Fall brings a lot of fun, with Halloween bringing loads of it.

But did you know that some Halloween practices could harm your vision? Take Halloween contacts, for instance. They vary widely, with everything from monster eyes to goblin eyes to cat eyes to sci-fi or a glamour look. They can be just the added touch you need for that perfect costume. However, some people do not realize that the FDA classifies contact lenses as a medical device that can alter cells of the eye and that damage can occur if they are not fit properly.

Infection, redness, corneal ulcers, hypoxia (lack of oxygen to the eye) and permanent blindness can occur if the proper fit is not ensured. The ICE, FTC, and FDA are concerned about costume contacts from the illegal black market because they are often unsafe and unsanitary. Proper safety regulations are strictly adhered to by conventional contact lens companies to ensure that the contact lenses are sterile and packaged properly and accurately.

Health concerns arise whenever unregulated black-market contacts come into the US market and are sold at flea markets, thrift shops, beauty shops, malls, and convenience stores. These contacts are sold without a prescriber's prescription, and are illegal in the US. There have also been reports of damage to eyes because Halloween spook houses ask employees to share the same pair of Halloween contact lenses as they dress up for their roles.

So the take home message is, have a great time at Halloween, and enjoy the flare that decorative contacts can bring to your costume, but get them from a reputable venue and be fit by an eye care professional with a proper legal prescription. Don't gamble with your eyes for a night of Halloween fun!

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

The tears that coat the surface of your eyes have both a liquid and a mucous layer to them. It is normal to have a very thin amount of mucus in your tear film. But that mucus can significantly increase when the eye gets irritated.

Some of the most common causes of irritation that can make the eye overproduce mucus are:

• Conjunctivitis, which could be caused by an allergy, bacteria or virus
• Blepharitis, which is an inflammation of the eyelids
• Dry Eye

When any of these conditions occur, the eye will begin to make more mucus.  

Sometimes the mucous production really is excessive and there is a temptation to keep pulling it out with either your fingers or a cotton swab. Don’t do it; it just leads to recurring irritation and problems.

Any mucus that gets deposited OUTSIDE the eye on the outer eyelid or on the lashes is fair game for removal. In fact, anything on the exterior of the eyelid or stuck to the eyelashes should be cleaned off.  Just don’t reach INSIDE the eyelids.

Every time you go in there to pull out mucus, your finger or a cotton swab further irritates the eye and causes it to make more mucus and you end up with the viscious cycle that we call mucus fishing syndrome.

If you have an acute problem that is causing excessive mucus, you need to try and get the underlying problems treated and under control. That means treating the allergy, blepharitis, infectious conjunctivitis, or Dry Eye.

In addition, you need to STOP putting your fingers in your eye and pulling the mucus out. Sit on your hands if you have to but you have to stop or it is never going to get better.

If you are through treatment for the original problem but still find yourself pulling mucus out of your eye you may need your doctor to try a steroid drop in order to decrease the production and try to help you get out of the habit of putting your fingers in your eyes.

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

Shingles is the term we use to describe a condition that is caused by a re-activation of the Herpes Varicella-Zoster virus. The origin of this infection usually goes way back to childhood with a disease we know as “chickenpox.”

When you have a chickenpox infection your immune system manages to eventually suppress that virus from causing an active infection, but the virus does not get completely eliminated from your body--it is able to go and hide in your nerve roots.

Your immune system manages to keep the virus in check for most of your life but there may come a time in adulthood when your immune system is not working as well as it used to, and the virus can reappear. It usually does this along the distribution of a single sensory nerve called a dermatome.

The most common area for this to occur is along your trunk (chest or abdomen) but it is also commonly found on the face.

There are three branches of nerves that supply sensation to your face. They are all branches of the fifth cranial nerve. Those three branches supply the upper face (V1), the mid face (V2), and the lower face (V3).  Most of the time, shingles breaks out along only one of the branches at a time. The one that most frequently involves the eye is a rash breakout in the V1 distribution. This can involve the forehead and both the upper and lower eyelid.  It is also much more likely that the inside of the eye will be involved if the tip of the nose has a lesion on it.  The reason for that is that there is a specific subbranch of the V1 nerve called the nasocilliary nerve. This nerve is responsible for sensation on the tip of the nose and the inside of the eye.

The hallmark of shingles is that once the rash erupts it stays on one side of the body, including when it happens on the face. The rash will go up to the centerline of your face but will not go to the other side. You may get lesions on your scalp, but they will not show up on the back of your head. That is because the V1 does not go past half way back on your scalp. The back of your head has its sensation handled by nerves that come out of your spinal cord not cranial nerves that come out of the front of your skull.

Many people have a hard-to-describe sensation of pain, irritation, or itching along the distribution of the nerve for a day or two before the rash shows up. It is important to recognize the rash as quickly as possible because the drugs that treat shingles--usually Acyclovir, Famvir (famciclovir), or Valtrex (valacyclovir)--are much more effective if they are started within three days of the beginning of the rash.

Eye problems may occur along with the rash, especially if there is a lesion on the tip of the nose.

The two biggest problems are swelling or inflammation of the cornea and inflammation inside the eye, which we call iritis or uveitis.  

The inflammation in the eye can cause pain and it can also increase the eye pressure and cause glaucoma. Most often the treatment for the eye problem is to use the same oral medication mentioned above and sometimes it also can require eye drops to decrease the inflammation the virus is causing (steroid drops) or drops to try and lower the elevated pressure (glaucoma drops).

The eye inflammation can cause blurred vision, pain, and significant light sensitivity. It can be hard to treat and control and can continue to be a problem long after the skin lesions are gone. In fact, many times problems don’t even start until the skin lesions are starting to go away.

It is recommended that if you have shingles effecting the distribution of V1 that you have an eye exam within a few days of the diagnosis being made and then again a week later because, as mentioned above, the eye problems can present a week later than the skin eruptions.

There can be some serious long-term effects of shingles on your eye including glaucoma and corneal scarring that can be bad enough to require a corneal transplant. The symptoms are often obvious with the vision being blurry and the eye being very red and painful, but sometimes the symptoms may be much more mild even when significant trouble is brewing inside the eye. So even if you think the eye feels fine, you need an exam to ensure there is not subtle inflammation or significant elevation of the pressure in the eye.

The other long-term problem with shingles around the eye is the possibility of there being ongoing pain in the area that can last for many years. This is called Post Herpetic Neuralgia (PHN). This pain can occur all along the dermatome where shingles had occurred. The eye itself may look perfectly normal but the pain persists. This is often treated with drugs that were originally developed as seizure medication but have since been shown to help alleviate neurological pain. The two most commonly used drugs for this are Neurontin (Gabapentin) and Lyrica (Pregabalin).

The most important thing you can do to try and make sure this doesn’t happen to you is to be vaccinated for shingles. The original vaccination called Zostavax has been available since 2006 in the U.S.  It is a single-injection vaccine and was recommend for everyone over 60.  The main issue with this vaccine is that it only reduced the risk of getting shingles by 51% and PHN by 67%.  In 2017 a new vaccine was approved in the U.S. called Shingrix. This vaccine is a two-injection vaccine with the second shot given 2 to 6 months after the first. This vaccine is recommended for everyone 50 years or older.  The big advantage of this vaccine is that is 90% effective in preventing both shingles and PHN. There have been some shortages of this vaccine since its introduction so it may take a while to get it but you should definitely do it when it is available.  For more information about this vaccine you can go to the CDC website by clicking here.

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

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

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

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

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

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

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

There is a third phase of the disease that is caused by long-term persistent infection.  This phase can create multiple neurologic problems and can appear very similar to the presentation of Multiple Sclerosis (MS). The eyes can show any of the same signs as phase two, but the most common presentation is persistent keratitis.

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

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

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

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

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

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

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

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

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

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

For more resources see these websites:

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

ADHD.com

American Optometric Association, AOA.org

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

There are many things that can cause your eye to turn red.

The eye looks red when the blood vessels that are in the conjunctiva (the mucous membrane that covers the white of your eye and the backside of your eyelids) becomes dilated.

Those blood vessels often dilate when the eye gets irritated. This irritation can originate from a problem occurring inside the eye or factors from outside the eye.

The most common external factors that can cause the eye to become red are exposure to infectious organisms (mostly viruses and bacteria), environmental irritants (smoke, chemicals, sunlight), or allergens.

Infectious organisms can cause infectious conjunctivitis, or what is more commonly referred to as “pink eye.” This condition often presents with the eye being red and a mucous discharge being produced, often to such a degree that the eyelids are crusted over upon awaking in the morning. Infectious conjunctivitis can be extremely contagious and it is often advised that you severely limit your exposure to others while the problem is active. Infectious conjunctivitis caused by bacteria can be treated with antibiotic eye drops but viral conjunctivitis currently has no treatment and must run its course like the common cold.

Environmental irritants can make the eye look red for a short period of time during and immediately after exposure. The irritation is usually self-limited but may resolve more quickly with the use of over-the-counter lubricating drops or artificial tears. It is very important to understand exactly which irritant you were exposed to because there are some chemicals (acids and bases) that can cause extreme damage to the eye. So if you’re exposed to a caustic chemical you need to immediately rinse your eye out with water and seek emergency medical attention.

Allergens can cause allergic conjunctivitis, which can look very similar to pink eye but usually has significantly less mucous discharge and is usually accompanied by fairly severe itching. Allergic conjunctivitis is not contagious and can usually be treated with anti-allergy eye drops.

Infectious and allergic conjunctivitis can cause mild discomfort and itching but they rarely cause significant pain or loss of vision. A red eye with significant pain, especially when accompanied by severe light sensitivity and vision loss, often indicates more significant problems such as iritis, angle closure glaucoma or a corneal ulcer, all of which require immediate medical attention. If your eye is red and there is significant pain do not assume you have pink eye--see your eye doctor immediately!

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

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 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.

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

Parkinson’s disease is a progressive degenerative condition of the neurological system.  The majority of Parkinson’s effects are on movement, often starting off very slowly and subtly. One of the earliest symptoms is a slight tremor in one or both hands. Other early symptoms include a lack of facial expression and decreased blinking of the eyes, so it looks like the person is always staring.  

The next stage usually results in difficulty with initiating movement, especially walking.  It frequently looks like it takes a tremendous concentrated effort to initiate walking and the steps often start off very small with a shuffling of the feet.  At the same time, the disease stiffens the muscles of the arms so that when the person is walking there is a noticeable decrease in the swinging of the arms. Speech becomes much softer and writing becomes more of an effort, with handwriting getting smaller and smaller as the disease progresses.

Parkinson’s can also affect your visual performance, mainly in two parts of your eyes: the tear film and the ocular muscles.

It affects your tear film because of the decreased rate of blinking. The tear film is an important component of your optical system. It coats the surface of the cornea and if it is not smooth and uniform the result is a blurring of your vision. Blinking helps refresh your tear film and spreads it out uniformly. It is analogous to the washers and wipers on your car. If the windshield (like your cornea) is spotty you have a hard time seeing through that windshield. Turn on the washers and now there is more moisture on the surface but that is also spotty and hard to see through until the wipers go by and spread the moisture out evenly. That is very similar to how your cornea, tear film and your eyelids blinking interact to keep your vision clear.

If you don’t blink enough, the tear film begins to dry out in spots and having dry spots next to moist spots results in an irregular film and therefore blurred vision. That is how the decreased blinking frequency in people with Parkinson’s disease results in a complaint of intermittent blurred vision.

The other way the disease affects your vision is by creating a problem called convergence insufficiency. When you read, your two eyes turn inward toward each other in a process called convergence. Your eye muscles are activated in order to have the two eyes point inward to focus on the near object. By interfering with the interaction between your nerves and muscles, Parkinson’s makes it difficult to both initiate and sustain the convergence you need to keep both eyes focused on a near object.

This sometimes results in a disconnect between what a person is capable of reading on an eye chart for a short period of time and what happens after trying to sustain the effort over a longer period of time. This disconnect can result in some frustration. Often during an exam, a quick look at the distance eye chart allows the patient to see fairly well because the dry eye may not be causing any blurring if the patient just blinked a few times before reading the chart.  A patient may also do well on the near chart because they are often being tested one eye at a time. When you read things up close with just one eye there is no need for the eyes to converge so they do well one eye at a time.

There are some other less-frequent eye problems that can occur with Parkinson’s. One is called blepharospasm, where the eyelids on either one side or both forcefully close involuntarily. A person can also end up with a condition called apraxia of eye opening, where they can’t voluntarily open the eyelids. This is different from blepharospasm because in this condition the lids are not being forcefully closed, they just won’t open when you want them to.

The majority of these problems do improve if the Parkinson’s is treated with medication or even brain stimulation.

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

CHEERS to your ocular health!

Did you know that nutrition plays a vital role in your ocular health?

Cardiologists stress lean meats, red wine, and exercise for your heart health. But what about your eyes? Well, studies show there are distinct food groups that show extreme benefit to the well being of your vision.

Macular Degeneration is a condition of the retina in the back of the eye that causes symptoms of loosing the fine detail vision we have been used to, replacing it with a central scotomas or blind spots. Your central vision gets destroyed by this disease. Macular Degeneration is an inherited disease, as well as some cataract formations, so check your family history to see if you are at greater risk. Lutein, found in green leafy vegetables such as kale, spinach, and broccoli create an added insulation in your retina against macular degeneration. Yellow vegetables and fruit (squash, yellow watermelon) and Omega III supplements (fish oil or flax seed oil) also help boost the pigment cells in the macula to promote crisp vision. As a side note, it is best to purchase molecularly distilled fish oil, and take the pills at night to prevent unwanted GI effects or “fish burp” which occurs with less expensive, non distilled fish oils. Remember, not all fish oil pills are created equally.

What about preventing cataracts, the clouding of the natural lens of the eye that causes symptoms such as dim vision, glare at night, decreased focusing, and blurred vision? Well, studies have shown that the vitamin C found in citrus fruits such as oranges, lemons, grapefruit, and kiwi can slow down cataract formation. Cutting your UV exposure by wearing sunglasses with UV-A and UV-B protection will also help, as well as smoking cessation.

It's good to be aware of these vision conditions that affect millions of people worldwide, and to do your best to incorporate preventative care such as good nutrition, regular check ups with your eye care practitioner, and sun exposure prevention.

If you don’t have time to eat all those fruits and vegetables in a day consider a fruit or vegetable smoothie and then drink to your good ocular health!  Additionally, cooked food devalues the precious live enzymes, so these foods are best eaten raw.

Remember, you can play a vital role in your ocular health. As Hippocrates, the father of medicine, said, "Let your food be your medicine and your medicine be your food."

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

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 we have both 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 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, so it is hard for the light to get around the lens.

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.

Don't be one of the thousands of parents every year who wish, "I wish I had realized sooner that my child coudn't see properly!"

Did you know that early intervention in children's vision is the key to success?

• 80% of learning comes through vision.
• In the first year of life, then again by age 3 or 4, each child needs a comprehensive eye exam.
• 6 months old is not too early.

Even though a school vision screening, nurse evaluation, or pediatrician screening is important, it doesn't take the place of a comprehensive eye exam by an eyecare professional. Some symptoms of an undetected vision problem include: decreased performance in school, aversion to reading, excessive blinking, eye rubbing, headache, or inability to see 3-D movies properly.

This could indicate conditions such as amblyopia (lazy eye), nearsightedness (myopia), astigmatism, or farsightedness (hyperopia) that can be corrected with glasses.

More serious conditions may need surgery such as esotropia, where the eye turns in, or exotropia where the eye turns out.

Although school screenings, nurses, and pediatricians are extremely valuable, they don't take the place of a comprehensive eye exam by an Optometrist or Ophthalmologist.

In fact, school screenings can give a false sense of security. There are visual skills necessary for reading that aren't diagnosed easily just by reading an eye chart. If a child frequently lose his or her place while reading, he or she may benefit from glasses, vision exercises, or therapy.

Vision Therapy is training of the eyes that help alleviate issues that glasses alone can not.

A comprehensive exam can also reveal more serous threats to vision and health in children. A more rare, but life threatening condition is a fast growing eye tumor called retinoblastoma. The proximity of the eye to the brain makes fast intervention critical. This is a condition that parents might notice by looking at pictures and noticing a "white pupil."

Resources to find out more information on children's vision can be found through your local eye care provider or websites such as American Optometric Association.

Also look for the InfantSEE program. It is a no cost public health program for early detection in the first year of life.

Don't Shake is the National center on Shaken Baby Syndrome

And American Academy of Pediatrics

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

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

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

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

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

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

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

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

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

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

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

No amount of new clothes, backpacks or supplies will help your child succeed in school if they have an undetected vision problem. 

The difference between eye exams and vision screenings

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

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

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

Why back-to-school eye exams matter

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

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

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

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

What to expect at your child's eye exam

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

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

Set your child up for success

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

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

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

The 2017 National Coffee Drinking Trends report showed that 62 percent of more than 3,000 people who participated in the online survey said they had drunk coffee the previous day, which is interpreted as daily consumption. This was up from 57 percent in 2016, said the report, which was released at the coffee association's conference in Austin, Texas.

Even though the U.S. population is drinking more coffee than ever, the nation still only ranks 22nd overall in per capita consumption. The people of Finland average 3 times as much coffee consumption as people in the U.S.

So what does all this caffeine intake do to our eyes?

The research is rather sparse and the results are mixed.

Here are some major eye topics that have been investigated:

Glaucoma

One study, published in the journal Investigative Ophthalmology and Visual Science, showed that coffee consumption of more than 3 cups per day compared to abstinence from coffee drinking led to an increased risk for a specific type of Glaucoma called Pseudoexfoliation Glaucoma.

Another analysis of several existing studies by Li,M et al demonstrated a tendency to have an increase in eye pressure with caffeine ingestion only for people who were already diagnosed with Glaucoma or Ocular Hypertension, but no effect on people without the disease. A separate study, published by Dove Press, done with the administration of eye drops containing caffeine to 5 volunteers with either Glaucoma or Ocular Hypertension showed that there was no change in the eye pressure with the drops administered 3 times a day over the course of a week.

Summing up the available studies in terms of Glaucoma, the evidence points to maybe a slight increase in Glaucoma risk for people who consume 3 or more cups of coffee a day.

Retinal Disease

A study done at Cornell University showed that an ingredient in coffee called chlorogenic acid (CLA), which is 8 times more concentrated in coffee than caffeine, is a strong antioxidant that may be helpful in warding off degenerative retinal disease like Age Related Macular Degeneration.

The study was done in mice and showed that their retinas did not show oxidative damage when treated with nitric oxide, which creates oxidative stress and free radicals, if they were pretreated with CLA.

Dry Eyes

A study published in the journal Ophthalmology looked at the effect caffeine intake had on the volume of tears on the surface of the eye. In the study, subjects were given capsules with either placebo or caffeine and then had their tear meniscus height measured. The results showed that there was increased tear meniscus height in the participants who were given the caffeine capsules compared to placebo. Increased tear production, which occurred with caffeine, may indicate that coffee consumption might have a beneficial effect on Dry Eye symptoms.

Eyelid Twitching

For years eye doctors have been taught that one of the primary triggers for a feeling of twitching in your eyelid has been too much caffeine ingestion (along with stress, lack of sleep and dry eyes). I have been unable to find anything substantial in the literature to support this teaching. Therefore, I’m going to have to leave this one as maybe, maybe not.

The End Result

Overall, the evidence for the pros and cons of coffee consumption and its effects on your eyes appear to be rather neutral. There are one or two issues that may increase your risk for glaucoma but it also may decrease your risk of macular degeneration or dry eyes.

Since there is no overwhelming positive or negative data, our recommendation is--and this holds for most things--enjoy your coffee in moderation.

Related links

• Study: Coffee is good for your eyes
• Study links caffeinated coffee to vision loss
• Effect of caffeine on intraocular pressure
• Effect of caffeine in patients with primary open angle glaucoma
• Drinking coffee prevents eye damage
• Caffeine increases tear volume

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.

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

The answer we give is “NO!"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

One bright spot on the horizon for those who absolutely MUST swim in their contact lenses is that with the ever-growing use of daily disposable contact lenses, swimming in contacts is safer than for those who wear extended wear 2-week or monthly lenses.

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

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

Article contributed by Dr. Jonathan Gerard

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

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 can not 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, that 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

Philadelphia Phillies prospect Matt Imhof lost his right eye in 2016 after suffering a freak injury during a normal training session.

He was the 47th overall pick in the 2014 draft.

Even though his injury did not occur on the playing field, the incident has brought significant attention to sports-related eye injuries.

Here are some facts about sports-related eye injuries:

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

Protective eyewear includes safety glasses and goggles, safety shields, and eye guards designed for a particular sport.

Protective eyewear lenses are made of Polycarbonate or Trivex.

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

The highest risk sports are:

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

The most common injuries associated with sports are:

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

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

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

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

It can be common that eye doctors get patients who come in asking if the white part of their eye, the sclera, has a growth or is turning a gray color.

This is called a 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 eyes 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 ages 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

Fireworks Eye Injuries Have More Than Doubled in Recent Years

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

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

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

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

If you experience a fireworks eye injury:

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

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

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

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

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

Though typically worse in the high allergy seasons of spring and summer, some people suffer with these problems 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.

One component of this itching that I've found particularly true is 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. Alaway and Zaditor are the ones I prescribe most often.

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.