Thursday, September 18, 2008

Alternative to Lasik for Nearsighted People . . .


If you are one of the many people who long for the days when you could see clearly without glasses or contacts, there's something new in corrective eye surgery. In December 2005, the US Food and Drug Administration (FDA) approved the Visian Implantable Collamer Lens (ICL). Although the Visian ICL is currently approved only for nearsightedness, doctors anticipate that it will soon be FDA-approved for farsightedness as well.

To learn more about this new option, I spoke with board-certified ophthalmologist Deborah DiStefano, MD, who already has performed a number of lens implants in her Chattanooga, Tennessee, practice. In her experience thus far, ICL is both safe and effective.


According to Dr. DiStefano, contact lens implants are an excellent alternative for people who are not good candidates for LASIK (laser-assisted in-situ keratomileusis), the most common type of refractive eye surgery. When your vision is too poor you may not have the best results with LASIK (which works best in those with mild to moderate vision problems). When your cornea is too thin or not the right shape for LASIK, implantable contact lenses may be the answer.


Implanting a contact lens takes only 10 to 15 minutes, says Dr. DiStefano. To begin, the surgeon numbs the eye with concentrated anesthetic drops. Next he/she makes a tiny incision to place the ICL in front of the eye's natural lens. The contact lens is rolled up like a little cartridge, explains Dr. DiStefano. When the surgeon inserts it through the incision, it unfolds like a flower petal in the eye. The lens is made of a proprietary, highly biocompatible Collamer material.

The procedure is not painful, and there is instant gratification. After years of visual impairment, patients almost immediately have 20-40 vision or better, which Dr. DiStefano refers to as "the wow factor." Within three years, more than half of people's vision improves to 20-20. Another advantage: The lens lasts "forever," though the procedure is reversible and the lens can be replaced should the cornea change or you develop a cataract. Because there is only a tiny, microscopic incision involved, there is a correspondingly minute degree of scar tissue -- even less than that of cataract surgery.

There is always a small risk for infection with any procedure, although infections were rare or nonexistant in clinical trials of the ICL. Another rare but potential complication is a nick to the eye. After a two-week recovery period, there are no activity limitations with the implanted lenses.


As with any procedure, you are best off in the hands of an experienced surgeon. Dr. DiStefano recommends that you choose an eye center that performs a variety of procedures, has the most up-to-date equipment and practices the latest technologies. Because ICL procedures are elective, there is little likelihood that your insurance will cover it. Depending on your geographical location, the out-of-pocket cost ranges on average from $2,900 to $5,000 per eye. Dr. DiStefano's patients think that the wow factor is worth it.

CranioSacral Therapy - A Little Bit Of Info On This Modality


Can a gentle scalp massage really cure illnesses and injuries as diverse as carpal tunnel syndrome and Bell's palsy -- not to mention healing long-ago trauma and emotional distress? As a matter of fact, it can -- if you put yourself in the hands of a trained and skilled craniosacral therapist. Of the many alternative therapies, craniosacral therapy (CST) is surely one of the most unusual. CST is a variation of osteopathic and chiropractic medicine, where a therapist gently places his/her hands atop your skull and feels for the oscillation frequency -- the small degree of movement that the skull bones naturally retain throughout life. This is a subtle motion of the membrane encasing the cerebrospinal fluid in the brain and spinal cord down to the sacrum, the bone at the bottom of the spine.

The therapist gently manipulates the bones to bring them back into proper alignment. It feels like a very gentle massage, but CST is a potent healing therapy for a wide variety of disorders, including chronic pain, headaches, carpal tunnel syndrome, fibromyalgia, learning disabilities, depression, post traumatic stress disorder, vertigo, whiplash injury, TMJ, herniated disc pain and musculoskeletal problems. While surprising and somewhat inexplicable, even many skeptics acknowledge that "sometimes it just works."

CST is based on research from the early part of the last century by osteopathic doctor William Garner Sutherland, DO. His work centered on the theory that the skull bones have a rhythm that he called the "breath of life" and others call "the vital force." The theory now associated with CST, besides one of treating illness, is that physical or emotional trauma, even from birth, can cause a disturbance in this oscillation that can last for years. Cerebrospinal fluid affects nerves that control all tissues in the body, so any disruption can contribute to a wide range of problems. It's believed that restoring its natural flow enables the body to begin healing itself.

Here in the US, thousands of osteopathic doctors, naturopathic doctors, chiropractors and massage therapists are also CST practitioners. But you probably won't be surprised to learn that the medical world considers CST just this side of loony. Skeptics say its very basis is impossible because the skull bones fuse completely in childhood. CST practitioners respond that this is not so -- the skull bones have motion throughout life. They say that even the elderly continue to respond well to CST.

To find out more about this curious and increasingly popular therapy, I called Thomas A. Kruzel, ND, who practices CST at the Rockwood Natural Medicine Clinic in Scottsdale, Arizona. He is the former vice president of clinical affairs and chief medical officer at the Southwest College of Naturopathic Medicine in Phoenix. Dr. Kruzel likens the concept of opening up cerebrospinal fluid flow to the underlying principles of chiropractic in which "communication channels" are realigned throughout the body. CST does not itself heal problems -- it releases inertia and congestion, thereby returning homeostasis and enhancing the body's ability to heal and regulate itself.

Dr. Kruzel says the hardest part of his CST training was learning to discern the motion in the skull, which he describes as something like an undulation. When a patient comes to see him, he places his hands on his/her head to get an exact sense of this person's motion. This gives him information he uses in clearing restrictions in the pumping of the fluid through the brain, into the spinal column and the emanating nerve roots. Sometimes he may also gently manipulate the lower part of the spine in an osteopathic fashion to restore tandem movement in the sacrum and the spine.

Patients don't always feel the change as it is occurring, he says, but they often experience a kind of gastrointestinal release such as a gurgling in the bowels when the fluid is freed up. Constipated patients frequently find that their bowels begin moving again after a treatment. Dr. Kruzel says in older people CST helps reduce risk of stroke and of falling, and that for children it helps with ADD as well as learning disabilities and even possibly autism. Virtually all patients, adults and children alike, find the treatment to be extremely relaxing, he says.

Dr. Kruzel often uses CST to treat Bell's palsy. He says he can correct it very quickly if the patient comes in right after onset. He has used it for hypertension -- he says it brings some patients' pressure back to normal. Some parents of newborns bring their baby for a treatment after the emotional and physical rigors of birth. Another frequent reason people come to him is after an athletic or other injury. One patient had been severely injured in a car accident the previous year. She had many broken bones and went through a year of physical rehab, but even after her physical injuries had healed she struggled with depression. When she came to Dr. Kruzel, he found that she had almost no cranial motion because the flow of the fluid had been truncated when her pelvis broke. He treated her regularly for a time and today she is doing very well physically and mentally.

Patients remain fully clothed for CST treatment. Sessions usually last 30 minutes to one hour. Patients may come only one or two times, or several times a week for a number of months. Elderly patients tend to check in for a session once every few months, says Dr. Kruzel. Costs vary by area of the country and many insurance plans cover the cost when treatment is from an osteopathic or naturopathic doctor.

The technique may seem simplistic, even magical -- but craniosacral therapy is actually a precise skill a good therapist has trained long and hard to learn. You can find a CST practitioner near you by going to the site of osteopathic doctor John Upledger, DO, OMM, (Dr. Upledger was instrumental in heightening awareness of CST in this country during the 1980s and today his institute trains many people in it.) Another resource is the Craniosacral Therapy Association of North America, which provides CST standards. Since quality may vary widely in the absence of national standards, it's helpful to get a recommendation from someone you trust who has personal experience with a particular therapist.


One unfortunate result of years of sun exposure is age spots -- also known, for no good reason, as liver spots (they have absolutely nothing to do with the liver). Generally small and flat, these are usually brown, all of one shade, which may be anywhere from the color of dark coffee to light tan. They tend to appear in people over the age of 40, most commonly on skin that's been most exposed to sun -- the face, arms, backs of the hands and shoulders.


Though many consider them unattractive, age spots are generally harmless. Dermatologists report that requests for removal are quite common, if not medically necessary. "These are simply what happens when melanocytes, the cells that create melanin, get busy and make too much pigment in one spot," Audrey Kunin, MD, dermatologist and founder of, explained. Melanin is the dark pigment that skin cells produce in response to sunlight, causing your skin to tan.

Short of removal, the most common treatment is a topical medication called hydroquinone, the only active ingredient that can legally be marketed for over-the-counter use for bleaching the skin. For topical use, many over-the-counter creams are available at a strength of 2%, while stronger concentrations of 3% to 4% are available by prescription. Some patients find that skin-rejuvenation products, especially the topical retinoids like Retin A, are also helpful, Dr. Kunin said. The most potent ones are available only by prescription.

Also, a variety of simple procedures can be used to help diminish these unattractive spots. For instance, exfoliating procedures such as microdermabrasion or chemical peels can lift away pigment that has been deposited high up in the epidermis. The use of home glycolic acid-based skin treatments and microdermabrasion creams can also be useful. And certain types of lasers can literally blast the pigment deposits into less visible fragments.


While age spots are of no concern most of the time, very infrequently they can develop into skin cancer. This can be a particular challenge since it can be hard to distinguish which ones are precancerous or actually cancer. Age or liver spots can be difficult to differentiate from actinic keratoses (though these tend to be flatter, scaly and more often reddish-brown than true brown), which turn into squamous cell carcinoma (a kind of skin cancer) 10% to 25% of the time. Another concern is melanoma, which 1% of the population is at risk for developing in their lifetime. Sometimes a melanoma in its earliest stages can look like an age spot. If you feel unsure or are concerned, visit your dermatologist. "It's far better to be safe than sorry," says Dr. Kunin.

Dr. Kunin recommends that all adults receive a complete skin exam by age 25 and then annually or more often if anything is concerning or changing... and then make decisions on follow-up together with your physician.

Age Spots are...
• Smooth and flat
• Light brown to dark brown
• Larger than a freckle
• Appear on sun-exposed areas
• Not flaky or scaly
See a dermatologist if any spot exhibits any of these signs...
• Change in size
• Irregular border
• Unusual color or varying colors within the spot, including black, brown or tan shades
• Asymmetry
Actinic Keratoses
These should always be removed, typically by freezing or burning with electrical current or a laser. They are...
• Rough and wart-like
• Brown, pink, red or flesh-colored
• Flat and scaly, or hard and slightly elevated

To view what melanoma and actinic keratoses look like, go to the American Academy of Dermatology's consumer site,


Audrey Kunin, MD, is a board-certified practicing dermatologist with a specialty in nonsurgical cosmetic dermatology. Dr. Kunin is a diplomate of the American Board of Dermatology and is an associate clinical professor of dermatology at the University of Kansas School of Medicine. She is founder and president of, an award-winning Web site considered to be one of the best dermatology Web sites for consumers on the Internet.

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