tag:blogger.com,1999:blog-40399909774787395382024-03-12T20:52:40.615-07:00Dr. Jon's Eyeblog: Eye Exams, Eye Doctors and Eye IssuesMany of the issues that patients have concerning their eyes seem to come up on a regular basis at our Westwood Village Eye Center in West Los Angeles. While these issues are important for each patient, there are a number of these issues that are commonly voiced by many patients. I will make an effort to address these issues in this blog as well as items of interest to me that I hope will be of interest to others.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.comBlogger45125tag:blogger.com,1999:blog-4039990977478739538.post-37764276862234604882015-12-11T17:27:00.000-08:002015-12-11T17:27:11.981-08:00Dry Eye Clinic at Village Eyes Optometry of West Los Angeles/Westwood Village<div dir="ltr" style="text-align: left;" trbidi="on">
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. <br />
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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. <br />
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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. <br />
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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.<br />
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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.<br />
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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. <br />
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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. <br />
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Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-37953730369601787192014-12-26T09:03:00.001-08:002014-12-26T09:03:43.517-08:00Glaucoma defined<div dir="ltr" style="text-align: left;" trbidi="on">
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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.</h2>
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Glaucoma Defined</h2>
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What is Glaucoma?</h3>
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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.</div>
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<strong style="box-sizing: border-box;">The optic nerve</strong></div>
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<img alt="The optic nerve" src="https://www.nei.nih.gov/sites/default/files/health-images/nerve.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /><br style="box-sizing: border-box;" />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.</div>
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How does the optic nerve get damaged by open-angle glaucoma?</h3>
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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.</div>
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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.</div>
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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.</div>
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<img alt="Fluid Pathway" src="https://www.nei.nih.gov/sites/default/files/health-images/pathway.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /><br style="box-sizing: border-box;" />Fluid pathway is shown in teal.</div>
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Can I develop glaucoma if I have increased eye pressure?</h3>
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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.</div>
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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.</div>
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Can I develop glaucoma without an increase in my eye pressure?</h3>
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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.</div>
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Who is at risk for open-angle glaucoma?</h4>
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Anyone can develop glaucoma. Some people, listed below, are at higher risk than others:</div>
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<li style="box-sizing: border-box;">African Americans over age 40</li>
<li style="box-sizing: border-box;">Everyone over age 60, especially Mexican Americans</li>
<li style="box-sizing: border-box;">People with a family history of glaucoma</li>
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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.</div>
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Glaucoma Symptoms</h2>
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At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.</div>
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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.</div>
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<img alt="Normal Vision" src="https://www.nei.nih.gov/sites/default/files/health-images/normalvision.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /><br style="box-sizing: border-box;" />Normal Vision.</div>
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<img alt="Glaucoma Vision" src="https://www.nei.nih.gov/sites/default/files/health-images/glaucomavision.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /><br style="box-sizing: border-box;" />The same scene as viewed by a person with glaucoma.</div>
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<img alt="Glaucoma Detected" src="https://www.nei.nih.gov/sites/default/files/health-images/detected.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /></div>
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How is glaucoma detected?</h3>
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Glaucoma is detected through a comprehensive dilated eye exam that includes the following:</div>
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<strong style="box-sizing: border-box;">Visual acuity test</strong>. This eye chart test measures how well you see at various distances.</div>
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<strong style="box-sizing: border-box;">Visual field test</strong>. This test measures your peripheral (side vision). It helps your eye care professional tell if you have lost peripheral vision, a sign of glaucoma.</div>
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<strong style="box-sizing: border-box;">Dilated eye exam</strong>. 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.</div>
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<strong style="box-sizing: border-box;">Tonometry</strong> 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.</div>
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<strong style="box-sizing: border-box;">Pachymetry</strong> 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.</div>
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Can glaucoma be cured?</h3>
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No. There is no cure for glaucoma. Vision lost from the disease cannot be restored.</div>
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Glaucoma Treatments</h2>
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Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.</div>
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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.</div>
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<strong style="box-sizing: border-box;">Medicines</strong>. 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.</div>
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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.</div>
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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.</div>
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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.</div>
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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.</div>
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<img alt="Tonometer that measures pressure." class="img-responsive" src="https://www.nei.nih.gov/sites/default/files/health-images/tonometry.jpg" style="border: 0px; box-sizing: border-box; display: block; height: auto; max-width: 100%; vertical-align: middle;" /><br style="box-sizing: border-box;" />A tonometer measures pressure inside the eye to detect glaucoma.</div>
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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.</div>
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<strong style="box-sizing: border-box;">Laser trabeculoplasty</strong>. 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.</div>
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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.</div>
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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.</div>
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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.</div>
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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.</div>
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<strong style="box-sizing: border-box;">Conventional surgery</strong>. 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.</div>
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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.”</div>
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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.</div>
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Conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart.</div>
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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.</div>
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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.</div>
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What are some other forms of glaucoma and how are they treated?</h3>
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Open-angle glaucoma is the most common form. Some people have other types of the disease.</div>
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In <strong style="box-sizing: border-box;">low-tension</strong> or <strong style="box-sizing: border-box;">normal-tension glaucoma</strong>, 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.</div>
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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.</div>
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In <strong style="box-sizing: border-box;">angle-closure glaucoma</strong>, 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. <strong style="box-sizing: border-box;">This is a medical emergency.</strong> 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.</div>
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In <strong style="box-sizing: border-box;">congenital glaucoma</strong>, 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.</div>
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<img alt="Conventional surgery." src="https://www.nei.nih.gov/sites/default/files/health-images/surgery.jpg" style="border: 0px; box-sizing: border-box; vertical-align: middle;" /><br style="box-sizing: border-box;" />Conventional surgery makes a new opening for the fluid to leave the eye.</div>
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<strong style="box-sizing: border-box;">Secondary glaucomas</strong> can develop as complications of other medical conditions. For example, a severe form of glaucoma is called<strong style="box-sizing: border-box;">neovascular glaucoma</strong>, 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.</div>
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<strong style="box-sizing: border-box;">Pigmentary glaucoma</strong> occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.</div>
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<strong style="box-sizing: border-box;">Pseudoexfoliation glaucoma</strong> occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.</div>
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Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.</div>
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What research is being done?</h3>
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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.</div>
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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.</div>
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What You Can Do</h2>
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If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.</div>
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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.</div>
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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.</div>
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What should I ask my eye care professional?</h3>
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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.</div>
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What are some questions to ask?</h3>
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<strong style="box-sizing: border-box;">About my eye disease or disorder…</strong></div>
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<li style="box-sizing: border-box;">What is my diagnosis?</li>
<li style="box-sizing: border-box;">What caused my condition?</li>
<li style="box-sizing: border-box;">Can my condition be treated?</li>
<li style="box-sizing: border-box;">How will this condition affect my vision now and in the future?</li>
<li style="box-sizing: border-box;">Should I watch for any particular symptoms and notify you if they occur?</li>
<li style="box-sizing: border-box;">Should I make any lifestyle changes?</li>
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<strong style="box-sizing: border-box;">About my treatment…</strong></div>
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<li style="box-sizing: border-box;">What is the treatment for my condition?</li>
<li style="box-sizing: border-box;">When will the treatment start and how long will it last?</li>
<li style="box-sizing: border-box;">What are the benefits of this treatment and how successful is it?</li>
<li style="box-sizing: border-box;">What are the risks and side effects associated with this treatment?</li>
<li style="box-sizing: border-box;">Are there foods, medicines, or activities I should avoid while I’m on this treatment?</li>
<li style="box-sizing: border-box;">If my treatment includes taking medicine, what should I do if I miss a dose?</li>
<li style="box-sizing: border-box;">Are other treatments available?</li>
</ul>
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<strong style="box-sizing: border-box;">About my tests…</strong></div>
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<li style="box-sizing: border-box;">What kinds of tests will I have?</li>
<li style="box-sizing: border-box;">What can I expect to find out from these tests?</li>
<li style="box-sizing: border-box;">When will I know the results?</li>
<li style="box-sizing: border-box;">Do I have to do anything special to prepare for any of the tests?</li>
<li style="box-sizing: border-box;">Do these tests have any side effects or risks?</li>
<li style="box-sizing: border-box;">Will I need more tests later?</li>
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<strong style="box-sizing: border-box;">Other suggestions</strong></div>
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<li style="box-sizing: border-box;">If you don’t understand your eye care professional’s responses, ask questions until you do understand.</li>
<li style="box-sizing: border-box;">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.</li>
<li style="box-sizing: border-box;">Ask your eye care professional to write down his or her instructions to you.</li>
<li style="box-sizing: border-box;">Ask your eye care professional for printed material about your condition.</li>
<li style="box-sizing: border-box;">If you still have trouble understanding your eye care professional’s answers, ask where you can go for more information.</li>
<li style="box-sizing: border-box;">Other members of your healthcare team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.</li>
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Today, patients take an active role in their health care. Be an active patient about your eye care.</div>
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Loss of Vision</h2>
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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.</div>
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How should I use my glaucoma eyedrops?</h2>
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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.</div>
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To properly apply your eyedrops, follow these steps:</div>
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<li style="box-sizing: border-box;">Wash your hands.</li>
<li style="box-sizing: border-box;">Hold the bottle upside down.</li>
<li style="box-sizing: border-box;">Tilt your head back.</li>
<li style="box-sizing: border-box;">Hold the bottle in one hand and place it as close as possible to the eye.</li>
<li style="box-sizing: border-box;">With the other hand, pull down your lower eyelid. This forms a pocket.</li>
<li style="box-sizing: border-box;">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.</li>
<li style="box-sizing: border-box;">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.</li>
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Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-14330608559384744002013-10-04T15:49:00.000-07:002013-10-04T15:49:40.738-07:00Back to school again!<div dir="ltr" style="text-align: left;" trbidi="on">
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. <br />
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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.<br />
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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.<br />
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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.</div>
Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-70919877364558742922012-04-30T13:05:00.000-07:002012-04-30T13:05:44.989-07:00How To Study For Your Eye Exam<div dir="ltr" style="text-align: left;" trbidi="on">
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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. </div>
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<li>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. </li>
<li>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. </li>
<li>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. </li>
<li>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. </li>
<li>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.</li>
</ul>
If you have any additional questions regarding the above material please feel free to communicate with me.</div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com2tag:blogger.com,1999:blog-4039990977478739538.post-57079628069639493412012-04-20T11:20:00.000-07:002012-04-20T11:20:53.902-07:00Eye Allergy Season<div dir="ltr" style="text-align: left;" trbidi="on">
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:<br />
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<li>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. </li>
<li>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. </li>
<li>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. </li>
<li>Don't overlook "home remedies" such as cool compresses over the eyes, chamomile tea bags (cool of course) and cucumber slices over the eyes.</li>
</ul>
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. </div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-71180017982895934912011-09-27T10:50:00.000-07:002011-09-27T10:50:25.091-07:00New Products for Keratoconus and Post Surgical Corneas<div dir="ltr" style="text-align: left;" trbidi="on">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.<br />
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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. <br />
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More to come.........</div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-10211493727767893292011-03-29T19:27:00.000-07:002011-03-29T19:27:13.089-07:00Nobody wears hard contact lenses anymore!!!!!!!!<div dir="ltr" style="text-align: left;" trbidi="on">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. <br />
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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. <br />
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.<br />
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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. <br />
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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 <a href="mailto:jon@villageeyes.com">jon@villageeyes.com</a>. </div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-21324327838544996572011-03-16T12:22:00.000-07:002011-03-16T16:44:57.727-07:00How To Tell If You Have Good Quality Sunglasses<div dir="ltr" style="text-align: left;" trbidi="on">It is well established that sunglasses are an important part of proper eyecare. Good quality sunglasses block out the sun's harmfull rays and provide comfort for the wearer. They can prevent eyestrain, eye irritation and can even slow down the development of cataracts and other eye aging changes. Prescription sunglasses should not only have the best possible prescription in them, but they should be treated to block the sun's harmful rays and have a degree of tint in them that is best suited to the individual patient.<br />
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In general, if you purchase non-prescription sunglasses from a quality provider you will most likely get a good product. If you buy them from the booth on the sidewalk at the beach, all bets are off. Good quality non-prescription sunglasses are made the same way as prescription eyeglasses. The lenses are optically ground. The difference is that they are ground to have zero prescription. The front and back surfaces exactly match one another. This creates a lens that allows light to pass directly through it without bending. Significant research goes into the determination of the tint in the lenses. The lenses can be polarized as well which does a great job of eliminating reflected glare from horizontal surfaces. This is helpful when on the water or skiing of after rainy days. Lenses that have a yellow color or amber color are noted to enhance contrast. This can be helpful of outdoor activities like shooting and skiing.<br />
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So how do you tell if the lenses are ground properly? Turn the sunglasses over and look for a reflection from the back surface of the lens. You can look at a reflection from a horizontal light tube or the edge of a light source. Move the lens so you can follow the reflection. If the reflection does not "wobble" or seem to become irregular as you move the lens, this indicates that the surface has been optically ground. There is another way to demonstrate the optical properties of the lens. Light can be projected through the lens at a doctor's office. The images projected through the lens should be clear and well defined. If not, this can indicate optical distortion.<br />
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Lenses can be treated to block UV but still may not be optically ground. Ideally the lenses should both be treated to block UV and be optically ground. </div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-44606307823629160612011-01-22T18:12:00.000-08:002011-01-22T18:12:22.235-08:00Small World<div dir="ltr" style="text-align: left;" trbidi="on">I am often reminded of what a small world we live in. In the last two months I have had contacts with some far away places. I received a contact from Moscow about two months ago and last week I received a contact from Romania. Both contacts were related to eye conditons that can be treated with new contact lens designs. The Moscow contact was from a person that had long term keratoconus and had received corneal transplants about 7 years ago. The patient was inquiring about a new type of lens that will treat irregular corneas called "Duette". The contact from Romania was from a parent that was concerned about the increase in his child's myopia and he was asking about options for treatment. <br />
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The world is getting smaller and through the internet new methods of treatment for many different conditons can be explored and analyzed. I look for this trend to continue and to expand in the years to come. It's a great thing. </div>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com1tag:blogger.com,1999:blog-4039990977478739538.post-15011284489813837902010-08-18T19:53:00.000-07:002010-08-18T19:53:50.679-07:00Back to School and Your Child's EyesIt's that time of year again! This is the best time to bring your children in for a comprehensive eye examination. The kids are available and there is no better way to get them ready for the new school year. You may be thinking: "Billy sees things that I don't see and he has always passed the school screening by the school nurse or pediatrician". The truth of the matter is that many conditions can be missed by a simple screening, especially in children. High degrees of hyperopia and well as moderate amounts of astigmatism can be completely missed. In addition, a simple screening does not evaluate how your child uses his or her eyes together. It is very important that children have adequate tracking skills as this is required to read efficiently and increase reading comprehension. Children should also be tested for color vision and depth perception. They should be tested for both their distance vision and their near vision. If they have not had their eyes dilated, this is also recommended. So, bring your children in for their yearly eye examination and while you are at it, get your eyes tested too.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-25565285242509308772010-06-15T10:32:00.000-07:002010-06-16T19:29:31.206-07:00Why Do Patients Need Computer Glasses?I am constantly asked about computer vision problems at the office. This is due, of course, to the amount of time that we all spend looking at a computer screen. There are lots of issues that patients have when looking at a computer screen. The many issues relate primarily to dryness, eye muscle problems, and focusing problems. If a patient has dry eyes to begin with, the problem increases when looking at a computer screen due to the fact that there is a significant decrease in the blink rate when lookng at the screen. I have discussed dry eyes in a previous entry in my blog. Please review that entry for some tips to help with dry eyes. Eye muscle problems can also make it difficult to look at a computer screen for an extended period of time, as this requires that both eyes be pointing at a fixed distance...arm's length for example....for an extended period of time. If the eyes cannot point with comfort at this distance they become tired and this can contribute to headaches and blurred vision and can have a negative effect upon work place performance. Eye exercises can be prescribed for patients that have this problem. There are certain instances where special lens treatments, called prisms, can help as well. These treatments can be incorporated into computer glasses as needed. Finally, there is all the issues associated with focusing problems. Most of these issues relate to the difficulty that patients have with near point focusing associated with the aging process. All of us eventually need help focusing our eyes for near. Regular bifocals don't work well for the computer screen unless we are working on lap tops. With lap tops we look down to see. Here a normal bifocal can often work. With desk top screens a regular bifocal is not the best solution because the patient will have to lift up their chin to look out of the bottom portion of the lens where the bifocal part is. In addition, the bifocal portion is normally set in closer..say about 16 inches.. for normal text viewing. The average computer screen is set out farther at about 26 inches. To view the screen with a regular bifocal, the patient would have to both lift up their chin and lean in to see the screen. This creates both eyestrain and neck strain. To avoid this problem, we can either make reading glasses that focus farther out at the 26 inch distance or design a custom bifocal that provides clear viewing through the top part at about 26 inches and then make the bottom more magnified for text viewing. There is a new computer bifocal available now that also allows the patient to be able to get some distance viewing out of the top part of the lenses when necessary. <br />
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All of these products discussed above function better when they are treated with a glare free coating. The only way to properly design the necessary type of computer lenses that are best for each individual patient is for the patient to have a comprehensive eye examination along with a detailed history that allows the doctor to discover exactly how the patient functions in their work and at home computer environments. <br />
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If the reader has any additional questions or comments about computer eyeglasses please contact me at jon@villageeyes.com.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-63320765696700651342010-04-29T09:41:00.000-07:002010-04-29T18:55:41.797-07:00Keratoconus Treatment: Contact Lenses, Corneal Cross Linking, and Common SenseKeratoconus is an eye disease in which the cornea of the eye becomes thin and bulges forward causing distortion to the optics of the eye. The cornea of the eye is the most powerful light bending surface of the eye and distortion to this surface can have a devastating effect on the clarity of vision. There has been a great deal of research into the causes of keratoconus and it's treatment. The purpose of this post is to discuss the disease, its various stages and the treatment options that are available. <br />
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In the early stages of keratoconus treatment can be relatively simple. When there is not a great deal of distortion to the cornea, eyeglasses and soft contact lenses can often provide good vision. As the disease progresses there is a decrease in what is known as "best corrected vision". This means that as the cornea becomes more irregular, eyeglasses and soft contact lenses may begin to no longer afford the patient the sharpenss to their vision that they had previously enjoyed. Different methods need to be employed to restore or to help capture a sharper image on the retina (the back of the eye). Here is an analogy: Imagine that you have a brand new camera. In the camera you have excellent quality film. At first the camera takes great pictures. Slowly, over time, you notice that the pictures are becoming fuzzy and not clear. The film is great, in this example, but a defect has occurred to the front part of the lens in the camera. The surface had become irregular, perhaps because the lens became scratched. Because of this irregular surface on the front of the camera, the images are no longer clear. This is what happens to the human eye when the cornea becomes distorted. In the human eye, the surface of the cornea actually becomes irregular and uneven....not scratched as in the camera analogy....but this irregularity distorts the images that are formed on the retina (the retina is the back of the eye that is similar to the film in a camera in this example). <br />
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As the cornea becomes more and more distorted, something has to be done to improve the surface quality of the cornea. Eyeglasses can still be worn, but the clarity of the vision becomes poorer and poorer. To restore this optical quality to the eye, rigid contact lenses are used. The reason that rigid contact lenses improve the quality of the image on the retina is that they become a new front surface for the eye. They are made from a rigid material and when placed on the eye, the area between the back surface of the rigid lens and the front surface of the cornea (which is now irregular and distorted) fills in with a patient's own tears. Optically speaking, the new front surface of the cornea is now the front surface of the rigid contact lens. Because it is smooth and regular it erases the distortion present on the natural corneal surface and light passes through to the retina causing a sharp and defined image to be formed on the retina, thereby returning sharp vision to the eye. <br />
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How are rigid contact lenses fitted to the cornea in keratoconus? This is a very complicated subject. Depending upon the degree of distortion to the cornea different types of rigid contact lenses can be used to improve the vision. First, the degree of distortion of the eye is measured by devices that can map or determine the shape of the corneal surface. Then the eye doctor or contact lens fitter has to try different lenses on the eye to determine which type of lens will best fit the cornea and the surrounding tissues. To do this, the eye doctor or contact lens fitter has to try on many different types of lenses. To be successful, a large inventory of diagnostic lenses must be available. In keratoconus contact lens fitting there is no such thing as one size fits all. Every cornea is different. Sometimes small contact lens designs work and sometimes larger lenses need to be employed. It is common to try on lenses from many different manufacturers before settling upon a lens design that is correct for the individual patient. It is important for the patient to understand that the fitting of contact lenses for keratoconus is a process. It requires many visits over a period of time. Even after the best fit and vision is determined by the contact lens fitter, the lens needs to be custom ordered. Once the lenses come back to the office and are verified to be correct they then need to be seen on the patient's eyes. The quality of the fit is determined by using a special diagnostic dye that will spread through the patient's tears and collect behind the contact lens. (This same dye is used in the initial fitting process as well.) The dye will glow when exposed to a special light that the doctor will shine on the eye to determine the best fit. By observing how the tears collect behind the lens the doctor can assess the quality of the fit. Once it is determined that the fit is proper, the vision is measured as well. If everything goes according to plan, both the vision and the fit are what was expected. The patient is trained on the care and handling of the products and is asked to begin wearing the lenses on a schedule that gradually increases the wearing time until the patient is able to work up to a full day of wear. After using the lenses for a period of time the patient is asked to return to further assess the quality of both the fit and the vision. It is common for both the fit and the power of the lenses to be modified on the first follow up visit. This may not be necessary, but it is a common scenario as the lenses can "settle" on the eye after using them for awhile requiring a modification in the fit of the lenses. New lenses are then ordered. It is helpful if the fitter or the doctor has the ability to modify the lenses in the office. If this is possible, many of the minor adjustments can be done on the premises rather than off site. This makes is easier to "fine tune" the fit for the patient. <br />
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After reading all of the above information it is easier to understand that the fitting of contact lenses for keratoconus is indeed a process. What should the keratoconus patient look for when choosing a doctor or contact lens fitter to help them with obtaining properly fitting contact lenses?<br />
Here are some suggestions: 1. Make sure the person fitting the lenses has lots of experience in fitting lenses specifically for keratoconus. 2. Make sure the fitter has many different fitting sets....remember that one size does not fit all eyes. 3. If possible, make sure the fitter can do contact lens modification is the office when appropriate. 4. Make sure that you are comfortable with the fitter and the office. You will be spending quite of bit of time at the office. It is no fun being in an office where you do not feel welcome. <br />
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Keratoconus can take different forms. While it is supposed to be a condition in which both eyes are involved, this is not always the case. Sometimes, only one eye is affected. Some cases continue to deteriorate, requiring refitting of the contact lenses. Some cases deteriorate to the degree that the cornea needs to be replaced. This is called a corneal transplant. Not all cases get to this point. Some cases never progress to the point where contact rigid contact lenses are required. Corneal transplant surgery is getting better all the time. There are many excellent surgeons that can help patients when their eyes get to the point that the cornea needs to be replaced. When a transplant is needed, this is due to either scarring that develops to the surface of the cornea or to distortion that becomes so great that contact lenses can no longer be successfully fitted. (Corneal translplant surgery is an entirely different discussion that I am not going to discuss extensively in this post.) Once the surgery is completed, contact lenses again need to be employed to best allow the patient to achieve good quality vision. If keratoconus contact lens fitting is difficult, post surgical contact lens fitting can be even more so. The good news is that the doctors that help patients with keratoconus contact lens fitting are also experts, in many cases, at fitting lenses to the cornea post surgically. Again, different lenses need to be employed to best correct the vision. <br />
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Are there any things that can be done to improve the condition of the cornea as the keratoconus progresses? The answer is yes. Here are some suggestion: Keratoconus has been associated with eye rubbing and eye allergies. Don't rub your eyes!!! It is believed that eye rubbing can help to distort and thin the corneal surface. To help you with not rubbing your eyes you can use eye drops that lessen the symptoms of eye allergies. Some of these are available over the counter and some need to be prescribed. A good over the counter anti-histamine eye drop is "Zaditor". Cool compresses help. There is also some evidence that using cooled tea bags and even cucumber slices help to calm the symptoms of eye itching. Keratoconus can be associated with dry eyes. There are a medications that can help with dry eyes that your doctor can prescribe. There is also a procedure called punctal occlusion that can be done in the doctor's office to help you capture your own tears before they drain from the eyes. Tear quality is very important too. Many patients have poor tear quality as well as keratoconus. Tear quality needs to be improved to make sure that contact lens wear is as comfortable as possible. There is increasing evidence that a new procedure called corneal cross linking can help to strengthen the cornea. In this procedure, the top surface of the cornea is removed and the eye is exposed to specially formulated Ribovlafin (vitamin B2) eye drops. The eye is then exposed to ultraviolet light for a short period of time. This procedure makes the collagen bonds in the cornea stronger and can help to stabilize the condition. The eye is patched with a bandage contact lens for a period of time until the top surface of the cornea can normalize. Once the top surface regrows, the bandage lens can be removed. This procedure is undergoing clinical trials here in the United States. Excellent results have been reported in Europe where the procedure originated. Evidence shows that to be successful the top surface of the cornea must be removed to allow proper penetration of the Riboflavin eye drops. In addition to this treament, it is possible to improve the cornea surface quality, once it no longer will support contact lenses due to irregularity, with the addition of what are known as "Intacts". These are small plastic inserts that are placed into the cornea to make the surface more regular. There have been positive reports from this procedure. This procedure is considered when the eye will no longer accept custom contact lenses due to increasing irregularity. Once the "Intacts" are inserted, contact lenses again need to be fitted to the eye. All of the above discussion regarding fitting of the contact lenses again applies to the refitting after the insertion of the "Intacts". <br />
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Here are some of the lenses that are used to fit corneas that have keratoconus: Rose K, Dyna Z Intralimbal, Macrolens, Acuity One, SI02, Soper, Synergeyes KC and Clear Kone and many more. In addition, sometimes "piggyback" contact lenses can be employed. This involves placing a soft contact lens on the eye first and then placing a rigid lens on top of it. This can be successful in many cases. It can be done with what are known as silicone hydrogel soft contact lenses and any variety of rigid lens placed over the soft contact lens. There are aslo available special soft contact lenses that have a small "cut out" in the center to allow the rigid lens to seat itself in the center of the lens and remain stable. Your contact lens fitter probably has some favorites to work with, but it is extremely important to know that it takes many different types of lenses in diagnostic sets at the fitter's office to best asses the proper fit for each patient. <br />
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I hope this discussion will be helpful to the keratoconus patient in learning the many different approaches to fitting contact lenses to the keratoconic cornea. If you have any questions, I may be emailed at jon@villageeyes.com.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-65660627187627924562010-04-21T15:36:00.000-07:002010-04-21T15:36:55.572-07:00Change Your Eye Color......Maybe?I attended a very interesting lecture and presentation last night that I want to share with everyone. The presentation was through the offices of Dr. Kerry Assil, M.D. Dr. Assil is an ophthalmologist and corneal specialist that I have co-managed several cases with over the years. The highlight of the presentation was two live surgeries that were performed by Dr. Assil. What made these lectures especially interesting was that they covered some topics that I had never seen before. The most interesting topic was the removal of a silicone colored disc that was surgically implanted in a patient's eyes by an ophthalmologist in the country of Panama. The patient that had the surgery originally had these colored silicone plastic discs implanted into his eyes to change his eye color. His eyes are originally brown and he wanted them to look green. The lenses are kind of shapped like a "life saver candy" with a colored ring and a hole in the center so light can enter the eye. I must say the the cosmetic effect of the lens on the eye prior to surgery was very natural looking. The eye actually did look green and very realistic. Here is the problem: The artificial iris that was placed into the eye sits in front of the natural iris and covers up the natural eye color. This would be OK except that the artificial iris rubs against the natural iris creating loose pigment particles that plug up the eyes natural drainage mechanism. In addition, the artificial iris rubs against the front surface of the cornea causing the cells there to be decompensated. This can cause the patient to develop corneal swelling and eventually require a corneal transplant. Not only this, but the patient can be more prone to developing cataracts at a much earlier date as well as chronic inflammation to the eyes. <br />
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The surgery proceeded without complication and after the procedure the patient was brought before the audience and questions were asked. The overall upshot of the questioning pointed to the fact that it is very easy for consumers to see something such as a cosmetic procedure as a safe and easy surgery when real risks and dangers can accompany the surgery. This can apply to everything from eye color change to weight loss procedures like the "lap band". All other things being equal, the best thing that patients can do is research. Ask other professionals in the field what they think of a particular procedure if you are considering it. Get a second opinion. If there is only one doctor doing the procedure and the doctor is in a country far away from where you live, how are you going to deal with possible problems that may arise. <br />
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There are many safe and effective ways to change eye color using tried and true products like cosmetic contact lenses. I think this patient has learned a very valuable lesson from this experience.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-1864659160466406732010-03-25T17:39:00.000-07:002010-03-25T17:39:49.948-07:00Post Surgical Contact Lens FittingPost 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.<br />
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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. <br />
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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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-18632734682410966862010-03-25T17:13:00.000-07:002010-03-25T17:13:43.439-07:00Bifocal And Multifocal Contact LensesBifocal 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. <br />
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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. <br />
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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. <br />
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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. <br />
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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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-61050800364643594212010-03-19T14:06:00.000-07:002010-03-19T14:06:36.876-07:00Eyecare HumorIf 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=v8GMFkc3iSAAnonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-56736023916588308032010-03-19T13:39:00.000-07:002010-03-19T21:08:06.341-07:00Choose 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. <br />
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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!<br />
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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?<br />
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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 <br />
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. <br />
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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<br />
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Good luck with your professional relationships. If you have any questions or comments, please contact me through my listed email on the blog.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-91390765453714202692010-03-19T06:02:00.000-07:002010-03-19T11:14:14.477-07:00How to find a lost contact lens and how to prevent contact lens lossLosing 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.<br />
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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. <br />
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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.<br />
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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. <br />
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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. <br />
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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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com2tag:blogger.com,1999:blog-4039990977478739538.post-13026719591357813442010-03-09T17:13:00.000-08:002010-03-09T17:24:47.419-08:00Eye Makeup Tips and Eyelash Growth: An Eye Doctor's PerspectiveI 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. <br />
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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. <br />
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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.<br />
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Who has problems with eye makeup? <br />
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.) <br />
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What problems can occur? <br />
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. <br />
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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. <br />
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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. <br />
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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. <br />
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What are some safety tips to using eye cosmetics? <br />
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• 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. <br />
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• 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 <br />
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• Replace cosmetics every six months (more often if you wear contact lenses) to avoid excess contamination with skin bacteria. <br />
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• Never use an old applicator in a fresh cosmetic product. The applicator will transfer bacteria to the new cosmetic. <br />
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• After any eye infection, such as conjunctivitis, buy fresh eye makeup. <br />
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• 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. <br />
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• Never apply eye makeup while in a moving vehicle. You may accidentally poke the applicator into the eye during a sudden bump or stop. <br />
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• Never use saliva to thin old or clumped makeup or to wet a mascara wand. Your saliva contains bacteria from your mouth. <br />
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• Do not use a safety pin or other sharp instrument to tease apart clumped eyelashes. <br />
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• 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. <br />
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• 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. <br />
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• 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. <br />
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• Check with your eye doctor if you think you have a cosmetic-related eye problem. <br />
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Are there special concerns for contact lens wearers? <br />
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: <br />
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• Insert contact lenses before applying makeup and take them out prior to removing makeup. Always wash your hands before touching your contact lenses. <br />
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• Apply makeup less heavily close to the eye. For example, mascara should be applied only to the tip of the eyelashes. <br />
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• Buy fresh eye makeup products every three to four months. <br />
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• 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. <br />
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• 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.) <br />
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• 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. <br />
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When can I wear makeup after eye surgery? <br />
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. <br />
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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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-9692110269753121312010-03-08T21:20:00.000-08:002010-03-08T21:20:41.836-08:00Emergency Eye CareHere 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. <br />
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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. <br />
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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. <br />
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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. <br />
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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. <br />
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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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-49804314031318541122010-03-05T08:36:00.001-08:002010-03-05T09:44:49.531-08:00Corneal Abrasions and Scratched CorneasCorneal 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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-66483423420193575812010-03-03T06:47:00.000-08:002010-03-03T07:10:15.148-08:00Why 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.<br /><br />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. <br /><br />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. <br /><br />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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-38501293485469479182010-03-02T20:42:00.000-08:002010-03-02T21:16:29.717-08:00My Son The DoctorI 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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-57095391456654238012010-02-26T13:35:00.000-08:002010-02-26T13:50:39.417-08:00Contact Lenses for SurfingContact lenses for surfing and water sports have come a long way over the last several years. Regardless of how high a person's prescription is, it is probably possible to construct a soft contact lens for that person to use in water sports. Most prescriptions can be formulated in a disposable contact lens prescription. Those that cannot are still availble in a custom form that is compatible with water sports. It is possible to construct a lens that is larger than normal for water sports. This allows the lens edges to tuck up under the eyelids creating a more stable lens design. <br /><br />While it is still possible for a surfer to have a big wipe out and occasionally lose a lens, this is the exception rather than the rule when contact lenses are used for surfing. If a lens is lost, it is usually on just one side. This allows usable vision to return to shore and either get another lens or call it a day. There are also certain disposable lens designs that are bigger than average and lend themselves to water sports. <br /><br />There is another alternative to vision correction that can work quite well for patients that have a correction up to -5.00 and even higher. This is known as "orthokeratology". In orhtokeratology, special rigid contact lenses are applied to the eyes to be worn at night (although they can be used during the day as well)and the lenses reshape the cornea to the point that the vision is good enough to be able to function in the water (and during the day in normal activities)so that no contact lenses are required after the lenses are removed from the eyes. This is an obvious benefit for surfing as it eliminates the contact lens loss factor.<br /><br />The best way for interested surfers to explore these contact lens possibilities is to visit an eye doctor that has experience in fitting custom contact lenses. If the reader of this blog has any questions regarding these options I am willing to discuss them on an individual basis. My email is: jon@villageeyes.com.Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0tag:blogger.com,1999:blog-4039990977478739538.post-59085819763901989292010-02-12T10:42:00.001-08:002010-02-12T10:44:28.481-08:00BlepharitisHere is an excellent description of blepharitis describing the condition and how to treat it. The following is a link to the article: <br /><br /><a href="http://www.facebook.com/l.php?u=http%253A%252F%252Fwww.agingeye.net%252Fotheragingeye%252Fblepharitis.php&h=089f6594573d68481aa5e7ab54593c90&ref=nf">Blepharitis</a>Anonymoushttp://www.blogger.com/profile/08049897649025466825noreply@blogger.com0