Friday, December 11, 2015

Dry Eye Clinic at Village Eyes Optometry of West Los Angeles/Westwood Village

We are very excited about our new Dry Eye Clinic at Village Eyes Optometry.  We are able to help patients with all of their dry eye issues.

Dry eyes can be a very complicated subject.  The reason is that there are different causes of dry eyes.  Dry eyes can be caused by certain medications, computer and cell phone usage, certain eyelid conditions such as blepharitis and many other causes.

There are two main types of dry eyes.  One is due to a patient's eyes not making enough tears.  This is called tear insufficiency dry eyes.  The other cause of dry eyes is called evaporative dry eyes.

In tear insufficiency dry eyes we just do not make enough tears to keep our eyes lubricated.  There are many underlying conditions that can contribute to this problem.  There are different ways to help this problem that can be as simple as using tear supplements to more complicated approaches that involve using a medication to  help our eyes create more tears.

In evaporative dry eyes our eyes don't make enough of the oil that our eyes normally make and this lack of oil, which functions sort of like an oil slick on water, allows our tears to evaporate too quickly.  It is possible to treat the oil glands that are meant to produce this oil to get them to properly secrete the oil that our eyes need.

It is also very important to create a healthy ocular surface when treating dry eyes.  This can be helped by properly cleaning the eyelashes and lids and sometime by the short time usage of certain treatment medications that can help bring the ocular surface back into a healthy state.

If any readers feel that they may be helped by seeking treatment for dry eyes, please contact Village Eyes Optometry and our Dry Eye Clinic of West Los Angeles to schedule a consultation.

Friday, December 26, 2014

Glaucoma defined

The following is an excellent article by the NIH that describes the eye disease of glaucoma and its treatment options.  For more information and to schedule a consultation, call 310 208-3011 to schedule an appointment for a consultation with the doctors at Village Eyes Optometry.

Glaucoma Defined

What is Glaucoma?

Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. However, with early detection and treatment, you can often protect your eyes against serious vision loss.
The optic nerve
The optic nerve
The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram above.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.

How does the optic nerve get damaged by open-angle glaucoma?

Several large studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
In open-angle glaucoma, even though the drainage angle is “open”, the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision loss—may result. That’s why controlling pressure inside the eye is important.
Another risk factor for optic nerve damage relates to blood pressure. Thus, it is important to also make sure that your blood pressure is at a proper level for your body by working with your medical doctor.
Fluid Pathway
Fluid pathway is shown in teal.

Can I develop glaucoma if I have increased eye pressure?

Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.
Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.

Can I develop glaucoma without an increase in my eye pressure?

Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.

Who is at risk for open-angle glaucoma?

Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:
  • African Americans over age 40
  • Everyone over age 60, especially Mexican Americans
  • People with a family history of glaucoma
A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.

Glaucoma Symptoms

At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.
Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.
Normal Vision
Normal Vision.
Glaucoma Vision
The same scene as viewed by a person with glaucoma.
Glaucoma Detected

How is glaucoma detected?

Glaucoma is detected through a comprehensive dilated eye exam that includes the following:
Visual acuity test. This eye chart test measures how well you see at various distances.
Visual field test. This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.
Dilated eye exam. In this exam, drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry is the measurement of pressure inside the eye by using an instrument called a tonometer. Numbing drops may be applied to your eye for this test. A tonometer measures pressure inside the eye to detect glaucoma.
Pachymetry is the measurement of the thickness of your cornea. Your eye care professional applies a numbing drop to your eye and uses an ultrasonic wave instrument to measure the thickness of your cornea.

Can glaucoma be cured?

No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.

Glaucoma Treatments

Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.
Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.
Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Taken regularly, these eyedrops lower eye pressure. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
Before you begin glaucoma treatment, tell your eye care professional about other medicines and supplements that you are taking. Sometimes the drops can interfere with the way other medicines work.
Glaucoma medicines need to be taken regularly as directed by your eye care professional. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes.
Many medicines are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new medicine may be possible.
Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.
Tonometer that measures pressure.
A tonometer measures pressure inside the eye to detect glaucoma.
Make sure your eye care professional shows you how to put the drops into your eye. For tips on using your glaucoma eyedrops, see the inside back cover of this booklet.
Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you will need to keep taking glaucoma medicines after this procedure.
Laser trabeculoplasty is performed in your doctor’s office or eye clinic. Before the surgery, numbing drops are applied to your eye. As you sit facing the laser machine, your doctor holds a special lens to your eye. A high-intensity beam of light is aimed through the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.
Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You will need to make several follow-up visits to have your eye pressure and eye monitored.
If you have glaucoma in both eyes, usually only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart.
Studies show that laser surgery can be very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment.
Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram on the next page.) Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure.
Conventional surgery, called trabeculectomy, is performed in an operating room. Before the surgery, you are given medicine to help you relax. Your doctor makes small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye. This fluid will drain between the eye tissue layers and create a blister-like “filtration bleb.”
For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.
Conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart.
Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.
Sometimes after conventional surgery, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, inflammation, infection inside the eye, or low eye pressure problems. If you have any of these problems, tell your doctor so a treatment plan can be developed.

What are some other forms of glaucoma and how are they treated?

Open-angle glaucoma is the most common form. Some people have other types of the disease.
In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.
A comprehensive medical history is important to identify other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.
In angle-closure glaucoma, the fluid at the front of the eye cannot drain through the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma may have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to restore the flow of fluid, the eye can become blind. Usually, prompt laser surgery and medicines can clear the blockage, lower eye pressure, and protect vision.
In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines are not effective and can cause more serious side effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.
Conventional surgery.
Conventional surgery makes a new opening for the fluid to leave the eye.
Secondary glaucomas can develop as complications of other medical conditions. For example, a severe form of glaucoma is calledneovascular glaucoma, and can be a result from poorly controlled diabetes or high blood pressure. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries. Steroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. There are two eye conditions known to cause secondary forms of glaucoma.
Pigmentary glaucoma occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.
Pseudoexfoliation glaucoma occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.
Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.

What research is being done?

Through studies in the laboratory and with patients, NEI is seeking better ways to detect, treat, and prevent vision loss in people with glaucoma. For example, researchers have discovered genes that could help explain how glaucoma damages the eye.
NEI also is supporting studies to learn more about who is likely to get glaucoma, when to treat people who have increased eye pressure, and which treatment to use first.

What You Can Do

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.
You also can help protect the vision of family members and friends who may be at high risk for glaucoma-African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember that lowering eye pressure in the early stages of glaucoma slows progression of the disease and helps save vision.
Medicare covers an annual comprehensive dilated eye exam for some people at high risk for glaucoma. These people include those with diabetes, those with a family history of glaucoma, and African Americans age 50 and older.

What should I ask my eye care professional?

You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.

What are some questions to ask?

About my eye disease or disorder…
  • What is my diagnosis?
  • What caused my condition?
  • Can my condition be treated?
  • How will this condition affect my vision now and in the future?
  • Should I watch for any particular symptoms and notify you if they occur?
  • Should I make any lifestyle changes?
About my treatment…
  • What is the treatment for my condition?
  • When will the treatment start and how long will it last?
  • What are the benefits of this treatment and how successful is it?
  • What are the risks and side effects associated with this treatment?
  • Are there foods, medicines, or activities I should avoid while I’m on this treatment?
  • If my treatment includes taking medicine, what should I do if I miss a dose?
  • Are other treatments available?
About my tests…
  • What kinds of tests will I have?
  • What can I expect to find out from these tests?
  • When will I know the results?
  • Do I have to do anything special to prepare for any of the tests?
  • Do these tests have any side effects or risks?
  • Will I need more tests later?
Other suggestions
  • If you don’t understand your eye care professional’s responses, ask questions until you do understand.
  • Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.
  • Ask your eye care professional to write down his or her instructions to you.
  • Ask your eye care professional for printed material about your condition.
  • If you still have trouble understanding your eye care professional’s answers, ask where you can go for more information.
  • Other members of your healthcare team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.
Today, patients take an active role in their health care. Be an active patient about your eye care.

Loss of Vision

If you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments.

How should I use my glaucoma eyedrops?

If eyedrops have been prescribed for treating your glaucoma, you need to use them properly, as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicine’s effectiveness and reduce your risk of side effects.
To properly apply your eyedrops, follow these steps:
  • Wash your hands.
  • Hold the bottle upside down.
  • Tilt your head back.
  • Hold the bottle in one hand and place it as close as possible to the eye.
  • With the other hand, pull down your lower eyelid. This forms a pocket.
  • Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eyedrop, be sure to wait at least 5 minutes before applying the second eyedrop.
  • Close your eye OR press the lower lid lightly with your finger for at least 1 minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects.

Friday, October 4, 2013

Back to school again!

It's that time of year when the kids head back to school.  After the long days of summer this portends a change in the weather as things cool down and winter approaches.  It is also an opportunity to revisit our children's vision and to make sure that they are ready for the new school year.  The prescription for eyeglasses for children can sometimes change significantly in only one year.  This is because they are growing and as they grow their prescription may need regular updating.  The best way to ensure that they are seeing properly is to schedule a comprehensive eye examination for them so they can start the new school year seeing as clearly as possible.  If they cannot see the "board" clearly they are likely to misinterpret a teacher's instructions.  If they have a significant amount of astigmatism they may develop reading difficulties.  The same goes for untreated near vision problems when the child is farsighted, especially when combined with astigmatism.

In earlier comments on this blog I have discussed options that are available for children's vision care.  This can range from eyeglasses to contact lenses to special therapeutic contact lenses that can actually control myopia by reshaping the cornea. The world of children's eyeglasses has expanded so much that kids now want to wear the latest frames even if they have a mild prescription.  The attitude about wearing a vision correction has dramatically changed over the years.  It is not uncommon for a parent to bring in a child for a vision wellness exam, and upon finding out that the child has normal vision and does not require eyeglasses the child will actually beg for glasses.  This is because of how popular the wearing of glasses has become. This never used to happen years ago.

In addition to using eyeglasses to correct and treat many different vision conditions, often eye exercises can be beneficial for children.  The exercises, when appropriate, can strengthen the extra-ocular muscles and make it easier for children to read in comfort for extended periods of time. Eye exercises can also be helpful for sports.

I recommend you use this time of the year to get your kids into their eye doctor for an eye exam and make sure they can visually do their best in the up and coming new school year.  Both you and your child will be happy with the decision.

Monday, April 30, 2012

How To Study For Your Eye Exam

Over the years I have noticed that patients can often struggle with the eye examination process.  The actual part that patients struggle with is officially known as "the refraction".  It is in this part of the exam sequence that the eye doctor is able to determine the best possible prescription for the patient.  What makes this part of the exam sequence difficult for the patient is the subjective nature of the process.  The patient is asked to make a choice between two offerings.  The two offerings may both look a little blurred to the patient, making it a difficult choice.  So, what is a patient to do?  Here are some suggestions to make it easier for a patient to sit through the exam process and come out with a more exact prescription.  
  • Chose the lens offering that represents the "lesser of two evils".  What I mean by this is that the image presented to the patient is often artificially blurred by the placement of an additional lens in front of the eye.  This additional lens does blur the image to a certain degree.  While neither choice may be perfect, if the patient chooses the lesser of two evils the patient will be consistent and the doctor will be able to arrive at an exact prescription. 
  • Some choices are very clear and easy to make and others will be more difficult.  Just go with the flow.  When the difficult choices are presented, understand that the doctor will retest you from different directions to make sure you are consistent in your choices.  
  • The end point, believe it or not, is when the patient cannot tell a difference between the choices presented.  This can be confusing for the patient, but a perfect answer is, "I can't tell the difference....or they are "the same".  In this case, the doctor will choose the least powerful choice for the prescription.  All attempts are made to make sure that the prescription is not too strong.  
  • Some patients  do better with the process if an eye drop is placed into the eye to help control the patient's focusing.  Your doctor will make a decision as to whether this is necessary during the exam process.  
  • What about when you pick up your new prescription?  How long should it take for a patient to adjust to a new prescription?  This is a variable issue.  Some patients will adjust to a new prescription immediately.  Others may need anywhere between a few days to a few weeks to adjust.  Be sure to communicate with your doctor if you are having trouble adjusting to your prescription.  The laboratories that make the prescriptions will allow for the doctor to adjust the prescription if a patient is having difficulty.  Some patients do better with a prescription that is not full strength.  Others prefer a full strength prescription.  Your doctor wants you to have the clearest and most comfortable prescription possible.  Be aware that there is a time limit if the prescription has to be remade.  I had a patient that came to me a year later and said that they did not like the prescription that had been written.  Unfortunately, this is way past the warranty period.  Please let the doctor know in a timely fashion if you are having difficulty and the problem will be solved.
If you have any additional questions regarding the above material please feel free to communicate with me.

Friday, April 20, 2012

Eye Allergy Season

Ah, the wonders of spring.  Flowers are blooming, grass is growing, and seasonal allergies are wreaking havoc on all of my patients.  Here are some suggestions as to what you can do to minimize the effects of these seasonal allergies:
  • Take an "over the counter" anti-histamine.  These come in "drowsy" and "non-drowsy" versions.  The "drowsy" products are the strongest and most effective, but they can make you feel like it's nap time. 
  • Prepare for your outing (golf, hike, etc.) in advance by pre-medicating either with a systemic anti-histamine product and/or an anti-histamine eye drop to control your allergy symptoms.  
  • Take a look at your environment and attempt to set it up to minimize the effects of seasonal allergies:  Set up your sleeping area with an air purifier, close the windows at night (cool air will enter the house through open windows and bring pollen, etc. along with it), try to make all the products you use as hypo-allergenic as possible.  
  • Don't overlook "home remedies" such as cool compresses over the eyes, chamomile tea bags (cool of course) and cucumber slices over the eyes.
Finally, if you are unable to get sufficient help from the above suggestions, visit your health care professional or your vision care specialist for a thorough work up.  New medications are available with prescription that can offer significant help for allergy sufferers.  

Tuesday, September 27, 2011

New Products for Keratoconus and Post Surgical Corneas

We have some exciting new products to help patients with keratoconus and post surgical corneas.  There are new designs in both scleral and hybrid lenses.  Scleral lenses are designed to rest on the sclera (the white part of the eye) and vault over the cornea.  This design allows the lens to avoid contact with the corneal surface.  This is especially helpful in advanced keratoconus or scarred corneas.  Hybrid lenses have improved recently as well.  These are lenses that have a rigid center and a soft periphery.  This allows the lens to have comfort like a soft contact lens and optics like a rigid lens.  The oxygen transmission of  hybrid lenses continues to improve.

The new kid on the block is a soft contact lens designed for keratoconus.  These lenses have a thickened central portion that allows the lens to mask the irregularity associated with the keratoconus.  I was initially skeptical about this lens design until I saw the results.  While the optics may not be exactly as clear as with a rigid lens, they are surprisingly close and often are very well accepted by the patient.   This is especially helpful when rigid lens designs have become intollerant.  It is also possible to correct any residual astigmatism by designing the lens in a toric configuration.  Because of the soft material, these lenses have proven to be very comfortable. 

More to come.........

Tuesday, March 29, 2011

Nobody wears hard contact lenses anymore!!!!!!!!

Nobody wears hard contact lenses anymore....right?   Whoa there horsey!  While many patients and the general public think that hard lenses are a thing of the past, this is definitely not the case.  Hard lenses in their new form, rigid gas permeable contact lenses, are still a viable alternative for many types of vision corrections.  They are terrific for those that want the sharpest vision possible, those that have astigmatism, those that have irregular corneas, post Lasik and refractive surgery patients, and those that want to actually improve their vision through corneal molding or Orthokeratology. 

It is true that it takes a little more time to adjust to rigid gas permeable contacts lenses.  When they are fitted correctly, the adjustment is very short and the lenses become very comfortable after adaptation.  There are many other advantages to rigid gas permeable contact lenses.  They last a long time.  The average life span of a rigid gas permeable lens is about two years.  In addition, if the lenses develop some scratches on the surface, these scratches can be polished out.  The lenses are less subject to prescription changes than are soft lenses.  Unlike soft lenses that correct astigmatism, the blinking of the eyes does not generally affect the clarity of the vision with "gas perms".  Gas perms are also terrific for multifocal applications.  It is also possible to adjust the fitting characteristics of "gas perms".  This is becoming a "lost art".  Doctors that are comfortable with adjusting "gas perms" can make the edges thinner, add power, loosen the lenses, make the lenses smaller, etc.  No way is this possible with soft lenses. 
It is very common in our office to modify rigid gas permeable lenses to fine turn both the vision and the fitting characteristics of the lenses.  This allows us to adjust the lenses to the finest fitting possible.

So, are rigid gas permeable contacts (gas perms) the best lenses for all patients?  I would definitely say "Maybe!".  Each case is different, but "gas perms" are  an excellent alternative for those patients that could best benefit from their unique characteristics. 

Be sure to ask your eye doctor if "gas perms" would be a good choice for you.  If you have any questions, please feel free to email me at