Map-Dot-Fingerprint

The condition is referred to as Cogan's dystrophy.

The symptoms among patients may vary widely in severity and include:

Light sensitivity

Glare

Fluctuating vision

Blurred vision

Irregular astigmatism (uneven corneal surface)

Mild to extreme irritation and discomfort that is worse in the morning

Corneal tear or rip with sharp rip stinging pain often lasting several days.

Among the various forms of care for this dystrophy, the following are the more common:

Medical Care: Numerous treatment options are available, and like the disease itself, results are variable and differ from patient to patient.

• Hypertonic drops or ointment often are the first line of treatment. They may help both irregular astigmatism and recurrent corneal erosion problems. Sodium chloride (5%) drops at breakfast, lunch, and dinner; and ointment at bedtime is recommended.

• Nonhypertonic lubricating drops or ointment: The only prospective study to date detected no difference in results of bland versus hypertonic lubricating treatment.

• Consider patching for acute episodes of associated corneal erosions.

• Bandage extended wear soft contact lens occasionally may be useful but risk of infectious keratitis makes this a secondary choice.

• Hard or gas-permeable contact lens may improve vision by masking corneal irregular astigmatism but often is poorly tolerated because of increased corneal fragility/erosion problems.

Surgical Care:

• Debridement/superficial keratectomy is preferred, for both significant visual loss from associated irregular astigmatism and recurrent corneal erosions, if treatment with hypertonic drops and ointment fails. Combined debridement and superficial keratectomy can be completed easily in the office setting, at the slit lamp, using topical proparacaine or a similar anesthetic drop. Place a lid speculum, then debride (with a rather blunt Kimura spatula) the entire extent of any loosely adherent epithelium or basement membrane level opacities. With sweeping and pushing motions using the trailing or leading edges of the instrument, keeping nearly parallel to the corneal plane, redundant basement membrane level material can be massaged away, while maintaining the integrity of the Bowman layer.

• Diamond burr superficial keratectomy is very useful for recurrent erosions associated with map-dot-fingerprint dystrophy that does not respond to keratectomy with a Kimura spatula. Following epithelial debridement, a 4- or 5-mm diameter diamond-dusted burr very gently is used to polish the basement membrane throughout the area of epithelial debridement.

• Excimer laser phototherapeutic keratectomy is an excellent treatment for recurrent corneal erosions associated with map-dot-fingerprint dystrophy, with results similar to above superficial keratectomy procedures (but much more expensive in most settings).

• Corneal anterior stromal needle puncture is useful for recurrent corneal erosions from trauma that recur in the same location. This procedure is not as successful for recurrent erosions associated with map-dot-fingerprint dystrophy, which is usually more diffuse and often migratory.

Perhaps the most frustrating aspect of Cogan's dystrophy, (also known as map-dot-fingerprint dystrophy) is the Following SPECIAL CONCERN.

Special Concerns:

• While patients with map-dot-fingerprint dystrophy may be bothered by painful recurrent erosion episodes and/or decreased vision, they typically are most frustrated by the unpredictability of the condition. They may have an episode of pain and poor vision the day of their wedding or of an important presentation after being asymptomatic for weeks or months. Physicians need to understand this important concern, as do others. Patients under such circumstances should not be pressured to perform or do activities while they are suffering from the pain of their erosion episode.

Night Riders

Night riders come rushing down the street. Zooming down the block swerving on two wheels around the corner.

Night riders come to take possession in the darkness that which they are denied in the light. Under cover of darkness they weave their way in and out of tight city streets and dark forsaken alleys. What are they looking for? Are they looking to simply release steam, burn off excess energy, or run away from the self that they dare not confront.

There are so many night riders in the big city. People for whom the daylight is a curse and night is their only cover. They emerge into the solitude and embrace the darkness because it is the only window that exists for them.

Lonely souls who find comfort in the persecution of others. Wretched folk who mug the innocent, rob the vulnerable, and hold hostage the weak.

The story we have recently read of the young woman who was abducted at night only to be found again five o'clock in the morning bound and gagged and tossed back to the same parking lot from which she was abducted, is one illustration of the dark decrepit souls of the night riders. He has implanted horror and terror in her life for the rest of her days. We all will not rest until he is caught, tried and convicted.

Night riders. At times, the scum of the earth.

No Thanks.

Miss Manners hasn't written a column yet for how to say no gracefully.

We have friends who seek to invite us out to a restaurant. Nothing wrong. Nice graceful people. But we just don't want to go. I don't see their question as an affront. And I have to find the right way to be able to say no.

It seems to be such a simple matter. Nice people, nice friends, want to invite us out. So why be sour? Why be some sullen old geezers that say no?

But what if you really are not interested -- I mean REALLY not interested? I have no interest in spending two or three hours holed up in a little restaurant with these people. I have no interest in eating restaurant food, nor an appetite for it. And I have no interest in masquerading with innocuous and meaningless conversation.

So they send us an e-mail and invite us. I should respond and decline gracefully. But instead, I fudge. I simply don't respond. I simply ignore the e-mail. As if, hoping they will go away? Well yes, they will go away. But perhaps they will go away more confused, less friendly, and thinking that either we were standoffish, or simply unfriendly.

And yet sometimes, because of the nature of who they are, I would rather handle it this way, than being upfront and refuse them.

Relationships get complex and messy sometimes.

On the Other Hand

Come Let Us Reason Together

There are issues whose adherents are very adamant that they have found the truth on their side. Those adherents who are so certain of the absolute truth of their point of view, have little or no tolerance to hear the other side.

You know the type. They're stuffy and so filled with their own selves. Hey, that wasn't a very intelligent sentence but who cares. So there we are in Gotham trying to arrange a paragraph for fast dictation. When some people are so hell-bent on their own views, that they are going to do everything it takes to make sure their view prevails, there is little room for dialogue.

Perhaps this was indicated in the community election that recently took place. There were sides, but the two sides did not have a chance to articulate the differences clearly enough. Because one side was sure that it had the truth on its side, it therefore did all that it can to push through its agenda. It took a communal vote, but when the people to fail to come out because they were not committed to its cause, they extended the vote for five days. Now what kind of an action is that? When you have ballots in a box overnight and there is no one guarding them, who is to stop someone with nefarious schemes from stuffing the ballot box?

And to go through the neighborhood with sound cars blaring and blasting, telling people come out and vote come out and vote -- where was the other side? This side even offered to come to your house and offer you a private ballot if you are "too scared, frightened, or intimidated to come to the polling place."

Methinks that they protest too loudly. Where were the reasonable discussions? Where were the broad committees that should have chosen the candidates, and they should not have been chosen, hand-picked actually, by one or two individuals.

In truth, those elected will be mostly irrelevant to the vast majority of the community. Indeed that entire group is mostly irrelevant.

The saddest part of this entire election is that in the end it really didn't count or matter very much at all.