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.

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

Hygiene is critical to wearing your contact lenses safely.

Contact lenses can significantly improve your vision, but it’s essential to care for them properly to avoid potentially serious infections or other problems.

These recommendations will help extend the life of your contact lenses and keep your eyes safe and healthy. 

Your lens insertion and removal routine

  • Before you handle contacts, wash and rinse your hands with a mild soap.
  • Make sure the soap doesn’t have perfumes, oils, or lotions. They can leave a film on your hands.
  • Dry your hands with a clean, lint-free towel before touching your contacts.
  • It’s a good idea to keep your fingernails short and smooth so you won't damage your lenses or scratch your eye when inserting or removing your contacts.
  • Lightly rubbing your contact in the palm of your hand with a few drops of solution helps remove surface build-up.
  • Rinse your lenses thoroughly with a recommended solution before soaking the contacts overnight in a multi-purpose solution that completely covers each lens.
  • Store lenses in the proper lens storage case.
  • Don't use tap water or saliva to wash or store contact lenses or lens cases.
  • If you use hair spray, use it before you put in your contacts.
  • Put on eye makeup after you put in your lenses. Take them out before you remove makeup.
  • Always follow the recommended contact lens replacement and wearing schedule prescribed.

Your supplies

  • Use doctor-recommended solution.
  • Rub and rinse your contact lens case with sterile contact lens solution. Never use water.
  • Clean the case after each use.
  • Replace your contact lens case at least once every three months. 
  • Don’t “top off” solution. Use only fresh contact lens disinfecting solution in your case. 
  • Never mix fresh solution with the old or used solution.
  • Change your contact lens solution according to the manufacturer's recommendations.

Your eye doctor

  • Visit us yearly or as often as recommended.
  • Ask us if you have questions about how to care for your contacts and case or if you are having any difficulties.
  • Remove your contact lenses immediately if your eyes become irritated. Call us and let us know what’s going on.
  • Call us if you have any sudden vision loss, blurred vision that doesn’t get better, light flashes, eye pain, infection, swelling, unusual redness, or irritation. 

Wear your contacts safely

  • Some contacts need special care and products. Always use the disinfecting solution, eye drops, and enzymatic cleaners your doctor recommends. Some eye products or eye drops aren’t safe for contact wearers.
  • Saline solution and rewetting drops do not disinfect lenses.
  • Use a rewetting solution or plain saline solution to keep your eyes moist.
  • Don’t wear your contacts when you go swimming in a pool or at the beach.
  • Don't sleep in your contact lenses unless prescribed by your eye doctor.
  • Don’t clean or store your contacts in water.
  • See us for your regularly scheduled contact lens and eye examination.
  • If you think you’ll have trouble remembering when to change your lenses, ask for a chart to track your schedule or make one for your needs.

Be sure to call us if you have any questions about caring for your contact lenses or if your eyes are having problems.

There is a common misconception that any adverse reaction to a drug is an allergy. That is definitely not the case.

Reporting to your doctors that you have an allergy to a medication when what you really had was a side effect could potentially create a substantial alteration to your medical care in the future. And this could mean a physician might avoid using a drug that could possibly save your life because of the fear of an allergic reaction.

An anaphylactic allergic reaction generally produces a very specific set of symptoms, including difficulty breathing due to constriction of windpipe, swelling of your tongue, and/or a rash and hives that break out over your body. While an allergic reaction can present in other ways, these are the most frequent reactions that occur when you have a true allergy to something.

If that is not the type of reaction you had then it probably isn’t an allergy. If you are uncertain if your reaction to a medication is an allergy or not, testing by an allergist may be able to tell you if your reaction was a true allergy or a side effect.

It is not always just the patient who misdiagnoses a side effect as an allergy. Sometimes it is the doctor or the dentist who tells the patient, “You must be allergic.” This is a quick and easy explanation but not always the correct one.

In optimal medicine, there are not always a lot of “lifesaving” incidences but there are several drugs that are the preferred treatment for certain conditions and if you report an allergy to these drugs it may make your doctor use a much less effective drug.

Here are some specific examples of when a false report of an allergy may lead to less effective treatment or even failure to offer life-saving treatment.

Epinephrine

The most common potential “lifesaving” drug to which patients sometimes report an allergy to is Epinephrine.

The story usually goes something like this: “I was having a dental procedure and soon after the dentist injected my mouth with a local anesthetic of lidocaine with epinephrine my heart started racing and pounding out of my chest and I almost passed out.” This hypothetical patient may come to the conclusion or the dentist may mention that the patient is allergic to epinephrine. That reaction is almost never an allergy but a side effect that occurs when a substantial dose of the lidocaine and the epinephrine gets into the blood stream and stimulates the heart.

The mouth and gums are very vascular, and it is easy to have some of that injection end up in the bloodstream, but that reaction is not an allergy and should not be reported as such.

Epinephrine is used to treat severe (anaphylactic) allergic reactions and not using it if you were to ever have a severe allergic reaction could lead to some very bad outcomes. This is not to say you can’t be allergic to epinephrine. You can, but it is extremely rare. If there is any doubt you should be tested by an allergist before you ever record yourself in a medical setting as being “allergic” to epinephrine.

Cortisone/Steroids

Cortisone is a highly effective drug to treat many conditions. Again, it is unlikely but not impossible to be allergic to it.

We all have naturally occurring cortisol circulating in our bodies and cortisone is a very similar molecule but not exactly the same. Cortisone also can have a wide range of side effects depending on where and how it is administered

Some of the common side effects of cortisone, which have been mislabeled as an allergy, are: Making your blood sugar rise, insomnia, mood swings, nausea, and weight gain. These are all known side effects of the drug and not allergies. Cortisone side effects are associated with only certain routes of administration and are often dose dependent.

Why is this important in terms of your eye care? We often use cortisone derivatives, like Prednisolone, to fight inflammation that may occur in your eye, particularly after any ocular surgery. If you report that you are allergic to cortisone when you really only experienced a side effect we are going to have to use a less-effective medication to deal with your eye inflammation.

As I mentioned above, most side effects are dose dependent and the dose you got in a pill may have caused a side effect you’d rather not have again but the dose in an eye drop is significantly less and highly unlikely to give you the side effect you got with a pill taken orally.

Antibiotics

People often report they are allergic to antibiotics when they really experienced a side effect.

The most common side effect with oral antibiotics is some type of gastrointestinal disturbance, like nausea, or diarrhea. If that was what you had and just prefer not to get that again you still shouldn’t report it as an allergy. If you do, then the drug can’t be used as an eye drop or ointment that might be the best treatment for your condition.

An antibiotic eye drop/ointment is very unlikely to produce the same gastrointestinal trouble that the same antibiotic gave you when given as a pill. You don’t want to take away the most effective treatment for your problem because you mislabeled a side effect as an allergy.

Sedatives/Anesthesia

Most of the time with these drugs the issue is how you felt either during or after a procedure.

Common comments are “it took me too long to wake up” (side effect not an allergy); “the sedative I got in my IV burned when it went in” (side effect not an allergy); “I was sleepy all day” (side effect not an allergy); “I was nauseous after the procedure” (could be an allergy but much more likely to be a side effect).

Why are these important? We can make you much more comfortable for a local anesthesia procedure if we can use some sedation. Using sedation may be better for you and the doctor performing the surgery because you are much less likely to move during the surgery if you are resting comfortably.

If you ever have an untoward reaction to a medication it is worth your time and effort to really probe into the issue to figure out if what you had was really an allergy or just a side effect because sometimes your life may depend on it.

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

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

Although we don’t know the exact mechanism by which humans have a decreased ability to focus up close as we age (a process called presbyopia), the fact remains that it will happen to 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 at 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 further 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 needs to get stronger, usually at a clip of about one step every 2 to 3 years.

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

The decrease in reading ability without using glasses is going to continue to get worse as you get older whether you wear the reading glasses or not. Trying not to wear the glasses and struggle 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 struggling needlessly.

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

Motherhood...the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has recently proven that there is a transference of emotion and programming from birth and infancy between a mother and her child--a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind? These questions and more can be answered through a term called “triadic exchanges” in which infants learn social skills.

The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now their world is no longer just one person, their mother, but a third party which teaches them the art and skill of organizing their social skills and interaction.

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

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

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

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

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

 

References:

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

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

 

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

If you were to do a Google news search for sports-related eye injuries today, chances are you'd find multiple recent stories about some pretty scary eye injuries.  Whether they are professionals, high school or college athletes, or kids in community sports programs, no one is immune to the increased danger sports brings to the eyes.

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 could be avoided with the use of protective eyewear.

Protective eyewear includes safety glasses and goggles, safety shields, and eye guards designed for individual sports.

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

The eye care medical field has an unusual split between two different types of insurance for covering eye issues: health insurance and vision insurance. Not all patients have both.

In most cases, your health insurance is used to cover medical and surgical eye problems but not routine exams or the cost of contacts or glasses. Those things are often covered by separate vision insurance.

Why the difference? Originally, health insurance was created to take care of health “problems” and wasn’t designed to cover “routine,” “screening,” or “wellness” exams.

Since health insurance wasn’t going to cover “routine” eye exams, the vision insurance industry arose to help insure/cover those routine exams as well as the costs of glasses and/or contacts if they were needed.

That dichotomy now often causes great confusion when you make an appointment at your eye doctor. When making your appointment, the office is going to need to know which insurance, if you have both, you are going to be using for this particular visit.

Why does the office need to know in advance which insurance you are using?

The main reason is that the rules and sometimes the providers are different for each insurance plan. The vision plans often require the office to check on your availability for coverage and get pre-authorization for the visit BEFORE you get to the office. There are also differences in which providers within an office are in network for the insurance. For example, in some practices the optometrists might be in all the vision plans but the ophthalmologists might not in those plans. If you make an appointment with one of the ophthalmologists and tell the office you are using your health insurance you can’t change your mind the day of the appointment and use your vision insurance instead.

There are also differences in what the insurance will cover as a reason for the exam.  Vision insurance typically covers ONLY routine exams. Those are exams during which you are coming in specifically to get your vision, glasses and/or contact lens prescription checked and get an overall eye health screening.  That means you CAN’T have a medical complaint about your eyes you want the doctor to deal with. Eyes itchy? Need to use your medical/health insurance.  Dry eyes? Need to use your medical/health insurance.  Have a cataract? Glaucoma? Macular Degeneration? Need to use your medical/health insurance.

Why not just use your medical insurance all the time? That’s mostly because if you have no complaint at all your medical insurance won’t cover that visit (and “my vision is a little blurry” usually won’t cut it).  There is one other issue and that is the refraction.

A refraction is when we check to see if you need a new eyeglass or contact lens prescription. For the most part, health insurance won’t cover the fee for the refraction, which is a procedure that is separate from your eye health exam. Your vision insurance will cover the refraction but not the exam if you are having a medical problem.

Here’s the real kicker. Your health insurance will cover your medical eye problems and your vision insurance will cover your refraction, BUT you can’t use both insurances at the same visit. It has to be one or the other.  (Ridiculous right? I didn’t make the rules, just trying to abide by them.)

So, what are your choices if you have both a vision plan and health insurance? If you have a problem, you need to use your health insurance. If you want to have your eyes refracted so you can get new glasses at the same time you can either pay out of pocket for the refraction OR you can come back in for a second visit, using your vision plan to get a refraction and eye health screening exam so that the refraction gets covered. (Again - I didn’t invent these rules--I am just trying to help you navigate them.) If you don’t want to make two visits, then use your health insurance (with the appropriate complaint) and pay for the refraction and just use your vision insurance to help pay for the actual contacts or glasses you are going to buy.

If you have a question, it’s best to ask when you call the office to inquire about an appointment.

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

 

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 where 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 painless sudden visual loss to no visual complaints. 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.

Nowdays, many people prefer shopping online to shopping in stores for many of their needs.

With technology constantly improving and evolving, people like the convenience of shopping online. Whether it’s clothing, electronics, or even food, you can easily find almost everything you need on the Internet.

Eyeglasses, unfortunately, are no different. Many online shops have been popping up in recent years, offering people that same convenience. But what they don’t tell you is that it comes at a price, and this article’s purpose is to shine a light on the negatives of shopping online for eyeglasses.

Here are some important reasons to avoid the temptation of ordering glasses online.

  1. Accuracy- Instead of saving the most important point for last, we will focus on the main reason that ordering eyeglass online is not the best choice. Product accuracy is a huge reason that the online market has not completely taken off. Every person who needs eyeglasses needs to understand the process for how their prescription is obtained in order to truly understand why shopping online is not ideal. It is called an eyeglass prescription for a reason. Your ophthalmologist or optometrist is prescribing your lenses as if they were prescribing any form of medication. To take that prescription and hand it over to a website that does not require licensed workers to interpret the prescription is not the wisest choice. Equally as important as the prescription itself are the pupillary distance (PD) and the optical centers measurements. These measurements are not given at the time of the examination by the ophthalmologist or optometrist, but instead are administered by the optician at the point of sale. Not having these measurements done accurately will negatively affect the quality of vision as much as an error in the prescription.
  2. Quality- The quality of the product you are purchasing is often affected when making the decision to purchase online. The saying “too good to be true” is the case more times than qualified optician. Websites rely on mass production in order to operate. Factory workers operating machines pale in comparison to the experience you will receive in a professional office. Skilled opticians who interpret and manufacture your eyeglass prescriptions are held to a much higher standard than factory workers.
  3. Warranty- Due to their low prices, most of these websites do not include any form of product warranty or guarantee. Local eyecare practices, however, stand behind your purchase. If there are issues with adjustment or a patient not being comfortable in a specific lens or product, professional optometrists and opticians are willing to work with you. This personal experience is not attainable on the web.
  4. Coordination with Your Doctor- With the complexity of eyeglass lenses, the ease of working in house is always a benefit worth keeping in mind. Eyeglass lenses can be very complex products. Having the benefit of being able to work directly with the doctor gives the optician the best chance to put you in the exact lenses you need. There is a substantial difference in the percentage of error between shopping online and the care you get in a private practice.
  5. Personal Experience- The biggest factor for many people is that the personal experience you get when shopping in person is something you cannot obtain by using the Internet. Dealing with the same opticians year in and out is something patients emphasize and appreciate. Just like people tend to keep the same doctors over the years, patients like knowing that the same people will be in charge of making/ordering their glasses. Shopping online will not offer that experience.

All of these factors should be carefully weighed when making the decision to shop online. While the initial price difference could entice you at first, know that it does come at a price. Whether it be a warranty, quality, or convenience issue, all of these are very important factors when buying glasses. People sometimes tend to discount how intricate eyeglasses are.

Purchasing eyeglasses is handled best in person by professionals who can provide you with the utmost care and quality.

 

Article contributed by Richard Striffolino Jr.

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

As an eye doctor, diagnosing a red eye can be challenging. Are we dealing with an infection, allergy, inflammation or dryness?

One of the most common questions I get is, “Doc, my eyes are red, burning, itchy, and tearing. Is this dry eye or from allergies?” The short answer is it could be one, both, or neither. I’ll outline various ways these conditions present clinically and the treatments for them.

The hallmark symptom of allergy – meaning if you have this symptom you almost definitely have the condition – is itching. Red, watery, ITCHY eyes are almost invariably due to an allergen, whether environmental or medicinal. It is one of the most common ocular conditions we, as eye doctors, treat -- especially when plants are filling the air with pollen as they bloom in the Spring and then die off in the Fall.

The itching occurs because an immune cell called a mast cell releases histamine, causing the itching sensation. It can be quite unbearable for the sufferer, causing them to rub their eyes constantly, which actually increases the amount of histamine in the eye, leading to worsening of the symptoms.

Treatments may include:

  • Over-the-counter or prescription allergy drops (mostly anti-histamines or mast cell stabilizers).
  • Topical steroids (to get the inflammation under control).
  • Cool compresses applied to the eye.

Patients sometimes need to take drops every day to keep their symptoms under control.

Dry eye can have many of the same symptoms as allergic eye disease, with the eye being red and possibly watery ("My eyes are tearin--how could it be dry eyes?"). The main exceptions are that people with dry eyes tend to complain more of burning and a foreign body sensation - like there is sand or gravel in the eye - rather than itchiness.

Dry eye is a multi-faceted disease with many different causes and treatments. Treatment ranges from simple re-wetting eye drops to long-term medications (both topical and oral), as well as non-medicinal treatments such as eyelid heating treatment.

So how do we determine the difference? The first question I ask patients who complain of red, watery, uncomfortable eyes is, “What is your MAIN symptom? Itching or burning?” The answer will likely direct which course of treatment we take, and as those treatments sometimes overlap, you may have a component of both dry eye and allergy.

That is important to distinguish because many of the treatments we use for allergies - like antihistamine eye drops - can sometimes make the dryness worse. Though neither of these conditions is 100% curable (except maybe for allergy, where if you remove the allergen, you obviously won’t get symptoms!). We have many tools in our treatment arsenal to keep the symptoms at bay.

Unfortunately, dry eye and allergy aren’t the only two things that can cause your eye to have the multiple symptoms of red, watery, itchy, burning eyes. There are other problems, such as blepharitis, that can produce a similar appearance, as well as bacterial and viral infections.

So before embarking on a particular therapy, it is wise to have a good exam to help you get on the right track of improving your symptoms.

Article contributed by Dr. Jonathan Gerard

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.

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

 

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The 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 ranks 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

 

 

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.

Hydroxychloroquine (Plaquenil) was originally used to treat malaria and is now used mostly to treat rheumatological and dermatological diseases. Its most frequent use now is 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 your 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.

One of the most commonly asked questions in an eye exam comes right after the refraction, or glasses prescription check: “What is my vision?”

Almost invariably, people know the term “20/20”. In fact, it’s a measure of pride for many people. “My doctor says I have 20/20 vision.” Or, on the other side of that same coin, having vision that is less than 20/20, say 20/400, can be a cause of great concern and anxiety. In this discussion I will describe what these terms actually mean.

To lay the foundation, let’s discuss some common terms. Visual acuity (VA) is clarity or sharpness of vision. Vision can be measured both corrected (with glasses or contact lenses) and uncorrected (without glasses or contact lenses) during the course of an eye exam. The result of an eye exam boils down to two different but related sets of numbers: your VA and your actual glasses prescription.

The notation that doctors use to measure VA is based off of a 20-foot distance. This is where the first 20 in 20/20 comes from. In Europe, since they use the metric system, it is based on meters. The 20/20 equivalent is 6/6 because they use a 6-meter test distance. The second number is the smallest line of letters that a patient can read. In other words, 20/20 vision means that at a 20-foot test distance, the person can read the 20/20 line of letters.

The technical definition of 20/20 is full of scientific jargon - concepts such as minutes of arc, subtended angles, and optotype size. If you’d like to read more of the technical details there is a well-written article with illustrations by Dr. John Ellman, you can find here.  For the purposes of our discussion here I’ll try to explain it in less technical terms.

“Normal” vision is somewhat arbitrarily set as 20/20 (some people can see better than that). Let’s say you have two people: Person A with 20/20 vision and Person B with 20/40 vision. The smallest line of letters that person B can see at 20 feet is the 20/40 line.  Person A, with “normal” 20/20 vision, could stand 40 feet away from that same line and see it. There is somewhat of a linear relationship in that the 20/40 letters are twice the size of the 20/20 letters and someone with normal vision could see a 20/40 letter at twice the distance as the person with 20/40 vision.

So how does this translate to a glasses prescription?

Eye doctors can often estimate what your uncorrected VA will be based on your glasses prescription. This works mainly for near-sightedness. Essentially, every quarter step of increasing glasses prescription (i.e. -1.25 as compared to -1.50) means a person can see one less line on a VA chart.

A prescription of - 1.25 works out to roughly 20/50 vision, -1.50 to 20/60 and so on. Anybody with an anatomically sound eyeball, meaning the absence of any kind of disease process, should generally be correctable to 20/20 with glasses or contact lenses. It is important to note, however, that rarely a person’s best corrected VA may be less than 20/20 with no noticeable signs of disease.

Far-sightedness is more difficult to estimate because it is affected by a number of other factors, including one’s age and focusing ability. But that’s a topic for another article.

So there you have it! Hopefully this has shed some light on what these measurements that we take actually mean, and it has allowed you to understand your eye health a little bit better.

Article contributed by Dr. Jonathan Gerard

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 from 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 either bacteria or chemicals that can leach into your contacts. If you absolutely need to wear them to be safe 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 schedules and maintenance 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.

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

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

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

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

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

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

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

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

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

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

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

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

But bilberry is not without potential side effects.

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

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

 

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

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 extra out-of-pocket for it.

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 an/ 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.

Here are some treatment options for Dry and Wet Age Related Macular Degeneration.

Nutritional supplements and Dry Age Related Macular Degeneration (AMD)

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

Following is the supplementation:

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

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

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

Wet AMD treatments

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

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

Laser Treatment for Wet AMD

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

Photodynamic Therapy or PDT

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

 

Article contributed by Jane Pan M.D.

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

Just like adults, children need to have their eyes examined. This need begins at birth and continues through adulthood.

Following are common recommendations for when a child needs to be screened, and what is looked for at each stage.

A child’s first eye exam should be done either right at or shortly after birth. This is especially true for children who were born prematurely and have a very low birth weight and may need to be given oxygen. This is mainly done to screen for a disease of the retina called retinopathy of prematurity (ROP), in which the retina does not develop properly as a result of the child receiving high levels of oxygen. Although rarer today due to the levels being monitored more closely, it is still a concern for premature babies.

The next time an eye exam is in order is around 6 months. At this stage, your pediatric eye doctor will check your child’s basic visual abilities by making them look at lights, respond to colors, and be able to follow a moving object.

Your child’s ocular alignment will also be measured to ensure that he or she does not have strabismus, a constant inward or outward turning of one or both eyes. Parents are encouraged to look for these symptoms at home because swift intervention with surgery to align the eyes at this stage is crucial for their ocular and visual development.

It is also imperative for parents and medical professionals to be on the lookout for retinoblastoma, a rare cancer of the eye that more commonly affects young children than adults. At home, this might show up in a photo taken with a flash, where the reflection in the pupil is white rather than red. Other symptoms can include eye pain, eyes not moving in the same direction, pupils always being wide open, and irises of different colors. While these symptoms can be caused by other things, having a doctor check them immediately is important because early treatment can save your child’s sight, but advanced cases can lead to vision loss and possibly death if the cancer spreads.

After the 6-month exam, I usually recommend another exam around age 5, then yearly afterward. There are several reasons for this gap. First, any parent with a 2- to 4-year-old knows that it’s difficult for them to sit still for anything, let alone an eye exam. Trying to examine this young of a patient can be frustrating for the doctor, the parent, and the child. Nobody wins. By age 5, children are typically able to respond to questions and can (usually) concentrate on the task at hand. If necessary at this stage, their eyes will be measured for a prescription for glasses and checked for amblyopia, commonly known as a “lazy eye”. Detected early enough, amblyopia can be treated properly under close observation by the eye doctor.

The recommendations listed above are solely one doctor’s opinion of when children should have eye exams. The various medical bodies in pediatrics, ophthalmology, and optometry have different guidelines regarding exam frequency, but agree that while it is not essential that a healthy child’s eyes be examined every year, those with a personal or family history of inheritable eye disease should be followed more closely.

Article contributed by Dr. Jonathan Gerard

NOTE: Many eye doctors commonly like to have another exam around age 3, in order to make sure a pre-schooler's vision is developing correctly. Please go by what your trusted eye doctor advises.

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 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 will 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.

Do you have family members with eye-related conditions?

The two main eye diseases in adults that have a genetic link are glaucoma and age-related macular degeneration (AMD).

Glaucoma is a deterioration of the optic nerve caused by pressure in the eye or poor blood flow to the optic nerve. It has no symptoms at its onset. In most cases if you wait until you begin to realize there is something wrong with your vision to get glaucoma diagnosed, upwards of 70% of your optic nerve will have already been destroyed. Once the nerve is destroyed there is no way of reversing that today and treatment is focused on trying to preserve whatever nerve tissue is left.

Your chances of getting glaucoma are four to 10 times higher if you have a close relative with glaucoma. Getting your eyes examined regularly is always important but even more so if there is a family history of glaucoma.

Macular degeneration is the leading cause of blindness in most of the developed world. It too can cause serious vision loss if you wait until you have significant symptoms before a diagnosis. There are now some preventative treatments for AMD--the earlier it is detected the better off you will be.

Having a close family member with AMD may increase your chances of having the disease as much as 50 percent, making timely diagnosis and treatment imperative.

Other eye diseases that run in families include strabismus (crossed eyes), myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

All of these family connections are important to know so that you and your eye doctor can together take the best possible care of your eyes. Before your next eye exam ask your relatives if they have any history of eye disease. It might not make for the lightest of conversation at your next family gathering but it could help save your vision.

 

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

Our Mission

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