Google Glass – friend or foe?

Publication1One of the newest trends in technology is wearables. Some of these devices like the Fitbit help you keep in shape by keeping track of how many steps the wearer takes and how well they sleep. Others like the Samsung Gear 2 allow you to check email, listen to music and do myriad tasks while looking like a normal watch. But, the most interesting wearable for optometrists is Google Glass.

As of a few weeks ago, Google Glass was only available for beta testing through its explorer program which allowed for only an elite group of tech-savvy individuals to purchase it ($1500). However, as of May 15th, anyone can purchase Glass and even obtain prescription eyewear that hosts the Glass computer. As such, some practices, including my own, have signed up to be Glass experts who can work with the approved frames.

So, what does Google Glass do and what makes it interesting to medicine? Well, for starters, Glass can take pictures and record video with voice commands. These applications can be extremely useful for hands free recording of surgical procedures. This can assist in educating health care providers, can serve as a permanent record in case complications arise, and allow for patients and doctors to communicate effectively even if they are not in the same city.

And what about day-to-day activities? Well, while using the recording device may unnerve people due to privacy concerns, I can certainly imagine recording video of my kids or maybe my favorite band at a concert. Glass can also translate words you see, help you with directions, and allow you to look up information. It can even help measure distances on a golf course and track the miles you run.  One detractor, some complain about eye pain after wearing the device for a number of hours.  Google has acknowledged this as a possible side effect of wearing Glass and can be due to unnatural eye movements like looking up for a long period of time.

As you can imagine, myriad applications are being developed to maximize this piece of technology. Also, other companies have developed similar devices. So, what do you think about Google Glass? Do you have privacy concerns? Do you think that this is a cool trend, or do you think Glass is lame and pretentious? Let’s discuss!

~David Ardaya, OD
California Optometric Association
http://eyehelp.org
http://www.coavision.org

My eye doctor prescribed spending time outside

We have all heard about how much time kids spend inside watching TV, studying, and playing video games. My seven-year-old son is addicted to rainbow looms, and could loom all day if I let him. New studies have indicated that the amount of time children spend outside may decrease the risk of developing myopia.

What is myopia?

Myopia, or nearsightedness, is a vision condition in which close objects are seen clearly but far objects appear blurred. Nearsightedness is a very common vision condition, affecting nearly 30 percent of the US population, and up to 90 percent of developed East and Southeast Asian countries such as Singapore, Taiwan, China, Japan and Korea. Myopia typically presents in school age children. Because the eye continues to grow as children grow, myopia may progress until approximately age 21.

Photo Courtesy of Shirley Binn

Photo Courtesy of Shirley Binn

Recent studies have indicated that more time spent on near work, less time spent outdoors, higher educational level and parental history of nearsightedness are risk factors for developing nearsightedness. Spending time outdoors plays a crucial role in myopia development and can slow its progression.

A recent study presented at the Association for Research in Vision and Ophthalmology (ARVO) 2014 Annual Meeting demonstrated the importance of time spent outdoors in order to control nearsightedness. The study evaluated visual acuity (vision) and axial length (length of the eye) of 6690 multiethnic children at 6 years of age. Axial length was significantly longer in children who spent less than one hour per day outdoors than in those who spent more than 2 hours outdoors.
Jan Roelof Polling, at the University of Applied Sciences Utrecht, lead investigator of the study recommended “Children with an increased risk of near-sightedness, such as those from a near-sighted family, should be prompted to spend at least 15 hours a week outside and should avoid spending long hours doing near work, even when they are very young.”

Photo Courtesy of RavEytan

Photo Courtesy of RavEytan

How does spending time outdoors help with myopia progression?

The protective effect of being outdoors is not well understood. Researchers suspect that bright outdoor light helps children’s developing eyes maintain the correct distance between the lens and the retina, keeping vision in focus. The intensity and / or specific spectral distribution of outdoor lighting may be beneficial. Indoor lighting that is dim does not provide the same kind of feedback. Therefore, when children spend too many hours inside, their eyes fail to grow correctly and the distance between the lens and retina becomes too long, causing far-away objects to look blurry. Hormonal changes associated with outdoor activities may also be beneficial.

Encouraging children to spend more time outdoors can be a simple and cost-effective way to improve their vision and general health. Head outside and enjoy the summer! Just remember to keep spending time outside when school resumes.

Melissa Barnett, OD, FAAO

California Optometric Association

Health care reform & vision coverage for your children

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Children’s vision now covered by most plans
If your child is covered by an individual or group health insurance plan in California, their annual eye exam and eye glasses are covered with no out-of-pocket cost until the child reaches age 19. This is required for health plans purchased through or outside Covered California.

Legal residents of California will be able to get health coverage through a new marketplace established by Covered California. Starting in 2014, there will be several new and expanded government programs, including Medi-Cal, that offer financial assistance to reduce the cost of health insurance.

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  1. Premium assistance — Federal help will be available to reduce the cost of an individual’s or family’s monthly health insurance payments.
  2. Cost-sharing assistance — Cost-sharing subsidies reduce the amount of health care expenses an individual or family has to pay at the time of medical care.
  3. Medi-Cal assistance — Starting in 2014, Medi-Cal will cover more people under age 65, including people with disabilities and those with incomes $15,856 or less a year for a single individual and $32,499 or less for a family of four. Medi-Cal is free for those who meet the requirements and is part of the changes included in the Patient Protection and Affordable Care Act (Affordable Care Act).

An online calculator at the Covered California website helps estimate how much it will cost to purchase health insurance in 2014 and the amount of financial assistance available to qualified individuals. In addition, by completing a Covered California application, an individual will learn whether he or she qualifies for financial assistance.

~Kristine Shultz, Government and External Affairs Director
California Optometric Association

The ABCs of cataracts

CataractCataracts are a fact of life. Anyone who lives long enough will get them and almost everyone knows someone who has had them.  The good news is, with the latest technology available, improving your vision is very safe and will often times leave you with better vision without glasses than you had before the cataract.

Let’s look at the ABCs of cataracts:

A – Age. Remember that cataracts are changes to the lens of our eye as we get older. Different factors can influence when the cataracts start to form. Cataracts tend to develop sooner in folks who spend a lot of time outdoors in the sun without sun protection or sunglasses. They also tend to form earlier if you have diabetes or if you are a smoker. So keeping your eyes out of the sun and staying healthy will help delay the onset.

B – Blurry Vision. The lens of the eye starts changing with cataract formation, making vision blurry. It is like looking out of a blurry window. Usually night driving will be much harder and cataracts can cause difficulty with headlights a night. Cataracts can also cause glasses prescriptions to change as well. It is common to need one or two changes in glasses prescription before the cataract is affecting vision enough to have it removed.

Courtesy of laulau555 on Flickr

Courtesy of laulau555 on Flickr

C – Cure! The good news about this eye disease is that there is a very good treatment option. Cataract surgery involves removing the blurry lens from the eye and inserting a prosthetic lens in its place. This is an outpatient procedure and can take as little as 20 minutes.  The new lens often has a prescription in it that will be very close to your current glasses or contact lens prescription and will allow you to see better without the use of glasses or contacts.  There are even lenses available that can help with near vision as well as far vision. Usually after cataract surgery, vision improvement can be noticed as early as the next day.

Remember, make sure to have routine eye health and vision exams to determine if cataracts are forming or changing.  Your eye care provider can assist you in determining the appropriate time to have them removed.  Until then, stay healthy and wear sunglasses!

~Lisa M. Weiss, OD, FCOVD
California Optometric Association
http://www.coavision.org

Vision and the aging eye

Courtesy of ORBIS US on Flickr

Courtesy of ORBIS US on Flickr

Many patients reach a certain life stage and realize they need to start thinking more about their vision and preventing eye problems.  This usually happens in their early to mid-forties when people notice reading is a lot easier when there’s plenty of light and the print is held further away.  Those who have seen an eye care provider for this problem should have already discovered that this is a normal aging process.  But how does one know when vision changes are normal or should be concerning?

Eye conditions that impact vision:

  • Presbyopia is the medical term for when the focusing muscles in the eye are not as flexible, causing poor focusing ability for objects nearby.  This typically occurs in the late thirties/early forties and is easily corrected with reading glasses or bifocal or progressive lenses.
  • Cataracts begin to develop in our forties and progress over time.  There is a natural clear crystalline lens in our eye which focuses light onto our retina.  With ultraviolet ray exposure, this lens can become more opaque and yellow over time, causing a dimming of vision and glare and haloes around lights.  The best way to prevent cataracts from progressing quickly is to protect the eyes with UV-blocking sunglasses anytime you are outdoors.  The good news about cataracts is that they can be easily removed and replaced with an artificial lens implant.  With the latest technology of intraocular lens implants such as muiltifocal lenses, patients are now able to see clearly at all distances without the use of glasses or reading glasses.
  • Glaucoma is a symptomless eye disease of the optic nerve head where the nerve slowly deteriorates over time.  Most patients who develop glaucoma will not have any symptoms until the late stages of the disease, when peripheral vision deteriorates and patients are left with tunnel vision.  There is no cure or preventative measure for glaucoma, however, it is easily treated with eyedrops.  The only way to determine if you have glaucoma is to have annual comprehensive eye examinations.

    Courtesy of Nargopolis on Flickr

    Courtesy of Nargopolis on Flickr

  • Macular Degeneration is another common eye disease that can cause debilitating vision loss.  This occurs when the macular region of the retina loses its integrity causing poor central vision with distortion or gray spots.  It is often detected upon routine examination, especially when photos of the retina are compared over time.  Fortunately, there have been extensive studies on macular degeneration and the field has changed dramatically over the last several years.  An important test in recent years is genetic testing to determine one’s risk factor for vision loss as a result of macular degeneration, as well as antioxidants that may be useful in reducing this risk.  Clear risk factors include a history of smoking, exposure to ultraviolet radiation, increased cholesterol levels and Caucasian women with lighter eyes and fairer complexions.
  • Retinal Detachment tends to occur more often in those who are older than 65.  The retina is a thin and fragile tissue that lines the back wall of the eye and sends visual information to the brain.  This tissue becomes more fragile over time and can easily develop a hole or tear leading to a retinal detachment.  If you experience flashes of light, new floaters, or a change in your vision, you need to be seen right away by your eyecare provider.

There are a myriad of eye conditions that can develop as one ages.  The most important and useful method of preventing vision loss is to stay healthy.  See your primary care physician regularly to evaluate and treat high blood pressure, high cholesterol, diabetes and other health conditions.  If you have uncontrolled health conditions, you can easily lose your vision to diabetic retinopathy, hypertensive retinopathy, or a stroke in the eye.

So, as I tell all my patients, see your physician regularly, eat green leafy vegetables, take your medications, and monitor your own blood pressure or blood sugar.  And of course, wear sunglasses outdoors and see your optometrist annually.

~Cindy P. Wang, OD, FAAO
California Optometric Association
http://www.coavision.org

The Low Down on Pink Eye

Just your luck, it’s Friday afternoon and you find that you or your loved one has a pink eye, it may be a little irritated or painful, and you are worried because the weekend is coming up.  Your optometrist’s office may be closing soon.  Should you call your optometrist, go to urgent care, or risk the weekend without seeing an eye doctor?

Photo Courtesy of Lone Primate on Flickr.com

Photo Courtesy of Lone Primate on Flickr.com

Pink eye is a term used to describe an irritated pink or red eye.  The medical term is conjunctivitis which is an inflammation of the thin tissue overlying the whites of the eyes.  However, there are a variety of eye conditions that can cause an eye to become pink or irritated, although conjunctivitis is the most common cause.  Conjunctivitis can often be categorized into 3 different categories:

Bacterial conjunctivitis – This form is caused by bacteria and can be transferred in a variety of ways ranging from airborne to direct contact on one’s fingertips.  Bacterial conjunctivitis can cause sticky, yellowish green discharge, occasionally resulting in the lids sticking shut in the mornings.  The eye may be pink, painful, and sensitive to light.  Usually only one eye is affected although the other eye can become infected by indirect contact.  It is contagious and is often treated with antibiotic eye drops.  Once you have been treated for 24 hours with antibiotics, you are no longer contagious.

If you are a contact lens wearer, an irritated, painful and pink eye is usually the result of a bacterial infection.  This needs to be treated right away because you may develop a corneal ulcer and risk permanent vision loss.

Viral conjunctivitis – Most instances of viral conjunctivitis will cause the eyes to appear red and glassy, and there may be a watery discharge.  It usually affects both eyes and may be accompanied by an upper respiratory infection.  The lymph nodes in front of the ears and along the neck may be tender and swollen.  These cases are highly contagious and cannot be treated with medication.  They will resolve on their own within 7 to 10 days.  Some may take as long as 3 weeks.  Until then, patients should avoid spreading it to others.  Some may find relief with cool compresses or artificial tears throughout the day.

Occasionally, an eye can become infected by the herpes simplex or herpes zoster virus.  Symptoms may include a pink eye, pain, decrease in vision, or blisters on one side of the face.  These patients need to be seen and treated immediately in order to prevent vision loss.

Allergic conjunctivitis – This form of pink eye is prevalent throughout the year, depending on a person’s allergies and the plants that are in bloom during that season.  Allergic conjunctivitis will typically cause itching, tearing, and sticky, thick and white discharge that affects both eyes.  Some may notice their symptoms are worse after being outdoors.  Many often complain of an itchy throat or runny nose.  Usually, oral allergy medications will alleviate the symptoms related to the eyes, but many require the additional use of topical allergy eye drops to relieve symptoms.

I have seen a number of patients on a Friday afternoon with complaints of a pink eye.  Many times, the symptoms are not severe enough to determine what form of conjunctivitis the patient has, which can make treatment a little trickier.  In those cases, we advise the patient to return for a follow-up visit to determine if the treatment was effective.

A good rule of thumb for whether or not you need to see an optometrist when you have a pink eye is that if you are experiencing pain, light sensitivity, are noticing reduced vision or wear contact lenses, then visit an eye doctor today.  Make sure you do not put on your contact lenses.  I often advise my patients to try seeing an eye doctor first, rather than visiting urgent care as they may not have all the tools required to adequately diagnose your eye condition.

So, keep your hands clean, don’t share towels and avoid touching your face and eyes!

– Cindy P. Wang, OD, FAAO

You’ve been diagnosed with diabetes – what does that mean for your eyes?

You’ve just been diagnosed with diabetes.  Your head is still spinning with the news.  Sensory information overload.  Somewhere in between hearing those 3 words “you have diabetes,” you also heard that you should get your eyes checked.  No problem.  There are many optometrists out there in your community just like me.  The first thing I usually do is to take a very detailed history of your overall health including various aspects of your diabetes management.  Be prepared to answer questions regarding when you were first diagnosed with diabetes about what oral or injectable medications you are currently taking and what your blood sugar readings are.  The history portion of the exam will also give me a chance to get to know you better and allow us to work together to set some important health care goals.

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Photo courtesy of Community Eye Health on Flickr

I tailor my diabetic eye work-ups for each patient that comes under my care, depending on if he/she is a newly diagnosed diabetic or have had some issues with diabetes in his/her eyes.

A complete diabetic examination may include but not limited to checking for prescription changes, lens clouding, and swelling or bleeding in the back of the eye.

With vigilant and periodic evaluations, you should reduce the chance of ever developing any of the following diabetic changes.  Diabetes may cause your vision to “fluctuate” making your vision clear during parts of your day and blurry at other times.  So, I will definitely check to see how different your prescription has changed from your previous exam.  Diabetes may also cause you to prematurely develop cataracts or clouding of your lens.  Most importantly, I will dilate your eyes to carefully inspect the retina for any bleeding, swelling, or new blood vessel growth.  Again, I assure you that no one should lose their vision to diabetes these days with close monitoring.  And if need be, I will refer you to a retinal specialist that I work in close partnership with for further evaluation.

Further testing or treatment by a retinal specialist may include:

  • A dye test to evaluate the back of the eye (fluorescein angiography)
  • Laser treatment (focal, grid, or pan retinal photocoagulation)
  • Injection with steroid to reduce swelling (triamcinolone acetonide)
  • Injection with anti-vegf medication that reduce swelling, stop the bleed, and stunt the growth of unwanted blood vessels (Avastin® or Lucentis®)

Now it’s your turn to do your part to prevent diabetes from developing in your eyes.

I always recommend four things to all my patients: 

1) Eat sensibly – according to the American Diabetes Association, fresh veggies should fill half of your plate, a lean protein for a quarter, and a carb of your choice for the last quarter
2) Exercise for 30 minutes daily
3) Take your medication(s) as recommended by your primary care physician or endocrinologist
4) Know your level of blood sugar control.  Ask your physician about your glycosylated hemoglobin or Hemoglobin A1C.

I look forward to seeing my patients back every year.  Until then, stay happy and healthy.

~Judy Tong, OD, FAAO