine. These patients don’t need to perform the whole routine, but applying a small amount of Vaseline with the fingertip to this area immediately stops the itching without blurring the vision.
One could argue the case of Vaseline’s sterility. This is a potential concern, but in three years of use with hundreds of patients, I have yet to see a problem.
I hope that you try this routine on some of your patients, or on yourself. It is usually enthusiastically accepted by patients who appreciate your help saving them money.
Lawrence J. Geisse, MD
Los Alamitos, Calif.
The November/December Blink credited Michael P. Kelly at Duke University Eye Center for the pseudoxanthoma elasticum photograph.
It should have instead given credit to Jason S. Calhoun at the Mayo Clinic in Jacksonville, Fla. EyeNet regrets the error.