Eyeworld

April 2011 by Faith A. Hayden EyeWorld Staff Writer Retiring into a new profession W hen you ask most medical professionals how they relax and relieve stress after a long workday, you'll hear about golf games, workout rou- tines, massages, and glasses of wine. But Dale Garland, Ph.D., an op- tometrist from North Carolina, uses a more creative outlet to wind down: writing. "If I had a lull between patients or was feeling a little bit of anxiety or wanted some escapism, I'd go back to my desk and write out little vignettes of things," Dr. Garland said. "Sometimes I'd write poetry." His stress-relieving hobby turned out to be lucrative not just for his mental state. Now semi-re- tired, Dr. Garland, 73, has devoted a large portion of his free time to writ- ing professionally. Although noth- ing ever became of his poetry, he has had success with his prose. Dr. Gar- land recently published his first novel, a murder-mystery thriller called Letters from Sweetwater. Writing may seem like an about- face career wise, but for Dr. Garland it was a lifelong goal. As an adoles- cent with an interest in creative writing and science, he toggled be- tween considering careers focused on facts and those focused on fan- tasy. "All my life, starting when I learned how to read, I wanted to write a book," he explained. "But circumstances were not favorable for that. I wanted to pursue a career that was a little more substantial." His interest in the sciences led him first to a career in microbiology and then optometry when he en- tered his mid-30s. The desire to write, however, was always there. "I put a lot of my energy into develop- ing my scientific career," he said. "Through the years, I had a yearning to do serious writing but just didn't have the time to dedicate to it. After raising my family and getting my three daughters educated, I sold my practice and discovered I had a little more time on my hands." Set in the mountains of North Carolina in the 1940s and 50s, Letters from Sweetwater follows the life of Jessie Gernon as he unravels long-held family secrets with the help of a little divine intervention. Dr. Garland admits to following an age-old writing rule for his first ef- fort—stick with what you know. "The central protagonist is a young man modeled after my own life," he said. Both Dr. Garland and his fic- tional hero are optometrists, earned doctorate degrees from Indiana Uni- versity, and even share a birthday. "Almost any first work an author does is going to contain autobio- graphical material. It found its way in there," he said. Mystery and intrigue may drive the plot but that's not the main focus of the novel. The murder mys- tery "isn't central," Dr. Garland said. "I classify the book as inspirational fiction, but others call it Southern literature. I used to say it is a cross between Touched By an Angel and The Waltons. The book will make you laugh and make you cry a little bit." Whatever the genre, the recep- tion has been positive so far. "I've had people I don't even know call me and talk for hours about the book," he said. If the Amazon.com reviews are any indication, readers seem to strongly connect with the manuscript. "This book made me feel like I was a part of something bigger, something with purpose," wrote one reviewer. "There are times that I for- get to stop and enjoy the basics of life. … I would highly recommend this book to someone who needs a little reminder that life is short." Dr. Garland isn't working on a second book yet, but he would like to write another novel. "I've got a couple of things in mind but I want to get through with this first, if I'm not too old," he said. Letters from Sweetwater runs 438 pages and can be found on Ama- zon.com in paperback and for the Kindle. To keep up with Dr. Garland and his writing, visit www.dalegar- land.com. He can also be found on Facebook and Twitter. EW Contact information Garland: drdale@verizon.net RESTASIS ® (cyclosporine ophthalmic emulsion) 0.05% Sterile, Preservative-Free INDICATIONS AND USAGE RESTASIS ® ophthalmic emulsion is indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti- inflammatory drugs or using punctal plugs. CONTRAINDICATIONS RESTASIS ® is contraindicated in patients with active ocular infections and in patients with known or suspected hypersensitivity to any of the ingredients in the formulation. WARNING RESTASIS ® ophthalmic emulsion has not been studied in patients with a history of herpes keratitis. PRECAUTIONS General: For ophthalmic use only. Information for Patients The emulsion from one individual single-use vial is to be used immediately after opening for administration to one or both eyes, and the remaining contents should be discarded immediately after administration. Do not allow the tip of the vial to touch the eye or any surface, as this may contaminate the emulsion. RESTASIS ® should not be administered while wearing contact lenses. Patients with decreased tear produc tion typically should not wear contact lenses. If contact lenses are worn, they should be removed prior to the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of RESTASIS ® ophthalmic emulsion. Carcinogenesis, Mutagenesis, and Impairment of Fertility Systemic carcinogenicity studies were carried out in male and female mice and rats. In the 78-week oral (diet) mouse study, at doses of 1, 4, and 16 mg/kg/day, evidence of a statistically significant trend was found for lymphocytic lymphomas in females, and the incidence of hepatocellular carcinomas in mid-dose males significantly exceeded the control value. In the 24-month oral (diet) rat study, conducted at 0.5, 2, and 8 mg/kg/ day, pancreatic islet cell adenomas significantly exceeded the control rate in the low dose level. The hepatocellular carcinomas and pancreatic islet cell adenomas were not dose related. The low doses in mice and rats are approximately 1000 and 500 times greater, respectively, than the daily human dose of one drop (28 µL) of 0.05% RESTASIS ® BID into each eye of a 60 kg person (0.001 mg/kg/day), assuming that the entire dose is absorbed. Cyclosporine has not been found mutagenic/genotoxic in the Ames Test, the V79-HGPRT Test, the micronu cleus test in mice and Chinese hamsters, the chromosome-aberration tests in Chinese hamster bone-marrow, the mouse dominant lethal assay, and the DNA-repair test in sperm from treated mice. A study analyzing sister chromatid exchange (SCE) induction by cyclosporine using human lymphocytes in vitro gave indication of a positive effect (i.e., induction of SCE). No impairment in fertility was demonstrated in studies in male and female rats receiving oral doses of cyclosporine up to 15 mg/kg/day (approximately 15,000 times the human daily dose of 0.001 mg/kg/day) for 9 weeks (male) and 2 weeks (female) prior to mating. Pregnancy-Teratogenic Effects Pregnancy category C. Teratogenic Effects: No evidence of teratogenicity was observed in rats or rabbits receiving oral doses of cyclosporine up to 300 mg/ kg/day during organogenesis. These doses in rats and rabbits are approximately 300,000 times greater than the daily human dose of one drop (28 µL) 0.05% RESTASIS ® BID into each eye of a 60 kg person (0.001 mg/kg/day), assuming that the entire dose is absorbed. Non-Teratogenic Effects: Adverse effects were seen in reproduction studies in rats and rabbits only at dose levels toxic to dams. At toxic doses (rats at 30 mg/kg/day and rabbits at 100 mg/kg/day), cyclosporine oral solution, USP, was embryo- and fetotoxic as indicated by increased pre- and postnatal mortality and reduced fetal weight together with related skeletal retardations. These doses are 30,000 and 100,000 times greater, respectively than the daily human dose of one-drop (28 µL) of 0.05% RESTASIS ® BID into each eye of a 60 kg person (0.001 mg/kg/day), assuming that the entire dose is absorbed. No evidence of embryofetal tox icity was observed in rats or rabbits receiving cyclosporine at oral doses up to 17 mg/kg/day or 30 mg/kg/day, respectively, during organogenesis. These doses in rats and rabbits are approximately 17,000 and 30,000 times greater, respectively, than the daily human dose. Offspring of rats receiving a 45 mg/kg/day oral dose of cyclosporine from Day 15 of pregnancy until Day 21 post partum, a maternally toxic level, exhibited an increase in postnatal mortality; this dose is 45,000 times greater than the daily human topical dose, 0.001 mg/kg/day, assuming that the entire dose is absorbed. No adverse events were observed at oral doses up to 15 mg/kg/day (15,000 times greater than the daily human dose). There are no adequate and well-controlled studies of RESTASIS ® in pregnant women. RESTASIS ® should be administered to a pregnant woman only if clearly needed. Nursing Mothers Cyclosporine is known to be excreted in human milk following systemic administration but excretion in human milk after topical treatment has not been investigated. Although blood concentrations are undetectable after topical administration of RESTASIS ® ophthalmic emulsion, caution should be exercised when RESTASIS ® is administered to a nursing woman. Pediatric Use The safety and efficacy of RESTASIS ® ophthalmic emulsion have not been established in pediatric patients below the age of 16. Geriatric Use No overall difference in safety or effectiveness has been observed between elderly and younger patients. ADVERSE REACTIONS The most common adverse event following the use of RESTASIS ® was ocular burning (17%). Other events reported in 1% to 5% of patients included conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, and visual disturbance (most often blurring). Rx Only Based on package insert 71876US14B Revised February 2010 ©2010 Allergan, Inc. Irvine, CA 92612, U.S.A. ® marks owned by Allergan, Inc. APC80OW11 U.S. Patent 5,474,979 Made in the U.S.A. Dale Garland, Ph.D. Source: Revival Publishing

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