A wrinkle on the retina -- which is also known as an epiretinal membrane (ERM) or a macular pucker -- is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina's surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma, or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Do you have floaters in your vision?

Floaters are caused by thick areas in the gel-like fluid that fills the back cavity of your eye, called the vitreous.

Many people, especially highly near-sighted people, often see some degree of floaters for a good portion of their lives. Often, these floaters are in the periphery of your vision and may only be visible in certain lighting conditions. The most frequent conditions are when you are in bright sunlight and are looking toward the clear blue sky. This I know from personal experience as I have a floater in my left eye that I most often see when swimming outdoors. Every time I turn my head to the left to breathe I see this floater moving in my peripheral vision.

This is totally harmless other than when I’m swimming in the ocean and swear that sudden object in my peripheral vision is a shark bearing down on me. Some people who have floaters are not as lucky and the floater can be very central and almost constantly annoying, especially when trying to read.

The second scenario in which floaters occur is during the normal aging process.  The vitreous gel in the back of the eye starts to shrink as we age and at some point it collapses in on itself and pulls away from the retina. This sometimes results in a sudden set of new floaters.

When that happens you need to be checked for signs of a retinal tear or detachment.  As long as your retina survives that episode without any problems, the floaters themselves may stick around for a while and can be rather annoying.  

Most people eventually adapt to the floaters; the brain learns to filter them out so you are no longer aware of them. The vitreous can also collapse more as time goes on and the dense floater you are seeing initially may move further forward and drop lower in the eye so the shadow it is casting is less intense and more in the periphery of your vision where it is much easier to ignore.

The first line of treatment for floaters has been, and still is, to live with them. Once you have your retina checked and there is nothing wrong there, the floaters themselves are harmless and will not lead to any further deterioration of your vision, which is why, if at all possible, you should just live with them. This is especially true if the floaters are new because the overwhelming majority of people with new floaters will eventually get to the point where they are no longer seeing them or at least where they are not interfering with normal daily activities.

If you have tried to wait them out and live with them but they are still interfering with your normal daily activities, you may want to consider having them treated with a laser.

This treatment is relatively new and involves using a special laser to try to break down large floaters into much smaller pieces that may no longer be visible. In a recent study of the laser treatment involving 52 patients, 36 were treated with the laser (a single laser treatment session) and 16 people had a sham treatment (meaning they went through everything the treated group did but did not actually have the real treatment done).  In the people who were actually treated, 54% reported a significant improvement in the floater symptoms while 0% in the sham group reported any improvement (no placebo effect). There were no significant side effects in either group.

Some points to note in the above study:

Fifty-four percent of people treated noted a significant improvement in their floater symptoms with a single treatment. That’s clearly not anywhere near a guaranteed improvement.

Other people have noted an improvement after more than one session, bringing the total expected improvement into the 70% range, with one or more treatments.

Another point to note is that there were no significant side effects to the treatment.

Although true in this small study, it does not mean that there are no risks to the laser treatment. Although rare, there have been reports of damage to the retina, optic nerve, or the lens of the eye. 

Another treatment that can be used to treat floaters is a surgical procedure called a vitrectomy. This involves surgically going inside the back of the eye and removing the vitreous. This surgical procedure carries a higher risk than the laser treatment and is not 100% effective.

In summary, this new laser treatment is a good addition to the tools to deal with significant floater problems. If you have floaters for at least six months and they are central and interfering with your normal daily activities such as reading or driving and you want to see if this laser treatment could be right for you, check with your eye doctor.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

 

Have you ever wondered what happens to the visual system as we age? What does the term "second sight" mean? What is presbyopia? What are the eyes more susceptible to as the aging process occurs? What can be done to prevent certain aging factors of the eye? The answer lies in a theory known as apoptosis (no that's not the name of the latest pop artist).

Apoptosis is the pre-programmed life of every cell in our body. Most studies show that it's a function of our programmed DNA. It's the ability for cells to survive and thrive in the anatomical environment. The body's ability to withstand and thrive during the aging process depends on proper nutrition, good mental health, exercise, and adequate oxygen supply. That's why studies have shown smoking can shorten your life by a decade or more.

In regards to aging and the eye, there is a phenomina during the 6th to 7th decade of life called "second sight". This is simply progressive nearsightedness in older adults secondary to cataracts. Close to 50% of the population over 60 years old has cataracts. Cataracts are a clouding of the natural lens of the eye that can impair vision causing glare and loss of detail. When patients experience second  sight, it is sometimes quite convenient for them: they see up close without the reading glasses they have been depended on since their 40s.

Another aspect of the aging process is losing your reading vision you had all your life. This is called Presbyopia. Presbyopia is a Latin term which means "old eyes."

What happens in Presbyopia?

Before our mid-forties, the natural lens of the eye is very pliable and can easily focus on items up close. But in our mid-forties, the lens tends to lose its elasticity. Whenexperiencing presbyopia, people generally hold reading material farther away to see it more clearly. Presbyopia can be managed through bifocal or multifocal glasses or contact lenses, and some surgeries.

As aging occurs, the eyes are more susceptible to cataracts, glaucoma, macular degeneration and vascular disorders of the eye as well as dry eye syndrome.

To help prevent and manage these conditions, there are a variety of options.

  1. Maintaining yearly dilated eye exams for preventative care.
  2. Protect your eyes against the sun with UV sunglasses.
  3. Take antioxidant vitamins to help bolster the protection of the macula.
  4. Use artificial tears to hydrate the eye and keep your body hydrated by drinking plenty of water.
  5. Keep emotional, physical, and mental stress to a minimum.

Being educated on how we age is the first steph towards good ocular health and diminished chances of early apoptosis.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

The Centers for Disease Control estimates that more than 2.8 million people in the United States suffer a concussion -- or traumatic brain injury (TBI) -- every year, and vision can be affected.

The rate of childhood TBI visits to the emergency department more than doubled between 2001 and 2009, making children more likely than any other group to go to the ER with concussion symptoms.

It was once assumed that the hallmark of a concussion was a loss of consciousness. More recent evidence, however, does not support that. In fact, the majority of people diagnosed with a concussion do not experience any loss of consciousness. The most common immediate symptoms are amnesia and confusion.

There also are multiple visual symptoms that can occur with a concussion, either initially or during the recovery phase.

Visual symptoms after a concussion include:

  • Blurred vision.

  • Difficulty reading.

  • Double vision.

  • Light sensitivity.

  • Headaches accompanying visual tasks.

  • Loss of peripheral vision.

Most people with visual complaints after a concussion have 20/20 distance visual acuity so more specific testing of near acuity, convergence amplitudes, ocular motility, and peripheral vision must be done.

In a study done at the Minds Matter Concussion Program at the Children's Hospital of Philadelphia, patients with a concussion diagnosis underwent extensive vision testing, which assessed symptoms, visual acuity, eye alignment, near point of convergence, vergence amplitude and facility, accommodative amplitude and facility, and saccadic eye movement speed and accuracy.

A total of 72 children (mean age 14.6 years) were examined, and 49 (68%) of those were found to have one or more vision symptoms after concussion. The most common problems were convergence insufficiency (47.2%); accommodative insufficiency (33.3%); saccadic dysfunction (30.5%); and accommodative infacility (11.1%). The investigators also found that 64% of the children with convergence insufficiency also had an accommodative disorder.

Difficulties with accommodation and convergence make it very hard to read for any length of time, with blurring and fatigue and then loss of concentration occurring after a fairly short period of reading time.

For the majority of people suffering a mild to moderate TBI, most of these symptoms resolve in one to three weeks but in some they can persist much longer.

If your visual symptoms after a concussion persist past three weeks, a visit with an eye care specialist is recommended. There may be several options to help improve the symptoms with either prescription eyeglasses or prisms to assist the two eyes to focus together.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Did you know that having one's eyes tested can reveal symptoms of ADHD (Attention Deficit Hyperactivity Disorder)? ADHD is a set of symptoms that include trouble with focus, overactivity, and behavioral control. It is estimated that one in five people has some sort of ADHD.

ADHD is a condition that has multiple symptoms and it can affect any age, though commonly it affects children. There is difficulty with visual processing, which includes doubling letters, reversing letters, and jumping words and lines of print.

Eye examinations are a crucial part of the diagnosis of ADHD. Proper visual function can be assessed through a thorough eye exam. During the exam, visual complaints, focusing, and processing can be assessed to rule out ADHD.

When glasses are prescribed for an patient with ADHD, prescribing the correct type of lens is vital. Many patients benefit from an anti-glare/anti-reflective or AR treatment on their lenses. This cuts unnecessary light from entering the eye, making visual processing easier.

In some cases, it is discovered that the person has a non-ocular visual processing problem. This simply means that their eyes have little or nothing to do with the symptoms of ADHD. This gives valuable information to the health care provider that is managing the patient and suggests more non-ocular testing for a compete diagnosis.

ADHD is very common, and the great news is there are many treatment options. Many resources for help are available on the Internet and through health care channels.

Having an eye exam should be one of the first items on the checklist if you are suspicious about ADHD because valuable information on visual processing can be gained.

For more resources see these websites:

National Institute of Mental Health, www.nimh.nih.gov/

ADHD.com

American Optometric AssociationAOA.org

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

There are many options available to adults and children when it comes to wearing corrective lenses (glasses and contacts) when engaged in physical activities.

Here is a look at the different modalities and the pros and cons of each:

Prescription Sports Goggles (i.e. Rec Specs)

The main benefits of goggles when playing sports are stability of vision and eye protection. When playing fast-moving sports, like basketball, soccer, rugby, etc., elbows, wrists, and heads are flying around at high speed, increasing the risk of eye injury. The eyes and eye sockets can be protected when covered by shatter-proof lenses. Additionally, there is no worry of having a contact lens pop out of your eye, which can be a debilitating experience for some people. The main drawback to goggles is that they can be cumbersome, decrease peripheral vision, and fog up. Additionally, very high prescriptions might not be available due to frame limitations. On the whole, this is a very good option for many people. One additional advantage to sports goggles is that in many cases you can have the lens made out Transition glasses, so the lens darkens in sunlight and lightens as it gets darker.

Contact Lenses

Far and away the best option for actually seeing when playing sports is contact lenses, particularly soft contact lenses. The main benefits include full field of vision, no fogging of lenses, and obviously no unsightly, heavy glasses on your face. But where sports goggles shine, contact lenses fall short: higher risk of injury, possibly less stable vision (especially when wearing multifocal or astigmatic lenses), and the potential of a lens falling out during activities. With modern contact lenses, this rarely happens, however. Gas permeable (hard) lenses are not recommended for sports.

Wearing Nothing!

For those whose prescriptions are not so high as to prevent proper functioning without correction, wearing no correction whatsoever is a fine choice. I’m often asked by parents whether their child absolutely needs to wear correction when they are playing sports. The answer is, it depends on how high the prescription is and the activity in which the child is engaged. If someone can see well enough to perform tasks without being hindered, not wearing any correction is perfectly fine.

There are plenty of options available for athletes. Visit your eye doctor to see what the best option is for your particular needs.

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Is making an appointment for a comprehensive eye exam for your children on your back-to-school checklist? It needs to be.

No amount of new clothes, backpacks, or supplies will allow your child to reach their potential in school if they have an undetected vision problem. 

The difference between eye exams and vision screenings

An annual exam done by an eye doctor is more focused than a visual screening done at school. School screenings are simply "pass-fail tests" that are often limited to measuring a child’s sight clarity and visual acuity up to a distance of 20 feet. But this can provide a false sense of security.

There are important differences between a screening and a comprehensive eye exam.

Where a screening tests only for visual acuity, comprehensive exams will test for acuity, chronic diseases, color vision and eye tracking. This means a child may pass a vision screening at school because they are able to see the board, but they may not be able to see the words in the textbook in front of them.

Why back-to-school eye exams matter

Did you know that 1 out of 4 children has an undiagnosed vision problem because changes in their eyesight go unrecognized? 

Myopia, or nearsightedness, is a common condition in children and often develops around the ages of 6 or 7. And nearsightedness can change very quickly, especially between the ages of 11 and 13, which means that an eye prescription can change rapidly over a short period of time. That’s why annual checkups are important.

Comprehensive eye exams can detect other eye conditions. Some children may have good distance vision but may struggle when reading up close. This is known as hyperopia or farsightedness. Other eye issues such as strabismus (misaligned eyes), astigmatism, or amblyopia (lazy eye) are also detectable. 

Kids may not tell you they're having visions issues because they might not even realize it. They may simply think everyone sees the same way they do. Kids often give indirect clues, such as holding books or device screens close to their face, having problems recalling what they've read, or avoiding reading altogether. Other signs could include a short attention span, frequent headaches, seeing double, rubbing their eyes or tilting their head to the side.

What to expect at your child's eye exam

Before the exam, explain that eye exams aren’t scary, and can be fun. A kid-friendly eye exam is quick for your child. After we test how he or she sees colors and letters using charts with pictures, shapes, and patterns, we will give you our assessment of your child’s eyes. 

If your child needs to wear glasses, we can even recommend frames and lenses that would be best for their needs.

Set your child up for success

Staying consistent with eye exams is important because it can help your kids see their best in the classroom and when playing sports. Better vision can also mean better confidence because they are able to see well. 

Because learning is so visual, making an eye examination a priority every year is an important investment you can make in your child's education. You should also be aware that your health insurance might cover pediatric eye exams.

Set your child up for success and schedule an exam today!

A refraction is a test done by your eye doctor to determine if glasses will make you see better.

The charges for a refraction are covered by some insurances but not by all.

For example, Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn’t cover most “routine” procedures--only health-related procedures.

So if you have a medical eye problem like cataracts, dry eyes, or glaucoma then Medicare and most other health insurances will cover the medical portion of the eye exam but not the refraction.

Some people have both health insurance--which covers medical eye problems--and vision insurance--which covers “routine” eye care (no medical problems) such as refractions and eyeglasses.

If you come in for a routine exam with no medical eye problems or complaints and you have a vision plan, then the refraction is usually covered by your vision insurance.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Ready or not...here are 13 more jokes to make you groan!

1. Patient: "What’s that floater doing in my eye, doctor?"  Doctor: “The sidestroke.”

2. Doctor: “Have your eyes ever been checked before?”  Patient: “No, they’ve always been hazel.”

3. Why did the cyclops have to close his school?  He had only one pupil!

4. Why wouldn’t the optometrist learn any jokes?  He had heard that a joke can help break the eyes.

5. What is it called when you poke your eye with safety glasses?  Eye-rony!

6. Did you here about the new website for people with chronic eye pain?  It’s a site for sore eyes.

7. When are your eyes not eyes?  When an onion makes them water!

8. Why do beekeepers have such beautiful eyes?  Because beauty is in the eye of the bee holder!

9. Why were the teacher’s eyes crossed?  Because she couldn’t control her pupils.

10. What's your eye doctor's favorite treat?  Candy cornea!

11. What has four eyes and a mouth?  The Mississippi.

12. Did you know that your left eye isn't real?  It's just in your head.

13. What did the optometrist say when the patient complained he made too many jokes?  “Bad puns are how eye roll.”

 

It's the summer and one of the most common questions eye doctors are asked is, “Is it safe to swim in my contact lenses?”

The answer we give is “NO!"

Do millions of people swim with their contact lenses? The answer is “Yes, they do, but it is NOT a recommended activity.’’ There are several reasons why, ranging from comfort issues to others that are far more sinister and potentially blinding.

The first reason not to swim with contacts in is that the pH and buffering of your tears is not the same as plain water, and certainly not that of ocean or pool water.

Contact lenses, especially soft ones, are designed to do best in pH and buffers of solutions that mimic your natural tear film. This pH difference is often why after you swim in a chlorinated pool your eyes tend to redden, burn or blur.

When pool water or another water source mixes with your tears, the pH rapidly changes and there is a mini-chemical reaction occurring on the surface of your eye. Now if you add a contact lens to this mix, it prolongs the chemical mixing that occurs. The actual contact lens will often swell due to the pH and buffer changes that are occurring and this swelling results in blurred vision.

When a contact lens swells it often tightens its fit onto your eye, causing discomfort or even pain. This is usually temporary until the volume of tears surpasses the volume of foreign water and the tears take over and the contact lens returns to its normal thickness, but the discomfort and blurring can last several minutes.

The second reason for not wearing your contacts swimming is that you can lose your lenses under water.

Contact lenses adhere to your eyes via a principle called capillary attraction, which happens when two surfaces are held together by a thin layer of liquid.

When a contact lens is placed on your eye it is the tears that hold it there more than anything else. Now if you go into a large body of water--like a pool, ocean, etc.--there is more water outside of your eye than the little layer between the contact and your eye and your contact lens floats out.

This can result in either a dislocated contact lens under an eyelid or a lost contact lens. Since most people wear disposable lenses it may not be a big deal, but if they were the only pair of lenses you wore to the beach and your sunglasses are not prescription, you could have a difficult ride back home.

The final and most important reason not to wear contacts while swimming is infection.

There are many different types of waterborne bacteria, viruses, fungi, and microorganisms. Some may result in the typical types of conjunctivitis that are easily treated with antibiotics. But as with any infection, you will have to stop wearing your contact lenses while you are being treated.

The two most difficult types of infections to treat are fungal infections and microorganisms/protozoans, and treatment options are limited.

Fungal infections are notoriously difficult to treat and tend to require very long treatment times; these infections can lead to corneal scarring and sometimes permanently decreased vision.

The most dangerous type of infection is called Acanthamoeba. This is a protozoa commonly found in soil and fresh water. If you happen to contract Acanthamoeba the infection commonly results in a painful eye, can ultimately cause blindness, and the only course of treatment if that happens is to consider a corneal transplant.

The incidents of this infection are quite low – but you don’t want to be the person who contracts it because you swam in your contacts.

To avoid infection risks, organizations like the American Optometric Association (AOA), American Academy of Ophthalmology (AAO), and even the US Food and Drug Administration (FDA) recommend against swimming in any type of pool, lake, ocean or other body of water while wearing contacts.

So with all those authorities advising against swimming with contact lenses, what are you options?

First, if your vision is not too bad, you should swim without your contact lenses and wear prescription sunglasses while on the beach. Second, if your prescription is significant, they do make prescription swim goggles that can be worn while swimming. Then once you have stopped swimming, switch over to prescription sunglasses for relaxing afterwards or consider putting your contact lenses in after you have done your laps.

One bright spot on the horizon for those who absolutely MUST swim in their contact lenses is that with the ever-growing use of daily disposable contact lenses, swimming in contacts is safer than for those who wear extended wear two-week or monthly lenses.

While there is still risk for potentially sight-threatening infections, those who dispose of their contacts after swimming see this risk decrease dramatically.

Please use extreme caution if you need to swim in contact lenses. For avid swimmers who have high prescriptions and cannot use prescription goggles, daily disposables are a must. However, most people do just fine with not wearing contacts at all while in the water.

 

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Lyme disease is an infection that is caused by a spirochete (a type of microorganism) called Borrelia burgdorferi. It is transmitted to humans by the bite of a deer tick.

The disease has a strong geographical incidence, being highly concentrated in the Northeast United States and now also has a high incidence in Minnesota and Wisconsin.

Lyme disease was first discovered in Old Lyme, Connecticut in 1975. It can start with a characteristic “bull’s eye” rash, in which there is a central spot that is surrounded by clear skin that is then ringed by an expanding rash. It can also appear just as an expanding rash.

This rash usually starts within days of the tick bite. Eye problems can occur along with this rash in the first phase of the disease. This includes red eyes that can look like full-blown pink eye, along with eyelid swelling. It also can produce iritis or uveitis, which include sensitivity to light and inflammation inside the eye.

The second phase of the disease usually starts within a few weeks of the tick bite and this occurs because the spirochete gets into the blood stream. This stage often has rashes starting away from the original bite site. It can also produce joint pain, weakness, and inflammation in several organs including the heart, spleen, liver and kidneys.  

There are also several ways it can affect your eyes. It can cause inflammation in your cornea (keratitis), retina (retinitis), optic nerve (optic neuritis), uveitis, inflammation in the jelly-like substance that fills the back of the eye called vitreous (vitritis) and the muscles that move your eye around (orbital myositis). It can also affect the eye if it causes problems with the nerve that controls your eyelid muscles so that your eye will not close properly (Bell’s palsy).

There is a third phase of the disease that is caused by long-term persistent infection.  This phase can create multiple neurologic problems and can appear very similar to the presentation of Multiple Sclerosis (MS). The eyes can show any of the same signs as phase two, but the most common presentation is persistent keratitis. Keratitis symptoms are an inflamed cornea, often accompanied by significant pain, light sensitivity, a gritty feeling, and sight impairment.

The diagnosis is made through observation of the presenting symptoms, being in an area where there are significant numbers of the disease-carrying ticks, and a blood test that can confirm the diagnosis.  

The symptoms and signs of Lyme disease can mimic many other problems, so it is important to keep Lyme disease in mind if you are having multiple problems involving different organs and you know or have any suspicion that you may have had a tick bite while you were in areas where the disease is prevalent.

Article contributed by Dr. Brian Wnorowski, M.D.

No this is not a late-night personal injury lawyer infomercial.

This is a recommendation that you have your LASIK records available, for your own good, later in life.

There are 2 million cataract surgeries done yearly in the U.S. and the odds are, if you live long enough, you will eventually need cataract surgery, too.

What does this have to do with LASIK surgery? 

When doctors perform cataract surgery they remove the cataract, which is the lens of your eye that has become cloudy.  And they replace that lens with an artificial lens called an Intraocular Lens implant (IOL).

The IOL needs to have a strength to it to match your eye so that things are in focus without the need for strong prescription eyeglasses.

Currently, we determine what the strength the IOL needs to be by using formulas that mostly depend on the measurements of the curvature of the cornea and the length of the eye.

Those formulas work best when the cornea is its natural shape -- i.e., not previously altered in shape from LASIK.

If you plug the “new” post-LASIK corneal shape into the formulas, the IOL strength that comes out is often significantly off the strength you really need to see well.

This is where having your records becomes important.

Knowing what your eyeglass prescription and corneal shape was BEFORE you had LASIK greatly improves our formula’s ability to predict the correct implant strength.

In most states there is a limit to how long a doctor needs to keep your records after your last visit, so everyone who has had LASIK surgery should get a copy of your pre- and post-LASIK records NOW before they no longer exist.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Have you ever felt a twitching sensation in your eye? Were you sure everyone was looking at you because of it? Worried that it was the beginning of a big problem?

Relax, it’s not likely to be a big deal. Most of the time it is not even visible to other people.

First, it’s almost never your actual eyeball that is twitching; it’s your eyelid muscle. Actual eye twitching is fairly rare and your vision would be pretty blurry if that's what was really happening.

The eyelid has a muscle in it that closes the eyelid and that muscle has a very high concentration of nerve innervation. Because of that dense nerve tissue in the eyelid, anything that makes your nervous system a little hyped up or off kilter can result in the eyelid twitching.

What are some of the risk factors for eyelid twitching?

Fatigue

Not getting enough sleep can result in your nervous system not performing at its best and one of the results of that may include twitching of your eyelid. If you are getting frequent eyelid twitching, try to make sure you are getting the proper amount of sleep.

Caffeine

Too much caffeine can certainly overexcite your nervous system and result in frequent eyelid twitching. If eyelid twitching is becoming something you experience frequently, it might be time to cut down your caffeine intake. While coffee tends to be the biggest offender, caffeine does come in other flavors. Tea, cola soda, and chocolate are the easy ones that come immediately to mind. Other items that you don’t think of as much: ice cream (especially chocolate or coffee flavors), de-caffeinated coffee (still has some caffeine), power or energy bars, non-cola soft drinks (Mountain Dew, Dr. Pepper, some root beers) and some OTC pain relievers (Excedrin Migraine, Midol Complete, and Anacin).

Stress

This is a hard one to quantify but if I ask most people who come to me with a complaint of eyelid twitching if they are under more stress than usual the answer is almost always, YES. This is not an easy thing to mitigate. You may need to seek some help from your internist or psychiatrist or you could try some home remedies like long baths or whatever helps you relax.

Dry Eyes

One of the first things I tell people suffering from eyelid twitching is to use a lubrication drop in their eye. Anything that irritates your eye may result in eyelid twitching and an OTC lubricating drop in the eye might decrease the eyelid twitching. It is certainly worth a try.

What if the twitching won’t go away? Could it be anything more serious?

There is a condition called essential blepharospasm that could cause frequent twitching of the eyelid. In this condition you don’t just feel the lid twitching, but the entire eye starts closing involuntarily like you are trying to wink at someone. This can start to interfere with your normal daily life and can make things like driving and reading difficult to do. If the lid closing gets that significant, the main treatment for it is Botox injection to weaken the muscle that closes the eyelids. This stops the lid twitching very effectively, but it often needs to be repeated every 3 or 4 months.

Most of the time, eyelid twitching just goes away on its own as mysteriously as it came. If you experience twitching that doesn’t go away, try making some of the modifications I mention above and if that doesn’t work you should schedule an exam.

Article contributed by Dr. Brian Wnorowski, M.D.

Need a  chuckle or a groan?  Here you go...

1. Did you hear about the guy who just found out he was color blind?  It hit him right out of the purple!

2. What happened to the lab tech when he fell into the grinder?  He made a spectacle of himself.

3. Why is our staff so amazing?  They were all bright pupils!

4. Why did the smartphone have to wear glasses?  It lost all of its contacts.

5. What did one pupil say to the other?  I’m dilated to meet you.

6. What do you call a potato wearing glasses?  A Spec-Tater!

7. What do you call an optician living on an Alaskan island?  An optical Aleutian.

8. What was the innocent lens’s excuse to the policeman?  "I’ve been framed, officer!"

9. Where is the eye located?  Between the H and the J.

10. Where does bad light end up?  In Prism!

 

The sun does some amazing things.  It plays a role in big helping our bodies to naturally produce Vitamin D. In fact, many people who work indoors are directed to take Vitamin D supplements because of lack of exposure to the sunshine. 

But being in the sun has risks, as well...

If sunglasses are not worn, there is a greater risk for cataracts or skin cancers of the eyelids. It is important to know that not all sunglasses are made alike. UVA,UVB, and UVC rays are the harmful rays that sunglasses need to protect us from.

However, many over the counter sunglasses do not have UV protection built into the lenses, which can actually cause more damage than not wearing sunglasses, especially in children. 80% of sun exposure in our lives comes in childhood. Without UV protection in sunglasses, when the pupil automatically dilates more behind a darker lens, more of the sun's harmful rays are let in.

The whole point is that consumers should be aware that it is vital to buy sunwear that has UV protection built into the lenses.

Polarization is another option to add to sunglasses to protect the eyes from glare from the road and water. Fisherman love polarized lenses because you can see the fish right through the water. People who boat also claim their vision is better because glare off the water is reduced.

There are so many reasons to wear good sunglasses!  Plus, they just look fabulous!

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Cataracts are part of the natural aging process. Everyone gets them to one degree or another if they live long enough. Cataracts, as they progress, create increasing difficulty with the normal activities of living. The symptoms vary from one person to another. Some people have more difficulty with their distance vision, some with reading. People may report difficulty with glare, or foggy, blurry, or hazy vision.

Doctors have noticed an increase in requests for second opinions because patients are sometimes told they have cataracts and they HAVE to have surgery--even though the patient has no visual complaints. Just having a cataract is not a reason to have cataract surgery.

According to the American Academy of Ophthalmology, "The decision to recommend cataract surgery should be based on consideration of the following factors: visual acuity, visual impairment, and potential for functional benefits." Therefore, the presence of a cataract is not enough to recommend surgery. There needs to be some degree of visual impairment that is altering the ability to perform your normal activities of daily living. There also needs to be some reasonable expectation that removing the cataract is going to improve vision.

A patients with advanced macular degeneration has significant visual impairment. If she has just a mild cataract, then removing that cataract is unlikely to alleviate the visual impairment. You therefore need to have both things - a visual impairment that interferes with your normal daily activities AND a reasonable expectation that removing a cataract is going to help improve vision to a significant degree.

There are some instances where a dense cataract might need to be removed even though the above criteria are not being met. One example is when a cataract gets so bad that it starts causing glaucoma. Another instance would be if the cataract interferes with treating a retinal problem because the retina cannot be well visualized if the cataract is severely hampering the view of the retina. Those conditions are VERY rare in the U.S.

Most people who need cataract surgery are aware they have a visual impairment and that impairment is altering their normal daily activities. There are times, however, when we recommend cataract surgery because there is a visual impairment but the patient is not aware of just how bad their vision is. For example, the legal driving requirement in New Jersey is 20/50 or better in at least one eye. So we do occasionally see a patient who think he sees fine but when tested his vision is worse than 20/50 and he is still driving. In that case we would recommend cataract surgery (assuming the cataract is the problem) even though the patient does not think he has an impairment.

If you have been told you need cataract surgery but feel you are not having any significant visual problem, you should consider getting a second opinion.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Hygiene is critical to wearing your contact lenses safely.

Contact lenses can significantly improve your vision, but it’s essential to care for them properly to avoid potentially serious infections or other problems.

These recommendations will help extend the life of your contact lenses and keep your eyes safe and healthy. 

Your lens insertion and removal routine

  • Before you handle contacts, wash and rinse your hands with a mild soap.
  • Make sure the soap doesn’t have perfumes, oils, or lotions. They can leave a film on your hands.
  • Dry your hands with a clean, lint-free towel before touching your contacts.
  • It’s a good idea to keep your fingernails short and smooth so you won't damage your lenses or scratch your eye when inserting or removing your contacts.
  • Lightly rubbing your contact in the palm of your hand with a few drops of solution helps remove surface build-up.
  • Rinse your lenses thoroughly with a recommended solution before soaking the contacts overnight in a multi-purpose solution that completely covers each lens.
  • Store lenses in the proper lens storage case.
  • Don't use tap water or saliva to wash or store contact lenses or lens cases.
  • If you use hair spray, use it before you put in your contacts.
  • Put on eye makeup after you put in your lenses. Take them out before you remove makeup.
  • Always follow the recommended contact lens replacement and wearing schedule prescribed.

Your supplies

  • Use doctor-recommended solution.
  • Rub and rinse your contact lens case with sterile contact lens solution. Never use water.
  • Clean the case after each use.
  • Replace your contact lens case at least once every three months. 
  • Don’t “top off” solution. Use only fresh contact lens disinfecting solution in your case. 
  • Never mix fresh solution with the old or used solution.
  • Change your contact lens solution according to the manufacturer's recommendations.

Your eye doctor

  • Visit us yearly or as often as recommended.
  • Ask us if you have questions about how to care for your contacts and case or if you are having any difficulties.
  • Remove your contact lenses immediately if your eyes become irritated. Call us and let us know what’s going on.
  • Call us if you have any sudden vision loss, blurred vision that doesn’t get better, light flashes, eye pain, infection, swelling, unusual redness, or irritation. 

Wear your contacts safely

  • Some contacts need special care and products. Always use the disinfecting solution, eye drops, and enzymatic cleaners your doctor recommends. Some eye products or eye drops aren’t safe for contact wearers.
  • Saline solution and rewetting drops do not disinfect lenses.
  • Use a rewetting solution or plain saline solution to keep your eyes moist.
  • Don’t wear your contacts when you go swimming in a pool or at the beach.
  • Don't sleep in your contact lenses unless prescribed by your eye doctor.
  • Don’t clean or store your contacts in water.
  • See us for your regularly scheduled contact lens and eye examination.
  • If you think you’ll have trouble remembering when to change your lenses, ask for a chart to track your schedule or make one for your needs.

Be sure to call us if you have any questions about caring for your contact lenses or if your eyes are having problems.

There is a common misconception that any adverse reaction to a drug is an allergy. That is definitely not the case.

Reporting to your doctors that you have an allergy to a medication when what you really had was a side effect could potentially create a substantial alteration to your medical care in the future. And this could mean a physician might avoid using a drug that could possibly save your life because of the fear of an allergic reaction.

An anaphylactic allergic reaction generally produces a very specific set of symptoms, including difficulty breathing due to constriction of windpipe, swelling of your tongue, and/or a rash and hives that break out over your body. While an allergic reaction can present in other ways, these are the most frequent reactions that occur when you have a true allergy to something.

If that is not the type of reaction you had then it probably isn’t an allergy. If you are uncertain if your reaction to a medication is an allergy or not, testing by an allergist may be able to tell you if your reaction was a true allergy or a side effect.

It is not always just the patient who misdiagnoses a side effect as an allergy. Sometimes it is the doctor or the dentist who tells the patient, “You must be allergic.” This is a quick and easy explanation but not always the correct one.

In optimal medicine, there are not always a lot of “lifesaving” incidences but there are several drugs that are the preferred treatment for certain conditions and if you report an allergy to these drugs it may make your doctor use a much less effective drug.

Here are some specific examples of when a false report of an allergy may lead to less effective treatment or even failure to offer life-saving treatment.

Epinephrine

The most common potential “lifesaving” drug to which patients sometimes report an allergy to is Epinephrine.

The story usually goes something like this: “I was having a dental procedure and soon after the dentist injected my mouth with a local anesthetic of lidocaine with epinephrine my heart started racing and pounding out of my chest and I almost passed out.” This hypothetical patient may come to the conclusion or the dentist may mention that the patient is allergic to epinephrine. That reaction is almost never an allergy but a side effect that occurs when a substantial dose of the lidocaine and the epinephrine gets into the blood stream and stimulates the heart.

The mouth and gums are very vascular, and it is easy to have some of that injection end up in the bloodstream, but that reaction is not an allergy and should not be reported as such.

Epinephrine is used to treat severe (anaphylactic) allergic reactions and not using it if you were to ever have a severe allergic reaction could lead to some very bad outcomes. This is not to say you can’t be allergic to epinephrine. You can, but it is extremely rare. If there is any doubt you should be tested by an allergist before you ever record yourself in a medical setting as being “allergic” to epinephrine.

Cortisone/Steroids

Cortisone is a highly effective drug to treat many conditions. Again, it is unlikely but not impossible to be allergic to it.

We all have naturally occurring cortisol circulating in our bodies and cortisone is a very similar molecule but not exactly the same. Cortisone also can have a wide range of side effects depending on where and how it is administered

Some of the common side effects of cortisone, which have been mislabeled as an allergy, are: Making your blood sugar rise, insomnia, mood swings, nausea, and weight gain. These are all known side effects of the drug and not allergies. Cortisone side effects are associated with only certain routes of administration and are often dose dependent.

Why is this important in terms of your eye care? We often use cortisone derivatives, like Prednisolone, to fight inflammation that may occur in your eye, particularly after any ocular surgery. If you report that you are allergic to cortisone when you really only experienced a side effect we are going to have to use a less-effective medication to deal with your eye inflammation.

As I mentioned above, most side effects are dose dependent and the dose you got in a pill may have caused a side effect you’d rather not have again but the dose in an eye drop is significantly less and highly unlikely to give you the side effect you got with a pill taken orally.

Antibiotics

People often report they are allergic to antibiotics when they really experienced a side effect.

The most common side effect with oral antibiotics is some type of gastrointestinal disturbance, like nausea, or diarrhea. If that was what you had and just prefer not to get that again you still shouldn’t report it as an allergy. If you do, then the drug can’t be used as an eye drop or ointment that might be the best treatment for your condition.

An antibiotic eye drop/ointment is very unlikely to produce the same gastrointestinal trouble that the same antibiotic gave you when given as a pill. You don’t want to take away the most effective treatment for your problem because you mislabeled a side effect as an allergy.

Sedatives/Anesthesia

Most of the time with these drugs the issue is how you felt either during or after a procedure.

Common comments are “it took me too long to wake up” (side effect not an allergy); “the sedative I got in my IV burned when it went in” (side effect not an allergy); “I was sleepy all day” (side effect not an allergy); “I was nauseous after the procedure” (could be an allergy but much more likely to be a side effect).

Why are these important? We can make you much more comfortable for a local anesthesia procedure if we can use some sedation. Using sedation may be better for you and the doctor performing the surgery because you are much less likely to move during the surgery if you are resting comfortably.

If you ever have an untoward reaction to a medication it is worth your time and effort to really probe into the issue to figure out if what you had was really an allergy or just a side effect because sometimes your life may depend on it.

Article contributed by Dr. Brian Wnorowski, M.D.

Will reading glasses make your eyes worse? The short answer is "No."

Although we don’t know the exact mechanism by which humans have a decreased ability to focus up close as we age (a process called presbyopia), the fact remains that it will happen to all of us.

The leading theory of how this occurs is that the lenses in our eyes get stiffer and thicker as we age--one of the muscles in the eye that contracts to change the shape of the lens does so less and less effectively because the lens itself gets less pliable.

The process of changing the focus of the lens from far away objects to up-close objects is called accommodation. If you have normal distance vision without glasses, then your eye's natural focus spot is far off in the distance. In order to focus on an object close to you, the lens in your eye has to alter its shape. The ability of your lens to do that is at its best when you are born and it slowly gets less and less pliable as the years go on. You have such a tremendous ability to accommodate when you are young that the slow loss of this ability is not perceptible, until you reach about the age of 45.

At around 45 the lens has lost so much accommodative ability that you start to have difficulty focusing on near objects. The impact usually starts when you notice that in order to look at anything small up close, you start holding it further away. Even though this decreasing ability to focus up close has been slowly getting worse since the day you were born, many people feel like the problem has occurred very suddenly. We have many people who come into the office at age 45 telling us “all of a sudden” they can’t read. What has probably been happening is they have just very slowly been adapting by holding things further away until one day “their arms are too short” and then they can’t read easily.

That is where reading glasses come in. Some people just buy over-the-counter readers, which can work fine for them, but if you haven’t had an exam in some time it is much wiser to get your eyes checked first to make sure the normal aging process is the only problem. Once it is confirmed through a medical eye exam that there are no other issues, reading glasses are usually prescribed. Contact lenses are also an option at this point.

At the beginning, a low-powered reading glass is used. As time goes on, the lens in your eye continues to stiffen and your ability to focus up close continues to get worse. The result of that is that your reading glass prescription needs to get stronger, usually at a clip of about one step every 2 to 3 years.

IT IS NOT USING THE READING GLASSES THAT IS MAKING YOU WORSE. TIME IS THE CULPRIT.

The decrease in reading ability without using glasses is going to continue to get worse as you get older whether you wear the reading glasses or not. Trying not to wear the glasses and struggle along without them is not going to stop the march of time. You really can’t preserve your reading ability by not wearing them--you are just struggling needlessly.

Article contributed by Dr. Brian Wnorowski, M.D.

Motherhood...the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has recently proven that there is a transference of emotion and programming from birth and infancy between a mother and her child--a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind? These questions and more can be answered through a term called “triadic exchanges” in which infants learn social skills.

The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now their world is no longer just one person, their mother, but a third party which teaches them the art and skill of organizing their social skills and interaction.

Interestingly, if a mother is blind, it does not adversely affect the child’s development. A study published in the Proceedings of the Royal Society B showed no deficit in their advancement. The sheer fact that the infant looks into the mother’s eyes helps with connectedness and emotional grounding.

Looking into mom’s eyes and face teaches facial recognition and expressions of emotions and is primarily how the child learns in the first few months of life. Additionally, infants tend to show a preference to viewing faces with open eyes rather than closed eyes, thus stressing the importance of the mother or caregiver’s gaze.

Some health benefits to gazing into the mother’s eyes is a lower incidence of autism, or spectrum disorders, better social skills, higher learning capacity, and emotional groundedness.

The beauty of a mother’s gaze is that the child can feel the emotions of love, security, safety, and overall well-being by connecting with her through eye-to-eye contact. This sets the stage for the future development of social skills, visual recognition of people, and readiness for social interaction in the world.

A big thank you to science and mothers for proving what we already know--that the values in life can be taught to a child “through a mother's eyes,” setting the course for proper interaction for life skills and relationships.

 

References:

1. Kate Yandell, Proceedings of the Royal Society B ,04/10/2013.

2. Maxson J.McDowell, Biological Theory, MIT Press, 05/04/2011.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

If you were to do a Google news search for sports-related eye injuries today, chances are you'd find multiple recent stories about some pretty scary eye injuries.  Whether they are professionals, high school or college athletes, or kids in community sports programs, no one is immune to the increased danger sports brings to the eyes.

Here are some facts about sports-related eye injuries:

  1. Eye injuries are the leading cause of blindness in children in the United States and most injuries occurring in school-aged children are sports-related.
  2. One-third of the victims of sports-related eye injuries are children.
  3. Every 13 minutes, an emergency room in the United States treats a sports-related eye injury.
  4. These injuries account for an estimated 100,000 physician visits per year at a cost of more than $175 million.
  5. Ninety percent of sports-related eye injuries could be avoided with the use of protective eyewear.

Protective eyewear includes safety glasses and goggles, safety shields, and eye guards designed for individual sports.

Protective eyewear lenses are made of polycarbonate or Trivex.

Ordinary prescription glasses, contact lenses, and sunglasses do not protect against eye injuries. Safety goggles should be worn over them.

The highest risk sports are:

  • Paintball
  • Baseball
  • Basketball
  • Racquet Sports
  • Boxing and Martial Arts

The most common injuries associated with sports are:

  1. Abrasions and contusions
  2. Detached retinas
  3. Corneal lacerations and abrasions
  4. Cataracts
  5. Hemorrhages
  6. Eye loss

Protect your vision--or that of your young sports star. Make an appointment with your eye doctor today!

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Our Mission

It is the mission of Lifetime Vision & Contact Lens Center to contribute to a lifetime of healthy vision by providing each patient with the best possible care to enhance quality of life. We will seek continuing education to remain at the forefront of our profession and will offer the latest in eye care technology, professional services, and products. The visual needs and wellness of each patient will always be our first priority. We will accomplish this in an atmosphere of uncompromised service, value, and friendliness.