Kohl

I'm reading a book about public health in Eygpt from a UC ebook site (no, I don't have the link: I copy the book and read at my leisure because the on and off internet connection makes streaming etc. a pain).

Kohl was used in Egypt since pre dynastic times to protect the eyes from disease (presumably  trachoma, which is spread by flies. Ever see those photos of starving babies whose eyes are covered with flies? Maybe the poisonous kohl did discourage this from happening).

this has been known since antiquity, but science has confirmed this only recently:

From the NIH:

In trachoma endemic areas, flies are frequently seen clustering around the face and eyes of children where they feed on mucus and discharge (Fig.​(Fig.1).1). This association of flies with the faces of infected children has not gone unnoticed, and they have been considered as vectors of trachoma for at least 400 years.¹

Fig. 1

Everted upper eyelid of a Gambian child with follicular trachoma and a feeding female bazaar fly (Musca sorbens)

Flies act as mechanical vectors of disease by picking up pathogens from infectious material and transferring them to an uninfected host. Flies have taste receptors on their front feet and when feeding they dip these into the food source as well as their proboscis. Thus, flies may be transferring Chlamydia trachomatis from the eyes of infected children to the eyes of uninfected people, on their feet and proboscis. However, the transmission of trachoma is poorly understood and there are other suggested routes which may be important in different places and at different times. Trying to prove that a particular route is operating, and establishing the relative importance of one route over another, is difficult. Until a recent intervention trial in The Gambia² there has been little strong evidence to prove that flies actually are important in the transmission of trachoma.

Factoid: Kohl in India is made from a lead compound, but kohl in Egypt is Stibnite, an antimony based compound.

The NIH points out that lead based kohl puts the user at danger of lead poisoning.

 This article from a tourism website notes that both antimony and lead based kohl were used in ancient Egypt.

In ancient Egypt, preparations were a little more extensive. The cosmetic material had to be powdered on a palette and then this powder mixed with a substance, (analysis indicates that these were usually ointments derived from animal fat) to make the powder adhere to the eye.
Eye makeup equipment (palettes, grinders, applicators) has been found among the earliest burials of the pre-dynastic period and seem to have been essential items for the afterlife.
Even the humblest graves consistently contain at least a simple palette. Small containers of galena have been found in tombs alternately stored in leather or canvas pouches, small jars, conch shells or within hollow reeds. What separated rich from poor was not the existence of makeup but the expense and luxury of containers and applicators. Everyone had galena powder however while the poor resorted to sticks to apply it, the wealthy had intricately carved and bejeweled containers of ivory or other precious materials.
That the Egyptians decorated their eyes with great aesthetic care is immediately obvious. Eye cosmetics bestowed beauty and style as well as other gifts, perhaps less immediately apparent to modern eyes.
Galena possesses disinfectant and fly-deterrent properties. It is believed to offer the eyes protection from intense sun. The medical papyri frequently prescribe mesdemet for assorted complaints of the eye.
Eye make up provided psychic protection as well. The Egyptian word for eye-palette seems to derive from their word for "protect." An unadorned and thus unprotected eye was believed vulnerable to the Evil Eye. Outlining the eyes thus became a personal protective amulet drawn right upon the skin; an amulet that once applied could not be lost or misplaced.

Read more: http://www.touregypt.net/egypt-info/magazine-mag09012000-mag4.htm#ixzz2lc3EFWdY

Wired points out that there is a long history of using arsenic as a pesticide and as a rat killer, and that although China has finally banned it's use, it is probably still being used illegally and could be in your child's apple juice

 Arsenic pesticides didn’t arrive in the United States until the 1860s, when they were used to fight the Colorado potato beetle. Lead arsenate wasn’t introduced until the 1890s when it was used against the gypsy moth. ... In 1919, the Boston Health Department destroyed arsenic contaminated apples because people were getting sick. The follow year, it had to do it again. 

...

and this is worrisome:

 Rice is an exception to that. Scientists have discovered that the rice plant, because it’s designed to pull silicon out of the soil (it strengthens the grain) does the same with the structurally similar arsenic. Researchers at Dartmouth College’s Toxic Metals Superfund Research program note that rice has been described as a natural arsenic accumulator. Most of this accumulation, of course, is due to naturally occurring arsenic in soil and water.

 this book discusses the ancient use of Kohl in Egypt as a fly repellant. LINK Alas, unlike many of the books published by the Metropolitan museum, it isn't a free download.

Going Blind? We don't care

Newest "expert" panel of the US Gov't says that there is no proof to say screening for glaucoma helps, nor is there proof to say early treatment improves the 'outcome".

This ignores Rumsfeld's rule: The absence of evidence is not the evidence of absense.

I mean, when there is a treatment for a disease that causes blindness, are you going to be part of the "double blind" study that doesn't treat you?

Glaucoma is increased pressure inside the eye. With time, the pressure destroys the nerves you see with: it starts with a decrease in peripheral vision.

this is from Dr. Higgon's webpage:

 

see that "early glaucoma" part? you probably wouldn't notice it. As it gets worse, you might first "notice" you've lost your side vision when you don't see a car or a pedestrian in your peripheral vision (as did my uncle, whose car was hit from the side).

However, there is "inadequate evidence" that treatment for people without symptoms can prevent more serious vision loss and blindness, the panel wrote Monday in the Annals of Internal Medicine.

That doesn't make sense. The NIH says you need screening.

Early symptoms are mild: Which is why so many folks end up with tunnel vision without treatment....and remember: the "symptoms" mean you have lost your vision already.

"It's clear that the treatment can improve the disease," Moyer told Reuters Health. "It's not crystal clear that the treatment of disease before it's noticeable improves the outcome."

It's not "crystal clear". It's probable, it makes sense that treatment would stop the damage, but never mind. 

What's more, most glaucoma tests available in primary care offices aren't very accurate,

True.

It's hard to do the measurement with the old fashioned "pressure" gauge during the yearly physical exam.

I used to use the Shultz tonometer. This is called "direct tonography": you numb the eyeball with drops, and then place a measuring device on the eye, and check your pressure directly.

This is the old fashioned one we used:

You lowered it to the eye, until the outer part hit the eyeball, and the middle part measured how much pressure difference there was.

Problem? If the person moved, they might end up with a scratched eyeball (abrasion of the cornea).

But the newer version is more expensive (usually only specialists have it) and easier.

Dr. Singh has a nice video here:



there is now a "puff" test that is quicker and easier to do, however it's not as accurate. 

We didn't do a lot of the tests because most of our older patients already we seeing eye doctors who had done the test...and so we only did a few a year and sort of forgot to check about it...the dirty little secret is if you don't do a test a few times a month, you are probably going to do it wrong.

Even if we came  up with a "positive" test, we just sent them to the eye docs for a second opinion...

there is a "third" way to test for glaucoma: Look into the eye with an opthalmoscope. But the dirty little secret is that it's a subtle change (and most of us can only see major problems, since few primary care practitioners "dilate" the eye before the exam...to do a proper examination, you need to put in those drops that make your iris open wide, and make your eyes sensitive to light and hard to drive home from the office, before you do the examination).



So the first part, saying the test isn't accurate by primary care docs/practitioners is correct.

The problem is the last part of the sentence.

What's more, most glaucoma tests available in primary care offices aren't very accurate, according to the USPSTF, and can't discern when vision problems are likely to get worse. That could lead some people who never would have developed advanced glaucoma to be diagnosed and treated unnecessarily.

 BINGO!

Translation: Well, the drops might stop you from going blind, but hey, we don't know, because few docs who pick up the disease on the screening test are willing to let you maybe go blind (and sue them) by not treating you when they diagnose it.

But that means a lot of money for you to spend (or your insurance company to spend) on eyedrops and repeat examinations of your vision. But now the government is paying for it, and man, it costs money.

So let's just not screen you. 

I don't have the US pricetag, but this "NICE" article (NICE is the health care rationing board in the UK) breaks down the costs to 100L a year (about $150) and less than a million pounds (or about a million and a half dollars) to treat 70 percent of those who need it (the 70 percent is the estimate of how many people actually will use their medicine).

Ironically, the NICE is willing to pay for screening and treatment, which tells you something since they are tightwads.

But what about that part you might not need treatment?

The cornerstone of pushing the new "health care" bill was that it would pay for yearly screening examinations on everyone. Supposedly, diseases would be caught early and either cured or treated early, so the patient would end up healthier and cost less money in the long run.

And since the health care bill was  passed, we see one report after another about how such screening tests are "not cost effective" or should only be used in a few patients.

That's because we were told to do them (and sued if we didn't do them), but most people don't go to docs for yearly exams, so no problem.

But now, if they all come in, the cost of screening everyone, mainly low risk people to pick up a few isolated cases, is too high.

Voila: One "screening test" after another is being discarded.

OK. You want to take the chance?

Dr. Angelo Tanna, a glaucoma researcher from the Northwestern University Feinberg School of Medicine in Chicago, said screening can still be useful when performed by an ophthalmologist.

ah, but most of us see optometrists, not opthalmologists.

So the end result should be the government paying for the test for older folks and to pay for a visit to the optometrist every two years or so.

That's what I do...