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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...

By Paddy Kalish, OD Almost every week, a patient with macular degeneration asks me the same question, usually with a little fear behind it: "Doctor, my mother lost her vision to this. Is there anything I can take so it doesn't happen to me?" For a long time, my honest answer had a gap in it. We have a proven vitamin formula for intermediate AMD — the AREDS and AREDS2 formulas, which cut the risk of progressing to advanced disease by about 25% in the original AREDS trial. But for early AMD, the stage far more of my patients are actually in, there has been no treatment with real evidence behind it. Nothing. Watch and wait. That's why a recent conversation caught my attention. On Ready, Set, Retina , Dr. Daniel Epshtein and retina specialist Dr. Priya Vakharia walked through the emerging evidence for something humble: B vitamins. Here's the story as I'd tell it to you in my exam chair. The heart trial that wasn't supposed to be about eyes The strongest...

 The head and neck, taught the way an optometric physician actually sees them. Most anatomy texts teach the head and neck as a map of structures. This book teaches them as a living clinical landscape — where every nerve, vessel, and sinus has a pathology attached and a treatment decision waiting. Clinical Head & Neck Anatomy: An Optometric Approach to Pathology and Treatment is a 21-chapter journey from the cranial nerves to the thyroid, written from the exam chair. Each chapter pairs precise anatomical description with the diseases that arise when anatomy goes wrong — and what to do about them. Inside: 21 fully illustrated chapters covering cranial nerves, orbit, sinuses, salivary glands, thyroid, vasculature, and more 45 original labeled illustrations drawn for clinical clarity 45 end-of-book quizzes with verified answers to lock in your learning Clinical pearls connecting anatomy to real presentations: Kawasaki disease, giant cell arteritis, thyroid eye disease, Ludwig's ang...

 

  New Migraine Prevention Guidelines - Q&A Q: What is new? A: The American Academy of Neurology and the American Headache Society released new prevention guidelines on August 31, 2026. The old ones were from 2012. The biggest change is they now include newer, migraine-specific drugs that block a protein called CGRP, which helps trigger migraines. These are pills like atogepant (Qulipta) and shots like eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Q: Who should think about taking a preventive medicine? A: Anyone with migraine should be told that prevention exists. You should be offered it if you have: 4 or more migraine days per month, OR 4 or more days per month with moderate-to-severe headaches, OR Migraines that really interfere with your work, family, or daily life. Prevention can mean fewer headache days and less disability, and may help stop occasional migraines from becoming chronic. Right now, many people who could benefit...

Horner’s syndrome is a pattern of eye and facial changes caused by reduced “sympathetic” nerve signals to one side of the face. It isn’t a disease by itself—it’s a clue that something along that nerve pathway has been affected, so clinicians focus on finding the underlying cause. Q: What is Horner’s syndrome? A: A condition where the nerves that help control the eyelid, pupil size, and sweating don’t work normally on one side of the face. Q: What are the usual signs? A: A droopy upper eyelid (ptosis), a smaller pupil on that side (miosis), and sometimes less sweating on that side of the face (anhidrosis). Some people also notice the affected eye looks “less open.” Q: Does it hurt or affect vision? A: Horner’s syndrome itself doesn’t usually damage the eye or directly cause vision loss, but the pupil difference can be more noticeable in dim light and may be associated with other symptoms depending on the cause. Q: What causes it? A: Anything that disrupts the nerve pathway from the brai...

  Cancer: Questions and Answers Q: What are the earliest warning signs of cancer? A: Cancer can cause many different symptoms depending on where it begins. Some general warning signs include unexplained weight loss, persistent fatigue, unexplained fever or night sweats, a new lump, persistent pain, changes in bowel or bladder habits, unusual bleeding, a persistent cough, changes in a mole, or a symptom that is new and does not go away. These symptoms are often caused by conditions other than cancer, but persistent or unexplained changes should be evaluated by a healthcare professional. Q: Does having one of these symptoms mean that I have cancer? A: No. Most individual symptoms have many possible causes, and many are not related to cancer. The concern increases when a symptom is new, unexplained, persistent, worsening, or accompanied by other concerning symptoms . A medical evaluation is the best way to determine the cause. Q: How long should I wait before seeing a doctor about a...