In refractive surgery we pride ourselves in how we make our patients better. The patient who could not see the alarm clock, can now see the tiny leaves on a tree far away. The patient who has their glasses right next to their bed for fear of not being able to get out of the house if there was a fire, is now able to swim and see the beautiful fish in the sea. This “vision” can allow for pleasures and memories never before possible, a wonderful thing. But what if physical clarity came with it a different type of clarity, a deeper clarity.
I had a patient last week who was very near sighted but just within the last few years began wearing glasses. She grew up in a small village in China so not seeing well did not prevent her from doing her work or driving, she did not drive. When asked why see did not wear glasses she replied, “When things were clear for me as a little girl, I saw all the flaws in everyone. And I did not like it.” Her solution to this dilemma was to not wear glasses and be in a blissful blur. Having been in refractive surgery for over 15 years, this was the first response of this nature I had ever heard, but made me ask; so why have surgery? She simply stated, “I no longer see the flaws only the beauty in people”. Sounds like a good reason for Lasik to me.


The Joy of Happy Medicine
It is January and the refractive surgery world is busy again! Thanks to Flexible Spending Accounts (FSA) my January’s are always busy with Fridays being the busiest. I am lucky because this is such a wonderful procedure and it has advanced so much in the past years.
I have had the pleasure of working in the refractive surgery world since its inception over 15 years ago. It started with Jeff Machat, MD describing how the excimer laser removes 39 millionth of an inch in 12 billionth of a second and a picture of a human hair. The advances in the technology have resulted in a decrease in complications and an improvement in outcomes. What were once deemed just a “side-effect” of the surgery are now the most common complication- dry eyes.
Today, two different types of lasers perform this elegant procedure. A femtosecond laser creates a “flap” in the cornea and an excimer laser removes tissue and in the case of near-sighted patients flattens the cornea. The magic of the procedure is patients see so well the next day! While the vision is not perfect the next day, most patients are amazed at their vision. Where in medicine to we get such immediate gratification? It is similar to the child who puts on their first pair of glasses and just stares in amazement at the stimulating world around them.
For all of those who are active, this procedure changes your life. Whether it is the burden of putting contact lenses in and having them feel scratchy at the end of a long run or just not seeing in the surf because you do not where your glasses, adding great vision to an active lifestyle is a corner piece of the puzzle.

This may not be the exact quote from Greg Glassman, founder of Crossfit, but it is close. The concept is profound as it relates to the maintaining health and fitness. Do we really need more lifeguards (doctors/medicine) or do we need more people learning how to swim (take care of their bodies). When it comes to swimming we teach our children, at a young age, to be safe in the water. There are an increasing number of programs with the purpose of making children safe in the water, such as Infant Swim ( Parents are taking the responsibility to teach their children a basic skill necessary for survival as well as pleasure throughout their life. There is not an assumption that there will always be a lifeguard at every pool or a life vest at every beach.
When it comes to overall health, the doctor can be seen as the lifeguard. We continue to push for greater access to doctors, better medicines to treat diseases, but do we really teach our children about how to be healthy and how to care for their bodies. Sure hygiene is one thing but how much time do we spend on how our bodies move, how to cook and use food properly. Since we are a land based species maybe we take for granted how to navigate on land and what to eat. GPS and the drive-thru further erode what skill we might possess. It might be safe to say 10,000 years ago man probably had much better skills on how to care for his body then today. She had to there was not any lifeguards.
Running, jumping, lifting heavy stuff and playing are all things our bodies were designed to do but less and less time is spent on those activities and little is taught about their importance. The skill required to sprint or lift something heavy can be just as important as how to swim when it comes to overall health. Ooops didn’t see that cab coming and need to dart across the street or you son just decided to be a hockey goalie, which means loading up one heavy bag for practice. It is nice when the physical demands of everyday life are easy, just like swimming.
Is poor nutrition the cause of the increase in allergies and asthma-no. Is there a link between the two-yes. Do more children die from asthma or drowning, yep asthma. I am happy to be a lifeguard and they are certainly needed, but there are days I wish more of my patients could swim.

In 1974 Jon Landau wrote in Rolling Stone, “I have seen the future of rock and roll and it is Bruce Springsteen”.

Well I have seen the future of cataract surgery and it is LenSx!

I was fortunate enough to travel with Dr. Cook and three patients to Laguna Hills for Glenn to perform his initial LenSx cases. The LenSx is a femtosecond laser (same laser technology as Intralase) that performs 3 of the 5 steps of cataract surgery. With the assistance of an OCT image and a computer, the laser fragments the lens, precisely places the corneal incisions, and perfectly centers a capsularhexis. You can also add limbal relaxing incisions to correct up to 2 diopters of astigmatism.

In all three patients, those three steps took less than 2 minutes, from set up to suction off. The patients did not complain of any discomfort and all were excited about having a good part of the surgery done by a laser.

Hydrodisection was very easy and straightforward in all three patients despite a relatively dense cataract. Dr. Cook commented on the uniformity of the pieces of lens material removed and the ease of precisely removing the crystalline lens.

“What is good for you is good for you”, is such a simple phrase but covers so much.  When speaking with patients who do not want to develop the eye diseases their parents or grandparents have they express a need to have control of the process.  They want something they can do so they do not need to go through the suffering of macular degeneration or glaucoma.

“Eat real food and move your body” is the next step in that simple phrase. Boiling down complex research and epidemiology you find that antioxidant foods and omega 3 fatty acids are protective for both macular degeneration and diabetic retinopathy. Specifically, the vitamins in dark green leafy vegetables such as spinach, eggs and broccoli contain lutein and zeaxanthin, which are protective for the macula. Wild salmon and grass feed beef both have an adequate balance of omega 3 fatty acids and are “real foods”.
The positive affect of exercise on the eye is curious to many patients. There is both basic science research and a large epidemiological studies that point to improved cardiovascular fitness having a positive impact on both macular degeneration and glaucoma. When you realize that there is an inflammatory component to macular degeneration and a vascular component to glaucoma it is not as surprising.
If you step back and accept the concept we are a species that was designed to be on this planet, eating what is naturally available and moving a body that was made to move (and move fast and at times for long distances, but I digress), then it is not unreasonable to conceive that one of our primary sensory organs would benefit from proper nutrition and exercise.

Using a strobe has long been an effective method of enhancing the visual performance of ball sport athletes. The strobe disrupts the flow of information from the eyes to the brain, forcing the eyes to track, the ball better. It also allows for “imprinting” of impact in the athletes brain. Good athletes have their eyes on the ball and the bat/racket/club at impact, but it happens so fast it is often not reinforced neurologically.
The challenge has always been finding and environment when a strobe light can be used for meaningful training. The typical batting cage is in a warehouse where the lights are either on or off. Either situation is not practical for using a strobe. Nike, working with top vision researchers, has developed Sparq™ Goggles (, which the athlete can wear during various drills to enhance their performance.
We are currently working with several hitting instructors and baseball coaches with these goggles and the athletes report better visualization of the ball, with the ball appearing to move slow and seem bigger. As with any training, there is nothing that replaces hard work, but these goggles seem to be a great tool in enhancing athletic performance. Contact our office for more information. 760-436-1877

I have come across a new, well not really new, but a reoccurring eye condition that is totally preventable. Visineitis, is that escalating irritated, red, sometimes itchy eye that results from using Visine or other “artificial tears” that either contain an agent that constricts blood vessels or high amounts of inexpensive preservatives. Recently, I saw a patient who had one very unhappy eye and the other look just fine. His comment was, “I do not understand why my left eye is so red, it is the one I keep putting the drops in?” This is an otherwise intelligent patient do what he thinks is correct, putting a drop in that is marketed as get the red out and all it does is put the red in!
This year’s allergy season has been worse than most and I have treated plenty of patients for red itchy eyes with the appropriate prescription eye drops. Artificial tears are a great first line of defense for irritated eyes. These drops can dilute or flush away irritating allergens and make the eyes look and feel better. Unfortunately, when you get to the drug store there are too many choices that all look the same. It is reasonable, when products all appear the same to pick the least expensive. Well they are not all the same. I could go down the list of preservatives or ingredients to avoid, but those names are long and the print too small to be useful to you. Instead the following products do a great job and are safe for your eyes. Blink® Tears, ReFresh® Tears, Optive® Tears and Gen Teal® Tears are all products I have experience with and do not contain any of the “Bad” stuff. They also come in preservative free preparations. If your eyes continue to be itchy see your eye doctor and get a prescription for an effective treatment.

I just finished reading an amazing book, The Last Season by Eric Blehm. It is the story of a backcountry ranger in the Sierra Nevada mountains, specifically in Kings Canyon. It is an adventure/survival book in the vein of Into Thin Air by Jon Krakaur, filled with the same type of excitement and suspense. Knowing nothing about backcountry rangers I was impressed with the skill and fitness that is essential in this thankless job. Furthermore, this is a story about the elite, the Michael Jordan of this unique profession.
Just as interesting, is how became aware of this great read. I have a friend Paul Huddle who is top trainer of endurance athletes ( and a co-host of a radio program called The Competitors. A few months back he posted on his Facebook how he had just interviewed a local author Eric Blehm ( who has written a new book The Only Thing Worth Dying For. While the Facebook post peaked my interest, it got lost in the shuffle of a wife, 3 kids, 2 dogs and a guinea pig.
As I mentioned, Paul also co-hosts a radio show with Bob Babbit. This show features their unique humor in interviewing top endurance sport athletes. I save the podcasts of these shows, and I have found them nice to listen to on trips. They have interviewed everyone from Lance Armstrong to Chrissie Wellington and they make the interviews very interesting. For all you cyclists, their interview of Chris Carmichael is worth a listen
On my most recent trip I listened to the interview with Cardiff resident, Eric Blehm and was fascinated with both his personal story, the background for the book The Last Season, and his “adventures” in writing The Only Thing Worth Dying For. These books were no longer on the back burner and I was able to download The Last Season onto my Kindle during a layover. Technology can be so cool.
As I sit back and think about it; it is amazing how the technology of Facebook, podcasts, and a Kindle, turned me on to an amazing book about the back country when none of that exists. I guess it is important to know when to go fast and when to go slow.

Fish oil, fish oil, fish oil, you are hearing about it from all sides. It helps with heart disease, dry eye, cholesterol and everyone has a fish oil product, it can get confusing. A Google search of fish oil yields over 38 million hits and narrow it down to EPA and DHA you still have over 500,000 hits.
Fish oil contains essential Omega 3 fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors to eicosanoids that reduce inflammation throughout the body. Smaller fish such as anchovies and sardines are high in EPA and DHA. Larger fish such as salmon, cod and tuna also have high concentrations of EPA and DHA. Because these fish are higher on the food chain they can also accumulate toxins such as polychorinated biphenyls (PCB) and mercury.
ABC News recently reported on the results from preliminary testing of some fish oil products on the market. Some of these products show levels of PCBs above California standards, but within national standards. Some of the brands included in the study were Nature Made, GNC and TwinLab.
When I evaluate fish oil I look for brands that use smaller fish and come from a producer that has U.S. Pharmacopeia verification (USP). This is the organization that establishes quality standards for the FDA and all medicines in the United States. Products that meet this standard include Science Based Health’s, HydroEyes and Nordic Natural’s, Arctic Omega.

Surfing is an essential part of our community. While you do not need great vision to surf, you need some vision to see waves and other surfers. I am always excited to hear from patients who surf for the first time in their contact lenses and how it is a much more rewarding experience. I often get asked about which contact lenses are best for surfing. Yes, there are contact lenses that act like sunglasses and are tinted to decrease the amount of light reaching the eye as well as absorbing ultra violet light, they have met with limited success. The marine layer rolls, in rolls out, many people surf either early or late in the day when the light is poor, you get the picture.
The lens that is the best for surfers is a daily disposable lens. This is a lens that you take out at night and throw away. While today’s disinfecting systems are very good, they do not always have the desired effect on contaminants that are in the ocean. Therefore, a daily disposable lens does not have time to get an accumulation of irritants within the lens, reducing irritation of the eyes and most importantly reducing the risk of infection. Additionally, the unit cost of a disposable lens is far less than that of a monthly replacement lens. So, if you unfortunately lose a lens when surfing the cost of the lost lens is much less. On average the yearly cost of daily disposable lenses is very similar to monthly replacement lenses because you do not need to buy solutions. Finally, if you are someone who prefers glasses but also would like to see when you are surfing these lenses are a nice solution. You do need to worry about expensive lenses drying out in a case because you have not worn them in a few weeks. Simple put in a new pair each time you surf or play other sports that do not do well with glasses. To learn more about daily disposable lenses you can go to

Encinitas Optometry

1279 Encinitas Blvd Encinitas, CA 92024 760-436-1877