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Viibryd And Cataracts
July 9, 2011 By Leave a Comment
Does Viibryd Cause Cataracts?
Can you believe everything you see on TV? Well no-but stay tuned. Some types of age related cataracts do display a higher concentration of serotonin as part of their molecular composition. The connection to prescription drugs that alter serotonin is a little more complex that it appears to be at first glance. The new blockbuster antidepressant vilazodone hydrochloride was released in the US market in July 2011. It falls under the category of SNRI, or a serotonin norepinephrine re-uptake inhibitor. Serotonin crosses between nerve endings to relay its message to the brain. When it is released there is also an adjacent site to reabsorb it before it crosses the gap in the nerve ending. Re-uptake inhibitors interfere with this site thus increasing the amount of “feel good” serotonin to pass along the message. After the Prozac generation of drugs, modifications were designed to also boost norepinephrine and dopamine, two other substances related to mood. Effexor, Cymbalta, Pristiq, and now Viibryd are the current SNRI medications. Viibryd claims to be unique in both blocking the re-uptake of serotonin and stimulating the serotonin receptor (type 5-HT1A).
The Eye Is An Outgrowth Of The Brain
The eye is developmentally an outgrowth of neural tissue and it is no surprise that there are a number of different types of serotonin receptors found in the different layers. The iris, ciliary body, cornea, lens,retina, central retinal artery and the ciliary artery all have serotonin receptors. The ciliary body (the root of the iris) has receptor cells that both increase the eye pressure and decrease it. There is some speculation that inadequate transformation of serotonin to melatonin by the ciliary body may lead to glaucoma. The human lens synthesizes melatonin which is known to be an antioxidant. Antioxidants like melatonin can prevent the damage free radicals inflict on lens proteins.
There is at least on type of serotonin receptor in the lens but this is not a well studied area. In animal models, serotonin disrupts enzymes (ATPase) that help provide energy to the lens epithelium (surface cells). With the loss of energy needed to keep cells healthy the lens starts to develop cataracts. Activation of serotonin receptor sites in the lens epithelial layer may also provoke cataract formation.
The fluid in the front half of the eye (aqueous humor) contains serotonin, presumably produced from the ciliary body and iris of the eyes. The lens may produce some serotonin but it probably receives most of its exposure from serotonin absorbed from the aqueous humor fluid. Taking a prescription drug like Viibryd has blocks the receptors in the brain and the receptors in the eye. Prozac has been shown to cause a transitory increase in eye pressure and in pupil dilation from blocking the re-uptake of serotonin receptor sites.
Eye Doctors Find Increase In Cataracts With Antidepressant Use In Study
A study in Vancouver in 2010 found a 15% increase in cataract formation in a large population of patients taking antidepressant drugs in the SNRI and SSRI categories. drugs. Effexor and Luvox were the worst offenders. Smoking is a known cause of cataracts and was not accounted for in this study. It is by no means a definitive study or the final word ion the subject.
Now the complicated part. There are seven known types of serotonin receptors with a number of subcategories. There are different mechanisms and activities for each one of these. The effect of Viibryd and other serotinergic type drugs on each receptor type is not completely known. SNRI drugs act in scattered small areas of the brain. The action of Viibryd is not completely known. The effect on receptors in the eye is largely unknown. It is not possible to say that Viibryd has any effect on cataract development with any degree of certitude.
Worrying Won’t Help Your Mood Or Your Eyes
Returning to reality, the 2010 study found only a 15% increase in the incidence of cataracts. That does not mean the antidepressant drugs increased your likelihood of getting cataracts by 15%, it is more like a 3% increase. When you factor in smoking, for all we know Viibryd might prevent cataracts. The activity on the the multiple types of receptor cells is not fully quantified. To my knowledge there has not been a reported association between Serotonin Syndrome and the acute .onset of cataract formation. Serotonin Syndrome occurs from an overdose of serotonin and you would expect to see this if SNRI drugs did cause cataracts.I have seen patients in my Fort Collins optometry practice that have been on SSRI and SNRI prescriptions for over 20 years with no signs of associated cataracts. This category of drugs is generally not considered a risk factor for cataracts by most eye doctors. Like any prescription you need to discuss the risks and benefits with your doctor. And most importantly help a friend quit smoking – smoking does cause cataracts, glaucoma, macular degeneration, and contributes to multiple other disease that result in blindness
Fort Collins Optometrist
March 16, 2010 By Leave a Comment
Fort Collins Optometrist
Five Reasons We Want To Be You Optometrist in Fort Collins
- As an Optometry Clinic serving Ft Collins for over 25 years we enjoy what we do and have fun helping people see and look their best
- Fort Collins is a great town to live in and you probably feel the same way. We want to be your eye doctors vision center of choice to help you see all of the great things Fort Collins has to offer.
- As an Optometry Clinic in Ft Collins we offer unique solutions for our low humidity dry climate that challenges contact lens wear. We gain great satisfaction in treating dry eye problems in Northern Colorado.
- We have fun integrating our eyecare center and optical eyeglass services with our optometry vision care. Many people don’t realize how many different lens and frame options there are for different lifestyles and sports. It is a special thrill to provide you with a beautifully crafted, thin lite lens with anti-glare coatings that looks great and resolves serious problems such as computer eyestrain syndrome.
- Last but not least, we just enjoy helping people. In an area like Fort Collins we meet a lot of nice people everyday. Optometric vision examinations can provide great vision and help detect and prevent eye disease and even serious health problems. There are not many more rewarding things than enhancing and protecting the exquisite sensory experience we refer to as vision.
Please stop by or call our office at 970-226-0959
181 West Boardwalk, Suite 201
How Long Do Eye Dilation Drops Last?
January 14, 2010 By 107 Comments
Patients frequently ask me how long their pupils will remain dilated after the eye exam. Eye Doctors use different drops,different strengths, and different dosages when dilating your pupils. If you are having light flashes or symptoms that could indicated retina problems two different drops may be used in higher concentration and several doses. A routine exam may only require less dilation and milder drops.
Eye color effects the duration of dilation. Since brown pigment in the iris is essentially the only eye pigment, blue eyes lack significant color and gain their blue shade from light reflecting in the iris. Pigment binds the dilating drops and require higher doses but blue eyes react faster and more to dilation drops.
Different drops are often used for children’s eye exams and occasionally for adults that have inflammation in the eye from contact lens injuries, eye trauma, or autoimmune diseases and they may keep eye dilated for several days.
Finally, there are individuals with idiosyncratic reactions to the prescription eyedrops used to dilate your eyes. Basically, that means the optometrist is an idiot and has no idea why one out of hundreds of eyes are extremely sensitive to dilation drops and stay dilated for 24 hours or more. (The meaning of idiosyncratic is a well kept secret by all types of Doctors so please don’t reveal me as the source of explanation). If you have this type of reaction you can try and request a little known secret we use-simply diluting the drop!
The final answer is your eyes will usually stay dilated for several hours but it could be up to several days. Good luck and remember, after the first time you will probably have a fairly good idea of what to expect in the future.
Swine Flu H1N1 and Eye Complications
October 2, 2009 By 2 Comments
As the H1N1 Swine Flu continues to spread pinkeye (conjunctivitis) is still uncommon and very mild. Rare cases have been showing up involving neurological complications that sometimes do manifest other eye problems. Encephalopathy is a neurological syndrome that disrupts large areas of the brain. This has been seen in a limited number of patients and can result in eyes turning up or to the side, usually accompanied by a seizure. Other problems that may be seen in the future with encephalopathy are photophobia (light sensitivity) and nystagmus (eyes rapidly moving in a tremor like manner). By this point the patient would normally be hospitalized from the other problems so it is highly unlikely to be seen in a home setting.
An unknown at this point is if the influenza can be transmitted from the tears in the eye. The normal routes of transmission are through airborne droplets created by coughing or sneezing or touching a surface that has been contaminated. While the HIV virus is present in tears there are no known cases of transmission by this route. It is unknown if this will be the same with the new Flu virus. Also, airborne droplets could contact the eye, drain into the sinuses and possibly result in infection. Until more is known it is probably best to err on the side of caution and wear some form of protective eyewear if you are around someone with flu symptoms.
Peripheral Side Vision Loss Retinitis Pigmentosa
September 18, 2009 By 1 Comment
retinal disease
Incredible images of a normal retina on the left and a damaged retina (tissue lining the back of the eye) courtesy of Robert N. Fariss, Ph.D., chief of the NEI Biological Imaging Core, and Ann H. Milam, Ph.D., former professor in the Department of Ophthalmology at the University of Washington.
Retinitis Pigmentosis is an eye disease that is primarily genetic and causes a slow, progressive loss of vision starting in the periphery and moving in, resulting in tunnel vision. Often eyesight will remain 20/20 until very late in the disease but with the extreme loss of side vision it can be very debilitating. Vitamin A has been used to slow the progression but doses of Vitamin A as low as twice the suggested normal dosage may increase the risk of hip fracture.
Ushers Syndrome, a combination of retinitis pigmentosa and hearing loss is common in Louisiana in the Acadian and Cajun population, French settlers that fled Canada and settled along the bayous of Louisiana. It is very uncommon to see this eye disease in Fort Collins since only a small percentage of cases result from spontaneous mutations.
If you are aware of any loss of peripheral or side vision it is important to schedule an appointment with your optometrist since other eye conditions like pituitary tumors and glaucoma can also create slowly progressive loss of side vision.
Eye Vision Restored By Tooth Implant
September 18, 2009 By Leave a Comment
From the strange realms of the eye world comes a new procedure referred to as modified osteo-odonto-keratoprosthesis also called MOOKP. It sounds like something that would have been in the TV show Mork and Mindy for those who saw Robin Williams in his early days portraying an alien on earth.
A patient’s tooth is extracted, drilled with a central channel, and a lens is attached to the lens. After growing in the patients cheek or shoulder for a month or so it is implanted in the eye in cases where a corneal transplant is not possible.
Performed at Bascom Palmer Eye Institute, one of the leading Eye Hospitals in the world, the procedures was performed by a corneal eye specialist, Dr Perez,M.D. assisted by a dentist Dr. Sawatari, D.D.S.
This procedure was initially developed in Italy. The last few years Italian Dentistry has purportedly been moving closer to the practices used in Northern America and Northern Europe. I’m not quite sure what that implies; in Fort Collins I have never known my dentist to move teeth to places outside of the mouth. I even checked under implants at Harbor Dental and didn’t find a thing about eyeteeth. Tongue in cheek (or tooth), the early results look promising for the small group of people who can really benefit from this unique procedure.
The down side is all of the baby boomers who in 20 to 30 years will be toothless with dentures, There could be a whole new dark side to the tooth fairy. And a root canal in an eye tooth could raise fear of dentists to a new level.
Angle Closure Glaucoma From Prozac
September 16, 2009 By Leave a Comment
Prozac is as common as aspirin today (and probably much safer). It is in the category of selective serotonin re uptake inhibitors which is a long winded way of saying it makes the molecule serotonin stay around longer instead of being recycled.
This allows a prolonged action of serotonin, one of the feel good molecules used to treat depression and a variety of other conditions. The eye has numerous receptor sites where serotonin acts, though they are not well understood at this time. Other prescription drugs you may have heard of somewhat similar to Prozac are Paxil, Zoloft, Cymbalta, Lexapro, and Luvox.
One thing they share in common is a tendency to mildly dilate the pupils. This is rarely a problem, but if you have been told you have” Narrow Angles” or are susceptible to angle closure glaucoma it can be a concern. Farsighted patients (Hyperopic) have smaller drainage angles for the fluid inside the eye to escape back into the general circulation. With age, the lens inside the eye grows and moves forward, further restricting the drainage channels. When you enter into a dark room or movie theater the pupil naturally dilates also. When dilated, the colored tissue known as the iris bunches up it’s outside edges. This thickens it right at the location where the fluid is supposed to drain out. In a normal eye there is plenty of extra space to compensate for this but eyes with narrow angles start to be blocked by the bunched up iris tissue. Eventually, the drainage can be completely blocked and since fluid is being produced in the eye the pressure skyrockets up.
Normally this results in an acute attack of a very painful, blurry red eye with nausea and headaches. Drugs like Prozac in a rare handful of cases have been known to push this process over the edge and precipitate angle closure glaucoma attacks. While highly unlikely, if you have narrow angles you should be aware of this, since this form of glaucoma is curable with early treatment.
The other possibility from this category of drugs is a transient rise in eye pressure for several weeks (though some cases report drops in pressure). If you have just started Prozac or a similar drug and your eye pressure readings are a little high, discuss this with your optometrist and have the pressures retested in 2-3 weeks. There is usually a return to normal if it is a mild medication induced increase.
A retest in a few weeks could save you money on unnecessary treatment and testing.
Finally, be happy that we have medications that have such better safety profiles than the prior generation.
Optometric Nutrition Society-Diet and Eye Health
September 3, 2009 By Leave a Comment
The Optometric Nutrition Society
A Professional Society Whose Time Has Come
Dr.David Kisling of Fort Collins,Colorado has become an active member of The Optometric Nutrition Society. Lifestyle modification and nutrient intake are proving to play an important role in vision health and eye disease prevention. Several studies have shown a correlation with nutrition and chronic eye disease. This area of study has become a focus of primary vision care doctors.
The purpose of the Optometric Nutrition Society is to:
To promote excellence in the care of optometric patients through nutritional support of eye health and the prevention and control of ocular and systemic disease.
To sponsor professional symposia as well as a website, and to generate materials to educate professionals regarding the role of nutrition in systemic and ocular health.
To provide a collegial atmosphere where health care professionals can exchange ideas and concepts regarding nutritional influences on vision.
Provide a resource pool of clinically relevant refereed studies that support the role of safe nutritional support for the management of ocular and systemic disease.
To monitor and validate claims made by industry regarding the quality and efficacy of nutritional supplements.
To encourage the inclusion of nutrition education in the curricula of optometry schools.
The society closely monitors peer-reviewed published science on nutritional influence on eye health, as well as safety and ethical issues regarding specific micronutrients included in supplements being marketed to vision patients.
For more information contact:
Name: Dr David Kisling, O.D.
Address 181 West Boardwalk Ste. 201
Fort Collins,CO. 80525
Phone: (970) 226-0959
Email info@harmonyeyes.net
Contact Lenses Star Trek Style
September 2, 2009 By Leave a Comment
Babak A. Parviz of the University of Washington is working on futuristic contact lens technology. His research includes work on contact lenses incorporating sensors for glucose monitoring for diabetics and potentially contact leness as display monitors out of the science fiction realm. If you are interested in where contact lens technology may lead to in the future his work and publications are a fun read.
In terms of futuristic contact lens technology the question remains where the corneal molding technology disappeared to. Several years back a California company had developed a permanent technique for reshaping the cornea to adjust the prescription. It involved a prescription medication to soften the collagen bonds of the cornea temporarily, and several days of rigid contact lens wear to reshape the tissue while in this malleable state. Oddly, it seems to have vanished after having some very positive reports.
Current technology not being used clinically allows determing blood glucose levels by utilizing laser or infared light directed into the fluid inside the anterior chamber, the front part of the eye. This fluid is referred to as the aqueous humor and the glucose levels allow an estimation of the blood levels.
A new type of contact lens should be on the market within a year. Developed at Harvard University it will allow constant steady release of eye medications instead of the variation in dosing levels that ocurrs with prescription eye drops. Other competitors are in the market. I have seen the effectiveness of this using todays contact lenses saturated with eye medications in off label applications. It should be a great option for certain eye diseases. I suspect glaucoma will be one of the first contact lens applications where it will deliver results like an insulin pump can for a diabetic who has wide swings in blood sugar levels when control was tried with injections.
Patents exist for photochromatic contact lenses that darken with sunlight and act as a sunlens. When this will see the “light of day” is unknown. Patents also exsist for liquid contact lenses. Researchers have looked for eyedrops to act as temporary corrective liquid lenses for years-maybe someday an eyedrop a day will keep the eye doctor at bay.
Contact lenses with added components to prevent infections are under study and probably will reach the market place in the next few years.
Custom eye specific shaped contact lenses are certainly going to be a part of the future. Wether you know it or not, you suffer from more vision problems than nearsightedness and astigmtism. You also have trefoil, quadrafoil, spherical abberation and other optical misfortunes degrading your vision. The future will only look better!
