Watch Your Mouth!

Now I know many of you visit this blog just for the gory eye pictures, and that I've been remiss in posting them lately, so here is one. This is a picture of a young woman who visited our office last week with severe diabetic eye disease. This is the retina. The white round thing in the middle is the optic nerve head (or "disc"). The 1.2 milliion nerve fibers of the retina leave the eye through the optic nerve and go to the brain (the eye is technically part of the brain -- an extension -- so yes, I'm a brain surgeon). The arteries and veins also enter and leave the retina through the center of the optic nerve. The darker spot is called the macula (which means "spot" in Greek or Latin or something). It's the specialized part of the retina that's involved with the sharpest clearest vision.

Diabetes affects blood vessels, and you can see all the massive intra-retinal hemorrhages from the diabetic damage. The retina is the one place in the body we can look directly at the blood vessels, but this same damage is taking place all over the body -- brain, heart, kidneys, feet, everywhere. Bummer.

Diabetes is a bad disease, and if I've said it once, I've said it a million times, it's a lifestyle disease. You get it by eating too much, eating fat, eating simple carbs, eating animal prodcuts, eating, eating, eating. It's prevented by keeping less than one inch of fat around your middle. It can be cured by losing the extra weight and exercising. The stage is set when you're young. So pay attention. You're not invincible. This is the reason the life expecancy for the indigenous population is 54 years. That makes 28 "middle age."

Center for Advanced Diabetic Eye Care Opens

(From Today's Saipan Tribune. The story is generally accurate.)

Marianas Eye Institute's Dr. David Khorram, MD, chief executive officer Russ Quinn, Saipan Mayor Juan B. Tudela, Public Health Secretary Joseph Kevin P. Villagomez and Deputy Secretary for Public Health Administration Lynn Tenorio lead the ribbon-cutting ceremony for the Center for Advanced Diabetic Eye Care on Beach Road, Garapan Friday. (Jacqueline Hernandez)

By Rianne Pangelinan-Brown
Reporter

The Marianas Eye Institute held a grand ceremony yesterday for the opening of its new $200,000 Center for Advanced Diabetic Eye Care, which features the latest technology in eye care.

According to Marianas Eye Care chief executive officer Ross Quinn, the center was built specifically to address the ocular needs of the islands' diabetic population. The CNMI has one of the highest rates for diabetes in the world, third only to Nauru and the Pima Indians.

The expansion project includes the Ocular Coherence Tomography, a breakthrough eye scan technology that provides detailed color CAT-scan like images of the structures of the eye.

OCT helps guide a doctor's evaluation and treatment of a patient's diabetic eye diseases, particularly glaucoma and retinal disease.

According to Marianas Eye Institute owner and ophthalmologist Dr. David Khorram, the OCT is used at least five times a week. “It really is a huge necessity. We wish we can use it less,” he said.

The center also features a digital retinal photography and flourscein angiography. Marianas Eye Institute is one of the first two centers in the United States to acquire the specially designed high-resolution digital camera.

“With this camera, we are able to document the level of diabetic eye disease and its response to treatment. Digital photography allows you to instantly see what is happening inside your eye and to better understand your diabetes and our recommendations,” Khorram said.

The advanced cataract removal system is another one of the advanced technologies the Marianas Eye Institute implemented. It is one of the world's most sophisticated pieces of surgical equipment for restoring vision. It uses digitally modulated ultrasound to remove cataracts and provides for a gentle procedure with enhanced safety and rapid recovery time.

Another equipment is the biological modulator. It is used to treat diabetic eye disease at a molecular level.

According to John Garland of the Advanced Medical Optics in California, “Dr. Khorram uses the latest extraction techniques that are being used at U.S. mainland facilities. Your patients in the CNMI are truly getting a world-class cataract operation.”

Public Health Secretary Kevin Joseph Villagomez said the new center will lessen the need to send people to off-island referrals.

“When we send people off island for eye care, it is really for severe cases. It usually requires us to send that person there in less than a day because of needed surgery that cannot be done here.”

But with the installment of the new center for advanced diabetic eye, “that will lessen the need for travel and the need to wait for visiting specialists who are here one week and gone the next,” said Khorram.

He added he understands the financial burden that diabetes can bring to individuals and families. “For this reason, we established the Eye Foundation Fund. We want to make sure that you get the care you need, even if you cannot afford to pay for it. It is our commitment to the community.”

“What is more important here, I think, is that we are improving the livelihood of the people of the Commonwealth-and we can never put a price to that,” said Villagomez.

The two ophthalmologist of the Marianas Eye Institute includes Dr. Mark Robertson, OD and Khorram. Both doctors have received national recognition in eye care. [Mark is an optometrist, not an ophthalmologist.]

For more information, visit Marianas Eye Institute.

Pars Plana Vitrectomy

That's the name of this procedure. The jelly in the back chamber of the eye is called the vitreous, and in some circumstances, like bleeding into the vitreous from diabetes, you want to take the vitreous out -- "vitrectomy" it. Right adjacent to the cornea, on the white part of the eye (the sclera) there is an area that is a few millimeters wide that doesn't have any retina behind it. This area is called the pars plana. It's a perfect place to insert instruments. If you insert an instrument further back, where the retina begins, you put a hole through the retina and cause a detachment. Not good. So, this is a pars plana vitrecomy.

The tube on the left is connected to an elevated bag of fluid that keeps the eye inflated so it doesn't collapse like a squished grape when you make your other incisions. Those two metal things on either side of the cornea and short hollow tubes that go through the pars plana into the vitreous chamber. We use these two tubes to place instruments through. Usually one hand has a fiberoptic light so you can see what you're doing in there. The other hand has an instrument, like a cutter, or a pick or a laser, or whatever you need at the moment.

It used to be that you would make an incision and just push the instruments in and out of the eye through the cuts. With this new "hollow tube" technique, you just stab the tubes in, do the surgery and then take them out at the end. You don't even need to put any stitches in. It's very cool surgery.

The little lens suspended above the cornea is actually attached to a huge operating microscope. The microscope usually focuses light onto the cornea, but this lens allows you to focus it further back into the vitreous.

Oh, and the big metal thing is a lid speculum. When I operate, people often tell me they're afraid they'll close their eyes. Not to worry. We just pry them open with metal instruments.

One more subtle, but important detail. In the lower right corner of the photo, above the eyebrow, next to the blue drape, there is a purple arrow. That arrow says "operate on this eye." It's bad form to operate on the wrong eye. Especially if you're doing an enucleation. (Look that one up. It gives me the shivers just thinking about it.)

I do have to say that I love my job!

Doctor's don't know jack.

Okay, they know a lot about disease, and treating disease, but not one lick about health, and keeping someone healthy. I was at a medical staff picnic last weekend, and the potluck menu included a bucket of KFC, two Pizza Hut slabs, white bread sandwiches, and if you were there, you would have seen a toddler being given sips of beer. All the food tastes good, but the stuff is toxic to your health.

The vast majority of diseases in America and its outcroppings like Saipan are "lifestyle" diseases -- heart disease, diabetes, cancer. You get that stuff because of the way you live -- eat high fat foods and live a sedentary point and click lifestyle. The way to determine where a country is on a developmental scale is to look at their diseases. Developing countries deal with infectious disease. People die of things like measles, influenza, etc. When they reach a level of affluence where they can afford high-fat foods and a higher percentage of animal products, then they begin to experience diabetes and heart disease.

In medical school we had exactly one day of lecture on nutrition. But this is the key to treating almost every disease that we face. Even if you don't exercise much, if you eat well, you'll do well. All the new fangled drugs to treat high cholesterol, heart disease, diabetes, are really just a testament to the failure of American medicine and preventive health. Our new dialysis center is a beautiful building that is a monument to the failure of our system to prevent diabetes.

The hard part about preventive medicine is that you require people to make changes before anything goes wrong. They have to realize that the morsel of fat they're about to put into their mouths won't cause problems now, but will lead to a rotten life later.

In reality, it's pretty simple stuff. You gotta stop eating garbage (and honestly, almost everything you eat falls into the category of garbage). You can turn your life around in a matter of weeks. Pick up a copy of Eat to Live. It will change your life. By reading it, you'll likely know more about nutrition and health maintenance than 95% of the doctors you'll ever meet. But don't just read it. Knowledge isn't enough. You have to take action.

Let me know if you need help. If you want to lose weight or improve your health, Eat to Live is the path. I usually help my patients lose about 20 pounds within 10 weeks. I lost 30 pounds in 12 weeks and got down to my high-school weight. That was three years ago, and I've kept it off.