Life In 19x19

I'm an eye doctor. I've been training with specialists on dry eye who visit over 15 patients with dry eye daily... there are ways to help symptoms derived from dry eye but we lack a method to increase the quality and amount of tears. Period.

Vitamins for retina pathology are controversial. First valuable studies on this topic appeared 4 years ago and included vitamin A. Two years ago patients who had enrolled these studies and were smokers developed lung cancer more often than regular smokers. Vitamin A, traditionally said to be "good for the eye" was removed from these vitamins. Latest valuable studies only find them useful in certain advanced dry age-related macular disease. Retina specialists don't agree when it comes to prescribing vitamins.

Vitamins for tear improvement are controvesial. Studies such as this one have been published: only 24 patients and sponsored by the vitamins seller. Here you have a suspicious thesis on the topic, with 8 patients leaving the study out of 38. I could go on like this. We lack a serious study on this field. Dry eye specialists tend to not prescribe vitamins.

alejo wrote: and sponsored by the vitamins seller.

I wonder how many prescription glass studies are sponsored by the seller? I just really feel eye doctors ignorance shows when they say things like there is no known way to increase tears, therefore they can't help dry eye, when a deficiency in tear production is rarely a cause in dry eye, the more common problem being the oils that spread the tears across the eye secreted by glands under the eyelids , which need omega-3 and possibly other vitamins furthermore warm heat packs can help these oils spread.

SmoothOper wrote:

alejo wrote: and sponsored by the vitamins seller.

[...]I just really feel eye doctors ignorance shows when they say things like there is no known way to increase tears, therefore they can't help dry eye, when a deficiency in tear production is rarely a cause in dry eye, the more common problem being the oils that spread the tears across the eye secreted by glands under the eyelids , which need omega-3 and possibly other vitamins furthermore warm heat packs can help these oils spread.

Alejo is an eye doctor. He quite likely knows something about te subject

RBerenguel wrote:

SmoothOper wrote:

alejo wrote: and sponsored by the vitamins seller.

[...]I just really feel eye doctors ignorance shows when they say things like there is no known way to increase tears, therefore they can't help dry eye, when a deficiency in tear production is rarely a cause in dry eye, the more common problem being the oils that spread the tears across the eye secreted by glands under the eyelids , which need omega-3 and possibly other vitamins furthermore warm heat packs can help these oils spread.

Alejo is an eye doctor. He quite likely knows something about te subject

The question remains why he would choose to say something, like vitamins don't help dry eye, when that is an especially narrow interpretation of what dry eye is and the relevant scientific material. Maybe they haven't done a large cohort study, but when they can isolate the components of the oils and tears in lab and it has omega-3 it's not a huge jump to say your eyes need omega-3. It reminds me of the Age Related Eye Disease Study(AREDS) where the two cohorts compared were doctors, in one cohort they prescribed vitamins, the other they gave placebo. Theoretically doctors should be well informed enough and care enough to get sufficient nutrients to prevent eye disease, but as it turns out the cohort which had the vitamins also had significantly less eye disease, go figure.

The human body is more complex than "Y needs X, if Y doesn't work add X until it does."

RBerenguel wrote:The human body is more complex than "Y needs X, if Y doesn't work add X until it does."

Sorry, I'm not letting them off the hook, because it is too complicated. They are supposed to be informed, intelligent, and well meaning, but it seems for any given doctor we can only get one or two of those qualities, along with a substantial dose of impatience. Maybe it takes more than five minutes to figure this out, and they need to crack a reference book, but then I guess they can't bill at $200 an hour to prescribe pain killers and antiinflamatories.

SmoothOper wrote:

RBerenguel wrote:The human body is more complex than "Y needs X, if Y doesn't work add X until it does."

Sorry, I'm not letting them off the hook, because it is too complicated. They are supposed to be informed, intelligent, and well meaning, but it seems for any given doctor we can only get one or two of those qualities, along with a substantial dose of impatience. Maybe it takes more than five minutes to figure this out, and they need to crack a reference book, but then I guess they can't bill at $200 an hour to prescribe pain killers and antiinflamatories.

I'm from a country where medicine is free. So all you say about prices is utter nonsense.

SmoothOper wrote: I just really feel eye doctors ignorance shows when...

This just proves your own when you fail to read my previous posts and you're just trolling around:
1. Your definition of a tear is wrong. I'll help you with that: tears are mostly composed by water and oil.
2. You failed to read my sentence: I wrote "increase the quality and quantity of tears". Therefore, it includes everything: quantity and quality of water and oil.
3. You failed to check that Omega-3 is included within all dry eye vitamins pills (at least in Spain). It has not proven to be useful. If you are into Evidence Based Medicine, you have no good evidence in favour of them.
4. You failed to read the bibliography I linked where I found the strongest evidence in favour of omega-3 to be a suspicious thesis with a too low amount of patients. This reference has been shown as evidence by two different pharmaceutics... so I guess this is their best result.
5. If you're against AREDS study, you're against the best evidence in favour of vitamins for eye-disease. AREDS I was the first study and was certainly skewed, check AREDS II and you'll get an even worse result. So, no, there is conclusive evidence in favour of vitamins.

They are supposed to be informed, intelligent, and well meaning

Thank you, you may ask any of my patients and they'll confirm this part of the sentence. About being impatient: imagine yourself working in a hospital with 40 patients. One patient every 10 minutes. Non-stop. Some of them need more than 10 minutes. By midday, you already have 1 hour delay and patients start complaining about the delay and yelling at you. One day after another.

So yes, we tend to be impatient in the Spanish public health system to avoid people yelling at us. The same doctors on the private health system spend way more time per patient. That may be the difference between free cost for the patient and 100$ per hour.
If you paid 200$ per hour to an ophthalmologist you didn't trust and you're not happy with him, get another one or deal with it. It's not my business.

alejo wrote:

SmoothOper wrote: I just really feel eye doctors ignorance shows when...

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5. If you're against AREDS study, you're against the best evidence in favour of vitamins for eye-disease. AREDS I was the first study and was certainly skewed, check AREDS II and you'll get an even worse result. So, no, there is conclusive evidence in favour of vitamins.

Ah whew you came back, I was just getting started!

Well, one conclusion that you can draw from AREDS, is that vitamin supplements can and reduce disease in the very least, another is that doctors aren't bright enough to feed themselves properly. Now please O mystic fascist drug doctors, please can we have some vitamins, I know the supplement companies can't afford large scale studies, like your big Pharma pals, and you have every under powered study memorized, but please can we have some vitamins, eye think it might help.

I think some people missed the point that I was critizing the entire medical profession(which alejo has sided with) , so I went ahead and edited the post to reflect the broader implications.

guys.. I think you wondered off into biology just a bit too far.

Can we switch back to the 10000 hour training related to go?