Dr William Boothe, Director of Boothe Laser Center

The team at Boothe Eye Care and Laser Center is proud to announce that founder, Dr. William Boothe has performed more LASIK surgeries than any surgeon in the United States.

For more than 22 years, Dr. Boothe has helped patients from around the globe reduce or eliminate their dependency on glasses and contact lenses. He incorporates state-of-the-art technology to help his LASIK Dallas patients achieve rewarding vision correction at his modern facility. For example, Dr. Boothe has performed more laser vision correction procedures with the VISX Custom 3D Wavefront Customized platform that any surgeon in the world. For this dedication to patient satisfaction, Dr. Boothe was recognized by VISX in 1999 as the VISX Surgeon of the Year.

Dr. Boothe also is noted as the busiest IntraLASIK surgeon on the globe since he has performed over 57,000 procedures of this sort.

This high level of expertise and dedication to patient safety and satisfaction has resulted in Dr. William Boothe being seen as a pioneer in the world of refractive vision correction. Patients from all over the world have trusted Dr. Boothe with their vision.

To learn more about Dr. Boothe and schedule a consultation to learn more about how you can eliminate your dependency on prescription vision correction, please visit Boothe Eye Care and Laser Center or call (214) 328-0444.

An uncommon ocular chemical injury today is from a foreign body consisting of the “lead” from an indelible pencil. The leads in violet colored indelible pencils at one time contained 30% methylrosaniline chloride (methyl violet), graphite, and a binder such as gum tragacanth said Dr William Boothe. The offending chemical is the methyl violet, an analine dye, and protoplasmlie poison. Toxicity to the external eye is manifested by diffusion of deep purple stain, with chemosis, edema, and necrosis. This process is relatively rapid and may occur from only a small retained foreign body. The eye can be left severely impaired or blind, and therefore such an injury is a true ocular emergency.

Treatment involves using as much debridement as is practical. If stained tissue remains, 2% fluorescein solution is used to irrigate the affected tissues over a period of 12 to 24 hr. The reaction of the dye can be totally reversed with early treatment in Boothe Laser Center.

Methyl violet is a high molecular weight dye that easily dissociate", to form cations. In the cationic form, it binds anionic groups in tissues. Sodium fluorescein competes with the tissue anions to form a slightly dissoci-ated salt, thus leaching the toxin from ocular tissues.

Graphite pencil lead today consists of 70 percent graphite, 30 percent clay, and some additives such as spindle oil, liquid paraffin, and silicone oil. Intraocular foreign bodies of this type are relatively inert and can re-main symptom- free over long periods of time.

Fluorescein has been used in a standard fashion to aid in the determination of the tear break-up time (BUT) said Dr William Boothe. The BUT is defined as the interval between the last complete blink and the development of the first randomly distributed dry spot in the tear film. To perform the BUT a fluorescein strip is moistened with one drop of distilled water and applied to the inlerotemporal bulbar conjunctiva. Patients are instructed to blink several times to evenly distribute the fluorescein. The patient is then asked to stare straight ahead without blinking. With a 3-mm wide vertical beam though a cobalt filter, the tear film is scanned until the first dry spot ap¬pears .

Lemp has proposed that an abnormal BUT is less than 10 sec . There has been wide variation in BUTs in normal patients, often ranging from 5 to 100 sec. In individual patients there has been marked variation .Hid lack of reproducibility. Thus BUT has been disappointing as a clinical test for diagnosis of diseases resulting in precorneal teat instability.

There are many variables that can influence the BUT. Some of these may be the result of fluorescein itself and the method of application. The concentration of fluorescein has been reported to affect BUT. Increasing concentrations have resulted in shorter BUTs . This may be due to alterations in the tear stability or differences in the ease of detecting dry spots, or both. Standardizing fluorescein concentration with a fluorescein strip is difficult at best. Irritation from touching the strip to the bulbar conjunctiva as well as the fluorescein itself can stimulate reflex tearing. This will affect BUT indirectly by affecting the fluorescein concentration and directly by affecting the quality and quantity of the precorneal tear film Reflex tearing is a highly individualized response and may be responsible for wide variations among individuals and in the same individual. These variables as well as others will need to be controlled before the BUT be-comes a practical test. This is available at Boothe Laser Center

Several methods of assessing the patency of the lacrimal system using fluorescein have been described by Dr. Boothe. Probing and irrigation with a fluoresein solution is one method . Though effective, this procedure may be uncomfortable and may itself damage the lacrimal excretory system.

Another method is the Jones primary and secondary dye test . A positive test results when 2% fluorescein instilled in the conjunetival cul-de-sac is found after 3 to 5 min in the inferior meatus of the nose. The dye is collected by passing a cotton-tipped malleable wire probe under the turbinate. If no dye is collected, the test is negative. The secondary test is performed if the primary test is negative. The nasolacrimal sac is irrigated to flush out residual dye. If fluorescein stained fluid is recovered after irrigation, then the test is positive and indicates an incomplete block of the nasolacrimal duct. A defect in the canaliculus or lacrimal pump exist it clear fluid is recovered. Recovery of no fluid from the nose indicates a complete block. The Jones test has been the mainstay of evaluation of the rimal obstruction. However, it is positive in only 80 percent of normal in dividuals. The test requires some expertise in the placement of the cotton pledget, which may be critical and can also be painful.

A noninvasive method utilizing fluorescein is the Jacobs dye test been shown to be variable and inconsistent. Campbell and co-workers collected oral and nasal secretions tissues after after instillation of 2% fluorescein to assess patency of the lacrimal drainage system . Four drops of fluorescein are placed into the eye. The patient then blinks forcibly 4 times and gentle massage of the ipsilateral lacrimal sac is done briefly. After 6 min, oral and nasal secretions are collected by blowing the nose and clearing the throat on tissues. Negative tests were most often found in patients with limited nasal and oral secretions. Use of an ultraviolet lamp on the recovered secretions of those patients yielded positive results. Only one eye at a visit be examined by this method in Laser Eye Center.

Flach introduced a simple noninvasive test using 2% fluorescein, a tongue blade, and an ultraviolet lamp . He placed fluorescein in the if eye and attempted to observe its deposition into the oropharynx. Under direct visualization. In 66 normal patients, 90 percent gave positive results in 30 min and 100 percent gave positive results in 60 min. Complete obstruction in other patients was confirmed by dacryocystograms or other means. Prolonged appearance times were correlated with decreased Schirmer test values. Both eyes may be examined at one visit by this technique.

According to Dr. Boothe Fluorescein and other stains can be useful adjuncts in performing anterior segment surgery and evaluating complications of the surgery. Entering the anterior chamber in patients with an opaque cornea can be facilited by using fluorescein. As soon as the blade enters the anterior chamber a color change from yellow-orange to green occurs.

Endothelial damage due to excess corneal bending or instrumentation can also be examined by several stains. Fluorescein, instilled into the anterior chamber, can detect loss of endothelium. Rose bengal and trypan blue 0.1% are more sensitive and stain damaged and devitalized and thelial cells. Excess bending results in staining curves located urn bends, indicating damage to the endothelium. Residual staining is not present after 24 hr. Clinical toxicity to anterior segment structured does not occur.

Assessment of anterior chamber depth can be done by injecting fluores cein into the anterior chamber. Deep chambers have intense central color while shallow chambers have a pale homogeneous color.

Apposing corneal wound edges is facilitated by staining with fluorencen or trypan blue 0.1%. Shelving can be easily detected using these stains. With trypan blue 0.1%, a double line will be seen when corneal wound edges are poorly apposed, making it superior to fluorescein for this put pose. Wound leaks after routine anterior segment operations are avoided if

that seide’s test is used immediately following wound closure. In cases in which the anterior chamber is very narrow or flat secondary to a wound leak, Seidel’s test may be negative explains Dr. Boothe in his Laser Eye Center. By filling the anterior chamber with 1% flourencein solution, a wound leak is detected by direct observation of fluorescein from the wound. Detection of leaks from conjunetival blebs may be easier by this method than by using Seidel’s test.

Several vital stains may be used to evaluate endothelial cell viability in donor corneas before keratoplasty. Unlike tissue culture and specular microscopy for assessing the endothelium, vital stains are inexpensive and require little expertise.

Fluorecein nontoxic and is helpful in demonstrating gross loss of endothelial cells. However, other stains are superior. Trypan blue has been several years to evaluate corneal endothelium in vitro. It stains degenerated and devitalized endothelial cells. Though trypan blue has been show to be teratogenic and carcinogenic in rats, ho complications have been seen in its use for staining corneal endo¬thelium. Several investigators have used it in double staining of endothal cells with alizarin red S.

Alizarin red S, a more toxic stain, stains intercellular substance and out¬lines the endothelial cell borders demonstrating the mosaic pattern. This double staining is particularly helpful in comparing the ratio of degenerated and devitalized cells to healthy cells. When this purpose is desired, use of trypan blue should precede alizarin red, otherwise trypan blue penetrates normal cells and stains their nuclei. The technique involves Using trypan blue 0.3% made in normal saline for 1 min. This is followed by 0 21 alizarin red buffered to a pH of 4.2. It should be in contact with the endothelium for only 1/2 to 1 min. Exposures to alizarin red longer than 1 min may result in loss of sheets of endothelial cells from the cornea. Alizarin red is recommended for experimental use only.

Rose bengal and alizarin red can be used as double stains also, since rose bengal stains in a similar fashion to trypan blue. Though the contrast is not as great, rose bengal is more readily available and easier to use .

In performing conjunctival grafts, it may become difficult to differentiate the epithelial aspect from the nonepithelial aspect. Fluorescein can be used to stain the raw, cut surface and distinguish it from the epithelial surface.

Viability of skin grafts can be assessed by using intravenous fluorescein. A viable graft will demonstrate perfusion and become bright yellow UN ultraviolet light, as will the surrounding skin. Nonperfused areas are dark blue.

Demonstration of two postoperative complications is aided by using in travenous fluorescein and watching its accumulation in the anterior chamber. One complication is detachment of Descemet’s membrane. Dlagnasis can be difficult because of the thinness and transparency of the main brane, and because secondary corneal edema may be present. Fluores-cein enters the anterior chamber through the pupil and collects behind the detachment, thus delineating it. This test is facilitated by tilting the patient head down 70 degrees from the upright position, Another complita-tion is pupillary block. Normally after intravenous injection, fluorescein can be seen diffusing into the anterior chamber through the pupil. This will not occur if a complete pupillary block is present. When the differ-ential between pupillary block and malignant glaucoma is needed, this test may be helpful. All this can be discussed and corrected at Boothe Laser Center