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.

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 are seeing the 3 F's, you might have a retinal tear or detachment and you should have an eye exam quickly.

The 3 F's are:

• Flashes - flashing lights.
• Floaters - dozens of dark spots that persist in the center of your vision.
• Field cut – a curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision.

The retina is the nerve tissue that lines the inside back wall of the eye and if there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss.

If you have a new onset of any of the three symptoms above, you need to get in for an appointment fairly quickly (very quickly if there are two or more symptoms).

If you have just new flashes or new floaters you should be seen in the next few days. If you have both new flashes and new floaters or any field cut, you should be seen in the next 24 hours.

When you go to the office for an exam, your eyes will be dilated. A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the outside of the eye to examine the peripheral retina. Some people have a hard time driving after dilation--since the dilating drops may last up to 6 hours, you may want to have someone drive you to and from your appointment.

If the exam shows a retina tear, treatment would be a laser procedure to encircle the tear.

If a retinal tear is not treated in a timely manner, then it will progress into a retinal detachment. There are four treatment options for retinal detachment:

• Laser.  A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment. 
• Pneumatic retinopexy. This is an office-based procedure that requires injecting a gas bubble inside the eye.  The patient then needs to position his or her head for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is then performed around the retinal break. This procedure has about 70% to 80% success rate, but not everyone is a good candidate for a pneumatic retinopexy.
• Scleral buckle.  This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure. 
• Vitrectomy. In this surgery, the gel - the vitreous inside the eye - is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place.  The gas bubble will slowly dissipate over several weeks.  Sometimes a scleral buckle is combined with a vitrectomy surgery.

Prognosis

The final vision after retinal detachment repair is usually dependent on whether the center of the retina - called the macula - is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that anyone with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome.

Article contributed by Dr. Jane Pan

Ocular allergies are among the most common eye conditions to hit people of all ages.

Though typically worse in the seasons of Spring and Summer, some people suffer with allergies all year. This is especially true for people who have allergies to pet dander, mold, dust mites, and other common allergens that tend to linger throughout the year.

The hallmark sign of ocular allergies is itching.

While itching can be a symptom of other eye conditions, the likelihood that there is at least some allergy component to the condition is quite high. This seems to be particularly true when the itching occurs mainly in the inner corner of the eyes. This signals that the condition is allergy-related, whereas itching along the eyelid margin suggests other conditions.

Allergy itching is usually accompanied by redness, tearing, and string-like mucus discharge from the eye. When accompanied by rhinitis, sinusitis, and sneezing, people can truly suffer from their allergies - especially as it relates to the eye.

The good news is there are numerous avenues for relief from this annoying condition.

There are many over-the-counter antihistamine drops. Talk to your eye doctor about which ones they recommend.

In particularly severe cases, prescription antihistamine/mast cell stabilizer combination drops, or even topical steroids, can be used. In addition, cold compresses can be a great therapy in combination with the drops.

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 it safe to use "Redness Relief" eye drops regularly?

The short answer is NO.

Here’s the slightly longer answer.

There are several eye “Redness Relief” products on the over-the-counter market, such as those made by Visine, Clear Eyes, and Bausch & Lomb - as well as generic versions sold by pharmacy chains.

Most commonly, the active ingredient in redness relief drops is either Tetrahydrozoline or Naphazoline. Both of these drugs are in a category called sympathomimetics.

Sympathomimetics, the active ingredient in redness relief drops, work though a process called vasoconstriction, an artificial clamping down of the superficial blood vessels on the eye surface. These blood vessels often dilate in response to an irritation. This increase in blood flow is trying to help repair whatever irritation is affecting the surface of the eye. Clamping down on those vessels by using a vasoconstrictor counteracts the body’s efforts to repair the problem.

The other downside to repetitively using redness relief drops is that after the vasoconstrictor wears off the vessels often dilate to an even larger degree than when the process started. This stimulates you to use the drops again.

All of these drops carry these same two warnings on their labels:

Do not overuse as it may produce increased redness of the eye.

Stop using and ask a doctor if you experience eye pain, changes in vision, continued redness or irritation of the eye condition worsens or persists for more than 72 hours.

Does anyone read those warnings?  Almost never.

These drops are meant to be used for a VERY short duration - one or two days. That’s it!

They are not meant to be used indefinitely and they are certainly not meant to be used daily.

Take a good look at that first warning: MAY PRODUCE INCREASED REDNESS OF THE EYE.

If you are using redness relief drops repetitively you are likely making your eye redness WORSE, not better.

If you have been using redness relief drops daily you need to stop and replace them with an artificial tear or lubricating drop - something that DOES NOT say “gets the red out.”

After you make that switch your eyes are initially going to be red as your blood vessels take time to regain their normal vascular tone without the vasoconstrictor clamping down on them. The lubricating drop will actually help the repair the damage done by exposure to adverse conditions. This will decrease the inflammatory signals that make the vessels dilate. You will actually be doing something helpful to the surface of your eyes instead of just masking everything by artificially clamping down on your vessels and decreasing the flow of oxygen and nutrients to the front surface of your eye.

Using redness relief drops if you wear contacts is an even worse idea. If you put the drop in with your contact in, the contact will hold onto the drug and keep it on your eye surface longer, thus likely increasing the vasoconstriction. 

Your cornea has no blood vessels in it and it depends on the blood vessels in the conjunctiva over the whites of the eye to bring in nutrients and oxygen. The other source of oxygen for the cornea is what it gets from diffusion from the atmosphere and that is also cut down by the presence of the contact lens.

The redness relief drop combined with the contact lens are now BOTH reducing the levels of oxygen getting to the cornea. Decreased oxygen to the cornea is one of the biggest risks for contact lens-related infections, including corneal ulcers.

Don’t get me wrong, I’m not condemning redness relief drops if used appropriately for a very short time to soothe the eyes if they have been temporarily exposed to elements that made them irritated. For a day or two redness relief drops are fine. But for long-term use or for use while wearing your contacts they are much more likely to cause problems than to provide any benefits.

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.

There are several treatable eye diseases that at their earliest onset have few or no visual symptoms. In fact, the three leading causes of legal blindness in the United States all start with almost no visual symptoms detectable by the person suffering from the disease. The three diseases are macular degeneration, glaucoma, and diabetic retinopathy. Each of these diseases gets more prevalent as people age. That is why the American Academy of Ophthalmology recommends regular eye exams at more frequent intervals as adults get older.

Macular Degeneration: The leading cause of legal blindness in the United States is a treatable but not curable disease. Early detection and treatment can significantly improve the long-term outcome. At the earliest stages, often when people are unaware that they have a problem, treating the disease with a very specific vitamin regimen called AREDS 2 can help. These vitamins have been shown to slow the progression of the disease and improve long-term outcomes. When the disease becomes more advanced there is the possibility of bleeding in the retina. If left untreated, that almost always results in severe visual loss. There now are several medications that when injected into the bleeding eye can arrest the bleeding and potentially improve vision.

Glaucoma: The second leading cause of legal blindness in the United States is often called "the silent thief of sight." With glaucoma, there is often severe damage to the optic nerve before a person recognizes he is having a problem. Usually by the time a person notices symptoms, 70% of the optic nerve is destroyed. As of now, once that damage has occurred it cannot be reversed. This makes early diagnosis absolutely critical to saving your sight. In most cases (but not all) early detection and treatment can preserve functional vision throughout your lifetime.

Diabetic Retinopathy: This is another leading cause of legal blindness that has no visual symptoms until the disease is in its advanced stages. Every diabetic should have an annual eye exam to check for signs of retinal disease. If detected and treated in its early stages, the disease can usually be controlled and the vision preserved.

As you can see, there are very strong reasons to have your eyes examined regularly - especially as we age - in order to keep good visual health and function throughout your lifetime.

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

Health and government agencies nationwide are warning people about the spread of the COVID-19 coronavirus and are they offering important advice on how to minimize your risks of contracting the disease.

Besides social distancing and isolating yourself from people who are ill, health experts are telling people to wash their hands and to keep them away from their eyes, nose and mouth.

Their advice is to wash your hands often with soap and water for at least 20 seconds, or to use a hand sanitizer with at least 60% alcohol. They also strongly emphasize to keep your hands away from your face, since your eyes, nose and mouth are passageways for germs to enter your system.

That means don’t rub your eyes, scratch your nose or put your fingers next to your mouth. And you’re right, it will be hard to avoid those things. Think about how often you might itch your eyes or watch others to see how often they do it.

How do you practice good eye health in these trying times?

Here are some suggestions:

• Consciously think about what you’re doing with your hands.
• If your eyes are itchy or are watering, don’t touch them with your bare hands. Wash your hands thoroughly first and then use a tissue to either dab away the moisture or gently rub your eyelid or the corner of your eye. Dispose of the tissue as soon as you are done.
• If you wear contacts, always wash your hands before putting them in or taking them out.
• If you have glasses, wear them. While they won’t specifically protect against germs, they might make you think twice about touching your eyes. If you have both glasses and contacts, consider wearing your glasses to help remind you to keep your hands away from your eyes.
• Keep your lenses and frames clean and be sure to wash your hands before touching them.

Be safe out there, staying away from people who are ill and if you are ill. And keep your hands clean and don’t touch your face!

For more health tips and information about the coronavirus, visit the Centers for Disease Control’s website as cdc.gov.

At some point, you might be the victim of one of these scenarios: You rub your eye really hard, you walk into something, or you just wake up with a red, painful, swollen eye. However it happened, your eye is red, you’re possibly in pain, and you’re worried.

What do you do next?

Going to the Emergency Room is probably not your best bet.

Your first reaction should be to go see the eye doctor.

There are many causes for a red eye, especially a non-painful red eye. Most are relatively benign and may resolve on their own, even without treatment.

Case in point: Everyone fears the dreaded “pink eye,” which is really just a colloquial term for conjunctivitis, an inflammation or infection of the clear translucent layer (conjunctiva) overlying the white part (sclera) of our eye. Most cases are viral, which is kind of like having a cold in your eye (and we all know there is no cure for the common cold).

Going to the ER likely means you’re going to be prescribed antibiotic drops, which DO NOT treat viral eye infections. Your eye doctor may be able to differentiate if the conjunctivitis is viral or bacterial and you can be treated accordingly.

Another problem with going to the ER for your eye problem is that some Emergency Rooms are not equipped with the same instruments that your eye doctor’s office has, or the ER docs may not be well versed in utilizing the equipment they do have.

The primary instrument that your eye doctor uses to examine your eye is called a slit lamp and the best way to diagnose your red eye is a thorough examination with a slit lamp.

Some eye conditions that cause red eyes require steroid drops for treatment. NO ONE should be prescribing steroids without looking at the eye under a slit lamp. If given a steroid for certain eye conditions that may cause a red eye (such as a Herpes infection), the problem can be made much worse.

Bottom line: If you have an eye problem, see an eye doctor.

Going to the ER with an eye problem can result in long periods of waiting time. Remember, you are there along with people having heart attacks, strokes, bad motor vehicle accidents and the like-- “my eye is red” is not likely to get high priority.

Whenever you have a sudden problem with your eye your first move should be to pick up the phone and call an eye doctor. Most eye doctor offices have an emergency phone number in case these problems arise, and again, if there is no pain or vision loss associated with the red eye, it is likely not an emergency.

Article contributed by Dr. Jonathan Gerard

There are many opinions on the topic of texting and driving. The goal of this blog is to explore the effects on vision during texting.

So why does texting make you more likely to crash from a visual perspective? The problem lies in distraction from driving. For example, it takes a fast texter approximately 20 seconds to read and reply to a text. At 55 mph on the highway, a driver glances away from the road for approximately one-third of a mile. When the driver is focusing on their screen, this essentially gives the driver tunnel vision, causing the visual system to essentially use peripheral vision for driving. Your central vision is used to detect depth perception, detail, and colors such as red or green. So when texting, your depth perception, or 3-D vision, is altered and if cars are stopped ahead or closing in rapidly, it's not as easily detected. Colors, such as red brake lights or traffic signals, are not as easily noticed.

Next time you encounter situations with texting and driving, know that the visual system was designed to perform advanced visual perception while using central vision. This includes detail vision, depth perception, and color vision....all of which are placed on hold while texting and driving.

For more information on texting and driving see:

www.itcanwait.com

US Dept. of Transportation

www.AAA.com

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

We commonly see patients who come in saying that their eye is bleeding.

The patients are usually referring to the white part of their eye, which has turned bright red. The conjunctiva is the outermost layer of the eye and contains very fine blood vessels.  If one of these blood vessels breaks, then the blood spreads out underneath the conjunctiva. This is called a subconjunctival hemorrhage.

A subconjunctival hemorrhage doesn't cause any eye pain or affect your vision in any way. Most of the time, a subconjunctival hemorrhage is asymptomatic.  It is only noticed when looking at the mirror or when someone else notices the redness of the eye.  There should not be any discharge or crusting of your lashes.  If any of these symptoms are present, then you may have another eye condition that may need treatment.  

What causes a subconjunctival hemorrhage?  The most common cause is a spontaneous rupture of a blood vessel.  Sometimes vigorous coughing, sneezing, or bearing down can break a blood vessel.  Eye trauma and eye surgery are other causes of subconjunctival hemorrhage.  Aspirin and anticoagulant medication may make patients more susceptible to a subconjunctival hemorrhage but there is usually no need to stop these medications.  

There is no treatment needed for subconjunctival hemorrhage.  Sometimes there may be mild irritation and artificial tears can be used.  The redness usually increases in size in the first 24 hours and then will slowly get smaller and fade in color.  It often takes one to two weeks for the subconjunctival hemorrhage to be absorbed.  The larger the size of the hemorrhage then the longer it takes for it to fade.

Having a subconjunctival hemorrhage may be scary initially but it will get better in a couple of weeks without any treatment. However, redness in the eye can have other causes, and you should call your eye doctor, particularly if you have discharge from the eye.

Article contributed by Dr. Jane Pan

Dry Eye Disease affects more than 5 million people in the United States, with 3.3 million being women and most of those being age 50 or over. And as people live longer, dry eye will continue to be a growing problem.

Although treatment options for dry eyes have improved recently, one of the most effective treatments is avoidance of dry eye triggers.

For some that might mean protecting your eyes from environmental triggers. To do that experts recommend using a humidifier in your home, especially if you have forced hot-air heat; wearing sunglasses when outside to help protect your eyes from the sun and wind that may make your tears evaporate faster; or being sure to direct any fans  - such as the air vents in your car - from blowing directly on your face. For others, it may mean avoiding medications that can cause dry eyes.

There is one other trigger that may need to be avoided that doesn’t get as much notice: the potentially harmful ingredients in cosmetics.

Cosmetics do not need to prove that they are “safe and effective” like drugs do. The FDA states that cosmetics are supposed to be tested for safety but there is no requirement that companies share their safety data with the FDA. There are also no specific definition requirements for labeling cosmetics as “hypoallergenic,” “dermatologist tested,” “ophthalmologist tested,” “sensitive formula” or the like, making most of those labels more marketing than science.

Things to watch out for in your cosmetics if you have dry eye include:

Preservatives

Preservatives are important to prevent the cosmetics from becoming contaminated but many are known to exacerbate dry eye. Common preservatives in cosmetics that could be adding to your dry eye problems (Periman and O’Dell, Ophthalmology Management August 2016) are: BAK (Benzalkonium chloride); Formaldehyde-donating (yes, Formaldehyde!) preservatives (often listed as DMDM-hydantoin, quaternium-15, imidazolidinyl urea, diazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol); parabens; and Phenoxyethanol.  All of these preservatives in sufficient quantities can cause ocular irritation or inhibit the function of the Meibomian Glands that produce mucous that coats your tear film and keeps it from evaporating too quickly.

Alcohol

Alcohol is used in cosmetics mostly to speed the drying time but the alcohol can also dry the surface of the eye.

Waxes

Waxes can block the opening of the Meibomian Glands along the eyelid margin. If these glands are blocked they will not be able to supply the mucous and lipids necessary to the tear film to prevent it from drying too quickly. If you have trouble with dry eye it would be advisable not to apply eye liner behind the eyelashes along the lid edge where the Meibomian gland openings are.

Anti-aging products

While these may be safe and effective for the skin of the face they should not be used around the eyes. Most of these products contain some form of Retin A. These products have been shown to be toxic to the Meibomian glands and could be contributing to your dry eyes.

These components of cosmetics do not adversely affect everyone. However, if you suffer from dry eye and are not effectively able to keep your eye comfortable and your vision clear, you should investigate your cosmetics as a potential contributor to your problem.

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

Despite requests that patients bring their current glasses to their office visit, many show up without them.

Sometimes it’s an oversight: “I was rushing to get here and forgot them”; “I left them in the car”; “I picked up my wife’s glasses instead of mine by mistake.” Doctors have heard them all.

Sometimes it is unavoidable: “I lost them”; “They were stolen”; “I ran them over with the car”; “I left them on the roof of the car and drove away and now they are gone.”

Frequently, however, it’s intentional. There is a perception by some people that if they don’t like their current glasses or feel like they are not working well for them that they are better off having their eye doctor start from scratch. “Why would I want the doctor to utilize a pair of glasses I’m not happy with as a basis or starting point for my next pair of glasses?”

But bringing your glasses to an appointment is important.

There are two main reasons for eye care professionals to know what your last pair of glasses were.

The first is to see what type of glasses they are and how you see out of them. Are they just distance? Just reading? A bifocal? A trifocal? A progressive?

Even if you feel they aren’t working for you it is essential for doctors to know the type of lens you had previously. It is also important to know how you see out of them and what the previous prescription was. This can help eye care professionals determine a new prescription that will work better for you.

The second reason doctors like to know what was in your last pair of glasses is that the majority of people who wear eyeglasses have some degree of astigmatism in their eyeglass prescription.

A significant change in either the amount or axis of the astigmatism correction from one pair of glasses to the next is often not tolerated well, especially in adults. If you make too much change from the previous prescription many people experience a pulling sensation in their eyes when they wear the new glasses. It can cause symptoms of eye strain, headaches, and distortion, making flat objects like a table look like they are slanted.

Many of the problems that occur when we try to give someone a new eyeglass prescription could be avoided if doctors knew the last prescription and how you did with it.

Anytime you are going to the eye doctor, it is essential to bring your most current pair of glasses with you to the exam--whether you love them or hate them!

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 on 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.

We are frequently asked if it’s wise to have cataract surgery if you have Macular Degeneration.

Let’s start with some background.

1. Cataracts and Age-related Macular Degeneration (AMD) are both leading causes of visual impairment in the elderly population.
2. Cataracts develop when the normal clear lens gets cloudy with age. This is correctable with cataract surgery, which involves replacing the cloudy lens with a clear, artificial lens.
3. While cataracts affect the front part of the eye, AMD causes damage to the retina, which is the inner back lining of the eye.

In the past, there was a concern about cataract surgery causing progression of AMD. It was thought that there was an inflammatory component to AMD and the normal inflammatory response after cataract surgery may lead to AMD progression.

But studies have looked at patients who underwent cataract surgery compared to patients who didn't have cataract surgery and the progression of AMD was not significantly different between the two groups. However, those patients with AMD who underwent cataract surgery had a significant improvement in vision.

AMD patients can further be characterized as having wet or dry AMD, and only those with wet AMD require treatment. Patients with wet AMD need injections to decrease the growth of new blood vessels and reduce fluid in the retina.

A 2015 study showed that after cataract surgery, there was an increase in fluid in the retina of patients with wet AMD. Therefore, in patients with wet AMD, we usually want the wet AMD to be stabilized before the patient has cataract surgery. Sometimes an injection may be given prior to cataract surgery to prevent any inflammatory changes that may be associated with cataract surgery.

The majority of the studies on the subject conclude that it is safe to have cataract surgery even if you have AMD and in most cases there is a significant improvement in vision. Removing the cloudy lens also helps the ophthalmologist to better monitor the status of the AMD.

Article contributed by Dr. Jan Pan.

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

So you’re going about your day and notice a slight twinge when you blink. It starts off as a mild awareness then proceeds to a painful feeling with every blink. You look in the mirror to see what could be causing it, and there you see a small red bump forming.

You decide to wait to see what happens and one of three things occurs. Either it gets bigger, redder, and more painful; it gets smaller and goes away; or it stays put and is no longer painful or growing in size. Let’s dive into one of the most common eye conditions we treat: hordeola (commonly known as “styes”) and chalazia.

Hordeola (or singular hordeolum), are infectious abscesses of the glands that line the eyelids. Bacteria that are naturally occurring on the eyelids and eyelashes can make their way into the gland and form what is essentially a pimple in the eyelid. If it goes untreated, hordeola can (rarely) lead to spreading of the infection throughout the eyelid (preseptal cellulitis) or even start to invade the orbit of the eye (orbital cellulitis).  At that point, infection can spread to the brain and even be life-threatening and require hospitalization. Thankfully it hardly ever gets to this point.

Treatment can consist of warm compresses, ointments, and oral antibiotics to kill the infection. Just like a pimple, it is not always necessary to be on antibiotics.  It’s actually the warm compresses that do the most good.  If you can get the mucous that is clogging the gland opening to thin out it will often just drain on its own without antibiotics.  Sometimes, however, if the warm compresses alone aren’t working then an antibiotic might be necessary.  Don’t buy the over-the-counter ointment called “Stye.” It is not going to make it any better and could further clog the glands.

Chalazia (or chalazion singular) often start off as hordeola, but are sterile in nature, meaning non-infectious. Once the infection clears out, what is left behind is often what amounts to a marble-like lump in the eyelid. These are often more difficult to treat, as they no longer respond to antibiotics. If small enough, people can just leave them alone and see if they go away on their own. Larger ones, however, can be rather unsightly. If it no longer responds to warm compresses or ointments, there can either be an injection of steroid to shrink it, or they can be excised.

We see these lumps and bumps on almost a daily basis in practice. Usually, they are very simple to treat and go away quickly.

Article contributed by Dr. Jonathan Gerard

Age-related macular degeneration, often called ARMD or AMD, is the leading cause of vision loss among Americans 65 and older.

AMD causes damage to the macula, which is the central portion of the retina responsible for sharp central vision. AMD doesn't lead to complete blindness because peripheral vision is still intact, but the loss of central vision can interfere with simple everyday activities such as reading and driving, and it can be very debilitating.

Types of Macular Degeneration

There are two types of macular degeneration: Dry AMD and Wet AMD.

Dry (non-exudative) macular degeneration constitutes approximately 85-90% of all cases of AMD. Dry AMD results from thinning of the macula or the deposition of yellow pigment known as drusen in the macula. There may be gradual loss of central vision with dry AMD, but it is usually not as severe as wet AMD vision loss. However, dry AMD can slowly progress to late-stage geographic atrophy, which can cause severe vision loss.

Wet (exudative) macular degeneration makes up the remaining 10-15% of cases. Exudative or neovascular refers to the growth of new blood vessels in the macula, where they are not normally present. The wet form usually leads to more serious vision loss than the dry form.

AMD Risk factors

• Age is the biggest risk factor. Risk increases with age.
• Smoking. Research shows that smoking increases your risk.
• Family history. People with a family history of AMD are at higher risk.
• Race. AMD is more common in Caucasians than other races, but it exists in every ethnicity.
• Gender. AMD is more common in women than men.

Detection of AMD

There are several tests that are used to detect AMD.

A dilated eye exam can detect AMD. Once the eyes are dilated, the macula can be viewed by the ophthalmologist or optometrist. The presence of drusen and pigmentary changes can then be detected.

An Amsler Grid test uses pattern of straight lines that resemble a checkerboard. It can be used to monitor changes in vision. The onset of AMD can cause the lines on the grid to disappear or appear wavy and distorted.

Fluorescein Angiogram is a test performed in the office. A fluorescent dye is injected into the arm and then a series of pictures are taken as the dye passes through the circulatory system in the back of the eye.

Optical coherence tomography (OCT) is a test based on ultrasound. It is a painless study where high-resolution pictures are taken of the retina.

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

Remember back to the last time you experienced the birth of a baby. What was one of the most common questions people asked? Most likely, "WHAT COLOR ARE HIS EYES?,” was right up there.

What makes the color of our eyes appear as they do? What role do genetics play? What if you don’t like your eye color--can you change it? Are there any medications that can change the eye color? Get ready to explore the science behind eye color by starting at the beginning.......

Baby’s eye color can change. A baby can start out with blue eyes, for example, that change to brown as she ages. It’s all dependent on a brown pigment called melanin which develops as a child grows. The more melanin present, the darker the eye color. Brown eyes have the most pigment saturation, green/hazel eyes have less melanin, and blue eyes have the least pigment. The color of eyes is dependent upon genetics. Genetics are complicated, but generally speaking brown trumps blue if there is a brown-eyed parent. This is because darker pigment is the dominant trait in genetics. This isn’t to say that two brown-eyed parents could not have a blue-eyed child......it's just not very common.

So what if you don’t like your eye color? Can you change it? Yes, you can. The most common way is through cosmetic colored contact lenses. It’s possible to change almost any eye color, even changing brown to blue. A special colored dye is injected into the contact lens material, creating magnificent colors. There are also surgical methods for changing iris color but the risks far outweigh the benefits, so it is not recommended. Furthermore, contact lenses are medical devices that alter cellular tissue, so only get contacts by obtaining a prescription from an eyecare practitioner.

Some medications can change eye color. A class of medication called prostaglandins, used to treat glaucoma, has a side effect of darkening the iris color. This same class, in a weaker strength, is used to lengthen eyelashes. Studies have shown that in a certain percentage of patients, light blue and green eyes have turned brown.

So maybe Crystal Gayle was looking into a crystal ball when she sang "Don’t It Make My Brown Eyes Blue," predicting eye color changing medications to come.

Only future science holds the key to permanent eye color change. But in the meantime, genetics, medication, and cosmetic colored contact lenses can enhance and change the color of your eyes. 

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

For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy.

In a trabeculectomy the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of the eye and then get resorbed by the blood vessels in the conjunctiva (the mucous membrane that covers the white part of the eye).

This surgery often resulted in a large decrease in the Intraocular Pressure (IOP). Reducing the IOP is the goal of glaucoma surgery because multiple studies on glaucoma show that if you can reduce the pressure in glaucoma the progression of the disease slows.

The problem with trabeculectomy is although it frequently lowers the pressure it also has a fairly high complication and/or failure rate. This led to some reluctance to perform the procedure unless the glaucoma was severe, or the pressure was very high. As a result of those issues there has been a search during the last 40 years for something that had a lower complication rate and could be more easily deployed earlier in the disease process.

Enter Minimally Invasive Glaucoma Surgery, or MIGS.  There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. They are utilized much earlier in the disease process and when combined with cataract surgery they can be used to not only help control the pressure over the long term but can often even reduce the burden of eye drops afterward.

The biggest advantage to MIGS over the trabeculectomy is that when used in conjunction with cataract surgery MIGS can lower the eye pressure (although not as much as the trabeculectomy) but often with no higher rate of complications as there is with cataract surgery alone.

The lower complication rate is mainly because the MIGS procedures do not create a full-thickness hole in the wall of the eye.  Most of them involve putting in some form of stent inside the eye. The stent lets the intraocular fluid get out of the eye more efficiently through its normal internal drain called the trabecular meshwork, rather than having to flow to the outside of the eye as with a trabeculectomy. There are currently several FDA-approved drainage stents with more on the horizon.

A stent is not the only way to lower the pressure along with cataract surgery. There is also a laser treatment you can do from the inside of the eye that slows the amount of fluid the eye makes, which also results in a lower pressure. It is called Endocyclophotocoagulation (ECP). Think of a partially clogged drain in a sink with constantly running water. If you don’t want the sink to overflow (or the pressure in the eye to get too high) you either try to unclog the drain (stent) or you turn down the faucet (ECP).

MIGS has been a great development over the last several years, enabling the ophthalmic surgeon to intervene surgically at a much earlier stage of glaucoma and with a significantly lower complication rate than the more invasive trabeculectomy.

At this point I utilize one of the MIGS procedures in almost all patients who need their cataracts removed and are on one or more glaucoma medications. Even if the glaucoma is fairly well controlled at the time, the MIGS procedure gives us the opportunity to try and get a glaucoma patient off their eye drops, which is both a decreased burden of treatment and lets us keep the eye drops in reserve should the pressure start to increase again later in life.

If you have glaucoma and a cataract you should definitely discuss this with your doctor to see if a MIGS procedure along with your cataract surgery could be the right choice for you.

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

1. Vision is so important to humans that almost half of your brain’s capacity is dedicated to visual perception.

2. The most active muscles in your body are the muscles that move your eyes.

3. The surface tissue of your cornea (the epithelium) is one of the quickest-healing tissues in your body. The entire corneal surface can turn over every 7 days.

4. Your eyes can get sunburned. It is called photokeratitis and it can make the corneal epithelium slough off just like your skin peels after a sunburn.

5. Ommatophobia is the fear of eyes.

6. You blink on average about 15 to 20 times per minute. That blink rate may decrease by 50% when you are doing a visually demanding task like reading or working on a computer – and that’s one reason those tasks can lead to more dry-eye symptoms.

7. Your retinas see the world upside down, but your brain flips the image around for you.

8. If you are farsighted (hyperopia) your eye is short, and if you are shortsighted (myopia) your eye is long.

9. An eyelash has a lifespan of about 5 months. If an eyelash falls out it takes about 6 weeks to fully grow back.

10. One in every 12 males has some degree of “color blindness.”