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floridatoday.com
LIFE & HEALTH
D
Tuesday
Nov. 2, 2010
FEATURES EDITOR SUZY FLEMING LEONARD, [email protected] or 242-3614
60
Dr. Pamela
Tronetti
Senior Consult
seconds
How to spot
Parkinson’s
disease
Of news you can use
Tell us your
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Do you have ideas or
feedback on the
health and medical
coverage in FLORIDA
TODAY? Contact
medical reporter
Susan Jenks at
242-3657 or
sjenks@florida
today.com.
Photos by Christina Stuart, FLORIDA TODAY
Reshaping the eye. Dr. Rafael Trespalacios of Brevard Eye Center lines up the laser while performing eye surgery on Crystal Harding, 29, at LaserVue Lasik Center in Orlando. Harding has keratoconus, an eye disease
that causes her cornea to thin. After using a special laser to cut pockets in the surface of Harding’s eye, Trespalacios implanted Intacts to put pressure on the cornea and keep it from bulging and thinning further.
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Synthetic cornea
rejuvenates sight
Laser surgery, plastic lens for keratoconus
can delay, prevent a corneal transplant
BY SUSAN JENKS
FLORIDA TODAY
B
efore her recent eye surgery, Crystal Harding’s
vision was so blurry she
had trouble seeing the
“big E” on an eye chart, or her
children standing more than a
few feet away.
“It interferes with everything,”
she said, describing an uncommon
eye disease that affects how light
enters the eye. “If my son’s nose is
running, I don’t even notice it.
The disease, keratoconus, occurs when connective tissues inside the eye begin to thin, causing
the cornea to bulge outward. In the
29-year-old Harding’s case, the
thinning began during her second
pregnancy 2 1⁄ 2 years ago, so imperceptibly at first, she was in denial.
“I thought I just needed stronger
glasses,” she said.
As the disease progressed, however, Harding, a Palm Bay single
mother who works at a local fitness
center, found everyday activities
even harder to do.
“People kept telling me ‘you
have beautiful eyes,’ ” she said,
minutes before undergoing the laser procedure in Orlando. “They
may be beautiful, but they don’t
work.”
The eye surgery, which requires
a special laser, takes about half an
hour under a topical anesthetic,
according to Dr. Rafael Trespalacios, a cornea refractive specialist
with Brevard Eye Center. It involves creating two channels
within the cornea, the clear window at the front of the eye, to insert
corrective plastic lenses inside it.
“The laser procedure itself takes
about 15 seconds,” Trespalacios
said. “I try to make little half circles
into the cornea. The goal is to
stiffen it,” to delay or prevent the
need for a corneal transplant.
About the disease
Keratoconus affects about 1 of
every 2,000 people, although the
actual incidence is unknown,
according to the National Keratoconus Foundation. Diagnosis
usually occurs in younger individuals at puberty or in young adults,
like Harding.
Although there may be a genetic
component to this eye disease, environmental factors or bad allergies, in which individuals “rub the
heck out of their eyes,” can contribute to its development, Trespalacios said.
“Glasses are always tried first to
correct the condition, and if they
don’t work, soft contact lenses,” he
said.
Trespalacios likens the disease
process in keratoconus to chapters
in a book.
“The last chapter is blindness,”
he said. “This is the chapter before
that.”
The lenses used to correct the
corneal distortion are known as Intacs, manufactured by Addition
Technologies in California. The
U.S. Food and Drug Administration approved the lenses as a medical device under a humanitarian
device exemption in July 2004,
which limits treatment to fewer
than 4,000 patients per year. As a
result, insurance coverage can be
spotty and coverage varies widely.
“We were told it would cost
$14,000 per eye and vision plans
don’t cover it,” said Jane Cook,
See EYE, 6D
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About keratoconus
0 A noninflammatory eye
disease in which the cornea
progressively thins, impairing
vision
0 About 1 of every 2,000
people is affected.
0 Earliest stages cause
slight blurring and visual
distortions.
0 Eyeglasses or soft
contact lenses can correct
the mild nearsightedness
and astigmatisms of early
disease.
0 As the disease
progresses, Intacs,
intracorneal rings that flatten
the cornea, may prevent or
delay the need for corneal
transplantation. The
procedure requires special
training.
0 A new treatment option,
being investigated, involves
chemically strengthening the
cornea to halt disease
progression.
— National Keratoconus
Foundation, FLORIDA TODAY
MORE INSIDE. What is involved in
the Intacs procedure, 6D
INSIDE
6 ways to undo
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Overdid it with the mini-candy bars?
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People’s Herbal Pharmacy .........5D
Health Newsmakers ................. 5D
Doctors group says specialist should review concussions
BY MALCOLM RITTER
Flu shots
Seeing eye to eye. Dr. Rafael
Trespalacios of Brevard Eye Center
uses a computer monitor to help
him perform eye surgery on Crystal
Harding.
Parkinson’s disease affects
1.5 million Americans each year.
It was named for Dr. James Parkinson, who described the disease in
1817, based on his observations of
patients he examined and people he
saw on his daily walks through his
neighborhood.
He could not see the cause, which
is damage to the area of the brain
called the substantia nigra. The
substantia nigra produces the
chemical dopamine, which keeps
our movements free-flowing and
supple.
Parkinson could not offer any of
the treatments we now take for
granted, which help improve the
dopamine levels in the brain.
Someone you know may have
Parkinson’s disease and not be diagnosed. You can help identify it
just like Parkinson did — through
your powers of observation.
The face: Parkinson’s patients
don’t blink as frequently as usual.
They seem to stare at you. They
also lose the subtle facial movements we see with emotion, such as
grins, raised eyebrows or frowns.
This is called the “mask face” of
Parkinson’s.
The voice: Speech becomes
quiet and hoarse. But what most
people notice is the slowness of the
speech. You want Parkinson’s patients to hurry up and finish what
they’re saying. But without adequate dopamine, it’s almost impossible to speak quickly.
The arms: There is no normal
arm swing with walking. They are
held stiffly at the side. Not to be disrespectful, but it is like how Frankenstein’s monster walks.
The hands: Sometimes patients
have a subtle tremor or a “pill
rolling” motion of the thumb rubbing up and down on the index finger.
See TRONETTI, 2D
NEW YORK — Athletes of all ages
who are suspected of suffering a concussion should be evaluated by a specialist
before they return to sports, a major doctors group said Monday in the latest sign
of concern over potential lasting damage
from head injuries.
The statement by the American Academy of Neurology follows rules already
adopted in college sports and pro football aimed at preventing and better treating blows to the head in competition. Research involving NFL players has suggested repeated concussions may have
long-term consequences, such as dementia and Alzheimer’s disease.
The neurology academy is the most
authoritative medical group when it
comes to concussions. And its new advice sweeps across all ages and types of
athletes.
Experts hope to publish new guidelines by 2012, following a careful review
of published studies, said Dr. Jeff
Kutcher, chair of the academy’s sports
neurology section.
The group’s new statement released
Monday is meant to offer guidance in the
meantime for child and adult athletes, he
said. Key points include:
0 An athlete suspected of suffering a
concussion should be removed from
competition until evaluated by a doctor
trained in assessing and treating sports
concussions. Symptoms like unconsciousness, unsteadiness, problems with
memory or concentration, dizziness or
headache are warning signs, Kutcher
said.
0 No athlete with symptoms should
be allowed to take part in sports.
0 After a concussion, a neurologist
or another physician with proper
training should be consulted before the athlete is allowed to return to sports.
0 A certified athletic trainer
should be present at all sports
events, including practices, where athletes are
at risk for concussion.
This recommendation is
crucial for middle school
and younger children,
for whom such trainers are rarely used,
Kutcher said.
Head check. Arkansas quarterback Ryan Mallett suffered a concussion after being injured on a pass attempt in the first half of an NCAA college football
game against Auburn on Oct. 16.
AP
B
6D TUESDAY, NOVEMBER 2, 2010
FLORIDA TODAY
Intacs treat uncommon eye disease
EYE, from 1D
Christina Stuart, FLORIDA TODAY
Medical first. Dr. Rafael Trespalacios of Brevard Eye Center has inserted Intacs in about 15 patients. But Harding is
the first patient in Central Florida to undergo a bilateral procedure in both eyes, he said.
About the Intacs procedure
0 Intacs is the trade
name for the semicircular
plastic rings inserted into
the mid-layer of the
cornea to flatten it.
0 The procedure is done
under topical anesthesia
and takes 15 to 20
minutes.
0 A special laser may be
used to create small
channels in the surface of
the cornea.
0 Once the lenses are
inserted, a single suture
in each eye holds them in
place.
Not for everyone
Dr. Payman Haft, a cornea
specialist with Florida Eye
Associates, described Intacs
as a “pretty new procedure,”
which is not favored by all
eye doctors and requires
special training. But it can
improve vision in appropriate candidates who fail conservative treatments, he
said.
“You really need to treat
patients on a case-by-case
basis,” Haft said. “I would
not say it’s good for everybody.”
For example, like Trespalacios, he said some patients
with advanced keratoconus
have too much scarring on
the cornea to benefit from
the lenses, so they have no
other option than a corneal
transplant. And yet, compared with eye diseases
where “there’s a background of inflammation,”
Haft said, patients with keratoconus — in which inflammation plays no role — fare
well, with a 95 percent success rate for transplantation,
During his surgery training, Haft said, he did no Intacs procedures, although he
doesn’t rule out the possibility of offering them in the future. He’s awaiting data
from a less-technically demanding approach, he said,
How caregivers
can help
Caregivers can offer
help and support to
people who are no
longer completely
independent.
Womenshealth.gov
suggests how a
caregiver can provide
assistance to people
with dementia, cancer
or another condition
that limits the ability to
perform basic daily
tasks:
0 Shopping for
groceries.
0 Preparing and
serving meals.
0 Cleaning the home
and performing other
chores.
0 Making sure the
bills are paid.
0 Administering
medications.
0 Assisting with
bathing, going to the
bathroom and getting
dressed.
— Gannett
0 Healing can take three
months or more.
0 Severity of
keratoconus dictates
whether glasses or
contact lenses may be
needed afterwards.
0 Possible
complications, as with
any surgery, include
infection.
0 The procedure is
reversible, so it can be
repeated, if necessary.
0 Insurance coverage
varies widely.
— National Keratoconus
Foundation, FLORIDA TODAY
which has been tested in Europe for five to 10 years with
good results. Called corneal
collagen crosslinking, it’s
not yet approved for use in
the United States.
“It ’s ve ry pr omis ing,
though,” Haft said. “The preliminary data are good.”
In this procedure, ophthalmologists use custom-made
riboflavin drops to accelerate chemical bonding or
“crosslinking” of collagen in
the cornea to strengthen or
anchor it, Haft said. The process occurs naturally in people as they age and explains
why keratoconus slows
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Healing process
As for Harding, several
weeks after her laser procedure, improvements in her
vision are happening slower
than she would like, but her
eyes “are starting to come
around.”
“I was upset initially because it seemed my vision
got better and then things
got worse again,” she said.
“The first couple of days
were really hard.”
But gradually, things have
improved.
“It’s just a long process before my eyes completely
heal,” she said. “The great
thing is the disease part is
under control.”
Also, the degree of nearsightedness improved immediately.
“I can see 20/40 in one eye
and 20/60 in the other now,
which is great,” Harding
said.
As for a lingering astigmatism in one eye, that will be
corrected after everything
heals.
“He’s very happy with it,”
she said, referring to Trespalacios’ assessment of her
progress.
In addition, Harding said,
she got a second opinion
from another eye doctor.
“He thought it looked awesome, too.”
In-House Physical Therapy
DPM, FACFS
321-543-7433
371113
Harding’s mother. But after
several appeals, Health First
Health Plans is paying for
the entire cost, she said,
while Trespalacios waived
the facility fee at LaserVue in
Orlando, where he leases
space to use the special laser.
The same laser is commonly
used to create flaps in Lasik
procedures and in corneal
transplants, Trespalacios
said.
So far, he said, he has inserted single Intacs in about
15 patients, though he estimated about 17,000 residents in Brevard County
might benefit, based on
rough incidence estimates.
But Harding is the first patient in Central Florida to undergo a bilateral procedure
in both eyes, he said.
A s wit h any surg ery,
among the possible complications are infections, although cuts into the cornea
also can be too shallow or too
deep, according to Trespalacios.
“But incisions are minimal
and the procedure is reversible,” he said. “So we can take
the Intacs out and do it again
if we need to.”
Also, although infections
can occur, “we use antibiotics and we’re not going into
the eyeball, so infections
would be limited to the area
where we make the cuts.”
down on its own in older individuals, he said. The drops
are activated by ultraviolet
light.
Still, despite crosslinking’s early promise, neither
Haft nor Trespalacios is in a
rush to offer it just yet.
There have been reported
cases of corneal melts, requiring emergency transplant surgery, Haft said. And
while it seems to be a rare
complication, “I want to wait
for FDA approval.”
Trespalacios said he also
would wait for “all the kinks
to be worked out” before offering it to patients. For now,
it’s too experimental, he
said.
CELEBRATING OUR 1ST YEAR IN BREVARD!
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