One of the hardest questions eye care professionals deal with every day is when to tell people who are having difficulty with their vision that they need to stop driving.

Giving up your driving privilege is one of the most difficult realities to come to terms with if you have a problem that leads to permanent visual decline.

The legal requirements vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, is 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes.

In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides).

According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. There are also other contributing factors such as slower reaction times and increased fragility but the fact remains that the rate is higher, so when vision problems begin to occur with aging it is extremely important to do what is necessary to try to keep your vision as good as possible.

That means regular eye exams, keeping your glasses prescription up-to-date, dealing with cataracts when appropriate, and staying on top of other vision-threatening conditions such as macular degeneration, glaucoma and diabetes.

It is our responsibility to inform you when you are no longer passing the legal requirement to drive. Although there is no mandatory reporting law in all states, it is recorded in your medical record that you were informed that your vision did not pass the state requirements to maintain your privilege. And, yes, it is a privilege -- not a right -- to drive.

If you have a significant visual problem and your vision is beginning to decline, you need to have a frank discussion with your eye doctor about your driving capability. If you are beginning to get close to failing the requirement you need to start preparing with family and loved ones about how you are going to deal with not being able to drive.

Many of us eye doctors have had the unfortunate occurrence of having instructed a patient to stop driving because of failing vision, only to have him ignore that advice and get in an accident. Don’t be that person. Be prepared, have a plan.

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. 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.

Who is Charles Bonnet?  He was a Swiss naturalist, philosopher, and biologist (1720-1793) who first described the hallucinatory experiences of his 89-year-old grandfather, who was nearly blind in both eyes from cataracts.   Charles Bonnet Syndrome is now the term used to describe simple or complex hallucinations in people who have impaired vision.  

Symptoms

People who experience these hallucinations know they aren't real.  These hallucinations are only visual, and they don't involve any other senses. These images can be simple patterns or more complex, like faces or cartoons.  They are more common in people who have retinal conditions that impair their vision, like macular degeneration, but they can occur with any condition that damages the visual pathway.  The prevalence of Charles Bonnet Syndrome among adults 65 years and older with significant vision loss is reported to be between 10% and 40%.  This condition is probably under reported because people may be worried about being labeled as having a psychiatric condition. 

Causes

The causes of these hallucinations are controversial, but the most supported theory is deafferentation, which is the loss of signals from the eye to the brain; then, in turn, the visual areas of the brain discharge neural signals to create images to fill the void.  This is similar to the phantom limb syndrome, when a person feels pain where a limb was once present.  In general, the images that are produced by the brain are usually pleasant and non-threatening.

Treatment and prognosis

If there is a reversible cause of decreased vision, such as significant cataract, then once the decreased vision is treated, the hallucinations should stop.

There is no proven treatment for the hallucinations as a result of permanent vision loss but there are some techniques to manage the condition.  Give these a try if you have Charles Bonnet Syndrome.

• Talking about the hallucinations and understanding that it is not due to mental illness can be reassuring.
• Changing the environment or lighting conditions.  If you are in a dimly lit area, then switch on the light and vice versa. 
• Blinking and moving your eyes to the left and right and looking around without moving your head have been reported as helpful.
• Resting and relaxing.  The hallucinations may be worse if you are tired or sick.
• Taking antidepressants and anticonvulsants have been used but have questionable efficacy. 

Over time, the hallucinations become more manageable and can decrease or even stop after a couple of years.

If you experience any of these symptoms, please get evaluated by your eye doctor to make sure there is not a treatable eye condition.  Don’t be embarrassed or ashamed—your issue is likely caused by a physical disturbance and we are here to help!

Article contributed by Jane Pan

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

Alzheimer's Disease International estimates that the number of people living with dementia worldwide - nearly 44 million in 2014 - will almost double by 2030 and more than triple by 2050.

There is no single test that can show if a person has Alzheimer's, but doctors can almost always determine if a person has dementia, although it may be difficult to determine the exact cause. Diagnosing Alzheimer's requires careful medical evaluation, neurological testing, and sometimes brain imaging and blood tests to rule out other causes of dementia.

Most of the testing for early disease - MRI scans of the brain, brain PET scans looking for amyloid, and spinal taps looking for certain proteins in the spinal fluid - are not very accurate, and they are invasive and often expensive.

Researchers have now turned to findings in the eye to help with early detection and are hoping to find ways to make the diagnosis earlier when potential treatments may have a better outcome. There is also hope that these tests will be less expensive and invasive then the other options.

One of the tests that has shown promise is an OCT of the retina. Almost every eye doctor’s office already has an OCT, and so if this research proves fruitful, the test could be done relatively cheaply because there is not a need to buy more expensive equipment. Right now, the average OCT exam is reimbursed at about the $50 per exam level, much less than the cost of an MRI or PET Scan.

Neuroscientists at the Gladstone Institutes in San Francisco showed a proof of concept in frontotemporal dementia, which is like Alzheimer’s but attacks much earlier and accounts for just 10% to 15% of dementia cases. They found that patients with frontotemporal dementia had thinning of the neuron layer of the retina on OCT.

In a study at Moorfields Eye Hospital they also found that people who had a thinner layer of neurons in the macula on an OCT exam were more likely to perform poorly on the cognitive tests - a clear warning sign they may be undergoing the early stages of dementia.

Study leader Dr. Fang Ko, said: “Our findings show a clear association between thinner macular retinal nerve fiber layer and poor cognition in the study population. This provides a possible new biomarker for studies of neurodegeneration.”

A second marker that is getting a careful look is identifying the presence of amyloid in the eye. Amyloid, thought to be one of the key causes of Alzheimer’s, which makes up most dementia cases, is often found to have formed into clumps and plaques in the brain. Scientists at Waterloo University in Canada found people with severe Alzheimer’s disease had deposits of a protein amyloid on their retinas.

Research conducted at Lifespan-Rhode Island Hospital in Providence co-led by Peter Snyder, a professor of neurology at Brown University, and Cláudia Santos, a graduate student at the University of Rhode Island, is attempting to detect amyloid in the retina by OCT and follows people over time to see if the amyloid increases and if it correlates with cognitive impairment.

Another angle being pursued by a company called Cognoptix is looking for amyloid in the lens of the eye. Using Cognoptix's SAPPHIRE II system, which detects amyloid in the lens, a 40-person Phase 2 clinical trial was conducted at four sites. The study recruited patients who were clinically diagnosed with probable Alzheimer’s disease (AD) via a rigorous neuropsychological and imaging workup. The study, using age-matched healthy controls, showed outstanding results of 85% sensitivity, and 95% specificity in predicting which people had probable AD.

The company is now planning a Phase 3 study that must show a strong correlation in a bigger study group to obtain ultimate FDA approval.

One of the other items I was going to include in this post was information on what visual symptoms occur in dementia patients and how family and friends can support them but I found an outstanding review already available online by the Alzheimer’s society that covers all those points. If you have a loved one with dementia this is an excellent read and I highly recommend you take the time to review it.

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.

Eye drops can be hard for some patients to put into their eyes. After cataract surgery, there are two main issues we are trying to control: Preventing infection and controlling inflammation.  Traditionally, we prescribed antibiotic eye drops to prevent infection, as well as steroid eye drops to control post-operative inflammation. Now we have some alternatives to using eye drops after surgery.   

There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better a job preventing infection as using antibiotic eye drops before and after surgery.

Just recently, the FDA approved two new steroid delivery methods to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery. Those two products are called Dexycu and Dextenza.

Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery. It will not be visible in most patients because it is injected behind the iris, or the colored part of the eye.  It sometimes doesn’t stay behind the iris and you might see a small white dot in the eye initially after surgery.  It is a sustained-released medication, is resorbed over a couple of weeks and replaces the need for post-operative steroid drops.  

Dextenza is a white pellet that is inserted into the lower punctum of the lid, which is the small opening for the drainage of tears. This insert is designed to deliver medication for up to 30 days.  It is slowly resorbed and doesn't need to be removed. Similarly, it is usually not visible and does not cause any discomfort.

If you have either a Dexycu or Dextenza implant placed and an antibiotic medication is injected inside the eye after surgery, then you may be drop free after surgery. The main difference between the two steroid injections is that Dexycu is injected inside the eye while Dextenza is deposited outside the eye.  For each of these new options there is a chance that in your particular case there may still be too much inflammation and you might need to take eye drops for a while, but the majority of the time you would not need drops.

If you are going to have cataract surgery and would like to be drop free after the procedure, then ask your surgeon if you would be a candidate for either the Dexycu or Dextenza implant.

Article contributed by Dr. Jane Pan.

"What are these weird floating things I started seeing?"

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

• Are nearsighted.
• Are aphakic (absence of the lens of the eye).
• Have past trauma to the eye.
• Have had inflammation in the eye.

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

• Sudden increase in number of floaters that are persistent and don't resolve.
• Increase in flashes.
• A shadow covering your side vision, or a decrease in vision.

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment. Only about 15 percent of people with PVD develop a retinal tear.

If left untreated, approximately 40 percent of people with a symptomatic retinal tear will progress into a retinal detachment – and a retinal detachment needs prompt treatment to prevent vision loss.

Generally, most people become accustomed to the floaters in their eyes.

Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed. And for most people, the risk of surgery is greater than the nuisance that the floaters present.

Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable. However, this is not a recognized standard treatment and it is not widely practiced.

In general, the usual recommendation for floaters and PVD is observation by an eye care specialist.

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. 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 majority of cataract surgeries performed in the U.S. are done with a local anesthetic and IV sedation.

The local anesthesia may be accomplished in one of two ways: either an injection of anesthetic around the eye or anesthetic eye drops placed on the eye, often combined with an injection of a small amount of anesthetic into the front of the eye at the very beginning of surgery.

The injection of anesthetic around the eye generally produces a deeper anesthesia for the surgery than the topical method but it also comes with increased risk. There is a very small chance of potentially serious bleeding behind the eye and a rare chance of inadvertent penetration of the back of the eye with the injection needle.

The topical anesthesia has lower risk but does not provide quite as deep of an anesthesia, although the overwhelming majority of people having cataract surgery with a topical anesthetic do not experience any significant pain during the procedure. 

The other difference between the two anesthesias is with that topical anesthesia you maintain your ability to move your eye around whereas with injection anesthesia the eye muscles are temporarily paralyzed so your eye doesn’t move during the surgery.  When you have topical anesthesia it is important for you to try to stare straight ahead at the light in the microscope above you. Most people accomplish this quite easily.

Along with the anesthetic to the eye, in most cataract surgeries an anesthetist will also give you some mild sedative medication through an IV. This relaxes you but does not put you “out,” although some people do fall asleep during the procedure from the effects of the sedation.

Many people who have cataract surgery with IV sedation don’t remember some of the surgery because of the amnesiac effect that occurs from the sedative. This often doesn’t happen when you return for surgery on your second eye. 

Despite often getting the exact same dose of sedative on the second surgery you have significant less amnesia the second time. This is caused by a quick buildup in tolerance to the medication. 

When they have their second surgery, many patients feel that the surgery was significantly different than the first time even though it was done exactly the same. The reason is just that you remember more the second time.

On rare occasions people need to have general anesthesia to have their cataracts removed. Today, that is mostly done for people who are incapable of cooperating and staying still for the surgery. For everyone who can cooperate it is generally not worth the risks, which include death, to put people to sleep for a surgery that is easily done under a local anesthetic.

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

What Is Intraoperative Aberrometry?

Yes, that is a mouthful, but the concept isn’t quite as hard as the name.

An Intraoperative Aberrometer is an instrument we can use in the operating room to help us determine the correct power of the implant we put in your eye during cataract surgery.

Cataract surgery is the removal of the cloudy natural lens of your eye and the insertion of a new artificial lens inside your eye called an intraocular lens (IOL).

The cloudy cataract that we are removing has focusing power (think of a lens in a camera) and when that lens is removed, we need to insert an artificial lens in its place to replace that focusing power. The amount of focusing power the new IOL needs has to match the shape and curvature of your eye.

To determine what power of lens we select to put in your eye, we need to measure the shape and curvature of your eye prior to surgery.  Once we get those measurements, we can plug those numbers into several different formulas to try and get the most accurate prediction of what power lens you need.

Overall, those measurements and formulas are very good at accurately predicting what power lens you should have. There are, however, several eye types where those measurements and formulas are less accurate at predicting the proper power of the replacement lens.

Long Eyes: People who are very nearsighted usually have eyes that are much longer than average.  This adds some difficulty with the accuracy of both the measurements and the formulas. There are special formulas for long eyes but even those are less accurate than formulas for normal length eyes.

Short Eyes: People who are significantly farsighted tend to have shorter-than-normal eyes.  Basically, the same issues hold true for them as the ones for longer eyes noted above.

Eyes with previous refractive surgery (LASIK, PRK, RK): These surgeries all change the normal shape of the cornea.  This makes the formulas we use on eyes that have not had previous surgery not work as well when the normal shape of the cornea has been altered.

This is where intraoperative aberrometry comes in. The machine takes the measurements that we do before surgery and then remeasures the eye while you are on the operating room table after the cataract is removed and before the new implant is placed inside the eye. It then presents the surgeon with the power of the implant that the aberrometer thinks is the correct one.  Unfortunately, the power that the aberrometer isn’t always exactly right, but with the combination of the pre-surgery measurements and the intra-surgery measurements the overall accuracy is significantly enhanced.

The intraoperative aberrometry is also very helpful in choosing the power of specialty lenses like multi-focal and toric lenses.

We would encourage you to consider adding intraoperative aberrometry to your cataract surgery procedure if you have either a long or short eye (usually manifested as a high prescription in your glasses) or if you have had any previous refractive surgery.

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

What do Amblyopia, Strabismus, and Convergence Insufficiency all have in common? These are all serious and relatively common eye conditions that children can have.

Did you know that 80% of learning comes through vision? The proverb that states ”A picture is worth a thousand words” is true!  If a child has a hard time seeing, it stand to reason that she will have a hard time learning.

Let’s explore Amblyopia, or “lazy eye”. It affects 3-5% of the population, enough that the federal government funded children’s yearly eye exams into the Accountable Care Act or ObamaCare health initiative. Amblyopia occurs when the anatomical structure of the eye is normal but the “brain-eye connection” is malfunctioning. In other words, it is like plugging your computer into the outlet but the power cord is faulty.

Amblyopia need to be caught early in life--in fact if it is not caught and treated early (before age 8) it can lead to permanent vision impairment. Correction with glasses or contacts and patching the good eye are ways it is treated. Most eye doctors agree that the first exam should take place in the first year of life. Early detection is a key.

Strabismus is a condition that causes an eye to turn in (esotropia), out (exotropia), or vertically. It can be treated with glasses or contacts, and surgery, if needed. Vision therapy or strategic eye exercises prescribed by a doctor can also improve this condition.

When we read, our brain tells our eyes to turn in to a comfortable reading posture. In Convergence Insufficiency, the brain tells the eyes to turn in, but they instead turn out, causing tremendous strain on that child’s eye for reading. Another tell tale sign of this condition is the inability to cross your eyes when a target approaches. The practitioner will see instead, that one of the eyes kicks out as the near target approaches. This condition can be treated with reading glasses or contacts, and eye exercises that teach the muscles of the eye to align properly during reading. Vision therapy is the treatment of choice for Convergence Insufficiency.

It is important to understand the pediatric eye and all the treatments that can be implemented to augment the learning process. Preventative care in the form of early eye examinations can mean the difference between learning normall or struggling badly. Remember, a young child can’t tell you if he hasa vision impairment. For the success of the child, be proactive by scheduling an early vision exam.

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

Have you ever seen a temporary black spot in your vision? How about jagged white lines? Something that looks like heat waves shimmering in your peripheral vision?

If you have, you may have been experiencing what is known as an ocular migraine. Ocular migraines occur when blood vessels spasm in the visual center of the brain (the occipital lobe) or the retina.

They can take on several different symptoms but typically last from a few minutes to an hour. They can take on either positive or negative visual symptoms, meaning they can produce what looks like a black blocked-out area in your vision (negative symptom), or they can produce visual symptoms that you see but know aren’t really there, like heat waves or jagged white lines that look almost like lightning streaks (positive symptoms).

Some people do get a headache after the visual symptoms but most do not. They get the visual symptoms, which resolve on their own in under an hour, and then generally just feel slightly out of sorts after the episode but don’t get a significant headache. The majority of episodes last about 20 minutes but can go on for an hour. The hallmark of this problem is that once the visual phenomenon resolves the vision returns completely back to normal with no residual change or defect.

If you have this happen for the first time it can be scary and it is a good idea to have a thorough eye exam by your eye doctor soon after the episode to be sure there is nothing else causing the problem.

Many people who get ocular migraines tend to have them occur in clusters. They will have three or four episodes within a week and then may not have another one for several months or even years.

There are some characteristics that raise your risk for ocular migraines. The biggest one is a personal history of having migraine headaches. Having a family history of migraines also raises your risk, as does a history of motion sickness.

Although the symptoms can cause a great deal of anxiety, especially on the first occurrence, ocular migraines rarely cause any long-term problems and almost never require treatment as long as they are not accompanied by significant headaches.

So if symptoms like this suddenly occur in your vision, try to remain calm, pull over if you are driving, and wait for them to go away. If they persist for longer than an hour, you should seek immediate medical attention.

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

When your eyes feel itchy, it’s a natural reaction to want to rub, rub, rub. It temporarily relieves the itching, and frankly feels great when you’re doing it. Unknowingly, however, you are likely doing short-term – and in some cases long-term – damage to your eyes. Here are some of the detrimental effects that can result from eye rubbing. 

• Worsening of ocular allergies: rubbing an eye inflamed from allergies starts a vicious cycle. During the allergic ocular response, a chemical called histamine is released from a cell called a mast cell. It is this release of histamine that starts the red, itchy, watery eyes associated with allergies. Rubbing the eyes releases more histamine, causing the eyes to become more inflamed, perpetuating the cycle.
• Risk of increased eye pressure: Putting pressure on the globe of the eye drastically increases intraocular pressure (IOP). While the effect is temporary, prolonged rubbing can increase your risk of developing glaucoma, a potentially blinding eye disease, especially if the IOP spikes high enough. 
• Risk of retinal detachment: Any trauma to the eye can risk detaching the retina, the paper thin film that lines the back of the eye. Retinal detachment can present with symptoms such as seeing flashes, floaters, or a blacking out of the vision, but other times it can go undetected until it’s too late. Rubbing the eye causes unnecessary trauma to the globe, which can rupture the attachment of the retina to the back of the eye.
• Keratoconus: More and more research is starting to show that ocular allergies and eye rubbing is a risk factor for developing keratoconus, a disease in which the cornea starts to bow out and form a cone shape. While the exact cause is not known, research suggests that the contant rubbing weakens the collagen bonds that helps the cornea keep its shape, resulting in the abnormal corneal bowing. 

Nothing good comes from eye rubbing. If your eyes are itchy, you can try over-the-counter antihistamine drops, cool compresses (which slows histamine release), and allergy medications to stop the itch.

Article contributed by Jonathan Gerard

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

Eye doctors typically pride themselves on being able to improve someone’s vision through glasses or contact lens prescriptions. Whether it’s a first-time glasses wearer, or someone having either a small or large change in their prescription, we like to aim for that goal of 20/20 vision.

Despite our best efforts, however, correcting vision to 20/20 is not always a positive outcome for the patient. Whether someone will be able to tolerate their new prescription is based on something called neuroplasticity, which is what allows our brains to adapt to changes in our vision.

You or someone you know may have had this happen: Your vision is blurry, so you go to the eye doctor. The doctor improves the vision, but when you get your new glasses, things seem “off.”

Common complaints are that the prescription feels too strong (or even too clear!) or that the wearer feels dizzy or faint. This is especially true with older patients who have had large changes in prescription, since neuroplasticity decreases with age. It is also more likely to happen when the new prescription has a change in the strength or the angle of astigmatism correction. Conversely, this happens less often in children, since their brains have a high amount of plasticity.

Quite often, giving the brain enough time to adapt to the new vision will decrease these symptoms.

Whenever a patient has a large change in prescription, I tell them that they should wear the glasses full time for at least one week. This is true for both large changes in prescription strength, as well as changing lens modality, i.e. single vision to progressives.

Despite the patient’s best efforts, though, sometimes allowing time to adapt to the new vision isn’t enough, and the prescription needs to be adjusted. Even when someone sees 20/20 on the eye chart with their new glasses, if they are uncomfortable in them even after trying to adjust for a week then we sometimes have to make a compromise and move the script back closer to their previous script so that there is less change and they can more easily adapt.

In conclusion, adapting to a new prescription can sometimes be frustrating. It does not mean there is anything wrong with you if you have difficulty adjusting to large changes in a prescription. With a little patience and understanding about how your brain adapts to these kinds of changes, your likelihood of success will be that much higher.

Article contributed by Dr. Jonathan Gerard

When soft contact lenses first came on the scene, the ocular community went wild.

People no longer had to put up with the initial discomfort of hard lenses, and a more frequent replacement schedule surely meant better overall health for the eye, right?

In many cases this was so. The first soft lenses were made of a material called HEMA, a plastic-like polymer that made the lenses very soft and comfortable. The downside to this material was that it didn’t allow very much oxygen to the cornea (significantly less than the hard lenses), which bred a different line of health risks to the eye.

As contact lens companies tried to deal with these new issues, they started to create frequent-replacement lenses that made from SiHy, or silicone hydrogel. The oxygen transmission problem was solved, but an interesting new phenomenon occurred.

Because these were supposed to be the “healthiest” lenses ever created, many people started to over wear their lenses, which led to inflamed, red, itchy eyes; corneal ulcers; and hypoxia (lack of oxygen) from sleeping in lenses at night. A new solution was needed.

Thus was born the daily disposable contact lens, which is now the go-to lens recommendation of most eye care practitioners.

Daily disposables (dailies) are for one-time use, and therefore there is negligible risk of over wear, lack of oxygen, or any other negative effect that extended wear (2-week or monthly) contacts can potentially have. While up-front costs of dailies are higher than their counterparts, there are significant savings in terms of manufacturer rebates. In addition, buying contact lens solution is no longer necessary!

While a very small minority of patient prescriptions are not yet available in dailies, the majority are, and these contacts have worked wonders for patients who have failed in other contacts, especially those who have dry eyes.

Ask your eye care professional how dailies might be the right fit for you.

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.

Sunglasses are more than just a fashion statement - they’re important protection from the hazards of UV light.

If you wear sunglasses mostly for fashion that’s great--just make sure the lenses block UVA and UVB rays.

And if you don’t wear sunglasses, it’s time to start.

Here are your top 6 reasons for wearing sunglasses:

Preventing Skin Cancer

One huge way that sunglasses provide a medical benefit is in the prevention of skin cancer on your eyelids. UV light exposure from the sun is one of the strongest risk factors for the development of skin cancers.  

Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.

Your eyelids, especially the lower eyelids, are also susceptible to UV light and they do develop skin cancers somewhat frequently.

Many people who now regularly apply sunscreen to help protect them from UV light often don’t get that sunscreen up to the edge of their eyelids because they know the sunscreen is going to make their eyes sting and burn. Unfortunately, that leaves the eyelids unprotected. You can fix that by wearing sunglasses that block both UVA and UVB rays.

Decreasing Risk For Eye Disease

There is mounting evidence that lifetime exposure to UV light can increase your risk of cataracts and macular degeneration. It also increases your risk of getting growths on the surface of your eye called Pinguecula and Pterygiums.  Besides looking unsightly, these growths can interfere with your vision and require surgery to remove them.

Preventing Snow Blindness

Snow reflects UV light and on a sunny day the glare can be intense enough to cause a burn on your corne--much like what happens when people are exposed to a bright welding arc.

Protection From Wind, Dust, Sand

Many times, when you are spending time outdoors and it is windy, you risk wind-blown particles getting into your eyes. Sunglasses help protect you from that exposure. The wind itself can also make your tears evaporate more quickly, causing the surface of your eye to dry out and become irritated, which in turn causes the eye to tear up again.

Decreasing Headaches

People can get headaches if they are light sensitive and don’t protect their eyes from bright sunlight. You can also bring on a muscle tension headache if you are constantly squinting because the sunlight is too bright.

Clearer Vision When Driving

We have all experienced an episode of driving, coming around a turn, looking directly into the direction of the setting or rising sun, and having difficulty seeing well enough to drive. Having sunglasses on whenever you are driving in sunlight helps prevent those instances. Just a general reduction in the glare and reflections that sunlight causes will make you a better and more comfortable driver.

So it’s time to go out there and find yourself a good pair of sunglasses that you look great in and that protect your health, too.

Your eye-care professional can help recommend sunglasses that are right for your needs.

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.

Fireworks Eye Injuries Have More Than Doubled in Recent Years

Fireworks sales will be blazing across the country from now through the Fourth of July. As retailers begin their promotions, the American Academy of Ophthalmology is shining a light on this explosive fact: The number of eye injuries caused by fireworks has more than doubled in recent years.

Fireworks injuries cause approximately 10,000 emergency room visits each year, according to data from the U.S. Consumer Product Safety Commission. The injuries largely occurred in the weeks before and after the Fourth of July. The CPSC’s most recent fireworks report showed that about 1,300 eye injuries related to fireworks were treated in U.S. emergency rooms in 2014, up from 600 reported in 2011.

To help prevent these injuries, the Academy is addressing four important things about consumer fireworks risks:

1. Small doesn’t equal safe. A common culprit of injuries are the fireworks often handed to small children – the classic sparkler. Many people mistakenly believe sparklers are harmless due to their size and the fact they don’t explode. However, they can reach temperatures of up to 2,000 degrees – hot enough to melt certain metals. 
2. Even though it looks like a dud, it may not act like one. At age 16, Jameson Lamb was hit square in the eye with a Roman candle that he thought had been extinguished. Now 20, Lamb has gone through multiple surgeries, including a corneal transplant and a stem cell transplant. 
3. Just because you’re not lighting or throwing it doesn’t mean you’re out of the firing line. An international study of fireworks-related eye injuries showed that half of those hurt were bystanders. The researchers also found that one in six of these injuries caused severe vision loss. 
4. The Fourth can be complete without using consumer fireworks. The Academy advises that the safest way to view fireworks is to watch a professional show where experts are controlling the displays.

If you experience a fireworks eye injury:

• Seek medical attention immediately.
• Avoid rubbing or rinsing the eyes or applying pressure.
• Do not remove any object from the eye, apply ointments, or take any pain medications before seeking medical help.

Watch the AAO’s animated public service announcement titled “Fireworks: The Blinding Truth.”

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

More middle-aged and older adults are wearing soft contacts than ever.

And one of the biggest reasons they decrease or stop wearing contacts is the difficulty they face reading with their contacts after presbyopia begins to set in around the early 40’s.

Presbyopia is the diminished ability of the natural lens in our eyes to focus up close on near objects. It begins with the occasional medicine bottle being a struggle to read and then over time more and more gets blurry. It can be very frustrating to stare at something up close and have it be blurry regardless of what you do.

So there are three basic choices a contact lens wearer can do to aid their reading while still wearing contact lenses.

Reading Glasses

Initially, the use of an over-the-counter reader or prescription reading glass for occasional use works well for people in the early stages of presbyopia. They are worn over distance contact lenses so there is little adjustment and vision is clear near and far. However, they need to be with you, not left in the car or at work, and oftentimes people end up just wearing readers all day since it is just that much clearer.

Monovision

This fitting technique can be used with any type of contact lens. The brand of lenses you are currently wearing can often be used to fit you with monovision. Your dominant eye is determined. Then the non-dominant eye prescription is adjusted to compensate to make it a reading contact lens. So once fitted you have one eye for distance and the other for reading. Yes, it sounds really crazy, but it actually works quite well. Your brain initially has to adjust to using each eye individually to obtain the sharpest vision, but once this is achieved, year-to-year adjustments can be made to the reading eye to allow comfortable distance and reading vision for many years.

Monovision fits are not always successful. Some people just cannot adjust to it regardless of motivation or desire. It seems to work best when someone has had some difficulty with reading and they are noticing more and more that they need their readers. At that point, they can appreciate the ability to read and their brain seems to adapt more readily. When I wear my contacts this is the option I have used for myself.

Multifocal Contacts

Another option is multifocal contact lenses. Most every major manufacturer of soft contact lenses has some type of disposable multifocal lens available. They do not work like multifocal glasses. They use a technique called simultaneous viewing where you are actually looking through all the powers at once.

To visualize this, imagine a vinyl record with the label in the center and the various tracks extending outward. Most of the lenses are made with the strongest reading power located in the center where the label would be, then each ring further out gradually becomes weaker until you reach your full distance power. So essentially you are looking “around” the reading part for distance then through the center for reading. It works, sort of.

Multifocal lenses work better on younger patients, say 40-50 years old, for help with reading. There is no adaptation period to these lenses like monovision. What you see is what you get. But if you have any significant amount of astigmatism or if you wear a toric contact that corrects for astigmatism, multifocal lenses are not for you. And because the reading is central in the lens, if you make it too strong for reading then you blur the distance vision too much, so oftentimes a multifocal lens wearer after age 50 faces a dilemma to either wear reading glasses to boost their reading needs or change to monovision.

Conclusion

In conclusion, while none of the options are perfect they all may present some level of relief in your quest to continue to wear contacts into middle age, retirement, and beyond. But some options may better serve you at a certain point in your life or career than others. Talk to your eye doctor to see what choices are best for you.

Article contributed by Eugene Schoener O.D.

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

Now that you have picked up your new pair of prescription eyeglasses, your focus becomes taking care of them. This is a task many disregard, but it is absolutely imperative that you make sure you are following a couple simple steps to keep the quality of your vision with your new spectacles.

We are all guilty of using a garment when in a rush to wipe away a pesky smudge on our glasses. This act is unfortunately the worst thing you can do for your lenses.

No matter how clean your clothes are, dust particles and even small bits of sand and debris cling to them. Since eyeglass lenses are not made of diamonds, these tiny little particles can do tremendous amounts of damage to your new lenses. The smallest little crumb can grind a scratch directly in your line of vision, which in turn can render your glasses almost useless.

Most of us know what it feels like trying to concentrate on the world in front of you when there is a little scratch distorting and distracting your vision. A majority of the time, these little scratches can be avoided by following a few simple steps.

You may have noticed while shopping in your favorite store that they sell a variety of eyeglass cleaners. You need to be careful because the sprays and wipes which you can purchase in retail stores are not necessarily approved for all types of eyeglass lens materials.

This factor makes them fall under that category of products that many eye care professions cannot recommend. Most of these liquids contain a form of acetone or other cleaning agent that is too harsh for plastic lenses. Many years ago, when all eyeglasses were actually made out of crown glass, these products would have worked just fine. Now, during a time where they have developed thinner, lighter materials like cr-39 plastic and polycarbonate, these products have proven to be too hard on the lenses.

Over time, the lenses will start to break down if exposed to the chemicals used in these sprays, causing a fogging effect. Once again, you are left with a pair of glasses that are now unable to be worn.

Now that we have gone over the two main culprits in the destruction of eyeglass lenses, other than accidents, let’s focus on some tips to extend the life of your glasses.

Most importantly, you should use an eyeglass case. For the large portion of patients who wear their glasses all day, it’s understandable how awkward it can be to carry a case around. But it’s nowhere near as frustrating as realizing the new pair of eyeglasses you just purchased is becoming scratched and ruined.

Also, you do not need to carry the case with you everywhere you go. Strategically leaving a case on a bedside table, in your car, or in a purse is the difference between “life or death” for your glasses.

This is also a simple way to clean your glasses that does not require you to purchase anything you probably don’t already have at home. Using lukewarm water at the sink, place a small, pea-sized dab of dish soap on your fingers. Gently rub the soap on both lenses from side to side, and then rinse with warm water. A disposable paper towel is recommended to dry the glasses.

Disposable towels work because they are just that, disposable - which guarantees they are not carrying dirt or sand from a prior use.

Taking care of your glasses today means you have them for clear vision tomorrow and into the future.

Article contributed by Richard Striffolino Jr.

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

A quick explanation and background of a progressive addition lens is necessary in order to understand the importance of choosing the proper lens for your needs.

A progressive lens gives people an array of prescriptions - placed in the proper positions throughout the lens - to best imitate normal vision. Imagine having the precise correction needed to see a television screen more than 15 feet from you, while reading this article on your desktop computer, and then looking down at your keyboard in order to start entering the address to your favorite website. This, in a nutshell, is exactly what the progressive lens is ideally capable of accomplishing with one pair of glasses.

Having the least amount of peripheral distortion, and one of the wider ranges in both distance power, astigmatism, prism, and add power availability, we find this lens to be very versatile. The most important thing to you is that this product feels very natural in front of your eye. For first-time progressive lens wearers, there is a stigma that it takes a bit of time to adjust to a lens that holds multiple prescriptions. This is often still an issue if places use old technology lenses or don’t take careful measurements to assure the proper placement on the lens in the frame. However, with modern technology, the use of computers to fine tune this amazing product, and careful measurements and lens positioning by your optician, this lens does the best job we have seen in mimicking perfect 20/20 vision at all focal lengths.

Along with the progressive lens itself, there are other additional treatments, or “add-ons” that can immensely improve one’s experience with their glasses. These options include photochromic lenses, anti-reflective coatings, and polycarbonate scratch-resistant lenses.  Talk with us about what options might work best for you!

Article contributed by Richard Striffolino Jr.

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

The eye holds a unique place in medicine. Your eye doctor can see almost every part of your eye from an exterior view. Other than your skin, almost every other part of your body cannot be fully examined without either entering the body (with a scope) or scanning your body with an imaging device (such as a CAT scan, MRI, or ultrasound).

This gives your eye doctor the ability to determine most eye problems just by looking in your eye. Even though that makes diagnosing most problems more straightforward than in other medical specialties, there are still many things you can do to get the most out of your eye exams. Here are the top 7 things you can do to get as much as possible out of your exam.

1) Bring your corrective eyewear with you. Have glasses? Bring them. Have separate pairs for distance and reading? Bring them both. Have contacts? Bring them with you and not just the lenses themselves but the lenses prescription, which is on the box they came in. What we most want to know is the brand, the base curve (BC) and the prescription. If you have both contacts and glasses bring BOTH--even if you hate them.  Knowing what you like and hate, can help us prescribe something that you will love.

2) Know your family history of eye diseases. There are several eye diseases that run in families. The big ones are glaucoma, macular degeneration, and retinal detachments.  If you have a family history of one of these, it may change a doctor’s recommendations for intervention compared to someone without a family history.

3) Know your medical problems. There are several medical problems that correlate with certain diseases of the eye. Diabetes, hypertension, thyroid disease, multiple sclerosis, and autoimmune diseases all correlate with particular eye problems.  Knowing your medical history greatly increases the likelihood of more accurately dealing with your eye problem.

4) Know your medications. Several medications are known to produce specific eye problems. Drugs like steroids, Plaquenil, Gleevac, amiodarone, fingolamide, diuretics and Topamax, to name a few, can create problems in your eye. Knowing you are on certain medications may make it much easier for the doctor to arrive at a diagnosis of your eye condition.

5) Be calm and do your best. There are several tests we do that require your participation. The two tests that make people most anxious are the refraction (which determinse glasses or contacts prescriptions) and a visual field test (which tests your peripheral vision.)  Stay calm and give your best answers. There are no perfect answers. You are not going to get shocked for a wrong answer, so don’t ramp up the anxiety.  Just give it your best try.

6) Bring someone with you when possible. There are two reasons for this. One is that it is better to not drive home if you are having your eyes dilated. Many people can do it comfortably, but some can’t. If you are not sure you can drive comfortably with your eyes dilated it is better to have someone with you who can drive home. The second reason is that is always better to have a second pair of ears to hear what the doctor is telling you - especially if the problem is significant. There are many studies that show a person often mishears or misremembers what they have been told, especially if they are anxious. Two pairs of ears are better than one.

7) Write down any questions. It’s very easy to forget to ask something you really wanted to know. You will get your questions answered much better if you have written them down prior to your appointment.

Follow these tips and you will have your best experience possible at your next exam.

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

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. UV A, B, and C 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 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. Polarized sun lenses protect the eyes from the sun as well as 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.

Punctal plugs are something we use to help treat Dry Eye Syndrome.  

This syndrome is a multifactorial problem that comes from a generalized decrease in the amount and quality of the tears you make.  There is often both a lack of tear volume and inflammation in the tear glands, which interfere with tear production and also cause the quality of the tears to not be as good.

We make tears through two different mechanisms.  One is called a basal secretion of tears, meaning a constant low flow or production of tears to keep the eye moist and comfortable.  There is a second mechanism called reflexive tear production, which is a sudden flood of tears caused by the excitation of nerves on the eye surface when they detect inflammatory conditions or foreign body sensations. It is a useful reflexive nerve loop that helps wash out any foreign body or toxic substance you might get in the eye by flooding the eye with tears.  Consider what happens when you get suntan lotion in your eye.  The nerves detect the irritation that the lotion creates, and your eyes quickly flood with tears.

That reflex mechanism is how some people get tearing even though the underlying cause of that tearing is dry eye.  They don’t produce enough of the basal tears, the eye surface gets irritated and then the reflex tearing kicks in and floods their eyes, tearing them up.  Once that reflex is gone then the eye dries out again and the whole cycle starts over.

One of the treatments for dry eyes is to put a small plug into the tear drainage duct so that whatever tears you are making stay on the eye surface longer instead of draining away from the eye into to the tear drainage duct and emptying into your nose.

There are several different types of punctal plugs.  Some are made of a material that is designed to dissolve over time.  Some materials dissolve over two weeks, while others can last as long as 6 months.  There are also plugs made out of a soft silicone material that are designed to stay in forever.  They can, however, be removed fairly easily if desired or they can fall out on their own, especially if you have a habit of rubbing near the inside corner of your eye.

One of the big advantages of punctal plugs is that they can improve symptoms fairly rapidly - sometimes as quickly as a day.

The long-term medical treatment for dry eyes such as Restasis, Xiidra or the vitamin supplement HydroEye can take weeks or months to have a good effect.

On the other hand, plugs simply make you retain your tears for a longer time; they don’t help the underlying inflammation.  That is where the medical treatment comes in.  Sometimes it is useful to use a temporary plug for more instant relief while you are waiting for the medical treatment to work.  Sometimes there is clearly just a deficiency of tears and not much inflammation and the plugs alone will improve your symptoms.

All in all, punctal plugs are a safe, effective and relatively easily-inserted treatment for dry eyes.

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