In a good month, you'll see lots of very attractive ads for wonderful diagnostic instruments in our pub­lication. The more, the merrier. The most crucial piece of di­ag­nostic equipment in your exam room, however, continues to be the one sitting in the chair, as evidenced this month by reports from several di­verse quarters.

From The Lancet ar­rives a report of a patient with no family history of ocular disease who developed glaucoma and cataracts after four years of taking oral prednisolone that she bought from an online pharmacy. The authors' recommendation: Physicians should start asking patients whether they are taking any medication purchased online.

Another small study finds that in­testinal surgery can impact ability to absorb vitamin A and affect vision as much as two decades later, far longer than earlier reports suggested. (See our news item on p. 10.)

Finally, an issue that has been re­ceiving much attention in the ophthal­mic press over the past year is the con­nection between Flo­max and in­traoperative floppy iris, which can complicate cataract surgery. The at­tention spread to the general media last month with a press conference an­nouncing the results of a study that re­commends a preop treatment regimen for patients with a history of alpha blocker usage. (See p. 6.)

The only proviso is that the surgeon has to know before arriving in the OR that the patient has this history. As Dr. David Chang, who helped identify the syndrome initially, pointed out at the press conference, "What patient having eye surgery would ordinarily think to tell their eye doctor about the drug they're taking for their prostate? Well it turns out the in­formation, according our study, is critical ..."

The issue is important, however, not just for men but women as well, who may take the drugs for urinary tract symptoms. And the ef­fects can manifest in patients for years even after they may stop taking the medication.

So, in the spirit of late summer and vacation season, no heavy lifting this month, no big issues, just an old lesson. You don't ask, you don't know. And the things you need to ask just seem to multiply all the time.