By Carrie Rossenfeld

While hard surfaces can look modern and edgy (and are often easier to keep clean), they’re not always welcome in the medical office setting. Stone, tile and hardwood floors, along with metalframe chairs and glass tables certainly look nice, but they have definite drawbacks for practices, including a lack of comfort and privacy, risk of injury, increased noise and an overall “cold” feeling.

The current trend in medical office design is to make these spaces feel more residential and less clinical, which calls for a softer touch. “This connects the human experiences of sight, sound, texture and movement with furniture and furnishings that feel more hospitable,” says Ashley Ginn, design manager for Shaw Contract Group’s healthcare and education studio in Cartersville, Ga.

“Creating softer surfaces in waiting/exam rooms can help make these spaces more approachable for patients, and can help lower acoustical noise, which has an added benefit of increasing patient acoustical privacy,” says Neil Chambers, CEO and founder of Chambers Design, Inc. in New York City. Decreased environmental noise is also linked to better healing, according to The Center for Health Design.

In addition, slipping and falling is more common on hard, slick surfaces, adds Barry Dubrow, president of Dubrow’s Discount Office Furniture in Cherry Hill, N.J.

Hard surfaces on vertical and horizontal planes also produce a glare and reflective issue, which can be both uncomfortable and anxiety-provoking, says Dan Lee, CEO and president of Lee Design Group PLLC in Dallas. In fact, all of the negative effects of hard surfaces can increase anxiety, fear and alarm in patients.

“Creating a warm and comfortable, ‘soft’ atmosphere to the waiting area is a step in subverting these fears and anxiety,” says Brian A. Bonanni, M.D., medical director for Gotham LASIK & Skincare in New York City. “It lends [itself] to a more relaxed and intimate relationship with the doctor and staff, leading to a better experience and better healthcare.”

How can you soften up your surfaces?
There are many options for minimizing unwanted hard surfaces in your office. Here, MOT shares some tips from design experts and knowledgeable medical practitioners alike.

Flooring
Select low-profile (not shag) carpeting to help prevent slips and falls, says Jeanmarie Zimmerman, associate and design director of Puchlik Design Associates, Inc. in Pasadena, Calif. Also choose durable and solution-dyed carpet that can handle the long-term strain of frequent cleanings as well as wear and tear from walkers, wheelchairs and medical equipment.

Dubrow cautions practices to make sure that sure carpeting is installed properly, without any exposed tacks or bubbling, to prevent trips and injury.

Try carpet tiles instead of traditional broadloom carpeting. “If a section of carpet gets damaged or stained, it can easily be removed and a new piece installed,” suggests Michael V. Swain of Wood Burghard Swain Architects in Irvine, Calif. Even better, carpet tiles are consider “green” or sustainable because they can be replaced in smaller pieces without the waste of replacing all the carpet.

For exam rooms, sheet vinyl, VCT (vinyl composite tiles) and rubber plank/tile flooring are great options that are easy to clean and yet comfortable for standing and walking. Some specialty resilient floorings, such as vinyl, can include a backer mat to assist in cushioning and support, eliminating the need for ongoing wax maintenance while securing the desired level of friction and providing better patient comfort and safety while walking, Zimmerman adds. You can soften the floor visually by using vinyl floor tiles that resemble wood, while welded-seam sheet vinyl with integral cove base is the most robust option, says Swain.

The judicious use of area rugs can soften a space, says Bonanni. Make sure they have a non-slip backing and are cleaned often.

Furniture
Fabric-upholstered furniture rather than harder upholstery vinyl improves privacy and comfort, Lee contends. Today, there are a number of fabrics that resist bacteria and staining, which is one of the main reasons why medical practices have shied away from upholstery.

Minimize or eliminate glass-top tables in waiting areas, suggests Maureen Carley-Vallejo Iida, a senior designer in the healthcare group at Perkins Eastman, a firm in Washington, D.C., that specializes in healthcare design. Also, look for soft or eased edges on chair arms, tables and other surfaces.

“Couches are so much more comfortable than a straight-backed chair,” says Sandra Lee Hartsell, an LPN in Thomasville, N.C. Consider upholstered couches or loveseats in your waiting room to replace some individual chairs and to help create a homier atmosphere, suggests Bonanni.

If appropriate for your practice, look into specialized bariatric and hip-injury chairs for waiting areas, says Zimmerman. These are often available from designated healthcare lines that are engineered for patient safety and include rubber cushions on arm rests to assist elderly or injured patients in the process of sitting and standing, and they are usually suitably weighted at the base to prevent instability or tipping. Also consider cushioned benches next to the reception desk so that patients don’t need to stand when talking with a nurse.

http://www.medicalofficetoday.com/content.asp?article=5285

ROP is thought to be caused by irregular growth of the blood vessels in the back of the eye (the retina). This can lead to scarring and retinal detachment leading to blindness. ROP is linked to prematurity (born before 30-32 weeks gestation) and the risk increases with very low birth weight(1500 grams or less), and both oxygen toxicity and hypoxia are contributing factors. Children with ROP are at greater risk of glaucoma, ‘eye turn’ (strabismus), cataracts, and myopia(nearsightedness). Diagnosis is done by eye exams performed on premature babies at regular intervals.

Avastin is a cancer drug originally approved to treat breast cancer but is being used for retinal eye diseases such as age-related macular degeneration. [The FDA may rescind its conditional approval for the treatment of breast cancer due to sine possible side effects. The dose used for retinal diseases is much lower and no side effects similar to those found in breast cancer treatment have been observed.]

The standard treatment today is Laser ablation of the peripheral retina which can stop the progress toward blindness, but it also may cause infants to lose peripheral vision and suffer from poor overall vision.

Only 4 percent of babies treated with Avastin suffered a recurrence of ROP compared to 22 percent in the laser ablation group. Treatment with Avastin cost about $40 for both eyes. Further research needs to be done to determine the best timing of the Avastin injections and to determine the best appropriate dose for the different forms of ROP.

Previous studies like the AREDS found that omega-3 intake might protect against advanced AMD. Macular Degeneration is a disease of the retina (the back of the eye) which has high concentrations of omega-3’s. The first study involved seniors aged 65 to 84 who were evaluated for AMD and graded as to extent, from none to advanced. Interestingly, all groups consumed fish, but those in the advanced AMD group were significantly less likely to consume high omega-3 fish.

In the second study, which involved following more than 38,000 women with no AMD over a span of 10 years, information on the intake of the omega-3 fatty acids found in fish, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), along with arachidonic and linoleic acids (omega-6 fatty acids) was garnered. Women who consumed the most DHA compared with women who consumed the lowest amount had a 38 percent lower risk of developing AMD. Similar results were observed with higher intake of EPA and both types together. Consumption of one or more servings per week had similar reductions in AMD when compared with consumption of less than one per month. Consumption of the omega-6’s had no significant association with AMD.

Good sources of omega-3’s are cold water oily fish such as sardines, anchovies, mackerel, herring and salmon, tuna as well as several types of shellfish. In addition to the health benefits regarding AMD, the omega-3’s also play a role in treating Dry Eye Disease. All very good reasons to consume heart healthy fish.

Now however, there may be hope for some of these bad cases. Researchers in Ottawa and Sweden have developed a new bioartificial cornea – a way to regenerate the cornea from within. With about 42,000 corneal transplants in the U.S. yearly and an estimated 10 million people worldwide with corneal blindness the need for donor corneas is high and the supply inadequate. Even with donor corneas, rejection is always a risk.

The researchers took human collagen and molded it into a contact lens-like shape providing a scaffold for a cornea. After damaged tissue was removed in 10 patients with severe vision loss, this corneal lens-film was implanted. Not only did it act as a replacement for the damaged corneal tissue but, what was truly amazing, was that healthy corneal cells started growing in the collagen forming a normal structure. Tear production normalized and even corneal nerves re-grew – a significant requirement for normal function. Though this was performed in patients with more superficial layer corneal diseases, the ultimate goal is to utilize this advance to treat patients with deeper corneal layer disease, obviating the need for full-thickness corneal transplants and potentially making the supply of artificial corneas widespread and capable of worldwide distribution.

Essentially, a cataract is a clouding of the natural lens in the eye. Though often described as a film or coating over the eye or the vision, the abnormality lies inside the eye. (See the pictures below.)

There are many different types of cataracts, but the most common, and the type most people are familiar with is the senile, or age-related cataract – often described as nuclear sclerosis, a generalized clouding of the lens. Other types that may occur alone or in conjunction with the senile cataract are posterior subcapsular, cortical, anterior polar, etc. They may be classified as immature, mature, hypermature, congenital, traumatic etc. But essentially, if a person lives long enough, they will develop cataracts.

A cataract can interfere with the vision in a variety of ways. Most often, the vision becomes slightly fuzzy or blurred with a loss of visual acuity (eye chart vision) – but since this usually happens slowly over many years the individual may not notice until late in the development of the cataract. Sometimes the patient experiences a lot of glare or a halo around lights, often becoming so bad as to make driving difficult, especially at night. Contrast sensitivity is also lost, so that contours, shadows and color vision are less vivid. A ‘browning or yellowing’ of the vision is a sign of cataracts.

Causes of cataract formation are many. Long-term exposure to ultraviolet light and radiation is a significant cause. Diseases such as diabetes or hypertension play a role as does any trauma to the lens or long term use of corticosteroids. Genetic factors also play a role.

As discussed previously, there is no tried and true way of preventing cataracts. The wearing of UV blocking sunglasses may slow the development of them. Regular intake of antioxidants through one’s diet may help prevent or delay cataracts (but supplements have shown no real benefit in this respect).

Treatment of cataracts ultimately means surgery. Compared to years ago when surgery would take an hour and a person was in the hospital for up to a week, today’s cataract surgery is revolutionary. It is performed on an outpatient basis with local anaesthesia and usually takes less than half an hour. Before, a person was restricted to the use of very thick glasses after cataract surgery for normal vision, but today with the latest intraocular lens implants, a person’s vision is usually very good starting soon after the procedure and without the need for glasses. New multifocal or accommodating intraocular lens implants may even afford the post-cataract surgery patient good vision both at near and at far.

Lasik Crossword Puzzle Update:

Congratulations goes to past patient Jackie Gauci from Michigan who was the first to successfully answer the crossword puzzle in last month’s newsletter. She opted for a $250 gift certificate.

Answers to Last Month’s Lasik Crossword

The theme for July is ‘Wellness and Health Naturally’, and so Gotham is providing some information and a few helpful hints for increasing your holistic health awareness and hopefully by doing so, improving your life and health. I refer you to my previous post in the March newsletter Doctor’s Note on nutrition and eye health. Below you will find some info to help with your skin and skincare routine. I would like to just mention something about blueberries since summer is upon us. Lutein and zeaxanthin are carotenoids found in blueberries. Both of these carotenoids show promise in slowing age-related vision disorders and eye disease. According to Jules A. Mares, PhD, et. al., in an article published in the Archives of Ophthalmology, lutein and zeaxanthin may even slow progression of disease once the disease is present, but I must stress that studies so far are inconclusive. In fact, eating at least three servings of any fruit per day may help prevent age related macular degeneration, not necessarily just blueberries. So at this time of year when fruit is so readily available and so fresh, it only makes sense to add it to your diet – it doesn’t hurt, it’s good for you, and it may help your eye health!

Crossword Puzzle!

This month I’ve included a crossword puzzle whose topic is the eye, lasik, and laser vision correction. The first person to finish the puzzle correctly will receive a prize. (Next month will be a puzzle for skincare.) All answers can be either emailed to me at: drbonanni@gothamlasik.com, sent by mail (postmark date) to our address: 156 West 56th St., 12th Flr, NY, NY 10019, or faxed to: 212.646.9998 Good luck!

It is important to see an ophthalmologist if the freckle or brown spot on your eyelids or on the white of the eye changes – increases size or changes shape or color. Remember, early detection is key in treating this condition. A local excision may be curative before it has a chance to metastasize at which time the prognosis is grim. Sunglasses are important for many reasons (guarding against UV rays which cause cataracts and retinal disease for example) but especially for increasing the risk of ocular melanoma.

Eye melanoma symptoms:

• In the early stages the person may have no symptoms (the person will not know there is a melanoma in the eye till he/she has their eyes checked and looked into with the opthalmoscope by the optician/ opthalmologist/ optometrist)
• The benign form of eye melanoma is called a nevus. Regular checks and close watching on it are done to ensure that it doesn’t turn into a melanoma.
• When it grows larger – there may be blurred vision, double vision, decrease in vision, retinal detachment and loss of vision)
• If the melanoma is on the conjunctiva or the iris it will be seen as a blackish/brownish spot on the iris/conjunctiva.
• If not caught and treated early, eye melanomas can spread to other parts of the body, mainly the liver.

Treatments for eye melanoma?

• Cryotherapy and plaque therapy. (to freeze and/or burn the melanoma)
• Laser therapy.
• Surgery to remove the eye, this is called an enucleation.
• Surgery to remove part of the eye, such as iridectomy and iridocyclectomy.
• Chemotherapy.
• Radiotherapy.

To know more about the signs and symptoms of melanoma, click here.