Cataracts vs Glaucoma

January is Glaucoma Awareness Month so it’s a good time to get a few things straight!  Many patients come into my office asking about glaucoma and cataracts and a lot of them get the two mixed up.  Let’s break it down:

• Cataracts are an age-related change that happens to everyone if you live long enough and can easily be corrected with surgery.
• Glaucoma is a disease process that can lead to permanent vision loss.  There is also a genetic component to glaucoma that can increase a patient’s risk for developing glaucoma if it runs in their family.

Cataracts

Cataracts are an age-related change that causes the lens inside your eye to become cloudy as you age.  There are several different types of cataracts: nuclear, cortical and sub-capsular.  This refers to the location of the lens where the cataract is forming.  We typically grade cataracts on a scale of 0-4, zero being very minimal and four being the densest.  During the formation of cataracts, patients normally notice their vision becoming cloudy or “like looking through fog”.

Cataracts can also cause changes in your glasses prescription, most commonly a myopic shift, which causes you to become more near-sighted.  Sometimes vision can be improved significantly just by updating the glasses prescription, but otherwise surgery is the only option to improve vision.  Cataract surgery is outpatient surgery, in fact, it is the most commonly performed procedure in the world.  For cataract surgery, only local anesthesia is needed in most cases, and the procedure takes less than an hour.  Most patients find a great improvement in not only the clarity of vision after surgery, but also brighter colors.

Glaucoma

For comparison, glaucoma is a disease process that causes damage to the optic nerve and can lead to permanent vision loss.  Typically, increased pressure within the eye causes the optic nerve damage, but it can also occur in patients whose eye pressure is within the normal range.  Also, glaucoma is painless in most cases, so most people do not realize they have it until the vision loss is severe.  In addition, vision loss begins peripherally, which is also difficult for most patients to notice in the early stages.  That is why it is very important to see an optometrist regularly so they can check your eye pressure as well as the health of your optic nerve.  If either of those things seems suspicious to the doctor, they will usually run other tests, including a visual field.  This is a special machine that can plot out any potential blind spots that would be too small for you to notice.  Because vision loss with glaucoma is irreversible, early detection is very important.  The current treatment for glaucoma is to lower the eye pressure to prevent further damage to the optic nerve and halt vision loss.  The most common way to decrease the eye pressure is to take eye drops; some work to increase the outflow of the fluid inside your eye, while others work to decrease the amount of fluid your eye produces.  Both are effective ways to lower the pressure.  Laser procedures to increase outflow are also useful and widely used.

Comprehensive Eye Exam is Key 

The most important thing to remember is if you have changes to your vision, have your eyes checked by an optometrist ASAP.  It may be as simple as changing your glasses prescription, but it could also be cataracts that may require surgery if new glasses do not improve your vision.  In addition, it is also important to have an annual comprehensive eye exam even without noticeable vision changes, because some problems like glaucoma are hard to detect without a thorough eye exam and permanent vision loss can occur if not detected in time.

Erin Swift, OD, FAAO

The Hazards of Halloween Contacts

Halloween is a special time of year where children often dress up as their favorite character.  Not to be left out, adults often join in on the fun and are inclined to spend more money on costumes than ever before. For extra costume emphasis, some adults might consider over-the-counter (OTC) cosmetic contact lenses. OTC cosmetic contact lenses are a tempting option because they are inexpensive and easily accessible at stores, swap meets and online.  Yet, people fail to realize that this final touch to their costume may wreak havoc to the health of their eyes.

Why are OTC cosmetic contacts hazardous?

Contacts are not a one size fits all fit.  Think of contacts in terms of shoe sizes. Although you try shoes of the same size, each shoe style fits differently. The wrong size can result in blisters and aching feet.  With contacts, an incorrectly fitted lens can cause serious ocular complications including infections, abrasions, ulcers, scarring, permanent vision loss and even blindness.  These complications may occur within 24 hours of wearing contacts if not diagnosed and treated quickly by an eye care professional.

Where to purchase cosmetic contacts that are safe for Halloween?

Contact lenses are medical devices that require a prescription from an eye care professional. Schedule an eye exam with an eye care professional to discuss your cosmetic contact options.  If a retailer informs you a prescription is not required, be scared.  Be very scared!  If you suspect illegal contact lens sales, please report these retailers to stopillegalCLs@aoa.org.

How to keep the eyes healthy when wearing prescription cosmetic contacts?

A crucial step in eye health is visiting a licensed eye care professional for an eye exam. You can then obtain a prescription for cosmetic contacts and purchase them from a retailer that requires a valid contact lens prescription.  In addition, it’s important to properly clean and care for your contacts and do not sleep overnight with your contacts. You can discuss this process during your exam.

When it comes to OTC cosmetic Halloween contacts, the risk is not worth the benefit.  Ocular complications from these types of contacts may occur rapidly.  Your eyes deserve the best care possible. One day of fun and silliness with cheap OTC cosmetic contacts may turn into a lifetime of regret.  Be safe and choose wisely.

Margie Recalde, OD, FAAO

Why is my vision fluctuating? Dry eye could be the answer.

Is your vision affected by dry eyes? Dry eye disease (DED) is one of the most frequently encountered ocular conditions. In fact, 25% percent of patients who visit eye care practitioners report symptoms of dry eye, making it one of the most common conditions.¹ The prevalence of DED is estimated to be 7.4% to 33.7% depending on which study is cited, how the disease is diagnosed, and which population is surveyed.^{2, 3}

Recently the Dry Eye Workshop (DEWS) II report was released by the Tear Film and Ocular Surface Society (TFOS), highlighting the importance of dry eye diagnosis and management.

There are many symptoms associated with dry eye including dryness, itching, burning, foreign body sensation, watery eyes and visual fluctuation. Dry eye may impact daily activities such as reading, night driving, watching TV, working on the computer and contact lens wear.^4-6 If you have any of these symptoms or your contact lenses are not comfortable all day long, you may have dry eye. Many people with dry eye have not been diagnosed. Thirty million American adults report symptoms of DED^7-8 and about 16 million American adults have been diagnosed with this condition.⁹

Dry eye symptoms are variable and quite common.

The healthy tear film is a delicate balance composed of mucin, proteins, aqueous and lipid components. In chronic dry eye, the concentrations of certain tear proteins are reduced. Patients with an altered tear film due to dry eye can result in symptoms of discomfort, ocular surface damage and visual disturbances, potentially impacting a range of daily activities.

A prospective multicenter study of 217 dry eye patients titled Progression of Ocular Findings (PROOF), evaluated the natural history of dry eye over 5 years.¹⁰ In this study, 57% of dry eye patients considered their vision to be moderate, severe or very severe compared to 10.5% for control subjects.

If you think your eyes may be dry or have any symptoms, schedule an appointment with your doctor of optometry today.

Melissa Barnett, OD, FAAO

References:

1. O’Brien PD, Collum LM. Dry eye: diagnosis and current treatment strategies. Curr Allergy Asthma Rep. 2004; 4:314–319.
2. Lin PY, Tsai SY, Cheng CY, et al. Prevalence of dry eye among an elderly Chinese population in Taiwan: The Shihpai eye study. Ophthalmology. 2003;110:1096–1101.
3. McCarty CA, Bansal AK, Livingston PM, et al. The epidemiology of dry eye in Melbourne, Australia. Ophthalmology. 1998;105:1114–1119.
4. Dry Eye WorkShop. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):75-92.
5. Walker PM, Lane KJ, Ousler GW III, Abelson MB. Diurnal variation of visual function and the signs and symptoms of dry eye. Cornea. 2010;29(6):607-612.
6. Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007;143(3):409-415.
7. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.
8. US Census Bureau. Annual estimates of the resident population for selected age groups by sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2014. http://files.hawaii.gov/dbedt/census/popestimate/2014-state-characteristics/
   PEP_2014_PEPAGESEX_HI.pdf. Published June 24, 2015. Accessed January 14, 2017.
9. Data on file. SHP606-801. Shire US Inc; 2016.
10. McDonnell P, et al. Progression of Ocular Findings (PROOF) Study of the Natural History of Dry Eye: Study Design and Baseline Pa9ent Characteris9cs. ARVO meeting Abstracts June 16, 2013 54:4338.

Generic Over-The-Counter (OTC) Products Available – What Type Should I Get?

Prescription Brand vs. Generic
Before we answer the question on what type of Generic OTC products are available, let’s first discuss the difference between prescription brand and generic. It takes about 10 years and costs about $1 billion for pharmaceutical companies to develop a drug that meets rigorous drug testing and Food and Drug Administration (FDA) approval. After approval, the drug is launched under a “Brand Name” (also known as Trade Name) that is usually more likeable and interesting than the actual chemical name for the drug.

Once a drug’s patent expires, other drug companies may pursue the generic form of the drug without having to undergo FDA approval. This is when the medication is called “Generic” and the drug is called by its chemical name. These companies have a simpler process where they just need to match dosage, route of administration, and concentration of the active ingredient. The branded drug is still available but once the generic form of the drug is launched, most insurance companies will cover generic at a lower copay compared to a branded medication.

Self-Diagnosing
In order for a prescription medication to become available OTC, the drug manufacturer must apply for a new drug application. The FDA reviews the safety profile, effectiveness of the medication and whether the condition the medication is indicated for is self-diagnosable.

Once the medication has received approval for OTC status, patients have the opportunity to save on cost by avoiding expensive branded medications that are not covered by their insurance. However, self-treating assumes the patient can accurately self-diagnose the condition. The patient also must deal with choosing from a wide array of eyedrops available over-the-counter.

Types of Generic OTC Products
If you have eye discomfort, you have the option of choosing between artificial tears or eye drops for ocular allergies. Artificial tears may provide temporary relief of dry eyes for patients that have intermittent symptoms. However, if your eye problem is specifically redness and itchy eyes related to ocular allergies, there are two generic medications that no longer need a prescription.

• Pheniramine Maleate/Naphazoline Hydrochloride (Active Ingredients)
Pheniramine Maleate is an antihistamine to stop the itch and Naphazoline Hydrochloride is a decongestant/vasoconstrictor that gets the red out. Both of these are the active ingredients for Naphcon-A, Opcon-A, and Visine-A. The dosage is one to two drops up to four times a day. For patients that have anatomically narrow angle or narrow angle glaucoma, this eye drop is contraindicated. Adverse reactions include dilation of pupils, increased eye redness, irritation, discomfort, blurry vision, punctate keratitis (a breakdown of the cells in the cornea), increased tearing, and elevated eye pressures. It is advised to use these drops for short-term use only due to risk of rebound hyperemia. This means overuse of an eye drop that shrinks the eye’s blood vessels may cause the vessels to become more fragile with time. Eventually a reverse effect may occur where the blood vessels stop shrinking and instead expand to a point where the red eyes are worse than before.

• Ketotifen Fumarate
This ingredient is found in Zaditor (Alcon), Alaway (Bausch & Lomb), Zyrtec Itchy Eye Drops, and Claritin Eye Drops. The dosage is one drop twice daily, every 8-12 hours. Common side effects are redness of the eyes, headache and rhinitis. Interestingly this also has a dilation of the pupil side effect but the incidence is low.

What Type of Generic OTC Eye Drop Should I Get?
We’ve finally reached the point where we can answer this question. If you can accurately self-diagnose your eye problem and determine ocular allergies is the proper diagnosis, you may consider Ketotifen Fumarate. Keep in mind that many patients fail on OTC eye drops. Truly, the best treatment relies on an accurate diagnosis. I advise making an appointment with your optometrist to examine your eyes and provide the correct diagnosis. Rather than asking what type of eye drop should I get, the better question to ask is how do I accurately diagnose my eye problem? If you agree your eyes deserve the best, then stop self-diagnosing and call for an appointment with your local optometrist.

Margie Recalde, OD, FAAO

California Optometric Association

Corneal Cross Linking: Halting Keratoconus Progression

What is Keratoconus?

Keratoconus is a bilateral, progressive disorder of the cornea (the clear front surface of the eye) which causes it to thin and bulge into the shape of a cone. Prevalence is about 1 in 2000. This cone shaped curvature causes a loss of vision similar to taking a picture through a warped camera lens.  The cause of keratoconus is not completely understood, however underlying genetic factors have been shown to play a large part and the genes responsible for it have been identified. Not everyone with the keratoconus gene gets the condition, so environmental factors such as allergies and resultant chronic eye rubbing, are believed to play a part in turning the genes on.

Healthy Vision Month – Important at Every Age

May is Healthy Vision Month. Make your eye health a priority and protect your vision for a lifetime. Your vision is important at every stage in your life, so start protecting it as early as you can. The following are how you can do that for every stage of life.

Kaleidoscopes, Zig Zags and Other Weird Visual Disturbances

Many patients come in to see me with the same complaint: “I had this weird kaleidoscope/zig-zagging lines/Bart Simpson’s hair in my vision last week!” They all, almost without fault, say the weird visual phenomenon started, then got a little bigger, and then smaller and then went away, in total lasting 20-30 minutes. It can be pretty scary the first time you see it; even I was freaked out the first time I experienced it, and I knew what it was! When I tell patients they have had an ocular or visual migraine, usually they reply, “But I didn’t have a headache.” And that is true, a visual migraine is not followed by a headache. A visual migraine, by definition, is a visual aura without a headache afterward. Each person experiences it a little differently, but the photo below is a visualization of the most common descriptions.

America’s Sweetheart Spreads Eyelove

Jennifer Aniston has everything – looks, talent, fame, and fortune. The gorgeous actress was crowned the World’s Most Beautiful Woman by ‘People’ magazine for the third time in 2016. At age 48, she maintains her natural beauty and age-defying physique by eating an incredibly healthy diet and incorporating a daily workout routine. It’s no surprise that people follow her diet and exercise tips in hopes of matching her amazing figure.

Tips for Controlling Nearsightedness

Myopia (nearsightedness) is the ability to see well at near but the inability to see well at distance without corrective help, such as glasses. Myopia is primarily caused by “axial elongation” (an eyeball that grows to long). Myopia is considered an optical condition of the eye, not a medial condition, and therefore treatment is not usually covered by medical insurances.

Scleral Lenses for Everyone!

What are scleral lenses? Scleral lenses are large diameter gas permeable contact lenses that vaults over the cornea and lands on the white of the eye (the sclera) and is supported by tear fluid that fills in between the lens and the eye – providing hydration for the surface of the eye.