The Background

Over the last several years, research has indicated a strong correlation between the presence of Obstructive Sleep Apnea (OSA) and glaucoma. Information from some of these pivotal studies is presented below.

Did you know

• Glaucoma affects over 60 million people worldwide and almost 3 million people in the U.S.
• There are many people who have glaucoma but have not yet had it diagnosed.
• Glaucoma is a leading cause of blindness in the United States. 
• If glaucoma is not detected and goes untreated, it can result in peripheral vision loss and eventual, irreversible blindness.

• Sleep apnea is a condition that obstructs breathing during sleep.
• It affects 100 million people around the globe and around 25 million people in the U.S.
• A blocked airway can cause loud snoring, gasping or choking because breathing stops for up to two minutes.
• Poor sleep due to sleep apnea results in morning headaches and chronic daytime sleepiness.

The Studies

In January 2016, a meta-analysis by Liu et. al., reviewed studies that collectively encompassed 2,288,701 individuals over six studies. Review of the data showed that if an individual has OSA there is an increased risk of glaucoma that ranged anywhere from 21% to 450% depending on the study.

Later in 2016, a study by Shinmei et al. measured the intraocular pressure in subjects with OSA while they slept and had episodes of apnea. Somewhat surprisingly they found that when the subjects were demonstrating apnea during sleep, their eye pressures were actually lower during those events than when the events were not happening.

This does not mean there is no correlation between sleep apnea and glaucoma - it just means that an increase in intraocular pressure is not the causal reason for this link. It is much more likely that the correlation is caused by a decrease in the oxygenation level (which happens when you stop breathing) in and around the optic nerve.

In September of 2016, Chaitanya et al. produced an exhaustive review of all the studies done to date regarding a connection between obstructive sleep apnea and glaucoma and came to a similar conclusion. The risk for glaucoma in someone with sleep apnea could be as high as 10 times normal. They also concluded that the mechanism of that increased risk is most likely hypoxia – or oxygen deficiency - to the optic nerve.

The Conclusion

There seems to be a definite correlation of having obstructive sleep apnea and a significantly increased risk of getting glaucoma. That risk could be as high as 10 times the normal rate.

It's highly recommended that if you have been diagnosed with obstructive sleep apnea that you have have a comprehensive eye exam in order to detect your potential risk for glaucoma.

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.

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying out-of-pocket for certain features.

Where did this come from? Why should you have to pay out-of-pocket for cataract surgery? Shouldn’t your health insurance just cover it?

In trying to answer these questions, you will first need a little history of both cataract and refractive surgery, which corrects errors of refraction such as nearsightedness, farsightedness, and astigmatism.

Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.

Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.

The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable, enabling them to fit through tiny incisions of around 3 millimeters.

Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.

Medicare and most other insurance do not cover refractive surgery (LASIK, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by non-surgical means, such as glasses and/or contact lenses.

Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.

The merging of cataract and refractive surgeries is why there are now options to not only get your cataract removed, but also to correct your astigmatism (irregular shape to cornea) and/or presbyopia (the inability to see well up close that hits nearly everyone in their 40’s).

This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.

Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.

If you want to address your astigmatism and/or presbyopia at the time of cataract surgery in order to be less dependent on wearing glasses after surgery, then paying for those components is going to be an out-of-pocket payment for you.

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.

The 2019 National Coffee Drinking Trends report showed that 64 percent of people who participated in the 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. 

Even though the U.S. population is drinking more coffee than ever, the nation still only ranked 25th 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.

What does blood in the back of the eye signify, anyway?

It could be a retinal vein occlusion, an ocular disorder that can occur in older people when the blood vessels to the retina are blocked.

The retina is the back part of the eye where light focuses and transmits images to the brain. Blockage of the veins in the retina can cause sudden vision loss. The severity of vision loss depends on where the blockage is located.

Blockage at smaller branches in the retinal vein is referred to as branch retinal vein occlusion (BRVO).  Vision loss in BRVO is usually less severe, and sometimes just parts of the vision is blurry.  Blockage at the main retinal vein of the eye is referred to as central retinal vein occlusion (CRVO) and results in more serious vision loss. 

Sometimes blockage of the retinal veins can lead to abnormal new blood vessels developing on the surface of the iris (the colored part of your eye) or the retina. This is a late complication of retinal vein blockage and can occur months after blockage has occurred. These new vessels are harmful and can result in high eye pressure (glaucoma), and bleeding inside the eye.

What are the symptoms of a retinal vein occlusion?

Symptoms can range from nothing to painless sudden visual loss. Sudden visual loss usually occurs in CRVO. In BRVO, vision loss is usually mild or the person can be asymptomatic. If new blood vessels develop on the iris, then the eye can become red and painful. If these new vessels grow on the retina, it can result in bleeding inside the eye, causing decreased vision and floaters – spots in your vision that appear to be floating.

Causes of retinal vein occlusion

Hardening of the blood vessels as you age is what predisposes people to retinal vein occlusion.  Retinal vein occlusion is more common in people over the age of 65. People with diabetes, high blood pressure, blood-clotting disorders, and glaucoma are also at higher risk for a retinal vein occlusion.

How is retinal vein occlusion diagnosed?

A dilated eye exam will reveal blood in the retina. A fluorescein angiogram is a diagnostic photographic test in which a colored dye is injected into your arm and a series of photographs are taken of the eye to determine if there is fluid leakage or abnormal blood vessel growth associated with the vein occlusion. An ultrasound or optical coherence tomography (OCT) is a photo taken of the retina to detect any fluid in the retina. 

Treatment for retinal vein occlusion

Not all cases of retinal vein occlusion need to be treated. Mild cases can be observed over time. If there is blurry vision due to fluid in the retina, then your ophthalmologist may treat your eye with a laser or eye injections. If new abnormal blood vessels develop, laser treatment is performed to cause regression of these vessels and prevent bleeding inside the eye. If there is already a significant amount of blood inside the eye, then surgery may be needed to remove the blood.

Outlook after retinal vein occlusion

Prognosis depends on the severity of the vein occlusion. Usually BRVO has less vision loss compared to CRVO. The initial presenting vision is usually a good indicator of future vision. Once diagnosed with a retinal vein occlusion, it is important to keep follow-up appointments to ensure that prompt treatment can be administered to best optimize your visual potential.

 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.

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

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

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

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

Reading Glasses

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

Monovision

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

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

Multifocal Contacts

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

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

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

Conclusion

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

Article contributed by Eugene Schoener O.D.

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.

Motherhood...the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has proven that there is a transference of emotion and programming from birth and infancy between a mother and her child--a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind?

The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now the baby's world is no longer just one person--its mother--but also includes third parties, thereby increasing social skills and interaction.

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

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

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

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

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

References:

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

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

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

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

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

Causes of a wrinkle on the retina

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

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

Risk factors

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

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

Diagnostic testing

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

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

Treatment and prognosis

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

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

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

Article contributed by Dr. Jane Pan

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

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.

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.

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

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

It's reassuring to know it’s almost never your actual eyeball that is twitching; it’s your eyelid muscle. Actual eye twitching is fairly rare and your vision would be pretty blurry if that's what were really happening.

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

What are some of the risk factors for eyelid twitching?

Fatigue

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

Caffeine

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

Stress

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

Dry Eyes

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

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

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

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

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

Demodex folliculorum -- often just called demodex -- is a mite that occurs naturally on many people's faces and resides in hair follicles, particularly the follicles of eyelashes. Most of the time, these mites cause no problems whatsoever. However, sometimes an infestation can become particularly parasitic, resulting in unhealthy eyelid margins and leading to problems.  Those problems as a group are called blepharitis.  Blepharitis can be caused by caused by several things, including allergies, bacterial overgrowth, Rosacea and also by demodex.

Often, diagnosis of mite infestation by your eye doctor can be difficult.  The symptoms can mimic other causes of blepharitis, which is one of the most prevalent diseases we see.

The most common sign of a demodex infestation is a cylindrical cuff or "sleeve" at the base of the eyelash. Symptoms include redness, itching, burning, dry eyes and general discomfort in the eyelid.

The probability of demodex infestation increases gradually with age, with nearly 100% of people having demodex in their eyelashes after age 70.  If there are no symptoms present, nothing needs to be done about demodex, as it is a natural occurence. If any of the before-mentioned symptoms are present, however, eyelid hygiene with tea tree oil is usually the first line treatment.  Tea tree oil is known to kill the mites and there are now several brands of “eye lid scrubs” that come with tea tree oil in them.

There are also often in-office methods available for exfoliating eyelids.

If you're experiencing any demodex symptoms, make an appointment to see what treatment might be right for you.

Article contributed by Dr. Jonathan Gerard, O.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.

Here are 11 bad contact lens habits we eye doctors often see--

#1 Sleeping in your contacts.

This is the No. 1 risk factor for corneal ulcers, which can lead to severe vision loss and the need for a corneal transplant. Your cornea needs oxygen from the atmosphere because it has no blood vessels. The cornea is already somewhat deprived of oxygen when you have your eyes closed all night, and adding a contact on top of that stresses the cornea out because of the lack of oxygen. You don’t need to see when you are sleeping!  TAKE YOUR CONTACTS OUT!  I promise your dreams will still look the same.

#2 Swimming in your contacts.

Salt, fresh, or pool water all have their individual issues with bacteria, amoeba, chemicals, etc., that can leach into your contacts. If you end up wearing them in the water, then take them out as soon as you are done and clean and disinfect them.

#3 Using tap water to clean contacts.

Tap water is not sterile. See No. 2.

#4 Using your contacts past their replacement schedule.

The three main schedules now are daily, two weeks, and monthly. Dailies are just that – use them one time and then throw them away. They are not designed to be removed and re-used. Two-week contacts are designed to be thrown away after two weeks because they get protein buildup on them that doesn’t come off with regular cleaning. Monthly replacement contacts need to have both daily cleaning and weekly enzymatic cleaning to take the protein buildup off. Using your lenses outside of these wearing and maintenance schedules increases the risk of infection and irritation.

#5 Getting contacts from an unlicensed source.

Costume shops and novelty stores sometimes illegally sell lenses. If you didn’t get the fit of the lenses checked by an eye doctor, they could cause serious damage if they don’t fit correctly.

#6 Wearing contacts past their expiration date.

You can’t be sure of the sterility of the contact past its expiration date. As cheap as contacts are now, don’t take the risk with an expired one.

#7 Topping off your contact lens case solution instead of changing it.

This is a really bad idea. Old disinfecting solution no longer kills the bacteria and can lead to resistant bacteria growing in your case and on your lenses that even fresh disinfecting solution may not kill. Throw out the solution in the case EVERY DAY!

#8 Not properly washing your hands before inserting or removing contacts.

It should be self-evident why this is a problem.

#9 Not rubbing your contact lens when cleaning, even with a “no rub” solution.

Rubbing the lens helps get the bacteria off. Is the three seconds it takes to rub the lens really that hard? “No rub” should never have made it to market.

#10 Sticking your contacts in your mouth to wet them.

Yes, people actually do this. Do you know the number of bacteria that reside in the human mouth? Don’t do it.

#11 Not having a backup pair of glasses.

This is one of my biggest pet peeves with contact lens wearers. In my 25 years of being an eye doctor, the people who consistently get in the biggest trouble with their contacts are the ones who sleep in them and don’t have a backup pair of glasses. So when an eye is red and irritated they keep sticking that contact lens in because it is the only way they can see. BAD IDEA. If your eye is red and irritated don’t stick the contact back in; it’s the worst thing you can do!

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

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

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

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

Prescription Sports Goggles (e.g., Rec Specs)

The main benefits of goggles while playing sports are vision stability and eye protection. When playing fast-moving sports--like basketball, soccer, and rugby--elbows, wrists, and heads fly around at high speed, increasing the risk of eye injury. The eyes and eye sockets can be protected when covered by shatter-proof lenses. Additionally, there is no worry over having a contact lens pop out of the eye, which can be a debilitating experience for some people. The main drawback to goggles is that they can be cumbersome, decrease peripheral vision, and fog up. Additionally, very high prescriptions might not be available due to frame limitations. On the whole, this is a very good option for many people. One additional advantage to sports goggles is that they can often be made with Transitions lenses, providing automatic sun protection in bright light.

Contact Lenses

For many people, the best visual option is contact lenses, particularly soft contact lenses. The main benefits include no decrease in visual field, no fogging of lenses, and no unsightly, heavy glasses. But where sports goggles shine, contact lenses fall short--there is a higher risk of injury, the possibility of less stable vision (especially when wearing multifocal or astigmatic lenses), and the potential of a lens falling out during activities. Gas permeable (hard) lenses are not recommended for sports.

Wearing Nothing

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

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

Article contributed by Dr. Jonathan Gerard

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

Oftentimes, contact lens wearers will skimp on their lens care because some of the solutions are costly and it seems like a good way to save some hard-earned cash. But this is not a good idea.

Cutting corners can result in infections or irritations, and after one or two copays to your eye doctor's office you probably will have spent more than what you saved in a year by cutting corners--plus you have to deal with your discomfort and inability to wear your contact lenses while you are being treated.

The reasons you clean your contacts is to give increased lens comfort, prolong lens oxygen permeability, and to protect your eyes from infection. The reason you have to disinfect your contact lenses is - as nasty as it may sound - that your eyeball and eyelids are covered in essential bacteria that are kept in check by your body’s immune system. When you remove your contact lens at night it is covered in these essential bacteria. If you don't kill them overnight this will allow the bacteria to grow unchecked and then, instead of inserting a freshly cleaned lens, you are inserting a lens covered in more bacteria than your eye is used to and you end up getting an infection.

Let’s talk about the most widely used type of solution - the multipurpose solution. While this is often the most incorrectly used solution, multipurpose solution is a very safe and effective disinfection method when used properly.

Many multipurpose solutions advertise themselves as “No Rub.” Just put it in the case and you are done. This is OK to do, but a quick rub with the no-rub solution in the palm of your hand and the opposite hand’s middle or ring finger provide an even better cleaning option. Just the slight roughness of your fingerprint adds a light scrubbing effect that helps improve the removal of surface debris, protein, and mucous better than just letting the lens soak overnight. This rubbing of the lens is especially important for women to remove any cosmetics that are rarely removed by just soaking alone. These few seconds of extra cleaning will make your lenses stay more comfortable longer during their wearing cycle, and help to keep the pores of the lenses open, allowing more oxygen to contact your cornea.

Many name brands and store/warehouse brands of multipurpose solutions exist. All are FDA approved to do the same thing: clean/disinfect/rinse/store your contact lenses. You can't really mess them up unless you try. Remove the lenses, lightly rub them with the multipurpose solution, place your lens into a CLEAN and DRY lens case, and cover the lens with solution to disinfect it. Then let it sit for the number of hours recommended by the manufacturer, generally between 4 to 8 hours, or overnight. Remove the lenses in the morning, rinse with the same multipurpose solution and rinse the lens case out and leave it open to air dry in an area away from your sink and toilet to prevent airborne contaminants from getting into your case as it dries.

The biggest misuse of the multipurpose solution is not changing your case’s solution nightly and just adding more solution to the case each night. We call this “topping off the case.” This is NOT safe because it will lose disinfection power since the old/used solution was busy killing the bacteria and organisms from the night before. Just adding a little fresh solution will eventually allow for the bacteria to take over and you may be adding more bacteria into your eyes than if you never disinfected the lenses to begin with.

Multipurpose solution companies oftentimes will give you a new case when you buy bigger bottles of solution. You should start using the new case with the new bottle of solution. Dont's just stash the case away. There are fungi and other organisms that have been demonstrated to grow from very old lens cases so USE the new case and don't keep it for when you break the old one.

There are many different multipurpose solutions on the market. They aren't cheap and it is tempting to purchase “what is on sale” to save a few dollars. If it does the same thing as the expensive one, then why bother spending the extra? But remember, your contacts are like little sponges that soak up your lens solution. The lens companies don't care if brand A’s solution is compatible with brand B’s or C’s. So over time you can develop a sensitivity to one particular brand of solution, or mixing solutions with the same lens can cause a chemical reaction that occurs because the solutions are not compatible. If you are using the same brand regularly and start having issues your doctor may recommend a solution change to another company that you haven't tried and this may potentially solve your problem. But if you have used several different ones in a few weeks prior to your visit it makes it much harder to determine the cause of your irritation.

The generic/store brands are usually fine products but a grocery store or discount chain doesn’t have a factory that makes their solution for them--they purchase it from a larger supplier. These third-party suppliers can alter their recipe for their multipurpose lens solution and you as the consumer would never know. You could just start finding your contacts are not as comfortable as they used to be and it is actually the unknown generic solution change that is bothering you. Brand name companies like Bausch and Lomb, AMO, and Alcon will rarely make product changes without making consumers aware that they've reformulated the product so if something changes with the reformulated product you have a better chance of knowing it than with a generic solution manufacturer.

Finally, there is a product called saline solution. Saline is extremely inexpensive, generally half to a third the price of multipurpose solutions. This is a product made by many different companies and was the first lens solution ever used. Saline solution was initially used in a heat disinfection system where the lenses were boiled nightly. The boiling of the lens provided the disinfection, not the saline solution. The solution was to just to prevent the lens from drying out while you cooked it. You should NEVER use saline solution as a replacement for multipurpose solution. Saline solution is NOT a disinfectant for your lenses. It doesn’t contain an agent that will prevent bacteria and organisms from growing in the case overnight. However, it’s totally acceptable if you want to rinse your lenses in the morning with saline prior to inserting them after they were disinfected with your multipurpose solution.

Oftentimes, a practitioner will recommend a certain type of solution to help with things like dryness, environmental allergies, or allergies to specific solutions. I always recommend to check with your practitioner before making any changes to your lens care solution or lens care routine. The best advice for saving money on your preferred solution is buy extra when it is on sale, buy in bulk, and buy what is most comfortable in a multipurpose solution for you. Then stick with it and use it correctly for many years of happy lens wear.

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.

Hydroxychloroquine (Plaquenil) was originally used to treat malaria and is now commonly used to treat rheumatological and dermatological diseases. It is frequently used for rheumatoid arthritis (RA) and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause.

One of the most significant side effects of the drug is its possibility of causing eye problems resulting in blurred or decreased vision. The most common issue is damage to the retina. It can impair  color vision or damage the retinal cells, particularly in the area right around the central vision.

In your retina, the area that you use to look straight at an object is called the fovea. The fovea is the area that provides you with the most definition when looking at an object. The area just around the fovea is called the macula and it has the ability to see objects with slightly less definition than the fovea but significantly better than the rest of your retina, which accounts for your peripheral vision. The most common place for Hydroxychloroquine to cause a problem is in a ring of the macula surrounding the fovea.

The reason it is important to detect any of these changes as early as possible is because in many instances the changes are not reversible even if you come off the medication.

The risk of this happening is highly correlated with the cumulative dose of the drug you have received. So, the higher the dose and the longer you have been on it the higher your risk.

The current recommendation is a daily dose that does not exceed 6.5 mg/kg/day (that is milligrams per kilograms per day).  There are approximately 2.2 pounds in a kilogram.  The pills come in 200 mg tablets.  Most people who are on this drug are on either 200 mg once a day or 200 mg twice a day. The safety break point comes at around 135 pounds. People weighing more than that will stay within the safety guidelines (not more than 6.5mg/kg/day) at 400mg per day, but people under 135 pounds should probably only be taking 200 mg per day.

Other risk factors for Hydroxychloroquine retinal toxicity include kidney or liver disease and obesity. Obesity is a risk factor because the drug does not penetrate fat tissue so there is more of the drug in your lean body mass (including your retina and its supporting cells called the retinal pigment epithelium). What that means in real terms is that if you take two people who each weigh 140 pounds and put them both on 400 mg a day and one person is 4-foot 11 and the other is 5-foot 9, the 4-foot 11 inch person is at greater risk for side effects because the shorter person has more of their body weight in fat tissue. Since the hydroxychloroquine can’t penetrate the fat tissue that means there is a higher concentration of it in sensitive tissues like the retina.  People with kidney and liver problems have a tougher time eliminating the drug from their system so they are at higher risk because the body is going to retain more of the drug for a longer period of time.

The recommendation is to have a baseline eye exam with dilation and a visual field test before or soon after starting the drug. A repeat of that exam should occur every year if there is no evidence of toxicity.  

The actual incidence of retinal toxicity from hydroxychloroquine is difficult to pin down because there is usually a long time between being started on the drug and the start of any identifiable retinal toxicity. The overall rate of probable retinal toxicity is in the range of 1 of every 200 people treated. The rate is much lower than that in the first 7 years of treatment but gets to about 5 times higher after 7 years of treatment. Some of that data is old now and there is much greater awareness currently about keeping people below that 6.5 mg/kg/day dosage level.

I have been in practice for over 25 years and have seen “probable” retinal toxicity from hydroxychloroquine a total of 5 times and only once in the last 10 years when people have been more careful about keeping the dosage in the right range.

The drug can be very effective in its treatment of RA and Lupus and the likelihood of serious vision problems is small and can potentially be avoided with the correct dosing and monitoring of the eyes. Other drugs in the treatment for RA or lupus may have more frequent or serious side effects then Hydroxychloroquine so it would be wise to consider it a viable treatment option and not easily dismiss it because of the risk of what amounts to a fairly infrequent eye issue.

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

In honor of St. Patrick’s Day and the “wearin’ of the green,” we thought it would be fun and fitting to share some interesting facts about green…eyes!

#1

Green is the rarest eye color. If your sparklers are truly green, you are something of a unicorn… only about 2% of the world’s population sport this hue.  

#2

Green-eyed people can be found all around the globe. There is a Chinese village, Liqian, where a high percentage of the population sports green eyes and lighter hair.

#3

There isn’t any actual green pigment in a green eye. Melanin, a natural pigment that helps determine our skin, hair, and eye color, is found in all eyes. Brown eyes have quite a lot and blue eyes have relatively little. Green eyes are also low on melanin, but in addition they contain lipochrome, a yellowish, fat-soluble pigment. Lipochrome is also found in things like butter, eggs, and corn. So a little melanin, some lipochrome, and a cool light dispersing scattering called the Tyndall Effect combine to produce those rare green eyes!

#4

At least 16 genes contribute to eye color. You might have been taught in biology class that two brown-eyed parents can have only brown-eyed children, but it’s more complicated than that.

#5

Green eyes are popular in cultural references. Here are some famous characters with green eyes:

·         Jane Eyre—that plucky governess living in a “haunted” mansion, from the book Jane Eyre

·         Rapunzel—another courageous hero in Tangled

·         Scarlet O’Hara—feisty protagonist in Gone with the Wind

·         Scar—the scheming uncle in The Lion King

·         Mary Jane Watson, Catwoman, Batgirl—green eyes are popular in the world of comics

·         Sara Crewe—brave little girl from A Little Princess

·         Harry Potter – from the Harry Potter book series by J.K. Rowling

#6

In a large survey performed by All About Vision, green was voted the most attractive eye color, with over 20% of the 66,000 respondents choosing this hue.

#7

More women than men have green eyes. Scientists aren’t sure why this is, but it suggests there is an underlying gender-related factor that causes this difference.

#8

Animals can also sport green eyes.  Green eyes occur in dogs, snakes, frogs, birds, monkeys, multiple members of the cat family, and many other animals.

#9

People with green eyes are more likely to have certain health issues. Green eyes are more prone to melanoma of the uvea, a type of eye cancer, than are dark eyes. The same is true for macular degeneration. If you have green eyes, protect those beautiful peepers with a quality pair of sunglasses to lower your chances for these diseases!