Why Are Contact Lenses Medical Devices?

It seems I am constantly confronted with questions from some patients that wonder why contact lenses are considered medical devices. Many people think that contact lenses are simply commodities that should be sold over the counter and available everywhere without the requirement of a prescription. Here is an example of how patients can get into trouble if they misuse contact lenses and why they should be controlled by a prescription and only be available through doctors.

I had a patient that came in about six months ago for an eye exam. The patient had been complaining of discomfort when wearing his contact lenses. He was experiencing discharge from his eyes and redness. He also complained of blurred vision. Upon examining the patient and taking a history I learned that the patient had been given a pair of disposable one day single use contact lenses and had left them in his eyes overnight continuously for six months. The lenses were coated with mucous. His eyelids, on the underside, were significantly inflammed and there were multiple "bumps" on the underside of the eyelids (called giant papillary conjunctivitis) causing the localized mucous glands under the lids to produce even more mucous. His corneas were swollen contributing to his blurred vision and his discomfort. Basically his eyes were "a mess". I asked him why he had been using his contact lenses in this fashion and he said that he did not think there was anything wrong with his usage of the contact lenses and that it was no big deal. His friend who had the same "number for his eyes" had given him a pair and at first everything was fine. Unfortunately his problems caught up with him and yielded the result I have described above. I am not saying that this could not happen to a patient that received his lenses from a doctor. If a patient chooses to ignore the instructions and bend the rules of usage of contact lenses in spite of proper instructions from his health care practitioner, there is not much his doctor can do about it. The odds, however, are much greater that this kind of behavior will not occur if patients are instructed about what contact lenses can do and how to properly use and care for them. This patient was quite nearsighted and did not have any glasses. He had to get some emergency glasses and discontinue contacts for two months. He had to undergo treatment for his condition which involved eyedrops that were fairly expensive. After successful therapy he is now back wearing contact lenses with a much greater appreciation of what they are and how to properly care for them.

It is extrememly important for patients to understand that contact lenses are medical devices and they require proper care, handling and disinfection. They should be used according to their individual proper use instructions. Lenses that are to be worn overnight need to have a very high oxygen transmission. In additon, because they are left in overnight, they tend to become soiled quickly. It is important to not leave them in too long and to change them reqularly. There is always some increased risk when lenses are worn overnight as opposed to lenses that are used during waking hours and then cleaned and disinfected...or discarded daily as it the case with single use disposable contact lenses.

If a patient has any questions about proper contact lens care it is best for them to contact their eye doctor to make sure they are using their lenses in the proper manner.

My Son The Doctor

I can't tell you how great it is to practice with your child. It was something that I had sort of given up on based upon the initial reaction of my children when I first broached the subject. When my children were much younger I invited both of them to consider optometry as a career. They both answered without hesitation: "No!" My son is the eldest of my two children and he wanted to be involved in the movie business. He initially wanted to write and produce movies. He majored in English when at UCLA and received his degree in that field. My daughter studied business and graduated with a double major at SMU in business and Spanish. She worked in a business climate for a couple of years and then decided that teaching was what she really liked. She received her credential and she now teaches at a private school in Santa Monica, California. She does all of this including being a mother to her wonderful family which includes her attorney husband, Marcos and her two children, Molly and Matthew.

My son initially worked for a few production companies and did some acting. After a few years of doing this he felt he was not going in the right direction. He then sold life insurance for a major insurance company, but did not really like doing it. After about a year of working in the insurance business, he came to me and asked if I was still interested in him going into the field of optometry. I said that I definitely was, and off he went.

This was no easy task as he had been an English major. He was a natural at writing and really loved it, but he had always taken the path away from math and science. Now he had to go back and take all the classes that he had initially avoided. He had to get good grades in the subjects and he had to take an entrance exam for optometry school. He did all of this and was accepted into a great school. While in school he met a terrific young lady who was also in optometry school and they are now married and both practice with me at Village Eyes Optometry in Westwood Village, California.

It is terrific to have these young and energetic doctors to practice with. We frequently discuss mutual cases and we are always talking about our field of optometry. At family outings, everyone knows to avoid us because we will almost always be discussing eyeballs in one sense or another. For me this is fun and challenging. It is a real pleasure to see them working so hard and enjoying what they do.

We have a wonderful family practice at Village Eyes Optometry. All five doctors get along extremely well and we all interact with our terrific staff and appreciate one another. My wife, Sissy, also works at the practice and takes care of all the daily business requirements that are needed to keep our business on track. For me, it's as good as it can get. I am looking forward to many more years of practice with my son, my daughter-in-law, and the rest of our optometric family.

Contact Lenses for Surfing

Contact 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.

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.

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.

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.

Blepharitis

Here is an excellent description of blepharitis describing the condition and how to treat it. The following is a link to the article:

Blepharitis

Surfer's Eye Problems

This entry will focus on issues that specifically confront surfers, but it could also apply to anyone that spends a great deal of time in the sun without adequate eye protection.

The problem that confronts surfers is related to their eye exposure to the sun and wind and the non-use of sun protection due to the water based nature of the sport. Sun protection does exist for surfers, but it is rarely used while in the water. This is due to the difficulty of keeping the protective eyewear on the head securely while surfing large and powerful waves. Even smaller waves have the potential, if the surfer "wipes out", to cause the wearer to lose the eye protective product. There is also the issue of the lenses "fogging up" as well as water droplets collecting on the surface of the lenses resulting in obscuring the vision.

It still would be better if surfers could wear eye protection. This would help prevent the occurence of various conditions that are commonly associated with sun exposure. Here are some of the conditions that are frequently seen among surfers as well as individuals that spend a great deal of time in the sun: 1. The pinguecula. This is a growth on the side of the cornea..typically in the 9:00 or 3:00 positions, that can either be caused by sun and wind exposure or can be aggravated by the exposure. These growths are elevated from the underlying white part of the eye. In so much as they are elevated, they are more prone to drying out as well as exposure. When they become irritated they can become red and can cause the eye to feel dry or "scratchy". In years past there was no recommended treatment for the pinguecula. Now there are improvements in surgical techniques that make their removal possible. If a pinguecula is irritated, relief can be obtained by the usage of artificial tears. The best artificial tears are of the non-preserved variety. Sometimes an anti-inflammatory medication can help make the eye more comfortable. 2. The pterygium. This is a growth in more of less the same area as the pinguecula, but in this case the growth actually is onto the cornea. The same conditions can cause and contribute to this problem, but the irritation can be more serious. In addition, should the pterygium grow to a large enough dimension, there is the possibility that it can impair the vision. Typically, the growth can induce an increase in astigmatism. The pterygium can also be treated by surgery. There is a risk that the pterygium can return after surgery. As a result, once surgery is performed, the patient must do everything possible to protect the eyes from sun and wind. The non-surgical treatment for the pterygium is basically the same as for the pinguecula (artificial tears and anti-inflammatory medications). 3. Solar Keratitis. This refers to an actual sunburn of the white part of the eye and the cornea. This is due to extreme sun exposure. This could occur, for example, if a patient were to spend a day skiing without wearing sunglasses. The condition is quite painful. While painful and uncomfortable, the condition is usually not serious and will abate over a short period of time. Artificial tears help to offer some relief. The patient can feel temporarily blinded by this condition as the cornea will become cloudy due to the irritation and swelling that accompanies the sun exposure. 4. Cataracts. There is a definite causal relationship between sun exposure and cataract formation. While everyone will eventually get cataracts if they live long enough (they are a normal aging change in the eyes), they can be brought on much sooner due to sun exposure. Again, sun protection is helpful in halting or slowing down cataract formation.

What can a surfer do to help avoid these conditions? The best way to protect the eyes is sun protective eyewear. There are a number of companies that make eyewear to protect the eyes even when in the water. Unfortunately, not all surfers are willing to wear the sun protection. It is also possible to wear a visor while in the water. This will protect from the sun getting directly into the eyes, but it will not really deal with reflected glare off of the water. There are also available certain types of contact lenses that offer some UV protection. The issue here is that while there is UV protection to the cornea the white part of the eye is still exposed. Again, sun protective eyewear is the best solution.

Patients that have to wear eyeglasses to see clearly can now use contact lenses when in the water doing various water sports. There are a number of products available. Many offer UV protection.

The best way for a surfer or avid outdoor enthusiast to find out how to protect their eyes is to visit their eye doctor. An eye doctor can custom tailor a treatment plan that will best suit the patient.

Dear Readers: I invite you to follow my blog!

I want to thank all the readers that have taken the time to view my blog. I also invite readers to make any comments that they feel are relevant in the comment section at the bottom of the various entries. In addition, if there are any subjects that an individual reader would like to be discussed in the blog, please let me know. I invite all readers to become followers of my blog. It is very easy to do so. Just click on the "Follow" icon and follow the prompts. By becoming a follower and a "fan" this allows readers to easily share the information that I have posted with their friends,families and associates.

Thanks again,

Dr. Jon

Blurred Vision: Should I Be Concerned?

Blurred vision is a major complaint of patients that come to Village Eyes Optometry. There can be several causes of blurred vision. Some of them are not serious and some of them can be very serious. It is up to the eye doctor to determine the cause of the blurred vision, the best remedy, and the necessity of any medical intervention should the blurred vision be due to a serious medical problem.

Here are some common causes of blurred vision:
1. Nearsightedness, farsightedness and astigmatism. These are probably the most common causes of blurred vision. The solution is to prescribe the proper eyeglasses or contact lens prescriptions to solve the problem.
2. Computer usage. In this case the eyes can become blurred due to long term looking at a computer screen. This can occur even if the patient does not have a condition such as nearsightedness (myopia), farsightedness (hyperopia), or astigmatism. The eyes can become dry and this can also contribute to blurred vision.
3. Eye muscle problems. Here the eyes can become blurred as they compensate for the inability of the eye muscles to point properly at the desired reading material.
4. General fatigue. If a person is physically tired, their vision can become blurred.
5. Medications. Certain medications can contribute to blurred vision. The eye doctor needs to take a well documented case history to make sure that a medication that the patient is taking is not causing the blurred vision.
6. Medical conditions affecting the eyes. There are a number of systemic conditions as well as localized eye medical conditions that can cause blurred vision.
Multiple Sclerosis, Graves Disease, Myasthenia Gravis, Muscular Dystrophy, Diabetes, and Hypertension are just a few of the systemic diseases that can cause blurred vision. Withing the eye itself, several conditions can cause blurred vision such as cataracts, dry eyes, glaucoma, corneal problems such as keratoconus, problems with the iris such as iritis, problems with the vitreous (the middle part of the eye), eye floaters, and problems with the retina. The retina can cause all sorts of blurred vision problems such as macular degeneration and macular edema.

These are just an overview of the various issues that can lead to blurred vision. The most important thing to do is to see your eye doctor when you experience blurred vision. Your eye doctor will be able to determine if the cause of your blurred vision is something simple or is a more complicated matter requiring more involved treatment.