Post surgical contact lens fitting can apply to a number of different situations: 1. There was a trauma to the eye that required surgery to the cornea requiring custom contact lens fitting to provide the best vision for the patient. 2. The patient had a corneal disease such as keratoconus) that required a corneal transplant and thereafter contact lenses needed to be fitted to obtain the best possible vision. 3. The patient had refractive surgery with an unsatisfactory outcome. To provide the patient with the best possible vision, contact lenses need to be fitted. This can apply to both Lasik and Radial Keratotomy.
Post surgical contact lens fitting is probably the most complicated form of contact lens fitting. In many cases the cornea is so irregular that traditional contact lenses cannot be used. Doctors use custom types of contact lenses that are typically larger than most contact lens designs. While most patients that wear traditional contact lenses often wear soft contact lenses, the majority of lenses prescribed for post surgical applications are made with rigid polymers or from special hybrid designs that incorporate both rigid and soft materials in the product. It is important that the doctor has a variety of different fitting sets and materials on hand so the best possible fit can be achieved. In the case of fitting these products, the patient needs to understand that the fitting is a process. It often takes many visits over a period of time to come up with the best product for the individual patient.
Once fitted these contact lenses often allow patients to again have very good usable and sometimes excellent vision. This allows them to return to doing normal activities that were difficult and often impossible prior to the fitting of the lenses. If you have any questions about custom contact lens fitting for post surgical corneas, please email me at jon@villageeyes.com.
Thursday, March 25, 2010
Bifocal And Multifocal Contact Lenses
Bifocal or multifocal contact lenses have come a long way in the last few years. The first attempts to make these products were not very good. They would work for some patients but this was the exception rather than the rule. Today, due to research and new product development, there are a multitude of designs from many different manufacturers. The lenses come in designs for both soft and rigid gas permeable polymers. I have had success with both the rigid and the soft products. In general, the vision can often be a little sharper with rigid gas permeable contact lens multifocals and bifocals than it is with soft lens bifocals and multifocals. While this does not universally apply, the reason it does frequently apply is due to the better optics provided by the rigid lens material.
Most of the fits that are performed today by doctors that fit these products are in the soft lens materials. Patients believe that rigid lenses are more difficult to wear and adjust to. While there is a little bit more adaptation with rigid lenses, the optics provided make the adaptation worth while for many patients. Once adapted, rigid lenses are very similar in comfort to soft lenses. I must say, however, that the soft lens products have improved significantly so that most patients find there vision to be satisfactory for most activities.
How do doctors determine which product is best for a patient? This is based upon the nature of the patient's prescription, the demands of the patient (how much and what type of close work the patient does), the work environment, the health of the eyes, the amount of moisture in the eyes, and the amount of time the patient wants to use the particular product.
The fitting of contact lenses, especially custom type products like bifocals and multifocals, has to be considered a process. This means that it often takes several types of lenses over a period of time to satisfy a patient's needs. Luckily, the contact lens manufacturers are aware of this and they will provide the doctor with diagnostic lenses to help the patient and the doctor to find the best lenses for the individual. Doctors charge a fitting fee to cover the cost of the time involved to find the best product for the individual patient. The fitting fee covers the time and effort required to evaluate the products and come up with the best options for the patient.
If you are interested in obtaining multifocal or bifocal contact lenses, make sure that you see a doctor that has lots of experience with the fitting of these products. They are more complicated and a positive outcome will be more likely achieved with an experienced eye doctor. If you have any questions, please contact me by email at jon@villageeyes.com.
Most of the fits that are performed today by doctors that fit these products are in the soft lens materials. Patients believe that rigid lenses are more difficult to wear and adjust to. While there is a little bit more adaptation with rigid lenses, the optics provided make the adaptation worth while for many patients. Once adapted, rigid lenses are very similar in comfort to soft lenses. I must say, however, that the soft lens products have improved significantly so that most patients find there vision to be satisfactory for most activities.
How do doctors determine which product is best for a patient? This is based upon the nature of the patient's prescription, the demands of the patient (how much and what type of close work the patient does), the work environment, the health of the eyes, the amount of moisture in the eyes, and the amount of time the patient wants to use the particular product.
The fitting of contact lenses, especially custom type products like bifocals and multifocals, has to be considered a process. This means that it often takes several types of lenses over a period of time to satisfy a patient's needs. Luckily, the contact lens manufacturers are aware of this and they will provide the doctor with diagnostic lenses to help the patient and the doctor to find the best lenses for the individual. Doctors charge a fitting fee to cover the cost of the time involved to find the best product for the individual patient. The fitting fee covers the time and effort required to evaluate the products and come up with the best options for the patient.
If you are interested in obtaining multifocal or bifocal contact lenses, make sure that you see a doctor that has lots of experience with the fitting of these products. They are more complicated and a positive outcome will be more likely achieved with an experienced eye doctor. If you have any questions, please contact me by email at jon@villageeyes.com.
Friday, March 19, 2010
Eyecare Humor
If you have not seen Brian Regan's take on his visit to his eye doctor you will certainly enjoy this. Here is the link:www.youtube.com/watch?v=v8GMFkc3iSA
Choose your eye doctor the best way. Do your homework!
There is no substitute for homework. By this, I mean that if you want to find a good eye doctor, dentist, podiatrist, physician, chiropractor, psychologist, hygienist, physical therapist or any health care professional you have to do research. This does not mean that you cannot trust the recommendation of your friends, family and colleagues. A personal recommendation is one of the best ways to find a health care professional. I would make sure that the person referring you has personal experience of the specific health care professional that you are being referred to. If the health care professional has a web site, you should check that out. Verify the education and experience of the doctor. Make sure that the description of what is available matches what you are looking for. In general, the more experience that a doctor has the greater the possibility that you will have a positive outcome. Doctors that have been in practice for a long time generally are successful because they satisfy their patients needs. This is not always the case, but in general it is true. Another good indication is a referral from another doctor. If lots of health care professionals use a particular doctor the chances are excellent that you will be well taken care of. It is also possible to go to the "Department of Consumer Affairs" in your local state and find if there are any complaints against the doctor. In addition, you can visit a site like "Yelp" and look at the reviews that are listed for the particular professional. You can also check reviews on "Google" and other sources.
A word about reviews: There are very few doctors that have perfect reviews. This is because doctors are people and they deal with events in the real world. The real world is not perfect, although we all want it to be. If the majority of reviews that an individual doctor has are positive, I feel that it can be assumed that the doctor is satisfying most of his patients. This will apply, especially, if there are mostly positive reviews more recently and only a few negative reviews from quite a ways back. In addition, readers have to realize that the negativity of the review may pertain to the staff and not the doctor. The doctor may be terrific but if the staff is not well trained in patient care and satisfaction, this will still not bode well for the doctor. A negative review based upon staff issues is just as valid as any other negative review. The first impression a patient has regarding a particular office is usually the telephone contact. Many things can have a negative impact upon a patient's impression: How long did it take for the receptionist to pick up the phone? Was the patient immediately put on hold and not gotten back to in a reasonable amount of time? Was the person representing the doctor friendly and helpful? Once in the office for the appointment, was the patient attended to in a timely manner? How long did the patient have to wait until being seen by the doctor? What kind of condition was the office in? Were the magazines up to date? Were the bathrooms clean? All of these questions can have a dramatic effect on a patient's impression of a particular doctor's office AND THE PATIENT HAS NOT EVEN SEEN THE DOCTOR YET!
What about the doctor? Was the doctor friendly? Did the doctor answer the patient's questions? Were the patient's reasons for being there addressed? Were follow up visits scheduled when necessary? Basically, did the patient get the overall impression that the doctor and staff were happy that the patient had come to them for professional services?
If the overall impression is negative, the office probably does deserve a negative review. I also feel that it is important for doctors to poll their patients to make sure that the overall impression of patients is
positive. Doctors want their patients to be satisfied. A problem occurs when feedback is not monitored by the doctor and staff. I think the most valuable thing that a patient can do for an office, if they have a negative experience, is to let the doctor know. It is much better for the doctor to know about the problem so the problem can be addressed and solved rather than the patient just leaving and going to another office and telling everyone about their negative experience. If after offering constructive criticism the patient still feels that their concerns are not being addressed, it is definitely time to find another doctor.
So, the bottom line is: 1. do your homework 2. be open minded 3. if you are not satisfied, let the doctor know 4. If you are happy with the services of the doctor and staff, tell others so they too can have a positive experience 5. Offer your own review of the office
Good luck with your professional relationships. If you have any questions or comments, please contact me through my listed email on the blog.
A word about reviews: There are very few doctors that have perfect reviews. This is because doctors are people and they deal with events in the real world. The real world is not perfect, although we all want it to be. If the majority of reviews that an individual doctor has are positive, I feel that it can be assumed that the doctor is satisfying most of his patients. This will apply, especially, if there are mostly positive reviews more recently and only a few negative reviews from quite a ways back. In addition, readers have to realize that the negativity of the review may pertain to the staff and not the doctor. The doctor may be terrific but if the staff is not well trained in patient care and satisfaction, this will still not bode well for the doctor. A negative review based upon staff issues is just as valid as any other negative review. The first impression a patient has regarding a particular office is usually the telephone contact. Many things can have a negative impact upon a patient's impression: How long did it take for the receptionist to pick up the phone? Was the patient immediately put on hold and not gotten back to in a reasonable amount of time? Was the person representing the doctor friendly and helpful? Once in the office for the appointment, was the patient attended to in a timely manner? How long did the patient have to wait until being seen by the doctor? What kind of condition was the office in? Were the magazines up to date? Were the bathrooms clean? All of these questions can have a dramatic effect on a patient's impression of a particular doctor's office AND THE PATIENT HAS NOT EVEN SEEN THE DOCTOR YET!
What about the doctor? Was the doctor friendly? Did the doctor answer the patient's questions? Were the patient's reasons for being there addressed? Were follow up visits scheduled when necessary? Basically, did the patient get the overall impression that the doctor and staff were happy that the patient had come to them for professional services?
If the overall impression is negative, the office probably does deserve a negative review. I also feel that it is important for doctors to poll their patients to make sure that the overall impression of patients is
positive. Doctors want their patients to be satisfied. A problem occurs when feedback is not monitored by the doctor and staff. I think the most valuable thing that a patient can do for an office, if they have a negative experience, is to let the doctor know. It is much better for the doctor to know about the problem so the problem can be addressed and solved rather than the patient just leaving and going to another office and telling everyone about their negative experience. If after offering constructive criticism the patient still feels that their concerns are not being addressed, it is definitely time to find another doctor.
So, the bottom line is: 1. do your homework 2. be open minded 3. if you are not satisfied, let the doctor know 4. If you are happy with the services of the doctor and staff, tell others so they too can have a positive experience 5. Offer your own review of the office
Good luck with your professional relationships. If you have any questions or comments, please contact me through my listed email on the blog.
How to find a lost contact lens and how to prevent contact lens loss
Losing a contact lens is something that has happened to all contact lens wering patients as well as to eye doctors who regularly dispense them. I confess that it is easier to lose a rigid gas permeable contact lens than a soft lens, but soft lenses can disappear from view as well. In the soft lens category, the toric lenses are the easiest to lose due to the fact that they are frequently thicker on one side making it more likely that the lens will slip off of your finger when trying to insert it.
So, how can you prevent the loss of a contact lens? First of all, if you are working over a sink make sure that the drain is closed. If you have a sink that does not have a drain stopper, place a washcloth over the drain to prevent the lens from going down the drain. If you do lose a contact lens down the drain, immediately turn off the water. You can take apart the pipes below the drain or call a plumber to do this. It is not very complicated. Have a bucket ready to place under the area that you are working in because once you disconnect the pipes water will come out as well as your contact lens. (Note: In our new era of disposable contact lenses the loss of one lens is not quite the emergency that it was when we did not have disposable lenses. Lenses are still being prescribed that are either not quite as disposable or simply not disposable, such as rigid gas permeable lenses. These lenses can be quite expensive and it is definitely worth it to make an effort not to lose these products.) Getting back to retrieving the contact lens, once it comes out check it out to make sure it is not scratched or damaged. Clean and disinfect it overnight and it should be good to go the next day. If the lens looks suspicious or you are not sure about its condition, please have your eye doctor inspect it.
If the lens falls on the floor, this is the best technique for finding it: Get a flashlight and turn off the lights in the room. Be careful where you step because if you step on the lens it will most likely be history. Get down low to the floor and shine the flashlight beam across the surface of the floor making sure your eyes are as close to the floor as possible. Using this technique the lens will be illuminated and will stand out so you can find it. Again, inspect, clean and disinfect it prior to putting it back in your eye. If the lens cannot be found on the floor it is most likely stuck on a vertical surface, on top of something nearby or in your clothing or it could even possibly have found its way under your clothing. You can use the side lighting technique I have described above for vertical surfaces as well. I have found contact lenses in pockets, cuffs, etc., and I have had my female patients actually report having found lost lenses in their bras. So check everywhere the lens might actually have gone.
A good technique to help prevent loss is to work over a desk or horizontal surface and to put down a white towel. Make sure you have good lighting. If you drop the lens it will fall on the (hopefully) clean towel surface and it will be unlikely to bounce off. Have a bottle of saline/disinfecting solution nearby for rinsing. If you are having problems with insertion and removal, schedule a tune up visit with your doctor for more recommendations on the best techniques for insertion and removal.
What do you do if you lose the contact lens in your eye? First of all, don't panic. The lens cannot work its way up into your brain because the area around the eye is an enclosed environment. Check your vision. If you can see, it is still on your eye. If you cannot see, it has to be above, below or on the sides. Look in the mirror and try to see it. If you can and it is a soft lens simply pull it out. If you cannot see it the lens can sometimes get folded in half and sort of lodge itself up under your upper eyelid. You can close your eyes and look down and use your fingers to massage the lens to either side where you can see it and remove it. If it is a rigid lens, do the same thing. You can either push the rigid lens back on the cornea and remove it or you can use a small suction cup...available from your eye doctor...to remove it. If all else fails, call your eye doctor and schedule an office visit to have it removed.
Lastly, there is a product available that is made of soft plastic that can be used to cover the drain opening. The center has a raised top that sits over the drain opening and there are multiple small holes so that water can go down the drain but your contact lens cannot. If you are interested in information about this product, please contact me at my email address. If you have any additional questions about the condition of lenses that have been dropped and possibly have become damaged, make sure your eye doctor inspects the lens before you use it again.
So, how can you prevent the loss of a contact lens? First of all, if you are working over a sink make sure that the drain is closed. If you have a sink that does not have a drain stopper, place a washcloth over the drain to prevent the lens from going down the drain. If you do lose a contact lens down the drain, immediately turn off the water. You can take apart the pipes below the drain or call a plumber to do this. It is not very complicated. Have a bucket ready to place under the area that you are working in because once you disconnect the pipes water will come out as well as your contact lens. (Note: In our new era of disposable contact lenses the loss of one lens is not quite the emergency that it was when we did not have disposable lenses. Lenses are still being prescribed that are either not quite as disposable or simply not disposable, such as rigid gas permeable lenses. These lenses can be quite expensive and it is definitely worth it to make an effort not to lose these products.) Getting back to retrieving the contact lens, once it comes out check it out to make sure it is not scratched or damaged. Clean and disinfect it overnight and it should be good to go the next day. If the lens looks suspicious or you are not sure about its condition, please have your eye doctor inspect it.
If the lens falls on the floor, this is the best technique for finding it: Get a flashlight and turn off the lights in the room. Be careful where you step because if you step on the lens it will most likely be history. Get down low to the floor and shine the flashlight beam across the surface of the floor making sure your eyes are as close to the floor as possible. Using this technique the lens will be illuminated and will stand out so you can find it. Again, inspect, clean and disinfect it prior to putting it back in your eye. If the lens cannot be found on the floor it is most likely stuck on a vertical surface, on top of something nearby or in your clothing or it could even possibly have found its way under your clothing. You can use the side lighting technique I have described above for vertical surfaces as well. I have found contact lenses in pockets, cuffs, etc., and I have had my female patients actually report having found lost lenses in their bras. So check everywhere the lens might actually have gone.
A good technique to help prevent loss is to work over a desk or horizontal surface and to put down a white towel. Make sure you have good lighting. If you drop the lens it will fall on the (hopefully) clean towel surface and it will be unlikely to bounce off. Have a bottle of saline/disinfecting solution nearby for rinsing. If you are having problems with insertion and removal, schedule a tune up visit with your doctor for more recommendations on the best techniques for insertion and removal.
What do you do if you lose the contact lens in your eye? First of all, don't panic. The lens cannot work its way up into your brain because the area around the eye is an enclosed environment. Check your vision. If you can see, it is still on your eye. If you cannot see, it has to be above, below or on the sides. Look in the mirror and try to see it. If you can and it is a soft lens simply pull it out. If you cannot see it the lens can sometimes get folded in half and sort of lodge itself up under your upper eyelid. You can close your eyes and look down and use your fingers to massage the lens to either side where you can see it and remove it. If it is a rigid lens, do the same thing. You can either push the rigid lens back on the cornea and remove it or you can use a small suction cup...available from your eye doctor...to remove it. If all else fails, call your eye doctor and schedule an office visit to have it removed.
Lastly, there is a product available that is made of soft plastic that can be used to cover the drain opening. The center has a raised top that sits over the drain opening and there are multiple small holes so that water can go down the drain but your contact lens cannot. If you are interested in information about this product, please contact me at my email address. If you have any additional questions about the condition of lenses that have been dropped and possibly have become damaged, make sure your eye doctor inspects the lens before you use it again.
Tuesday, March 9, 2010
Eye Makeup Tips and Eyelash Growth: An Eye Doctor's Perspective
I am asked frequently about eye makeup at my office in Westwood Village, California. Patients have questions about the type to use, when and how to use it, when to change it, etc. I have had patients upset with me when they develop an eye infection and I tell them they have to discard their makeup. I understand that makeup can be expensive, but in the case of an eye infection it is not worth it to keep using the makeup after it has been contaminated. There is a "new kid on the block" as far as eyelashes growth goes. Here I am referring to "Latisse". This is a product that is now available to actually increase eyelash length. It is a derivative of a product that has been used to treat glaucoma. It has been found that a side effect of this medication is the growth of a patient's eyelashes. The product has been reformulated to specifically increase the length of eyelashes without having the theraputic effect of lowering the intraocular pressure. Certain side effects can accompany the usage of this product: It can darken the iris and it can rarely cause a darkening of the tissue at the base of the lashes. Questions regarding this new product can be addressed to your eye doctor.
Below is an excellent article from "The Eye Digest" at the University of Illinois Eye and Ear Infirmary. It does an excellent job of describing the in's and out's of eye makeup usage.
Since ancient history, women have worn cosmetics to enhance the appearance of their eyes. Most people who wear eye makeup never have a problem related to makeup use. Some women can, however, develop an allergic reaction, infection or injury of the eye or eyelids. These problems can range from minor annoyance, such as tearing of the eyes, to visual loss or even blindness.
Who has problems with eye makeup?
Contact lens wearers and people with allergies or sensitive skin are more likely to confront problems while using eye cosmetics. However, anyone who wears eye makeup should be aware of basic safety tips to help prevent injury or infection. (See safety tips below.)
What problems can occur?
The most serious problem related to eye make-up involves injury to the cornea (the clear front surface of the eye), often during application of the cosmetic. A mascara or eyeliner wand or a fingernail can scratch the cornea (corneal abrasion). Occasionally a corneal abrasion can become infected leading to a potentially blinding corneal ulcer. Corneal injuries are usually painful and always require prompt medical attention.
All eye cosmetics contain preservatives that retard the growth of bacteria in the makeup. However, if certain precautions are not taken, bacteria from the skin can still grow in the cosmetic after use. (See safety tips below.) Some women develop frequent conjunctivitis (infection of the outer part of the eyeball) due to contamination of their eye cosmetic or makeup applicator.
Although preservatives partly protect against infection, they can irritate the eye and skin in some sensitive persons. Additionally, some people may be allergic to fragrances or other ingredients in some cosmetics, such as Rosin (also called colophony), nickel and lanolin. They may develop tearing, itching and redness of the eyes, or swelling and flaking of the eyelids. Allergic persons may need to try different hypoallergenic products until they find one that is safe for them. For instance, pencil eyeliner and powder eye shadow may cause less irritation than liquid liner and liquid shadow.
Also, if some women are sensitive to water-proof mascara, they may have less difficulty with a water-based product (one that washes off with water). However, if they continue to have problems after switching products, the cause may not be an allergy. The problems could be caused by blepharitis, a chronic inflammation of the eyelids, which the eye doctor can diagnose.
What are some safety tips to using eye cosmetics?
• Apply eyeliner outside the lash line (away from the eye) to avoid direct contact of the cosmetic with the eye. There also will be less chance that the liner will flake off into the eye.
• Keep eyeliner pencils sharpened so that the rough wood casing won't scratch the eye or eyelid. As the pencil becomes old, the liner tip becomes stiff, requiring more pressure to apply. When this happens, replace the pencil with a new one
• Replace cosmetics every six months (more often if you wear contact lenses) to avoid excess contamination with skin bacteria.
• Never use an old applicator in a fresh cosmetic product. The applicator will transfer bacteria to the new cosmetic.
• After any eye infection, such as conjunctivitis, buy fresh eye makeup.
• Even though eye makeup removers are designed for use around the eye, they can irritate the eye. Apply them carefully to the eyelid and avoid getting them in your eye.
• Never apply eye makeup while in a moving vehicle. You may accidentally poke the applicator into the eye during a sudden bump or stop.
• Never use saliva to thin old or clumped makeup or to wet a mascara wand. Your saliva contains bacteria from your mouth.
• Do not use a safety pin or other sharp instrument to tease apart clumped eyelashes.
• If you use an eyelash curler, make sure the rubber is soft, not stiff and cracking. Always use the curler before applying mascara. Persons allergic to nickel should not use an eyelash curler, as the metal frame contains pickle.
• Do not share your eye cosmetics with others. Each person has different skin bacteria. If you contaminate your cosmetics with another person's bacteria, you may get an infection.
• When at a store cosmetics counter, be sure the cosmetics demonstrator uses fresh applicators and does not let a used sample product come into direct contact with you.
• Check with your eye doctor if you think you have a cosmetic-related eye problem.
Are there special concerns for contact lens wearers?
People who wear contact lenses are prone to corneal abrasions or corneal ulcers if they have poorly fitting lenses or get dust specks under the lens. In addition, they may contaminate their lenses with the oils, residues and possible bacteria found in cosmetics. Some simple precautions can minimize the chance of contamination:
• Insert contact lenses before applying makeup and take them out prior to removing makeup. Always wash your hands before touching your contact lenses.
• Apply makeup less heavily close to the eye. For example, mascara should be applied only to the tip of the eyelashes.
• Buy fresh eye makeup products every three to four months.
• Avoid using cosmetics such as lash-building or thickening mascara and metallic-sheen eye shadows, which contain particles that can flake off into the eye. If these particles get between the contact lens and corneal surface, they can scratch the cornea and may lead to infection.
• Do not wear eye cosmetics during a contact lens fitting examination. (All contact lens wearers should have yearly eye exams to assure the health of the cornea and proper fit of the lenses.)
• If you hurt your eye while applying cosmetics, it is important that an eye doctor examine you. Sometimes a minor injury can become serious without proper medical attention. If possible, take the applicator and cosmetic with you to the doctor so that the products may undergo tests for bacteria. Follow your doctor's advice on when to resume wearing eye makeup.
When can I wear makeup after eye surgery?
Your surgeon will give you instructions about the use of cosmetics before and after eye surgery. In order to avoid bacterial contamination, you should stop wearing makeup a few days before surgery. Depending on the type of surgery, you may be able to resume makeup use after only a few days. Ask your physician. Water-based products will require less rubbing to remove and are gentler on an eye healing from surgery.
Used properly, cosmetics can safely enhance the beauty of your eyes. Consult your eye doctor if you have further questions about the safe use of eye cosmetics.
Below is an excellent article from "The Eye Digest" at the University of Illinois Eye and Ear Infirmary. It does an excellent job of describing the in's and out's of eye makeup usage.
Since ancient history, women have worn cosmetics to enhance the appearance of their eyes. Most people who wear eye makeup never have a problem related to makeup use. Some women can, however, develop an allergic reaction, infection or injury of the eye or eyelids. These problems can range from minor annoyance, such as tearing of the eyes, to visual loss or even blindness.
Who has problems with eye makeup?
Contact lens wearers and people with allergies or sensitive skin are more likely to confront problems while using eye cosmetics. However, anyone who wears eye makeup should be aware of basic safety tips to help prevent injury or infection. (See safety tips below.)
What problems can occur?
The most serious problem related to eye make-up involves injury to the cornea (the clear front surface of the eye), often during application of the cosmetic. A mascara or eyeliner wand or a fingernail can scratch the cornea (corneal abrasion). Occasionally a corneal abrasion can become infected leading to a potentially blinding corneal ulcer. Corneal injuries are usually painful and always require prompt medical attention.
All eye cosmetics contain preservatives that retard the growth of bacteria in the makeup. However, if certain precautions are not taken, bacteria from the skin can still grow in the cosmetic after use. (See safety tips below.) Some women develop frequent conjunctivitis (infection of the outer part of the eyeball) due to contamination of their eye cosmetic or makeup applicator.
Although preservatives partly protect against infection, they can irritate the eye and skin in some sensitive persons. Additionally, some people may be allergic to fragrances or other ingredients in some cosmetics, such as Rosin (also called colophony), nickel and lanolin. They may develop tearing, itching and redness of the eyes, or swelling and flaking of the eyelids. Allergic persons may need to try different hypoallergenic products until they find one that is safe for them. For instance, pencil eyeliner and powder eye shadow may cause less irritation than liquid liner and liquid shadow.
Also, if some women are sensitive to water-proof mascara, they may have less difficulty with a water-based product (one that washes off with water). However, if they continue to have problems after switching products, the cause may not be an allergy. The problems could be caused by blepharitis, a chronic inflammation of the eyelids, which the eye doctor can diagnose.
What are some safety tips to using eye cosmetics?
• Apply eyeliner outside the lash line (away from the eye) to avoid direct contact of the cosmetic with the eye. There also will be less chance that the liner will flake off into the eye.
• Keep eyeliner pencils sharpened so that the rough wood casing won't scratch the eye or eyelid. As the pencil becomes old, the liner tip becomes stiff, requiring more pressure to apply. When this happens, replace the pencil with a new one
• Replace cosmetics every six months (more often if you wear contact lenses) to avoid excess contamination with skin bacteria.
• Never use an old applicator in a fresh cosmetic product. The applicator will transfer bacteria to the new cosmetic.
• After any eye infection, such as conjunctivitis, buy fresh eye makeup.
• Even though eye makeup removers are designed for use around the eye, they can irritate the eye. Apply them carefully to the eyelid and avoid getting them in your eye.
• Never apply eye makeup while in a moving vehicle. You may accidentally poke the applicator into the eye during a sudden bump or stop.
• Never use saliva to thin old or clumped makeup or to wet a mascara wand. Your saliva contains bacteria from your mouth.
• Do not use a safety pin or other sharp instrument to tease apart clumped eyelashes.
• If you use an eyelash curler, make sure the rubber is soft, not stiff and cracking. Always use the curler before applying mascara. Persons allergic to nickel should not use an eyelash curler, as the metal frame contains pickle.
• Do not share your eye cosmetics with others. Each person has different skin bacteria. If you contaminate your cosmetics with another person's bacteria, you may get an infection.
• When at a store cosmetics counter, be sure the cosmetics demonstrator uses fresh applicators and does not let a used sample product come into direct contact with you.
• Check with your eye doctor if you think you have a cosmetic-related eye problem.
Are there special concerns for contact lens wearers?
People who wear contact lenses are prone to corneal abrasions or corneal ulcers if they have poorly fitting lenses or get dust specks under the lens. In addition, they may contaminate their lenses with the oils, residues and possible bacteria found in cosmetics. Some simple precautions can minimize the chance of contamination:
• Insert contact lenses before applying makeup and take them out prior to removing makeup. Always wash your hands before touching your contact lenses.
• Apply makeup less heavily close to the eye. For example, mascara should be applied only to the tip of the eyelashes.
• Buy fresh eye makeup products every three to four months.
• Avoid using cosmetics such as lash-building or thickening mascara and metallic-sheen eye shadows, which contain particles that can flake off into the eye. If these particles get between the contact lens and corneal surface, they can scratch the cornea and may lead to infection.
• Do not wear eye cosmetics during a contact lens fitting examination. (All contact lens wearers should have yearly eye exams to assure the health of the cornea and proper fit of the lenses.)
• If you hurt your eye while applying cosmetics, it is important that an eye doctor examine you. Sometimes a minor injury can become serious without proper medical attention. If possible, take the applicator and cosmetic with you to the doctor so that the products may undergo tests for bacteria. Follow your doctor's advice on when to resume wearing eye makeup.
When can I wear makeup after eye surgery?
Your surgeon will give you instructions about the use of cosmetics before and after eye surgery. In order to avoid bacterial contamination, you should stop wearing makeup a few days before surgery. Depending on the type of surgery, you may be able to resume makeup use after only a few days. Ask your physician. Water-based products will require less rubbing to remove and are gentler on an eye healing from surgery.
Used properly, cosmetics can safely enhance the beauty of your eyes. Consult your eye doctor if you have further questions about the safe use of eye cosmetics.
Monday, March 8, 2010
Emergency Eye Care
Here are some examples of an emergency eye care event. It's a Sunday and you are working in the garden and you brush up against a bush and scratch your cornea. This is a very painful event and it requires attention ASAP. You have options: 1. You could call your eye doctor 2. You could go to the "emergency room" at the nearest hospital 3. You could go to an "urgency care center" 4. You could hope for the best and just use artificial tears until Monday rolls around.
The best thing to do in this situation is to seek professional treatment. If you go to an urgency care center or an emergency room, make sure that they have what is called a "slit lamp". This is a high powered microscope that allows the doctor to visualize the front part of the eye with a very high degree of magnification. With this tool the doctor can see the exact cause of the abrasion, whether any material remains embedded in the corneal tissue, and can determine the best approach for treatment. If any debris or a foreign body is in the cornea, this must be removed for proper healing to occur. The doctor will use an anesthetic eye drop and remove the object or debris.
The treatment usually involves prescribing an antibiotic eyedrop or ointment, a pain reliever and resting the eyes for a few days. The best way to find a doctor that provides emergency eye care is to first try your regular eye doctor. If your regular eye doctor is not available and you cannot get a reference to a doctor that is available, look up doctors that provide emergency eyecare using an internet search engine such as "Google" or "Yahoo". In most cases, it will be significantly less expensive to seek out an individual eye doctor for treatment rather than to go to an emergency room. The chances are that you will be seen very quickly and the problem will be attended to. There is normally a premium charged for after hours care, but it is still significantly less expensive than going to a hospital emergency room in most situations. Make sure to ask if the doctor takes your insurance so that you can be reimbursed for a portion of the cost of the visit.
It is possible that the problem is so serious that it does require the care of an eye specialist. If this is the case, the eye doctor that sees you can refer you to the proper facility for further treatment when necessary. This may be the case if a caustic chemical gets in the eye. If this is the case, you should flush the eyes out with lots of water and seek treatment ASAP. Other eye emergencies or urgencies involve eye infections, iritis, pain in the eye, loss of vision, visual disturbances, increases in floaters, sudden blurred vision and light flashes.
The best way to deal with these issues is to first call your regular eye doctor. Your regular eye doctor may be able to see you to take care of the problem or to refer you to someone that is available to help you. If not, try the above mentioned internet search engines or go the the emergency room at the nearest hospital. You may have to wait longer, but they will make sure that you are treated for the particular problem.
If you have any questions about the above information, please contact me at jon@villageeyes.com or review the information contained in our website, www.villageeyes.com.
The best thing to do in this situation is to seek professional treatment. If you go to an urgency care center or an emergency room, make sure that they have what is called a "slit lamp". This is a high powered microscope that allows the doctor to visualize the front part of the eye with a very high degree of magnification. With this tool the doctor can see the exact cause of the abrasion, whether any material remains embedded in the corneal tissue, and can determine the best approach for treatment. If any debris or a foreign body is in the cornea, this must be removed for proper healing to occur. The doctor will use an anesthetic eye drop and remove the object or debris.
The treatment usually involves prescribing an antibiotic eyedrop or ointment, a pain reliever and resting the eyes for a few days. The best way to find a doctor that provides emergency eye care is to first try your regular eye doctor. If your regular eye doctor is not available and you cannot get a reference to a doctor that is available, look up doctors that provide emergency eyecare using an internet search engine such as "Google" or "Yahoo". In most cases, it will be significantly less expensive to seek out an individual eye doctor for treatment rather than to go to an emergency room. The chances are that you will be seen very quickly and the problem will be attended to. There is normally a premium charged for after hours care, but it is still significantly less expensive than going to a hospital emergency room in most situations. Make sure to ask if the doctor takes your insurance so that you can be reimbursed for a portion of the cost of the visit.
It is possible that the problem is so serious that it does require the care of an eye specialist. If this is the case, the eye doctor that sees you can refer you to the proper facility for further treatment when necessary. This may be the case if a caustic chemical gets in the eye. If this is the case, you should flush the eyes out with lots of water and seek treatment ASAP. Other eye emergencies or urgencies involve eye infections, iritis, pain in the eye, loss of vision, visual disturbances, increases in floaters, sudden blurred vision and light flashes.
The best way to deal with these issues is to first call your regular eye doctor. Your regular eye doctor may be able to see you to take care of the problem or to refer you to someone that is available to help you. If not, try the above mentioned internet search engines or go the the emergency room at the nearest hospital. You may have to wait longer, but they will make sure that you are treated for the particular problem.
If you have any questions about the above information, please contact me at jon@villageeyes.com or review the information contained in our website, www.villageeyes.com.
Friday, March 5, 2010
Corneal Abrasions and Scratched Corneas
Corneal abrasions and scratched corneas can be extremely painful. The reason that they are so painful is that there are nerves just under the surface of the cornea that become sensitized once the top layer of the cornea (called the epithelium) is removed. These cells on the top of the cornea are very soft and pliable and the layer is very thin. They can easily be removed by a sharp object rubbing across the cornea. This can be anything from a fingernail to the edge of a piece of paper or even the leaf of a tree or bush.
When a patient scratches or abrades the cornea, this becomes an event that the individual has to pay attention to due to the pain involved. While corneal abrasions heal very quickly under most situations (the cornea is the fastest healing tissue in the body) care has to be taken to make sure that an infection does not develop. Once the epithelium is disturbed, the cornea becomes subject to infection. The epithelium presents a barrier to bacteria and other agents that can harm the eye. Eye doctors normally protect the eye from infection by prescribing an antibiotic eyedrop to protect the eye while the cornea heals.
There are different types of abrasions that can affect the cornea. If the cause of the abrasion is something like a fingernail or mascara brush that scratches but does not embed itself into the cornea, the treatment is usually an antibiotic eyedrop and a pain control medication. If the cause of the abrasion involves something that becomes embedded in the cornea, the treatment is different as the embedded object needs to be removed. Removal involves the administration of an anesthetic eye drop and the removal of the object. If the object is on the surface the removal is relatively easy. If the object penetrates the cornea deeply this becomes a much more complicated procedure. Occasionally a metal foreign body will embed in the cornea and leave "rust" residue. The object has to be removed and sometimes the rust must be removed as well.
For large corneal abrasions where the area of the abrasion is clean of debris, a soft contact lens can be placed on the cornea to help with the healing. The soft lens is used in a theratputic fashion in this case. The soft lens becomes a "bandage" for the cornea allowing the epithelium to fill in the area of the damaged cornea and allowing the patient to be much more comfortable during the healing process.
The location of the abrasion is important as well. If the abrasion involves the area over the pupil, care must be taken to not damage the tissue as this can have a permanent effect upon vision. Surface abrasions are easily dealt with in this case, but penetrating abrasions can present a problem and permanently alter vision if the penetration is deep enough to cause a scar to the corneal area over the pupil.
The bottom line is to immediately contact your eye doctor if there is an abrasion to the cornea. While painful, the treatment is often pretty straight forward and the outcome is excellent. In the event of a more serious abrasion, the eye doctor can take the necessary steps to make sure the outcome is as good as can be expected.
When a patient scratches or abrades the cornea, this becomes an event that the individual has to pay attention to due to the pain involved. While corneal abrasions heal very quickly under most situations (the cornea is the fastest healing tissue in the body) care has to be taken to make sure that an infection does not develop. Once the epithelium is disturbed, the cornea becomes subject to infection. The epithelium presents a barrier to bacteria and other agents that can harm the eye. Eye doctors normally protect the eye from infection by prescribing an antibiotic eyedrop to protect the eye while the cornea heals.
There are different types of abrasions that can affect the cornea. If the cause of the abrasion is something like a fingernail or mascara brush that scratches but does not embed itself into the cornea, the treatment is usually an antibiotic eyedrop and a pain control medication. If the cause of the abrasion involves something that becomes embedded in the cornea, the treatment is different as the embedded object needs to be removed. Removal involves the administration of an anesthetic eye drop and the removal of the object. If the object is on the surface the removal is relatively easy. If the object penetrates the cornea deeply this becomes a much more complicated procedure. Occasionally a metal foreign body will embed in the cornea and leave "rust" residue. The object has to be removed and sometimes the rust must be removed as well.
For large corneal abrasions where the area of the abrasion is clean of debris, a soft contact lens can be placed on the cornea to help with the healing. The soft lens is used in a theratputic fashion in this case. The soft lens becomes a "bandage" for the cornea allowing the epithelium to fill in the area of the damaged cornea and allowing the patient to be much more comfortable during the healing process.
The location of the abrasion is important as well. If the abrasion involves the area over the pupil, care must be taken to not damage the tissue as this can have a permanent effect upon vision. Surface abrasions are easily dealt with in this case, but penetrating abrasions can present a problem and permanently alter vision if the penetration is deep enough to cause a scar to the corneal area over the pupil.
The bottom line is to immediately contact your eye doctor if there is an abrasion to the cornea. While painful, the treatment is often pretty straight forward and the outcome is excellent. In the event of a more serious abrasion, the eye doctor can take the necessary steps to make sure the outcome is as good as can be expected.
Wednesday, March 3, 2010
Why Are Contact Lenses Medical Devices?
It seems I am constantly confronted with questions from some patients that wonder why contact lenses are considered medical devices. Many people think that contact lenses are simply commodities that should be sold over the counter and available everywhere without the requirement of a prescription. Here is an example of how patients can get into trouble if they misuse contact lenses and why they should be controlled by a prescription and only be available through doctors.
I had a patient that came in about six months ago for an eye exam. The patient had been complaining of discomfort when wearing his contact lenses. He was experiencing discharge from his eyes and redness. He also complained of blurred vision. Upon examining the patient and taking a history I learned that the patient had been given a pair of disposable one day single use contact lenses and had left them in his eyes overnight continuously for six months. The lenses were coated with mucous. His eyelids, on the underside, were significantly inflammed and there were multiple "bumps" on the underside of the eyelids (called giant papillary conjunctivitis) causing the localized mucous glands under the lids to produce even more mucous. His corneas were swollen contributing to his blurred vision and his discomfort. Basically his eyes were "a mess". I asked him why he had been using his contact lenses in this fashion and he said that he did not think there was anything wrong with his usage of the contact lenses and that it was no big deal. His friend who had the same "number for his eyes" had given him a pair and at first everything was fine. Unfortunately his problems caught up with him and yielded the result I have described above. I am not saying that this could not happen to a patient that received his lenses from a doctor. If a patient chooses to ignore the instructions and bend the rules of usage of contact lenses in spite of proper instructions from his health care practitioner, there is not much his doctor can do about it. The odds, however, are much greater that this kind of behavior will not occur if patients are instructed about what contact lenses can do and how to properly use and care for them. This patient was quite nearsighted and did not have any glasses. He had to get some emergency glasses and discontinue contacts for two months. He had to undergo treatment for his condition which involved eyedrops that were fairly expensive. After successful therapy he is now back wearing contact lenses with a much greater appreciation of what they are and how to properly care for them.
It is extrememly important for patients to understand that contact lenses are medical devices and they require proper care, handling and disinfection. They should be used according to their individual proper use instructions. Lenses that are to be worn overnight need to have a very high oxygen transmission. In additon, because they are left in overnight, they tend to become soiled quickly. It is important to not leave them in too long and to change them reqularly. There is always some increased risk when lenses are worn overnight as opposed to lenses that are used during waking hours and then cleaned and disinfected...or discarded daily as it the case with single use disposable contact lenses.
If a patient has any questions about proper contact lens care it is best for them to contact their eye doctor to make sure they are using their lenses in the proper manner.
I had a patient that came in about six months ago for an eye exam. The patient had been complaining of discomfort when wearing his contact lenses. He was experiencing discharge from his eyes and redness. He also complained of blurred vision. Upon examining the patient and taking a history I learned that the patient had been given a pair of disposable one day single use contact lenses and had left them in his eyes overnight continuously for six months. The lenses were coated with mucous. His eyelids, on the underside, were significantly inflammed and there were multiple "bumps" on the underside of the eyelids (called giant papillary conjunctivitis) causing the localized mucous glands under the lids to produce even more mucous. His corneas were swollen contributing to his blurred vision and his discomfort. Basically his eyes were "a mess". I asked him why he had been using his contact lenses in this fashion and he said that he did not think there was anything wrong with his usage of the contact lenses and that it was no big deal. His friend who had the same "number for his eyes" had given him a pair and at first everything was fine. Unfortunately his problems caught up with him and yielded the result I have described above. I am not saying that this could not happen to a patient that received his lenses from a doctor. If a patient chooses to ignore the instructions and bend the rules of usage of contact lenses in spite of proper instructions from his health care practitioner, there is not much his doctor can do about it. The odds, however, are much greater that this kind of behavior will not occur if patients are instructed about what contact lenses can do and how to properly use and care for them. This patient was quite nearsighted and did not have any glasses. He had to get some emergency glasses and discontinue contacts for two months. He had to undergo treatment for his condition which involved eyedrops that were fairly expensive. After successful therapy he is now back wearing contact lenses with a much greater appreciation of what they are and how to properly care for them.
It is extrememly important for patients to understand that contact lenses are medical devices and they require proper care, handling and disinfection. They should be used according to their individual proper use instructions. Lenses that are to be worn overnight need to have a very high oxygen transmission. In additon, because they are left in overnight, they tend to become soiled quickly. It is important to not leave them in too long and to change them reqularly. There is always some increased risk when lenses are worn overnight as opposed to lenses that are used during waking hours and then cleaned and disinfected...or discarded daily as it the case with single use disposable contact lenses.
If a patient has any questions about proper contact lens care it is best for them to contact their eye doctor to make sure they are using their lenses in the proper manner.
Tuesday, March 2, 2010
My Son The Doctor
I can't tell you how great it is to practice with your child. It was something that I had sort of given up on based upon the initial reaction of my children when I first broached the subject. When my children were much younger I invited both of them to consider optometry as a career. They both answered without hesitation: "No!" My son is the eldest of my two children and he wanted to be involved in the movie business. He initially wanted to write and produce movies. He majored in English when at UCLA and received his degree in that field. My daughter studied business and graduated with a double major at SMU in business and Spanish. She worked in a business climate for a couple of years and then decided that teaching was what she really liked. She received her credential and she now teaches at a private school in Santa Monica, California. She does all of this including being a mother to her wonderful family which includes her attorney husband, Marcos and her two children, Molly and Matthew.
My son initially worked for a few production companies and did some acting. After a few years of doing this he felt he was not going in the right direction. He then sold life insurance for a major insurance company, but did not really like doing it. After about a year of working in the insurance business, he came to me and asked if I was still interested in him going into the field of optometry. I said that I definitely was, and off he went.
This was no easy task as he had been an English major. He was a natural at writing and really loved it, but he had always taken the path away from math and science. Now he had to go back and take all the classes that he had initially avoided. He had to get good grades in the subjects and he had to take an entrance exam for optometry school. He did all of this and was accepted into a great school. While in school he met a terrific young lady who was also in optometry school and they are now married and both practice with me at Village Eyes Optometry in Westwood Village, California.
It is terrific to have these young and energetic doctors to practice with. We frequently discuss mutual cases and we are always talking about our field of optometry. At family outings, everyone knows to avoid us because we will almost always be discussing eyeballs in one sense or another. For me this is fun and challenging. It is a real pleasure to see them working so hard and enjoying what they do.
We have a wonderful family practice at Village Eyes Optometry. All five doctors get along extremely well and we all interact with our terrific staff and appreciate one another. My wife, Sissy, also works at the practice and takes care of all the daily business requirements that are needed to keep our business on track. For me, it's as good as it can get. I am looking forward to many more years of practice with my son, my daughter-in-law, and the rest of our optometric family.
My son initially worked for a few production companies and did some acting. After a few years of doing this he felt he was not going in the right direction. He then sold life insurance for a major insurance company, but did not really like doing it. After about a year of working in the insurance business, he came to me and asked if I was still interested in him going into the field of optometry. I said that I definitely was, and off he went.
This was no easy task as he had been an English major. He was a natural at writing and really loved it, but he had always taken the path away from math and science. Now he had to go back and take all the classes that he had initially avoided. He had to get good grades in the subjects and he had to take an entrance exam for optometry school. He did all of this and was accepted into a great school. While in school he met a terrific young lady who was also in optometry school and they are now married and both practice with me at Village Eyes Optometry in Westwood Village, California.
It is terrific to have these young and energetic doctors to practice with. We frequently discuss mutual cases and we are always talking about our field of optometry. At family outings, everyone knows to avoid us because we will almost always be discussing eyeballs in one sense or another. For me this is fun and challenging. It is a real pleasure to see them working so hard and enjoying what they do.
We have a wonderful family practice at Village Eyes Optometry. All five doctors get along extremely well and we all interact with our terrific staff and appreciate one another. My wife, Sissy, also works at the practice and takes care of all the daily business requirements that are needed to keep our business on track. For me, it's as good as it can get. I am looking forward to many more years of practice with my son, my daughter-in-law, and the rest of our optometric family.
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