EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 Corneal diagnoses and systemic disease February 2011 EW FEATURE 49 Eyeing the GI tract for vital vitamins by Maxine Lipner Senior EyeWorld Contributing Editor AT A GLANCE • Gastric bypass and conditions such as celiac disease or cystic fibrosis can rob the eye of needed vitamin A • Patients suffering a deficiency may have complaints such as dry eyes, more generally associated with other conditions • Turning the tables may require mega-doses of vitamin A in conjunction with high doses of cyclosporine Making the gastric bypass connection and beyond I t may be the last thing you're thinking of when you see a pa- tient whose main complaint is dry eyes or a touch of night blindness—the idea that the culprit may be a gastrointestinal (GI) problem that's spawning a vitamin A deficiency. But the fact is that this may very well be the case. At the root of such a deficiency can be any- thing from cystic fibrosis to celiac disease or even a weight loss proce- dure. W. Barry Lee, M.D., Eye Consultants of Atlanta, has found himself in that situation a number of times with patients who, unbeknownst to him, had under- gone gastric bypass surgery. Back in 2005 he came across his first case when he saw a patient who had a classic case of xerophthalmia, with very dry eyes and poor acuity that he suspected might be linked to gastrointestinal origins. "She was completely blind, she couldn't see anything. I asked her about her medical history, and she said that she hadn't done anything at all," Dr. Lee said. "I asked her about celiac disease, cystic fibrosis, and various other conditions (that can also cause a deficiency), and she kept saying, 'No, no, no.'" Dr. Lee was stumped until he pressed a bit further. "I asked if she had any kind of surgery, I had to ask her twice, and she fi- nally said, 'Well, I did have gastric bypass surgery,'" he said. "People are a little embarrassed that they've had that, and they don't think that it has any relation to their dry eyes." Dr. Lee stressed that physicians have to get the history out of patients to fig- The power of one ure out that their dry eye is related to a dry eye condition. Starved for vitamin A The link between gastric bypass and xerophthalmia, marked by dryness of the eye, is something that he finds is on the rise. "There were al- most 20,000 gastric bypass surgeries done in 2009," Dr. Lee said. "The problem with gastric bypass surgery is that it either removes or blocks the portion of the intestines that ab- sorbs vitamin A." He dubs vitamin A continued on page 50 THE ONE FEMTO PLATFORM for cornea, presbyopia and cataract. Presenting the unparalleled Ziemer FEMTO LDV Z Models – a technical revolution in ocular surgery. No laser is more precise, more powerful or more progressive when it comes to meeting all your procedural needs in a single platform. With Ziemer's FEMTO LDV Z Models, now you can operate with a modular femtosecond system that is easy to configure, designed to grow with your practice – cornea and presbyopia today, cataract tomorrow. www.ziemergroup.com The creation of a corneal pocket is part of a presbyopia intervention. Availability of related corneal inlays and implants according to policy of the individual manufacturers and regulatory status in the individual countries. Cataract procedures with the FEMTO LDV Z2, Z4 and Z6 models are not cleared in the United States and in all other countries. An upgrade possibility for these devices is planned once cataract options are available and cleared by the responsible regulatory bodies.