Posts

Entropy and the Eye: Clear Vision Is a Daily Victory Over Disorder

Image
Entropy and the Eye: Clear Vision Is a Daily Victory Over Disorder Every so often a patient asks me a question that has nothing to do with glasses and everything to do with life: Doctor, why does vision get cloudy as we get older? Why doesn't it just stay clear? The honest answer comes from physics, and its name is entropy . Entropy is simply a measure of disorder — how jumbled, scattered, and run-down things have become. The deepest law of nature says that left to itself, everything drifts toward disorder. Rooms get dusty. Gardens go to weeds. And eyes — eyes fog, scatter light, and lose their edge. Your eye knows this law intimately, and it fights it every minute of your life. Clear vision is order. Almost everything I check in the exam room is, in one way or another, a report on how that fight is going. Let me show you four ways to see it. 1. The Little Pumps That Bail Out Your Cornea The cornea — the clear front window of the eye — stays transparent only because a si...
Post a Comment
Read more

Vascular Endothelial Function Testing: A New Frontier in Preventive Eye Care

Image
How retinal vascular findings may help identify systemic cardiovascular risk Every day in my exam room, I get to do something no other clinician quite can: look directly at living blood vessels, no incision, no dye required for a first look. The retina is the one place in the body where the microcirculation shows itself. And what it shows is often not just about the eye. When I see arteriolar narrowing, arteriovenous nicking, a small retinal hemorrhage, or a cotton-wool spot, I am looking at vessels — and vessels elsewhere in that same patient are living under the same blood pressure, the same blood sugar, the same cholesterol. Retinal findings like these don't diagnose heart disease. But they are frequently the first visible hint that the vascular system as a whole deserves a closer look. That is why a recent article from the American Optometric Association caught my attention. In "Endothelial function testing: What doctors of optometry should know," Kerry Gelb, O.D....
Post a Comment
Read more

When a Laser Pointer Meets an Airliner: New Glasses Built to Protect Pilots' Eyes

When a Laser Pointer Meets an Airliner: New Glasses Built to Protect Pilots' Eyes By Paddy Kalish, OD I spend my days in an exam room in Brookline, looking into people's eyes. I spend a fair amount of my other time writing about aviation — I am the author of Flight of Fate — and thinking about what can go wrong, and right, at 35,000 feet, and more importantly, in the few hundred feet just above a runway. So when eye care and aviation safety meet in the same story, I pay attention. This one deserves your attention, too, even if you never sit in a cockpit. Because the hazard is a gadget many people have in a desk drawer, and the people at risk are the two pilots guiding your next flight down through the dark. A small pointer, a very big problem A pocket laser pointer feels harmless. It makes a bright dot on a wall, your cat chases it, and that seems to be the end of the story. Pointed up at an aircraft, it is a different story altogether. A laser beam spreads as it travel...
Post a Comment
Read more

Amaurosis Fugax: When One Eye Goes Dark

Every so often, a patient sits in my chair and tells me a story that stops the small talk cold. "Doctor, last Tuesday my right eye went dark — like a shade being pulled down. It lasted maybe two minutes, and then it just… came back." No pain. No injury. Nothing to see by the time they reach me, because the eye looks perfectly normal again. That little episode has a name — transient monocular vision loss — and when we suspect a tiny embolus caused it, we call it amaurosis fugax, Latin for "fleeting darkness." It is one of the most important stories a patient can tell me, because it is a symptom, not a diagnosis — and sometimes it is the only warning before a stroke. A blackout in one eye is a TIA of the eye Here is the idea I need every patient to carry home: if a blood clot briefly blocks the circulation to one retina, that is a transient ischemic attack — a TIA — that happens to announce itself through the eye instead of through speech or a weak arm. The American H...
Post a Comment
Read more

Contact Lens Insertion and Removal — Paddy Kalish, OD

Contact Lens Insertion and Removal — Paddy Kalish, OD By Paddy Kalish, OD Learn how to insert and remove soft contact lenses safely with Paddy Kalish, OD — including when to wear your lenses, where to handle them, proper hand hygiene, and the warning signs that mean you should leave your lenses out. More eye care guides at paddykalish.com. Video: Contact Lens Insertion and Removal — Paddy Kalish, OD Originally published at paddykalish.com .  
Post a Comment
Read more

Tethered Cord Syndrome: When the Spinal Cord Is on a Leash

Tethered Cord Syndrome: When the Spinal Cord Is on a Leash By Paddy Kalish, OD — optometric physician, Brookline, Massachusetts This is the condition behind a case I wrote about recently — the one neurosurgeon Dr. Betsy Grunch shared, where ChatGPT spotted the pattern after many doctors had missed it: tethered cord syndrome, or TCS. It's worth a fuller explanation, because TCS is a master of disguise. Its symptoms creep in insidiously, and unless a clinician keeps tethering on the list of possibilities, they get filed away as muscle strain, aging, or "functional" complaints — while the real problem quietly progresses. What TCS is — and what it isn't "Tethered cord" describes abnormal fixation of the spinal cord that limits its normal movement inside the spinal canal. Your cord is meant to glide a little as you bend and move. When it's anchored down, traction does two kinds of damage: it impairs the cord's blood flow and metabolism, and it mec...
Post a Comment
Read more

Atropine: The Eye Drop That's Also an Antidote

Atropine: The Eye Drop That's Also an Antidote By Paddy Kalish, OD Here is a piece of medical trivia I never get tired of. Centuries ago, Italian women put drops from the deadly nightshade plant into their eyes to make their pupils large and dark — considered the height of beauty. The plant's Italian name, bella donna , means "beautiful lady." The active ingredient in that dangerous beauty trick is the very same medicine I keep in my exam room today: atropine . Atropine is one of the hardest-working medicines I know. It rides in ambulances, stands by in emergency rooms as an antidote to poison, and sits quietly in eye clinics like mine. What fascinates me is that all of those jobs flow from a single, simple trick — and once you understand the trick, the whole résumé makes sense. One trick, explained plainly Your body has two broad "modes" of automatic control. One speeds you up for action. The other — the rest-and-digest mode — slows the heart, gets...
Post a Comment
Read more
Paddy Kalish, OD — Optometric Physician
1296 Beacon St, Brookline, MA 02446
Call or text: 857-314-4645
paddykalish.com