What’s up with people wearing those big sunglasses after cataract surgery?

The main reason is for protection - physical protection to assure nothing hits the eye immediately after surgery, and protection from sunlight and other bright lights.

We want to protect the eye from getting hit physically because there is a small incision in the eyeball through which the surgeon has removed the cataract and inserted a new clear lens. In most modern cataract surgeries that incision is very small - about one-tenth of an inch in most cases. The vast majority of surgeons do not stitch the incision closed at the end of surgery. The incision is made with a bevel or flap so that the internal eye pressure pushes the incision closed.

The incision does have some risk of opening, especially if you were to provide direct pressure on the eyeball. Therefore, immediately after surgery we want you to be careful and make sure that you or any outside force doesn’t put direct pressure on the eye. The sunglasses help make sure that doesn’t happen while you are outside immediately after surgery. It’s the same reason that most surgeons ask you to wear a protective plastic shield over the eye at night while you are sleeping for the first week so that you don’t inadvertently rub the eye or smash it into your pillow.

The other advantage of wearing the sunglasses is to protect your eye from bright light, especially in the first day or two when your pupil may still be fairly dilated from all the dilating drops we used prior to surgery. Even after the dilation wears off, the light still seems much brighter than before your surgery. The cataracts act like internal sunglasses. The lens gets more and more opaque as the cataract worsens and so it lets less and less light into the eye. Your eye gets used to those decreased light levels and when you have cataract surgery the eye instantly goes from having all the lights dimmed by the cataract to 100% of the light getting through the new clear lens implant. That takes some getting used to and the sunglasses help you adapt early on. Think of this as if you were in a dark cave for a long period of time and then were thrust out into the bright sunlight. It would be pretty uncomfortable. The sunglasses help with that adjustment.

So why do people keep wearing those sunglasses long after their surgery? Mostly because some people really like them. They not only provide sun protection straight on, they also give you protection along the top and sides of the frame, reducing the light that can enter around the frame

If you have a spouse who wants to keep wearing those...let’s call them “inexpensive” and “less than fashionable”...sunglasses, but you’d like them to look better, there is a solution. There are sunglasses called Fitovers that go over top of your regular glasses and still provide top and side protection from the sun but look much better than the “free” ones you got for cataract surgery.

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.

Is bilberry a wonder supplement for your macular degeneration?

The jury is still out on that question. There is some supportive experimental data in animal models but no well-done human studies that show significant benefit.

What you shouldn’t do is pass up taking the AREDS 2 nutritional supplement formula, which is clinically proven to reduce the risk of severe visual loss that can happen with macular degeneration. Almost all the data supporting the POSSIBLE benefits of bilberry in visual conditions is related to NON-HUMANS. Stick with the AREDS 2 formula that has excellent clinical evidence.

So, what is bilberry and why do some people use it?

Bilberry (Vaccinium myrtillus), a low-growing shrub that produces a blue-colored berry, is native to Northern Europe and grows in North America and Asia. It is naturally rich in anthocyanins, which have anti-oxidant properties.

It is said that during World War II, British pilots in the Royal Air Force ate bilberry jam, hoping to improve their night vision. No one is exactly sure where the impetus to do this came from, but it is believed that this story is what lead to some widespread claims that bilberry was good for your eyes.

A study by JH Kramer,  Anthocyanosides of Vaccinium myrtillus (Bilberry) for Night Vision - A Systematic Review of Placebo-Controlled Trials, reviewed most of the literature pertaining to the claim that bilberry improves night vision. He found that the four trials, which were all rigorous randomized controlled trials (RCTs), showed no correlation with bilberry extract and improved night vision. A fifth RCT and seven non-randomized controlled trials reported positive effects on outcome measures relevant to night vision, but these studies had less-rigorous methodology.

Healthy subjects with normal or above-average eyesight were tested in 11 of the 12 trials. The hypothesis that V. myrtillus improves normal night vision is not supported by evidence from rigorous clinical studies. There is a complete absence of rigorous research into the effects of the extract on subjects suffering impaired night vision due to pathological eye conditions.

Even though there is no solid evidence in human studies that bilberry produces any positive visual effects on night vision there is some experimental evidence that implies it might be useful in some ocular conditions whose mode of action is oxidative stress. There are recent epidemiologic, molecular and genetic studies that show a major role of oxidative stress in age-related macular degeneration.

There have been some studies showing oxidative protective effects of bilberry in non-human models. 

In Protective Effects of Bilberry and Lingonberry Extracts Against Blue-light Emitting Diode Light-induced Retinal Photoreceptor Cell Damage in Vitro, Ogawa et al showed that cultured mouse cells that had bilberry extract added before subjection to high-energy short-wavelength light survived better than those that hadn't received the extract. 

In Retinoprotective Effects of Bilberry Anthocyanins via Antioxidant, Anti-Inflammatory, and Anti-Apoptotic Mechanisms in a Visible Light-Induced Retinal Degeneration Model in Pigmented Rabbits, Wang et al found similarly improved survival of pigmented rabbit retinal cells when exposed to bilberry abstract prior to high-intensity light.

But bilberry is not without potential side effects.

Bilberry possesses anti-platelet activity and it might interact with NSAIDs, particularly aspirin. Excessive drinking of bilberry juice might cause diarrhea. One study of 2,295 people given bilberry extract found a 4% incidence of side effects or adverse events. Further, bilberry side effects may include mild digestive distress, skin rashes and drowsiness. Chronic uses of the bilberry leaf may lead to serious side effects. High doses of bilberry leaf can be poisonous.

Bilberry has not been evaluated by the Food and Drug Administration for safety, effectiveness, or purity.

 

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

One of the hardest questions eye care professionals routinely have to deal with is when to tell people with visual difficulaties that they need to stop driving.

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

The legal requirements for visual acuity vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, has been 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 fatality rate is higher. , And 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 getting regular eye exams, keeping your glasses 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 not all states have mandatory reporting laws, your eye doctor will record 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 getting 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.

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.

We have all heard the term ”Love is in the Air,” but can love really be in the eyes? Actually, Science has proven it so. Certain chemicals (or endorphins) that produce the emotion of love can be emitted through emotions expressed in the eyes. There are physiological changes in the eyes that occur when love is expressed between two individuals. Love for a romantic partner, a family member, or a favorite pet can all cause the same physical response: the pupil (black part in the center of the eye) dilates.

The size of the pupil can be an indication of emotional responses and messages. According to Scientific American, the autonomic nervous system (ANS), which directs our fight or flight response, causes the pupil to have a quick dilating response. The ANS is also in charge of heart rate and perspiration, and when a person is extremely interested in another person, the pupil has a dilating effect that is slightly less than the pupillary light reflex. This bounce in size is an automated response that gives scientists indication of mood or interest (or love) shown to a person or pet.

Mounting scientific evidence also shows the benefit of looking into the eyes of your pet, especially dogs. Stroking them causes you to become more healthy on all fronts, and a few minutes a day of lovingly looking at the dog and stroking the pet releases serotonin, prolactin, and oxytocin, which are "feel good" hormones.

There are also studies inspired by psychologist Arthur Aron, from over 20 years ago, that show if you stare into someone's eyes for 4 minutes you can fall in love... looking eye to eye allows you to connect with someone new or reminds you why you fell in love with this person in the first place.

Overall health is improved and years can be added to your life when looking at something or someone with love. Your eyes and autonomic nervous system play an intricate role in the expression of love.

Source:

12/07/2012 article of Scientific American entitled:

Why Do Pupils Dilate in Response to Emotional States?

By Joss Fong

 

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

When confronted with a diagnosis of Age Related Macular Degeneration (AMD), it's natural to wonder what you should do.  Here are some treatment options for both Dry and Wet Age Related Macular Degeneration.

Dry AMD Treatments

Nutrition Supplements

The Age-Related Eye Disease Study 2 (AREDS2) showed that people at high risk of developing advanced stages of AMD benefited from taking dietary supplements. Supplements lowered the risk of macular degeneration progression by 25 percent. These supplements did not benefit people with early AMD or people without AMD.

Following is the supplementation:

  • Vitamin C - 500 mg
  • Vitamin E - 400 IU
  • Lutein – 10 mg
  • Zeaxanthin – 2 mg
  • Zinc Oxide – 80 mg
  • Copper – 2 mg (to prevent copper deficiency that may be associated with taking high amount of zinc)

Another study showed a benefit in eating dark leafy greens and yellow, orange and other fruits and vegetables. These vitamins and minerals listed above are recommended in addition to a healthy, balanced diet.

It is important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision. However, these supplements may help some people maintain their vision or slow the progression of the disease.

Wet AMD Treatments

Injection of Anti-VEGF

The most common treatment for wet AMD is an eye injection of anti-vascular endothelial growth factor (anti-VEGF). This treatment blocks the growth of abnormal blood vessels, slows their leakage of fluid, potentially helps slow vision loss, and in some cases, improves vision. There are multiple anti-VEGF drugs available: Avastin, Lucentis, and Eylea.

You may need monthly injections for a prolonged period of time for treatment of wet AMD.

Laser Treatment for Wet AMD

Some cases of wet AMD may benefit from thermal laser. This laser destroys the abnormal blood vessels in the eye to prevent leakage and bleeding in the retina. A scar forms where the laser is applied and may cause a blind spot that might be noticeable in your field of vision.

Photodynamic Therapy or PDT

Some patients with wet AMD might benefit from photodynamic therapy (PDT). A medication called Visudyne is injected into your arm and the drug is activated as it passes through the retina by shining a low-energy laser beam into your eye. Once the drug is activated by the light it produces a chemical reaction that destroys abnormal blood vessels in the retina. Sometimes a combination of laser treatments and injections of anti-VEGF mediations are employed to treat wet AMD.

 

Article contributed by Jane Pan 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 have been studies undertaken over the past several years to try and understand if there are any of our day-to-day activities that either help or hurt the management of glaucoma.

Most of the studies demonstrated very little impact on the course of glaucoma. Here are some of the things researches have looked at.

Aerobic exercise: This means doing something at least four times per week for more than 20 minutes at a time that raises your pulse rate to a level that makes your heart work harder. Going from a sedentary lifestyle to active one with aerobic exercise resulted in a very slight decrease in baseline eye pressure.

Yoga: A study conducted at the Mount Sinai Health System (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144505) showed a significant increase in eye pressure with any head-down positioning. People with glaucoma would be wise to avoid any exercise that involves a position where your head is lower than your heart.

Weight lifting: Holding your breath while exerting yourself (called the Valsalva maneuver), is also a time when your eye pressure can go sky high. So if you lift weights for exercise, which is generally a good idea to maintain bone density, make it low weights with more repetitions of lifting, rather than heavy weights that make you grunt.

Wind instruments: A similar breath-holding problem applies to those playing the larger wind musical instruments like the French horn. One study suggested that there was a greater chance of glaucoma in symphonic wind players. If you play a brass instrument, it makes sense to have frequent checks of pressure, optic nerve head, and visual field.

Marijuana: Smoking marijuana can lower eye pressure. However, due to its short duration of action (3-4 hours), side effects, and lack of evidence that it alters the course of glaucoma, it is not recommended for glaucoma treatment.

Wearing tight neckties: This creates a very short-duration increase in eye pressure but doesn’t seem to have any long-term effects.

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 are recommended.

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.

Living an overall healthy life is good for your eyes. Healthy vision starts with healthy eating and exercise habits.

There's more to complete eye health than just carrots. Are you eating food that promotes the best vision possible? Learn what foods boost your eye well-being and help protect against diseases. Here are important nutrients to look for when selecting your foods.

  • Beta carotene or Vitamin A (helps the retina function smoothly): carrots and apricots
  • Vitamin C (reduce risk of macular degeneration and cataracts): citrus and blueberries
  • Vitamin E (hinders progression of cataracts and AMD): almonds and sunflower seeds
  • Riboflavin (helps your eyes adapt in changes in light): broccoli and bell peppers
  • Lutein (antioxidant to maintain health while aging): spinach and avacado
  • Zinc (transfers vitamin A to the retina for eye-protective melanin productions and helps with night vision): beans and soy beans
  • DHA (helps prevent Dry Eye): Fatty fish like salmon and tuna

Keep in mind, cooked food devalues the precious live enzymes, so some of these foods are best eaten raw.

 

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.

Dry eye is a very common problem that affects women more than men and becomes more prevalent as people get older.

It can present in many ways, with symptoms that can include a foreign body sensation, burning, stinging, redness, blurred vision, and dryness. Tearing is another symptom and occurs because the eye initially becomes irritated from the lack of moisture and then there is a sudden flood of tears in response to the irritation.

Unfortunately, this flood of tears can wash out other important components of the tear film that are necessary for proper eye lubrication. Signs and symptoms can range from mild to severe.

There are medications that have the potential to worsen the symptoms of dry eye. Here are some of the broad categories and specific medications that have been known to potentially worsen the symptoms:

  • Blood Pressure Medications - Beta blockers such as Atenolol (Tenormin), and diuretics such as Hydrochlorothiazide.
  • GERD (gastro-esophageal reflux disorder) Medications - There have been reports of an increase in dry eye symptoms by patients on these medications, which include Cimetidine (Tagamet), Rantidine (Zantac), Omerprazole (Prilosec), Lansoprazole (Prevacid), and Esomeprazole (Nexium).
  • Antihistamines - More likely to cause dry eye: Diphenhydramine (Benadryl), loratadine (Claritin). Less likely to cause dry eye: Cetirizine (Zyrtec), Desloratadine (Clarinex) and Fexofenadine (Allegra). Many over-the-counter decongestants and cold remedies also contain antihistamines and can cause dry eye.
  • Antidepressants - Almost all of the antidepressants, antipsychotic, and anti-anxiety drugs have the propensity to worsen dry eye symptoms.
  • Acne medication - Oral Isotretinoin.
  • Hormone Replacement Therapy - The estrogen in HRT has been implicated in dry eye.
  • Parkinson's Medication - Levodopa/Carbidopa (Synamet), Benztropine (Cogentin), Procyclidine (Kemadrin).
  • Eye Drops - In addition to oral medications many eye drops can actually increase the symptoms of dry eye, especially drops with the preservative BAK.

If you are suffering from dry eye and are using any of the medications above you should discuss this with your eye doctor and medical doctor. Don't stop these medications on your own without consulting your doctors.

 

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.

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.

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.

It's pretty common for eye doctors to have older patients come in asking if the white part of their eye, the sclera, has a growth or is turning a gray color.

Usually, the culprit is senile scleral plaque, which is commonly seen in people over the age of 70. It is a benign condition and more commonly seen in women.  This condition is symmetrically found on both sides of the eye and is due to age-related degeneration and calcification of the eye muscle insertion into the eye.  In one study, the size of the senile scleral plaque increased as the person aged and was not associated with any medical conditions.  People are asymptomatic, as the plaques do not affect vision and no treatment is needed.

Another commonly asked question is: Why is the colored part of my eye turning white?  

The colored part of the eye is the iris, which is covered by a clear layer called the cornea.  It is actually the edge of the cornea that attaches to the white part of the eye that becomes grey or whitish colored.

This condition is called arcus senilis, which is seen in over 60% of people over the age of 60 and approximately 100% over the age of 80.  There is no visual impairment and no treatment is needed. Sometimes when this condition is seen in younger patients, it may be related to high cholesterol, so a visit to the primary care doctor may be needed.  

These are two very commonly encountered conditions that may cause distress for patients because it seems like their eyes are changing colors.

Thankfully, no treatment is needed for these two conditions, as they do not affect vision.

Article contributed by Dr. Jane Pan

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

Recent Census Bureau data shows a population of approximately 71 million baby boomers (the generation born from 1946-1964). What does that have to do with low vision you may ask? Approximately 40 million people worldwide have some sort of blindness, and aging increases the incidence of macular degeneration and other vision impairment that qualifies them as “low vision” persons.

Low vision is a condition of the eye in which the vision falls below 20/70 in the better seeing eye. It impairs the recipients, rendering them unable to perform daily tasks that others take for granted. With this rising aging population, the awareness of low vision therapy, diagnosis, and treatments are more widely available.

Low vision treatment can help people recover from decreased visual function due to retinal disease, brain injury, neurological damage, and other causes.

It is not only the elderly population that is affected--approximately 20% of low vision patients are children under the age of 18. Childhood genetic disorders of the eye such as retinitis pigmentosa, albinism, Bests disease, ROP, rod/cone disorders, and glaucoma are among the causes of low vision in the pediatric population.

What can be done to help these millions?

There are eye care practitioners that specialize in low vision, as well as therapists. They train the patient to adjust their current lifestyles to make them more independent and utilize the current salvageable vision they do have. For example, if a person has lost their central vision due to macular degeneration, they can be trained to use their peripheral vision to accommodate for many tasks.

Because patients with low vision cannot be corrected with regular eye glasses, the use of telescopes, magnifiers, computer generated aids, training, biofeedback, and optical magnification devices are among some of the resources available to help. Occupational therapists also employ orientation and mobility assistance to help patients in their daily living skills.

There are many technologies that help to improve vision. One such technology is a bionic eye device that uses a pair of glasses with a camera that transmits video data to an implant in the back of that patients eye (the retina). This device uses technology similar to cochlear implants that stimulate auditory nerve signals to restore hearing. In the same way, visual impulses can be restored by stimulating neurons in the retina, brain, or optic nerve.

Maybe the Bionic Man TV series wasn’t too far out there and can someday be a reality............restoring vision to millions.

For more valuable information on low vision visit:

National Eye Institution

Prevent Blindness

American Optometric Association AOA

American Occupational Therapy Association AOTA

American Academy of Ophthalmology AAO

 

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

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.

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.

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

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.

A quick explanation and background of a progressive addition lens (or PAL) 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 your eyecare team about what options might work best for you!

Article contributed by Richard Striffolino Jr.

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.

The word “astigmatism” is used so much in the optometric world that most people have talked about it when discussing their eye health with their doctor.

“Astigmatism” comes from the Greek “a” - meaning “without” - and “stigma” - meaning “a point.” In technical ocular terms, astigmatism means that instead of there being one point of focus in the eye, there are two. In other words, light merges not on to a singular point, but on two different points.

This is experienced in the real world by blurred, hazy vision, and can sometimes lead to eye strain or headaches if not corrected with either glasses or contact lenses.

Astigmatism is not a disease. In fact, more than 90% of people have some degree of astigmatism.

Astigmatism occurs when the cornea, the clear front surface of the eye like a watch crystal, is not perfectly round. The real-world example we often use to explain astigmatism is the difference between a basketball and a football.

If you cut a basketball in half you get a nice round half of a sphere. That is the shape of a cornea without astigmatism.

If you cut a football in half lengthwise you are left with a curved surface that is not perfectly round. It has a steeper curvature on one side and a flatter curve on the other side. This is an exaggerated example of what a cornea with astigmatism looks like.

The degree of astigmatism and the angle at which it occurs is very different from one person to the next. Therefore, two eyeglass prescriptions are rarely the same because there are an infinite number of shapes the eye can take.

Most astigmatism is “regular astigmatism,” where the two different curvatures to the eye lie 90 degrees apart from one another. Some eye diseases or surgeries of the eye can induce “irregular astigmatism,” where the curvatures are in several different places on the eye’s surface, and often the curvatures are vastly different, leading to a high amount of astigmatism.

Regular astigmatism is treated with glasses, contact lenses, or refractive surgery (PRK or LASIK). Irregular astigmatism, such as that caused by the eye disease keratoconus, usually cannot be treated with these conventional methods. In these circumstances, special contact lenses are needed to treat the condition.

The next time you hear that either you or a loved one has astigmatism, fear not.

It is easily corrected, and although astigmatism can cause your vision to be blurry, it rarely causes any permanent damage to the health of your eyes.

If you experience blurred vision, headaches, or eye strain, having a complete eye exam may lead to a diagnosis and treatment of this easily-dealt-with condition.

 

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.

There are several different variations of glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the glaucoma, like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which we won't be discussing today, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of glaucoma we treat.

Glaucoma is a disease where the optic nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP).  Most - but not all - people diagnosed with glaucoma have an elevated IOP.  Some people have fairly normal IOP’s but show the characteristic deterioration in the optic nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP.  We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications or laser treatments. There are other places in the world where glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications, most often in the form of eye drops, or a laser treatment.

Drops

There are several different classes of medications used to treat glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s.  Some of the PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes, they are reasonably well tolerated by most people, and they are dosed just once a day, while most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option for initial treatment is a laser procedure.

Two common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT).  These treatments try to get an area inside the eye called the trabecular meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year.  Both laser treatments can be repeated if the pressure begins to rise again in the future, but the SLT works slightly better as a repeat procedure compared to the ALT.

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

There is an old adage in the eye care industry--Glasses are a necessity, contact lenses are a luxury. Ninety-nine percent of the time this is absolutely true. In the absence of unusual eye disorders or very high prescriptions that don’t allow a person to wear glasses comfortably, contact lenses should only ever be worn if there is a good, sturdy, updated set of prescription glasses available, too. This is due to the fact that there are often emergencies where people cannot wear their contact lenses.

In the 21st century, contact lens technology has gotten to the point where we have drastically cut down on the number of adverse events related to contact lens wear. However, human beings were not meant to wear little pieces of plastic in their eyes. Contact lenses are still considered a foreign body in the eye, and sometimes with foreign bodies, our eyes might feel the need to fight back against the “invader.” As such, issues like red eyes, corneal ulcers, eyelid inflammation, dry eyes, and abnormal blood vessel growth can result from wearing contact lenses.

More often than I would like, I have patients who are longtime contact lens wearers come in, and when I inquire as to the condition of their glasses, they say they don’t own any. My next question is inevitably, “What happens if you get an eye infection and you can’t wear your contacts?” I then see the proverbial light bulb go off in their heads followed by a blank stare. Why? “Because I’ve never had a problem before.” Well, just because you maybe have never been in a car accident before, doesn’t mean you shouldn’t wear your seat belt!

I will therefore repeat the most important takeaway here--Glasses are a necessity, contacts are a luxury. Even if you don’t want to go “all out” and get the most expensive frames or lenses in your glasses, having a reliable pair of glasses is an absolute must for any contact lens wearer.

Article contributed by Dr. Jonathan Gerard

In light of the holiday season, here are our top 10 eye care jokes.

1) What do you call a blind deer? No Eye Deer!

2) What do you call a blind deer with no legs? Still No Eye Deer!

3) Why do eye doctors live long lives? Because they dilate!

4) Why did the blind man fall into the well? He couldn’t see that well.

5) Why shouldn’t you put avocados on your eyes? Because you might get guac-coma!

6) What did the right eye say to the left eye? "Between you and me, something smells."

7) A man goes to his eye doctor and tells the receptionist he’s seeing spots. The receptionist asks if he’s ever seen a doctor. The man replies, “No, just spots.”

8) How many eye doctors does it take to screw in a light bulb? One … or two

9) Unbeknownst to her, a woman was kicked out of peripheral vision club. She didn’t see that one coming!

10) What do you call a blind dinosaur? A do-you-think-he-saurus

Bonus: What do you call a blind dinosaur’s dog? A do-you-think-he-saurus rex!

Article contributed by Dr. Jonathan Gerard

Red, Itchy, swollen eyelids are often due to a condition called blepharitis. Blepharitis tends to be a chronic condition due to thick eyelid mucous gland production that sticks to the bases of the eyelashes. This adherent mucous can allow bacteria to overgrow and also attract and retain allergens. The standard treatment for blepharitis is doing warm compresses and cleaning off the eyelids with a mild baby shampoo and water solution. This treatment works for some people but there are many more sufferers who have chronic irritation and relapses despite this treatment. If the warm compresses and eyelid scrubs are not quite keeping the condition under control there are several other additional treatments that can be used to control the symptoms. One such treatment that your doctor may decide upon is to use an antibiotic/steroid combination drop or ointment. We usually use these for short periods of time to try to bring the condition under control. They are not good to use chronically because it can build resistant bacteria and the steroid component can cause other eye issues like cataracts and glaucoma. The treatment is very safe for short term use but chronic use is usually not a good option. There are also antibiotic eyelid scrubs such as Avenova which can be prescribed and used on a more long-term basis. Oral Doxycycline can also be used longer in very low doses. Doxycycline is an antibiotic that when used to treat infections is generally prescribed in a dose of 100mg twice a day. For chronic Blepharitis suffers we generally use a much lower dose of around 50 mg a day. At that dose we are using the Doxycycline to help thin out the mucous production from the eyelid glands more than for its antibiotic properties. In summary, blepharitis can be a chronic issue that requires some persistent “maintenance” work be done to keep it under control, with further intervention sometimes needed for flare-ups.

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

Choroidal nevus is the fancy term for a freckle in the back of the eye.

This lesion arises from a collection of cells that make pigment in the choroid, which lines the back of the retina and supplies the retina with nutrients. These choroidal nevi (plural of nevus) are usually grayish in color and develop in about 5-10% of the adult population. They are usually asymptomatic and detected during a routine dilated eye exam.

Just like any freckle on our body, we should monitor it for any change in size or growth.  This is usually done with a photograph of the nevus and annual exams are normally recommended to monitor any change.  

In addition to a photograph, other tests that can be used to monitor the nevus are:

  • Optical coherence tomography - a test that uses light waves to take cross-section pictures of the retina. This test is used to detect if the nevus is elevated or if fluid is present underneath the retina.
  • Ultrasound - uses sound waves to measure the size and elevation of the nevus.
  • Fluorescein angiography - a dye test to detect abnormal blood flow through the nevus.

The concern is for transformation of the choroidal nevus into melanoma, a cancer in the eye. It has been estimated that 6% of the population have choroidal nevus and 1 in 8,000 of these nevi transform into melanoma.  Some factors predictive of possible transformation in melanoma are:

  • Thickness of the lesion, greater than 2 mm.
  • Subretinal fluid, observed on exam or optical coherence test.
  • Symptoms that include decreased or blurry vision, flashes, or floaters.
  • Orange pigment in the lesion.
  • Located near the optic nerve.

Early detection of choroidal melanoma results in earlier treatment and better outcomes for the patient. Many times, a patient with choroidal melanoma may be asymptomatic, and so routine dilated eye exams should be performed to identify any suspicious choroidal nevus.

In general, there is no treatment for choroidal nevus other than observation and monitoring for change. Therefore, a visit to your eye doctor is recommended to detect any freckles in the back of your eye.

Article contributed by Dr. Jane Pan

Our Mission

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