The aging eye

Image courtesy of Sohrab Gollogly website at www.sohrabgolloglymd.com

Image courtesy of Sohrab
Gollogly website at http://www.sohrabgolloglymd.com

Age is never a diagnosis. Although certain eye conditions may become more common with increasing age, you should not assume that they cannot be corrected. It can be confusing for a patient to know what part of the normal aging process is correctable and what is not. In this article we hope to clear up some of the most common symptoms of the aging eye. Continue reading

Common eye emergencies and how to react

Courtesy of Brandon Koger on Flickr

Courtesy of Brandon Koger on Flickr

Many people don’t give their eyes much thought until an eye emergency happens. Chances are, it happens on a holiday weekend at midnight when all doctors’ offices are already closed. What should you do and can it wait until Monday morning?

Below are the most common emergent symptoms that you need to pay attention to.

Eye Pain: If you have extreme pain that burns, stings and causes your eyes to water, it’s usually from a foreign object or a corneal abrasion. If rinsing the eyes out with artificial tears or contact lens solutions doesn’t help and the pain is just as intense after 20 minutes, you need to be seen by an eye doctor. Try to keep your eye closed until then.

Boring eye pain with headache, nausea, blurry vision: If you are experiencing a boring pain in one eye with a severe headache, haloes around lights, foggy or steamy vision, and/or nausea, you need to be seen immediately. You may be experiencing a spike in the intraocular pressure of your eye caused by a disease called narrow angle glaucoma.

Change in vision: If you notice a drastic change in your vision such as a shower of floaters or flashes of lights followed by a curtain or veil over one area of your vision, you may be experiencing a retinal tear or detachment and need to be seen. If your vision change is a gradual dimming of vision that doesn’t improve, you may be experiencing a central retinal artery occlusion where a large clot blocks the flow of blood to the eye resulting in gradual vision loss. This may be reversible within a narrow window of a few hours, so it is important to find adequate treatment immediately.

Chemical injury to the eye: If you are splashed in the eyes with a chemical, immediately rinse them out with saline solution (contact lens solutions are okay), artificial tears, or tap or bottled water. If possible, rinse them for 15 minutes with a steady stream of water. Do not use high speeds of water to avoid further injury. If your vision is reduced or you still experience extreme pain after 15 minutes of rinsing, you should be seen by an eyecare physician. Depending on the chemical you are exposed to, the eye may be at risk for further damage.

Physical injury to the eye: If you have been hit in the eye or head, always check your vision and compare the vision in each eye. If one eye is uncharacteristically more blurry than the other, you should be checked to make sure the structures in the eye are intact. If you experience unbearable pain that does not improve within five minutes, you should see your eye doctor immediately.

If you are a contact lens wearer and are experiencing pain with and without contact lenses plus a reduction in vision, you also need to check in with your eye doctor. This is especially important if you have been exposed to water such as oceans, lakes, and water parks which can cause a severe eye infection resulting in vision loss.

The more important question is, “Do you have someone you can call in emergencies?” Emergency rooms see a good deal of patients for ocular emergencies. However, some of the above scenarios require a retinal or corneal specialist, which may be more difficult to find in a timely manner. In emergencies, call your optometrist first. They may have an on-call line or emergency services available. If they are not available to see you or believe you need the services of a specialist, they may be able to find one more quickly for you than the emergency room can.

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

Seven myths about contact lenses

  1. Photo courtesy of Valley Eyecare Center

    Photo courtesy of Valley Eyecare Center

    There is one “best” contact lens
    Do not think that if your first contact lens experience is less than ideal that you must be “contact lens intolerant”.   The truth is, what one patient loves another patient may hate.  It is all about how that contact’s shape and material interacts with your unique eyeball.  Not every contact lens and eyeball play well together.  There is no way to predict if you eye will like a particular lens until you give the lens a test drive for a few days in a trial pair.  Expect some trial and error with various lens brands.Every doctor will have their go-to contact lens that “on average” they find the most success with in their area.  However, you may not be average.  It is not unusual for the second or even third trial pair of different contact lens brands be the “ah-ha!” moment when great comfort is found.  Most doctors will have the patience as long as you do to find your “ah-ha!” contact lens.

  2. All contact lens cleaners are alike
    The following is a very common conversation heard in an eye doctor’s office:
    Patient:  I suddenly noticed a month ago my contacts were not as comfortable anymore.
    Doctor:  Are you still using the same cleaner I prescribed when you ordered your contacts?
    Patient:  No. A month ago I found a generic cleaner for half the price so I started using that one.

    Contact lens cleaners are not alike.  Stick with the solution your doctors recommends when you order your contacts and the risk of solution-caused comfort issues will be greatly minimized.  Generic cleaners frequently will increase irritation with contact lens wear and reduce wear time.

  3. Contacts can roll behind my eye into my brain
    There is an anatomical barrier called the conjunctiva which prevents the contact lens, or any foreign object, from getting behind the eye.
  4. Swimming will cause the lens to float out of my eye into my brain
    To the contrary, swimming in contacts will actually adhere the contact lens to the eyeball tighter.  For this reason, it is recommended to not remove the lens for a half hour after swimming to allow it time to dry.  Trying to remove the lens too soon after swimming may cause a scratch on your eyeball from having to use extra force removing it.

    Although pool swimming in contacts is generally safe (hot tubs and ocean water being an exception and an absolute no-no), if you swim frequently most eye doctors will recommend you use daily disposable contact lenses so that you never have to use the same lens twice since pool chemicals and other impurities may build up on the lens, increasing the risk of infection.  If a daily disposable lens is not an option for you, your doctor will likely recommend a hydrogen peroxide based cleaning system.  Hydrogen peroxide cleaners provide extra-strength cleaning of most things the pool may leave behind on your contacts.  Wearing swim goggles is highly advised to reduce the risk of sight-threatening infections from wearing contacts while swimming.

  5. Buying contact lenses online is always the most economical way to buy contacts
    Actually, this is rarely the case.  Historically, online retailers averaged a few dollars cheaper than doctor’s offices for the same contacts.  Recently, many of the most common contact lens manufactures now require “uniform pricing”, meaning online retailers and doctors now provide the exact same price for many brands of contacts.

    The real cost savings in purchasing contacts from your doctor’s office occur when manufacture rebates (typically not valid with online purchases) and insurance benefits are applied.

  6. “I have allergy eyes, so I cannot wear contacts.”
    For contact lens wearers who suffer from allergies, Dr. Butterworth, an optometrist from University of Iowa Department of Ophthalmology, states she recommends daily disposable soft lenses for her allergy patients. “Not only does this allow the patient to have a fresh, clean lens on the eye every day, but it eliminates several factors that can make patients’ ocular allergies worse,” she said. “Daily disposables also minimize a lot of debris buildup, which can exacerbate allergies.”
  7. Your eyes are too weird for contacts
    Many patients believe that astigmatism will keep them from being able to wear contacts.  However, we all have astigmatism to some degree.  Astigmatism is the amount by which your cornea (the front surface of the eye) is not perfectly spherical.  But nobody’s cornea is perfectly spherical, just like nobody’s head is perfectly round.  If your astigmatism is high enough, you will likely be placed in an astigmatism correcting contact lens.  For most doctors, more than half of their contact lens patients wear contacts specifically designed for astigmatism.   Whether it is a small amount or a larger amount, there is a contact lens out there for you.

~ David McCleary, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

Eye protection: three ways you can protect your eyes

Photo courtesy of StoneHouseSigns.com

Photo courtesy of StoneHouseSigns.com

For many people, eye protection is an afterthought until an unfortunate event occurs. Your local optometrist will be happy to help you if an injury occurs, but you can save yourself significant aggravation by shielding your eyes from a potential injury.

Consider the following three scenarios:

1. You spent a beautiful day skiing on the slopes. The day was special due to fresh powder, clear blue skies, and laughter with friends. While reflecting on the day later that evening, you start to notice eye pain and your vision becomes blurry.

2. It’s Saturday morning, and you are rushing to clean the house before some guests arrive. While scrubbing a toilet, some of the water splashes up into your eye. The water had been mixed with toilet bowl cleaner. You notice an immediate burning sensation and blurry vision.

3. Spring has inspired you to do some yard-work. You start by trimming hedges and branches that have become over-grown during the winter months. One of the branches unexpectedly falls toward your face, scratching your eye before it lands on the ground. Your eye is tearing profusely and you are in tremendous pain.

In each of these three cases, the person will need to seek medical attention from an eye doctor for resolution. More important, all three of these injuries would have been avoided with proper protective eyewear.

In the first case, the eye was burned by harmful ultraviolent wavelengths (UV) of light. The eyes can be shielded from harmful UV ray by choosing lenses which block these wavelengths. Be sure to keep this fact in mind next time you shop for sunglasses. Recent studies are also demonstrating that our eye can be damaged by the rays emitted by computer, phone, and tablet screens. Your optometrist can help guide your choices to ensure the proper combination of protection and function.

The second case involved an alkaline chemical burn. Even when the eye is flushed and treated properly, the burn results in significant pain and the potential for permanent scarring. A simple pair of safety lenses can shield your eyes from this type of injury.

Finally, the tree branch in the third example caused a corneal abrasion. Tremendous pain and risk of infection are associated with corneal abrasions. There are endless scenarios in which an airborne object can cause an injury to the eye or to the tissues surrounding the eyes. The injuries can be superficial abrasions or scratches as described in the yard-work example, or they can involve blunt force injuries such as impact with a ball while playing a sport. Certain occupations such as automobile mechanics, construction workers, and machine operators involve an especially high risk for eye injuries due to the nature of their work. Safety glasses can protect you from industrial injuries when engaging in these activities.

The Occupational Safety and Health Association (OSHA) has set federal standards for safety eyewear in the workplace, and employers are required to provide proper protection for employees whose jobs involve exposure to eye health hazards. Employers will provide eyewear which incorporates the employee’s spectacle prescription if needed. There are frame and lens requirements designated by the American National Standards Institute (ANSI) which will ensure that the safety glasses provided by your employer meet the standards for adequate protection.

If you are unsure what to wear for a specific activity, be sure to seek guidance from your optometrist. We enjoy educating our patients and we can demonstrate proper protection in our offices. Last but not least, please don’t hesitate to call your optometrist if you experience an eye injury. Although we prefer to help you avoid the injury altogether, we will certainly guide you through the healing process as quickly as possible.

~ Lisa Heuer, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

The Blinding Cost of Diabetes – It’s Time to Fight Back!

Do you know someone with diabetes? I bet you do. In fact, over 25.6 million Americans over 20 years old suffer from diabetes, which costs over $250 million in health care spending for Type 2 alone.

Image Courtesy of The National Eye Institute

Image Courtesy of The National Eye Institute

So why do optometrists care so much about this condition?

Well, unfortunately, diabetes is the leading cause of vision loss in working age patients. So, not only do thousands of my patients have diabetes, including my father, they are all at risk for debilitating vision loss. Considering that this condition hits so close to home for me, I have made it my mission to reach out to the community and remind everyone of the importance of a yearly dilated eye examination.

By checking your eyes, optometrists can find early changes in the retinal blood vessels. These changes can include small areas of blood and fluid leakage as well as areas that are not getting the blood they need to survive. If these changes get bad enough, new blood vessels start to grow that are even more prone to leakage. Soon, without treatment, people lose their sight. The scary part is that most of these changes occur silently and without pain until it is too late to salvage what’s left of the person’s vision. The fortunate part is that if caught early, treatment can slow and sometimes halt the progression. This problem is so important that primary care doctors are now graded on the percentage of patients they refer for a yearly dilated examination.

So please, if you have diabetes, do the following:

  1. Find the time to visit an eye care professional for your yearly examination.
  2. Show up to all of your scheduled appointments for your primary care doctor.
  3. Take your medicine!
  4. Be honest with your doctors if you are struggling.
  5. Exercise in any safe manner.  Do what interests you.
  6. Know your number!  Check your blood sugar and ask your doctor for a goal.
  7. Study and eat a proper diabetic diet.  That does not just mean not eating sweets.  Ask a dietician or your doctor for advice.

Look, I know from personal experience that it is easier said than done, but keeping up with these seven principles can save your vision and extend your life.  Also, if you have a family member with diabetes, please help me spread the word!

Thank you,

~ David C. Ardaya, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

How much time should your child spend on the computer?

138284-425x282-child-on-computerIn our society today, children increasingly use computers, smart phones and tablets on a daily basis. Children as well as adults may experience symptoms related to computer use called computer vision syndrome. Symptoms after extensive viewing of technology can lead to eye discomfort, fatigue, blurred vision and headaches, dry eye and eyestrain. These symptoms may be exacerbated by poor lighting, glare, an improper work station arrangement, uncorrected refractive error (vision problems), or a combination of these factors.

In addition, children may be more susceptible than adults to computer vision syndrome.

Why?

1. Children use an adult computer.
Since a child is smaller than an adult, the computer workstation may not fit them well. Children may have difficulty reaching the keyboard or placing their feet on the floor, causing arm, neck or back discomfort. For example, a child using a computer on a typical office desk often must look up further than an adult. The optimal viewing angle is slightly down at 15 to 20 degrees. If a different viewing angle is used, problems with binocular vision (both eyes working together) can occur.

2. Children are not as self-aware as adults.
A child may use a computer or keep playing video games without taking breaks for many hours. Prolonged activity without breaks can cause accommodative problems. The eyes focus at a particular target, which may cause accommodation spasm. In some cases, the eyes may be unable to smoothly and easily focus on a particular object, even long after the original work is completed. Also, eye irritation may occur due to reduced blinking. When concentrating and viewing a screen, blinking is reduced.

3. Children may ignore problems.
For example, a child may ignore significant glare or poor lighting when viewing a computer screen, which may lead to excessive eyestrain. Intensified light can contribute to excessive glare and problems associated with eye adjustments to different levels of light. Also, children often accept blurred vision caused by nearsightedness (myopia), farsightedness (hyperopia), or astigmatism because they think everyone sees the way they do. Uncorrected refractive error can cause eye strain.

Important tips for children using a computer:

1. A comprehensive eye examination.
Eye examinations are important for all children and adults, starting at 6 months of age. An eye examination will ensure that the child can see clearly and comfortably at all distances and detect conditions that may contribute to eyestrain. If needed, glasses, contact lenses or vision therapy (eye exercises) can provide clear and comfortable vision for computer use.

2. Check the height and arrangement of the computer.
A computer screen should be 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and held 20 to 28 inches away from the eyes. The child’s size should determine where the monitor and keyboard are placed. If the computer monitor is too high in the child’s field of view, an adjustable chair may be used that can be adjusted for the child’s comfort. A footstool may be helpful in supporting the child’s feet.

3. Check for glare on the computer screen.
Windows or other light sources should not be directly visible when sitting in front of the monitor. If needed, adjust the desk or computer to prevent glare on the screen. A lower-wattage light can be substituted for a bright overhead light or a dimmer switch may be installed to give flexible control of room lighting.

4. Take a break.
A 20 second break every 20 minutes will reduce the development of eye focusing problems and eye irritation.

5. Keep blinking.
Remind your child the importance of blinking. In order to minimize the chances of developing dry eye when using a computer or digital device, make an effort to blink frequently. Blinking keeps the front surface of the eye moist. Non-preserved lubricant artificial tears may be helpful for children as well as adults.

~ Melissa Barnett, OD, FAAO
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

What You Need To Know About Measles

Courtesy of the Gates Foundation

One of the more impossible-to-miss news stories right now is the measles outbreak that started at Disneyland. Since measles is an airborne virus that can last up to two hours, and because Disneyland attracts guests from all over the world, this was a perfect spot for the virus to spread. At this time, approximately 60-70 persons in California have contracted the virus.

Interestingly, if we take a trip back in time to the year 2000, the CDC declared that the United States had achieved measles elimination. So what happened and why are we hearing about a second outbreak in as many years? Well, in 1998 a study of 12 children by a former doctor, Andrew Wakefield, demonstrated a link between autism and the measles, mumps, rubella vaccination. Since then, this study has been shown to be fraudulent and Andrew Wakefield was stripped of his medical license. Despite evidence to the contrary, many well meaning and intelligent parents began declining vaccinations for their children. As a result, school districts in our state have up to 14.5% of students who are unvaccinated – the majority of whom are from affluent, coastal communities.

So what should we look out for in our friends, families and patients? First of all, a fever, head cold, and red rash are all signs of measles. Additionally, conjunctivitis (pink eye) is also very common as 65% of all measles patients develop this malady. Be especially careful if you have family members that are unvaccinated or have only received a single dose. Patients who have received two doses have less than a 1% chance of getting measles.

While measles is still relatively rare in the United States, 20 million people are infected worldwide and according to the World Health Organization 145,700 children died from measles worldwide in 2014. As a parent, I understand the apprehension many of us have about the numerous shots our kids get at such a young age. However, the evidence clearly demonstrates that vaccines save lives. So, I encourage every parent and unvaccinated person to do your part to eradicate this illness from the planet and get vaccinated or have your child vaccinated.

~ David C. Ardaya, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

Glaucoma: Irreversible but preventable blindness

glaucoa visual field defect - croppedAfter reading Dr. Weiss’ article last week on early detection of glaucoma, I was back in my office seeing one of my patients that drives this point home. My patient, let’s call him Jim, is a 59 year old gentleman who has lost vision from glaucoma. My partner and I had been seeing Jim for his annual exams and providing glasses to correct his vision since 1999. Beginning in about 2004, the pressure in his eyes started to increase. Normal intraocular pressure (IOP) is between the range of 10 to 20 millimeters of mercury (mmHg). Over a few years, his IOP slowly increased until they were running in the 20 to 21 range – not too bad – but enough that we discussed that we needed to monitor this more closely. In 2008 Jim’s IOP was 20, so he decided to skip his 2009 exam.

When, Jim came in for his “annual” exam in 2010, he had a very different complaint. He complained that if he covered his right eye, he could not see the lower part of his vision.  This fast loss of vision could be caused by a retinal detachment, but would be a very unusual symptom for glaucoma.

Vision loss with glaucoma usually takes years, or decades to advance to the point where it is noticeable to the patient. After ruling out a retinal tear or detachment, I took some time to look at glaucoma. The pressure in his eyes was up to 30mmHg, and close examination of the back of the eye showed glaucomatous damage to the optic nerve consistent with his visual field loss. We started treatment right away, and luckily stopped the progression of vision loss.

Over the years, my partners and I have created a large practice with increasing population of glaucoma patients. I am always amazed with the fact that no two patients progress in the same way. I have seen “normal pressure” glaucoma patients who have damage to their optic nerves even with “normal” pressures. I have patients with significantly high pressures who have no damage to their optic nerves. I have patients that we are able to control with eye drop medications that are only used one time each day. And, I have patients that need surgery to lower their eye pressure to prevent blindness. I am treating as many patients who have a family history of glaucoma as who have no family history. I have patients with glaucoma from 21 to 94 year old. The only way to prevent blindness from glaucoma is to catch it early with annual eye exams.

~ Steven Sage Hider, OD
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

Peek Retina: Technology that could change optometry

Photo courtesy of wired.co.uk/health

Photo courtesy of wired.co.uk/health

Peek stands for Portable Eye Examination Kit. It is comprised of a smartphone app and low-cost adaptor that enables eye examinations anywhere in the world, such as remotely located medical clinics. The adapter that is attached to the smartphone is portable – small enough to fit in a pocket. Peek retina includes both a retina camera function and an ophthalmoscope using the smartphone’s camera. The importance of this technology is to diagnose ocular conditions in the back of the eye such as glaucoma, diabetes and high blood pressure.

Since the adapter works with a smartphone, the images can be saved and shared with specialists located in other regions. The device was created by Dr. Andrew Bastawrous and is funded through Indiegogo. Per Dr. Bastawrous, “Around 39 million people are blind — 80% of this blindness is avoidable, but in many regions people don’t have access to eye care.”

At this time, a pledge of £60 ($95) can be used to purchase the kit or to donate an adapter to a medical worker. Shipping is estimated for October 2015. The kit currently is compatible on a Samsung S3. Also, it does not have FDA approval and cannot be shipped to the U.S.

If Peek retina actually works, this would be incredibly useful technology to provide eye examinations around the world. Of course, the resolution of the retina image must be in focus to provide the most reliable information.

There are a few disappointments, which could change in the future. First, Peek retina is only compatible with Samsung S3. There are many other smartphones out there that will not have the opportunity to use Peek retina. Second, since it does not have FDA approval, those of us in the U.S. are unable to obtain this technology to help people worldwide.

However, this technology is promising and does have the potential to prevent blindness worldwide.

~ Melissa Barnett, OD, FAAO
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

Vision therapy, you may need it if……

Vision therapy is a process in which we retrain the eyes and brain to work better together to more easily and efficiently capture visual information, processes it and have a good motor output. When over two thirds of the sensory information coming into the brain is processed through the visual system, it is imperative that all of the functions work as easily, as comfortably, and automatically as possible. Then, we can use more brain power for higher level interpretation of what we are seeing and learning.

Photo courtesy of digital kid2007 via Flickr

Photo courtesy of via Flickr

When eye tracking, eye teaming, eye focusing, visual information processing and visual motor integration are not working properly, these are some of the common problems that are noticed in the school setting and these are some of the signs that your child may need vision therapy:

  • Does your child seem to struggle with school work more than his peers?
  • Does a simple homework sheet seem to take hour and hours causing a “homework war” in the evening?
  • Does your child avoid reading? Or get headaches, double or blurry vision when doing near work?
  • Is your child not performing as well on reading and writing tasks as she does if she is read to?
  • Most importantly, is your child not performing to their potential in school or sports?
  • Having attention or behavioral problems in the classroom?

What about for us adults? Vision therapy is not just for kids.  With the use of computers and tablets and smartphones, adults can experience a multitude of visual problems that affect fatigue levels and performance at work that Vision Therapy can help eliminate.

  • Do you experience headaches after working on the computer?
  • Do you ever see double vision?
  • Does your vision get blurry on and off?
  • Do you ever have blurry vision driving home at night after working on the computer all day?
  • Do you find that you skip words or numbers while reading documents, spreadsheets, etc?

With any of these symptoms, a complete eye health and developmental vision evaluation can diagnose the specific problem, determine if vision is the cause and if vision therapy can help. At your next eye examination, let your COA optometrist know if you or your child are experiencing any of the above symptoms and ask if vision therapy will help. For more information on vision therapy and the signs and symptoms of vision related problems, visit http://www.COVD.org

 

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