A Question of Health: seeing is believing

I'm short-sighted. Where can I find objective, impartial advice on laser eye surgery? My optician is very negative about the procedure, but that could be because he wants to keep me as a customer. Conversely, I suspect that businesses which offer the service would give me the hard sell. Who can give me honest advice on the pros and cons, and tell me whether I'd be suitable for treatment?

Last month the BBC did an undercover investigation into laser eye surgery and their findings confirm your fears. They found that different optometrists gave differing advice. They also found evidence of the "hard sell" from companies that offered laser surgery. But even among highly-qualified ophthalmic surgeons, there is disagreement about who should have laser eye surgery. Laser treatment for short-sighted eyes has now been used on thousands of patients, and the vast majority are satisfied with the result. No one will guarantee a successful result, and it is possible that you will still have to wear spectacles even after surgery. This is particularly true if you suffer from presbyopia in addition to short-sightedness. Presbyopia is the condition that makes it difficult for people in their forties and fifties to read small print. It is caused by a stiffening of the lens, and laser surgery cannot correct it.

About 20 per cent of people do not achieve perfect vision after laser surgery. Some people (up to 10 per cent) may end up with worse vision. The most important factor that determines the success of the surgery is the experience of the surgeon who performs the operation. A patient's guide to laser eye surgery, published by the Royal College of Ophthalmologists, includes a list of questions you should ask before signing on the dotted line. The leaflet is on their website: www.rcophth.ac.uk.

IS THIS DRUG SAFE?

I am a slightly overweight, 47-year-old female. For the past few years I have had increasingly heavy periods. Last year I had a polypectomy and D & C performed, which was expected to clear up the problem. There was some lessening, but the periods remain extremely heavy, resulting in anaemia if I don't take iron regularly. The gynaecologist has prescribed tranexamic acid to alleviate the heavy bleeding, which I usually take for two to three days every period. But my periods come about every 25 days, so I am effectively taking tranexamic acid for five to six days a month. While I don't experience any unusual side-effects, except headaches, which might be attributable to menstruation anyway, I don't like taking the tranexamic acid. I have read in the product information that there is a slight possibility of the increased risk of blood clotting and possible effects on vision. My GP is very reassuring about it, but I am still not happy taking it so regularly. Can you offer me any advice?

Tranexamic acid is probably the most effective medication for heavy periods. It has been used for many years in other European countries, but for some odd reason there has been a reluctance to use it among British doctors. Nevertheless, all the evidence shows that it works better than other medications. I agree with your GP about the risks of serious side-effects. There is a theoretical risk of blood clots, but a long-term study of Swedish women who were taking tranexamic acid showed they were no more likely to get blood clots than women who were not taking it. There have been a few rare reports of disturbances of colour vision. This is not a serious risk, but you should stop the drug if you think your vision is being disturbed.

Another good way of treating heavy periods is with an intrauterine device called Mirena. Mirena is like a contraceptive coil (IUCD), but it slowly releases a tiny dose of progesterone into the uterus. Unlike other coils, which tend to increase menstrual blood loss, Mirena often substantially reduces blood loss after a few months. It has the added advantage of being an effective contraceptive. You could also think about a technique called endometrial ablation. This is a surgical technique that is designed to destroy the lining of the womb. It is much less aggressive than a hysterectomy, but can be just as effective in controlling bleeding.

HAVE YOUR SAY

Many letters have arrived with suggestions for treating and preventing age-related macular degeneration.

DBW writes: A few years ago the Journal of the Harvard Medical School carried an article saying that people who ate spinach or some sort of kale five times a week did not get macular degeneration. My brother, who had just developed it, tried this and within nine months he was cured, and his ophthalmologist could find no trace of the condition. Following his advice, I eat 4oz (125 gm) of spinach every day. The simple thing is to get deep frozen spinach, as sold in most supermarkets, and microwave it. I find ophthalmologists disagree as to whether any benefit is to be expected.

SL has another suggestion:

Bilberry extract has been shown to help. Apparently it increases blood flow to the retina, and regenerates eye pigment. Another thing that might help is to eat more yellow and orange fruit and vegetables, and dark green vegetables. These contain carotenoids. People with macular degeneration have been found to have 70 per cent less carotenoids in their eyes than people with perfect vision. The Macular Disease Society can be contacted at Darwin House 13a Bridge Street Andover, Hampshire, SP10 1BE, or on the web at www.maculardisease.org.

Please send questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or by e-mail to health@independent.co.uk Dr Kavalier regrets that he is unable to respond personally to questions