Certainly, central corneal thickness (CCT) and peripheral corneal characteristics impact significantly on outcomes in all refractive surgery including premium intraocular lens implants. Likewise the corneal thickness relates very strongly to the outcomes in corneal replacement procedures. A lot of time is spent in the clinical work up of all surgical patients to ensure the maximal possible outcome. Clinical experience and research supports this hypothesis. But then what is the generally accepted attitude toward the importance of central corneal thickness and glaucoma?
Articles in Category: Articles
Special Health Alert: Myopia and Glaucoma
Glaucoma is a multifaceted disorder as described in the up-coming series…Challenging the Glaucoma Archetype in eyelessons.com. The standard methods of treatment revolve around lowering the IOP to an acceptable range….whatever that may be. That pressure-lowering approach is a paradigm that really does not recognize all of the components of the glaucoma issues yet it remains the standard of care. The glaucoma concept as a systemic disorder is addressed in the companion piece in eyelessons.com but the topic of Mirtogenol™ deserves a separate highlight. Mirtogenol™ is a supplement that has been suggested as being potentially beneficial in the management of glaucoma. This is a report of this product and should neither be considered an endorsement nor an encouragement to prescribe.
As with most things in my life, I seem to learn things the hard way. A few years ago, I was following a 47 year-old patient with a strong family history of glaucoma. He came in every 6 months and was particularly annoying because he always asked more questions than I deemed appropriate. His intraocular pressure always ran around 16 mm Hg O.U. but on one particular day I measured 27 mm Hg. I told him that it appeared that we should start treatment with a prostaglandin and we agreed that he should recheck in one month. There was no apparent structural damage nor functional loss and the angles were open by gonioscopy. When he returned in one month his pressure was down but he said he thought “I had missed something and that he was sure he shouldn’t be on medication.”
Biologic Rationale And Evidence
Pycnogenol® is a patented extract of bark from the French maritime pine tree, Pinus pinaster, subspecies Atlanticus des Villar. Ingestion and topical application of pine bark and needle preparations for medicinal purposes dates back several centuries, with the first described use by the French explorer Jacques Cartier as a remedy for his scurvy afflicted crew on the St Lawrence River near Quebec in 15351. Nearly four centuries later, the French researcher, Jacques Masquelier isolated an ascorbate-enhancing flavanol (polyphenolic antioxidant containing catechins) he called oligoprocyanidin2 (OPC) from French Maritime Pine and patented the extraction process, later dubbing the end product Pycnogenol®.