A quick explanation and background of a progressive addition lens is necessary in order to understand the importance of choosing the proper lens for your needs.

A progressive lens gives people an array of prescriptions - placed in the proper positions throughout the lens - to best imitate normal vision. Imagine having the precise correction needed to see a television screen more than 15 feet from you, while reading this article on your desktop computer, and then looking down at your keyboard in order to start entering the address to your favorite website. This, in a nutshell, is exactly what the progressive lens is ideally capable of accomplishing with one pair of glasses.

Having the least amount of peripheral distortion, and one of the wider ranges in both distance power, astigmatism, prism, and add power availability, we find this lens to be very versatile. The most important thing to you is that this product feels very natural in front of your eye. For first-time progressive lens wearers, there is a stigma that it takes a bit of time to adjust to a lens that holds multiple prescriptions. This is often still an issue if places use old technology lenses or don’t take careful measurements to assure the proper placement on the lens in the frame. However, with modern technology, the use of computers to fine tune this amazing product, and careful measurements and lens positioning by your optician, this lens does the best job we have seen in mimicking perfect 20/20 vision at all focal lengths.

Along with the progressive lens itself, there are other additional treatments, or “add-ons” that can immensely improve one’s experience with their glasses. These products will be touched upon in future articles in more depth, but options such as Transition Photochromic application, Anti-Reflective Coatings, and choosing a Polycarbonate scratch-resistant lens are just a few of the more popular choices.

So when making a decision for your next pair of eyeglasses, please understand this: Vision is an incredibly important aspect of daily life, and it should be treated with the utmost care and importance. Along with keeping up with your yearly examinations, make sure you are treating your eyes properly when it comes to your decisions for corrective lenses.

 

Article contributed by Richard Striffolino Jr.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

One of the hardest questions eye care professionals deal with every day is when to tell people who are having difficulty with their vision to stop driving.

Giving up your driving privilege is one of the most difficult realities to come to terms with if you have a problem that leads to permanent visual decline.

The legal requirements vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, is 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes.

In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides).

According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. There are also other contributing factors such as slower reaction times and increased fragility but the fact remains that the rate is higher, so when vision problems begin to occur with aging it is extremely important to do what is necessary to try to keep your vision as good as possible.

That means regular eye exams, keeping your glasses prescription up to date, dealing with cataracts when appropriate and staying on top of other vision-threatening conditions such as macular degeneration, glaucoma and diabetes.

It is our responsibility to inform you when you are no longer passing the legal requirement to drive. Although there is no mandatory reporting law in all states, it is recorded in your medical record that you were informed that your vision did not pass the state requirements to maintain your privilege. And, yes, it is a privilege - not a right - to drive.

If you have a significant visual problem and your vision is beginning to decline, you need to have a frank discussion with your eye doctor about your driving capability. If you are beginning to get close to failing the requirement you need to start preparing with family and love ones about how you are going to deal with not being able to drive, preferably before it becomes absolutely necessary.

We have had the very unfortunate occurrence of having instructed a patient that he should stop driving because his vision no longer met the requirements only to have him ignore that advice and get in an accident. Don’t be that guy. Be prepared, have a plan.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician.

The word “astigmatism” is used so much in the ophthalmic world that most people have talked about it when discussing their eye health with their doctor.

“Astigmatism” comes from the Greek “a” - meaning “without” - and “stigma” - meaning “a point.” In technical ocular terms, astigmatism means that instead of there being one point of focus in the eye, there are two. In other words, light merges not on to a singular point, but on two different points.

This is experienced in the real world by blurred, hazy vision, and can sometimes lead to eye strain or headaches if not corrected with either glasses or contact lenses.

Astigmatism is not a disease. In fact, more than 90% of people have some degree of astigmatism.

Astigmatism occurs when the cornea, the clear front surface of the eye like a watch crystal, is not perfectly round. The real-world example we often use to explain astigmatism is the difference between a basketball and a football.

If you cut a basketball in half you get a nice round half of a sphere. That is the shape of a cornea without astigmatism.

If you cut a football in half lengthwise you are left with a curved surface that is not perfectly round. It has a steeper curvature on one side and a flatter curve on the other side. This is an exaggerated example of what a cornea with astigmatism looks like.

The degree of astigmatism and the angle at which it occurs is very different from one person to the next. Therefore, two eyeglass prescriptions are rarely the same because there are an infinite number of shapes the eye can take.

Most astigmatism is “regular astigmatism,” where the two different curvatures to the eye lie 90 degrees apart from one another. Some eye diseases or surgeries of the eye can induce “irregular astigmatism,” where the curvatures are in several different places on the eye’s surface, and often the curvatures are vastly different, leading to a high amount of astigmatism.

Regular astigmatism is treated with glasses, contact lenses, or refractive surgery (PRK or Lasik). Irregular astigmatism, such as that caused by the eye disease keratoconus, usually cannot be treated with these conventional methods. In these circumstances, special contact lenses are needed to treat the condition.

The next time you hear that either you or a loved one has astigmatism, fear not.

It is easily corrected, and although astigmatism can cause your vision to be blurry it rarely causes any permanent damage to the health of your eyes.

If you experience blurred vision, headaches or eye strain, having a complete eye exam may lead to a diagnosis and treatment of this easily-dealt-with condition.

 

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

As an eye doctor, diagnosing a red eye can be challenging. Are we dealing with an infection, allergy, inflammation or dryness?

One of the most common questions I get is, “Doc, my eyes are red, burning, itchy, and tearing. Is this dry eye or from allergies?” The short answer is it could be one, both or neither. I’ll outline various ways these conditions present clinically and the treatments for them.

The hallmark symptom of allergy – meaning if you have this symptom you almost definitely have the condition – is itching. Red, watery, ITCHY eyes are almost invariably due to an allergen, whether environmental or medicinal. It is one of the most common ocular conditions we, as eye doctors, treat - especially when plants are filling the air with pollen as they bloom in the spring and then die off in the fall.

The itching occurs because an immune cell called a Mast cell releases histamine, causing the itching sensation. It can be quite unbearable for the sufferer, causing them to rub their eyes constantly, which unbeknownst to them, actually increases the amount of histamine in the eye, leading to worsening of the symptoms.

Treatments may include:

  • Over-the-counter or prescription allergy drops (mostly anti-histamines or mast cell stabilizers).
  • Topical steroids (to get the inflammation under control).
  • Cool compresses applied to the eye.

Patients sometimes need to take drops every day to keep their symptoms under control.

Dry eye can have many of the same symptoms as allergic eye disease, with the eye being red and possibly watery (‘My eyes are tearing how could it be dry eyes?’). The main exceptions are that people with dry eyes tend to complain more of burning and a foreign body sensation - like there is sand or gravel in the eye - rather than itchiness.

Dry eye is a multi-faceted disease with many different causes and treatments. Treatment ranges from simple re-wetting eye drops to long-term medications (both topical and oral), as well as non-medicinal treatments such as eyelid heating treatment.

So how do we determine the difference? The first question I ask patients who complain of red, watery, uncomfortable eyes is, “What is your MAIN symptom? Itching or burning?” The answer will likely direct which course of treatment we take, and as those treatments sometimes overlap, you may have a component of both dry eye and allergy.

That is important to distinguish because many of the treatments we use for allergies - like antihistamine eye drops - can sometimes make the dryness worse. Though neither of these conditions is 100% curable (except maybe for allergy, where if you remove the allergen, you obviously won’t get symptoms!). We have many tools in our treatment arsenal to keep the symptoms at bay.

Unfortunately, dry eye and allergy aren’t the only two things that can cause your eye to have the multiple symptoms of red, watery, itchy, burning eyes. There are other problems, such as Blepharitis, that can produce a similar appearance, as well as bacterial and viral infections.

So before embarking on a particular therapy, it is wise to have a good exam to help you get on the right track of improving your symptoms.

Article contributed by Dr. Jonathan Gerard

Have you ever seen a temporary black spot in your vision? How about jagged white lines? Something that looks like heat waves shimmering in your peripheral vision?

If you have, you may have been experiencing what is known as an ocular migraine. Ocular migraines occur when blood vessels spasm in the visual center of the brain (the occipital lobe) or the retina.

They can take on several different symptoms but typically last from a few minutes to an hour. They can take on either positive or negative visual symptoms, meaning they can produce what looks like a black blocked-out area in your vision (negative symptom), or they can produce visual symptoms that you see but know aren’t really there, like heat waves or jagged white lines that look almost like lightning streaks (positive symptoms).

Some people do get a headache after the visual symptoms but most do not. They get the visual symptoms, which resolve on their own in under an hour, and then generally just feel slightly out of sorts after the episode but don’t get a significant headache. The majority of episodes last about 20 minutes but can go on for an hour. The hallmark of this problem is that once the visual phenomenon resolves the vision returns completely back to normal with no residual change or defect.

If you have this happen for the first time it can be scary and it is a good idea to have a thorough eye exam by your ophthalmologist or optometrist soon after the episode to be sure there is nothing else causing the problem.

Many people who get ocular migraines tend to have them occur in clusters. They will have three or four episodes within a week and then may not have another one for several months or even years.

There are some characteristics that raise your risk for ocular migraines. The biggest one is a personal history of having migraine headaches. Having a family history of migraines also raises your risk, as does a history of motion sickness.

Although the symptoms can cause a great deal of anxiety, especially on the first occurrence, ocular migraines rarely cause any long-term problems and almost never require treatment as long as they are not accompanied by significant headaches.

So if symptoms like this suddenly occur in your vision, try to remain calm, pull over if you are driving, and wait for them to go away. If they persist for longer than an hour, you should seek immediate medical attention.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

  • Are nearsighted.
  • Are aphakic (absence of the lens of the eye).
  • Have past trauma to the eye.
  • Have had inflammation in the eye.

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

  • Sudden increase in number of floaters that are persistent and don't resolve.
  • Increase in flashes.
  • A shadow covering your side vision, or a decrease in vision.

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment. Only about 15 percent of people with PVD develop a retinal tear.

If left untreated, approximately 40 percent of people with a symptomatic retinal tear will progress into a retinal detachment – and a retinal detachment needs prompt treatment to prevent vision loss.

Generally, most people become accustomed to the floaters in their eyes.

Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed. And for most people, the risk of surgery is greater than the nuisance that the floaters present.

Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable. However, this is not a recognized standard treatment and it is not widely practiced.

In general, the usual recommendation for floaters and PVD is observation by an eye care specialist.

 

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician.

A wrinkle on the retina - which is also known as an epiretinal membrane (ERM) or a macular pucker - is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

It could be a retinal vein occlusion, an ocular disorder that can occur in older people where the blood vessels to the retina are blocked.

The retina is the back part of the eye where light focuses and transmits images to the brain. Blockage of the veins in the retina can cause sudden vision loss. The severity of vision loss depends on where the blockage is located.

Blockage at smaller branches in the retinal vein is referred to as branch retinal vein occlusion (BRVO).  Vision loss in BRVO is usually less severe, and sometimes just parts of the vision is blurry.  Blockage at the main retinal vein of the eye is referred to as central retinal vein occlusion (CRVO) and results in more serious vision loss. 

Sometimes blockage of the retinal veins can lead to abnormal new blood vessels developing on the surface of the iris (the colored part of your eye) or the retina. This is a late complication of retinal vein blockage and can occur months after blockage has occurred. These new vessels are harmful and can result in high eye pressure (glaucoma), and bleeding inside the eye.

What are the symptoms of a retinal vein occlusion?

Symptoms can range from painless sudden visual loss to no visual complaints. Sudden visual loss usually occurs in CRVO. In BRVO, vision loss is usually mild or the person can be asymptomatic. If new blood vessels develop on the iris, then the eye can become red and painful. If these new vessels grow on the retina, it can result in bleeding inside the eye, causing decreased vision and floaters – spots in your vision that appear to be floating.

Causes of retinal vein occlusion

Hardening of the blood vessels as you age is what predisposes people to retinal vein occlusion.  So retinal vein occlusion is more common in people over the age of 65. People with diabetes, high blood pressure, blood-clotting disorders, and glaucoma are also at higher risk for a retinal vein occlusion.

How is retinal vein occlusion diagnosed?

A dilated eye exam will reveal blood in the retina. A fluorescein angiogram is a diagnostic photographic test in which a colored dye is injected into your arm and a series of photographs are taken of the eye to determine if there is fluid leakage or abnormal blood vessel growth associated with the vein occlusion. An ultrasound or optical coherence tomography (OCT) is a photo taken of the retina to detect any fluid in the retina. 

Treatment for retinal vein occlusion

Not all cases of retinal vein occlusion need to be treated. Mild cases can be observed. If there is blurry vision due to fluid in the retina, then your ophthalmologist may treat your eye with a laser or eye injections. If new abnormal blood vessels develop, laser treatment is performed to cause regression of these vessels and prevent bleeding inside the eye. If there is already a significant amount of blood inside the eye, then surgery may be needed to remove the blood.

Outlook after retinal vein occlusion

Prognosis depends on the severity of the vein occlusion. Usually BRVO has less vision loss compared to CRVO. The initial presenting vision is usually a good indicator of future vision. Once diagnosed with a retinal vein occlusion, it is important to keep follow-up appointments to ensure that prompt treatment can be administered to best optimize your visual potential.

 

 Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Here are some treatment options for Dry and Wet Age Related Macular Degeneration.

Nutritional supplements and Dry Age Related Macular Degeneration (AMD)

The Age-Related Eye Disease Study 2 (AREDS2) showed that people at high risk of developing advanced stages of AMD benefited from taking dietary supplements. Supplements lowered the risk of macular degeneration progression by 25 percent. These supplements did not benefit people with early AMD or people without AMD.

Following is the supplementation:

  • Vitamin C - 500 mg
  • Vitamin E - 400 IU
  • Lutein – 10 mg
  • Zeaxanthin – 2 mg
  • Zinc Oxide – 80 mg
  • Copper – 2 mg (to prevent copper deficiency that may be associated with taking high amount of zinc)

Another study showed a benefit in eating dark leafy greens and yellow, orange and other fruits and vegetables. These vitamins and minerals listed above are recommended in addition to a healthy, balanced diet.

It is important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision. However, these supplements may help some people maintain their vision or slow the progression of the disease.

Wet AMD treatments

The most common treatment for wet AMD is an eye injection of anti-vascular endothelial growth factor (anti-VEGF). This treatment blocks the growth of abnormal blood vessels, slows their leakage of fluid, may help slow vision loss, and in some cases can improve vision. There are currently three anti-VEGF drugs available: Avastin, Lucentis, and Eylea.

You may need monthly injections for a prolonged period of time for treatment of wet AMD.

Laser Treatment for Wet AMD

Some cases of wet AMD may benefit from thermal laser. This laser destroys the abnormal blood vessels in the eye to prevent leakage and bleeding in the retina. A scar forms where the laser is applied and may cause a blind spot that might be noticeable in your field of vision.

Photodynamic Therapy or PDT

Some patients with wet AMD might benefit from photodynamic therapy (PDT). A medication called Visudyne is injected into your arm and the drug is activated as it passes through the retina by shining a low-energy laser beam into your eye. Once the drug is activated by the light it produces a chemical reaction that destroys abnormal blood vessels in the retina. Sometimes a combination of laser treatments and injections of anti-VEGF mediations are employed to treat wet AMD.

 

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

The jury is still out on that question. There is some supportive experimental data in animal models but no well-done human studies that show any significant benefit.

What you shouldn’t do is pass up taking the AREDS 2 nutritional supplement formula, which is clinically proven to reduce the risk of severe visual loss in. Almost all the data supporting the POSSIBLE benefits of bilberry in visual conditions is related to NON-HUMANS. Stick with the AREDS 2 formula that has excellent clinical evidence.

So, what is bilberry and why do some people use it?

Bilberry (Vaccinium myrtillus), a low-growing shrub that produces a blue-colored berry, is native to Northern Europe and grows in North America and Asia. It is naturally rich in anthocyanins, which have anti-oxidant properties.

During World War II, British pilots in the Royal Air Force ate bilberry jam, hoping to improve their night vision. No one is exactly sure where the impetus to do this came from, but it is believed that this event is what lead to some widespread claims that bilberry was good for your eyes.

A study by JH Kramer,  Anthocyanosides of Vaccinium myrtillus (Bilberry) for Night Vision - A Systematic Review of Placebo-Controlled Trials, reviewed most of the literature pertaining to the claim that bilberry improves night vision. He found that the four most recent trials, which were all rigorous randomized controlled trials (RCTs), showed no correlation with bilberry extract and improved night vision. A fifth RCT and seven non-randomized controlled trials reported positive effects on outcome measures relevant to night vision, but these studies had less-rigorous methodology.

Healthy subjects with normal or above-average eyesight were tested in 11 of the 12 trials. The hypothesis that V. myrtillus improves normal night vision is not supported by evidence from rigorous clinical studies. There is a complete absence of rigorous research into the effects of the extract on subjects suffering impaired night vision due to pathological eye conditions.

Even though there is no solid evidence in human studies that bilberry produces any positive visual effects on night vision there is some experimental evidence that implies it might be useful in some ocular conditions whose mode of action is oxidative stress. There are recent epidemiologic, molecular and genetic studies that show a major role of oxidative stress in age-related macular degeneration.

There have been some studies showing oxidative protective effects of bilberry in non-human models. 

In Protective effects of bilberry and lingonberry extracts against blue-light emitting diode light-induced retinal photoreceptor cell damage in vitro, Ogawa et al showed in cultured mouse cells that adding bilberry extract to cells before subjecting them to high-energy short-wavelength light that the cells survived better mostly by reducing the amount of reactive oxidative molecules. 

In Retinoprotective Effects of Bilberry Anthocyanins via Antioxidant, Anti-Inflammatory, and Anti-Apoptotic Mechanisms in a Visible Light-Induced Retinal Degeneration Model in Pigmented Rabbits, Wang et al found similarly improved survival of pigmented rabbit retinal cells when exposed to bilberry abstract prior to high-intensity light.

But bilberry is not without potential side effects.

Bilberry possesses anti-platelet activity; it may interact with NSAIDs, particularly aspirin. And excessive drinking of bilberry juice may cause diarrhea. One study of 2,295 people given bilberry extract found a 4% incidence of side effects or adverse events. Further, bilberry side effects may include mild digestive distress, skin rashes and drowsiness. Chronic uses of the bilberry leaf may lead to serious side effects. High doses of bilberry leaf can be poisonous.

Bilberry has not been evaluated by the Food and Drug Administration for safety, effectiveness, or purity.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The retina is the nerve tissue that lines the inside back wall of your eye. Light travels through the pupil and lens and is focused on the retina, where it is converted into a neural impulse and transmitted to the brain. If there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss.

Symptoms

The three 3 F’s are the most common symptoms of a retinal detachment:

  • Flashes: Flashing lights that are usually seen in peripheral (side) vision.

  • Floaters: Hundreds of dark spots that persist in the center of vision.

  • Field cut: Curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision.

Causes

Retinal detachments can be broadly divided into three categories depending on the cause of the detachment:

Rhegmatogenous retinal detachments: Rhegmatogenous means “arising from a rupture,” so these detachments are due to a break in the retina that allows fluid to collect underneath the retina. A retinal tear can develop when the vitreous (the gel-like substance that fills the back cavity of the eye) separates from the retina as part of the normal aging process.

The risk factors associated with this type of retinal detachment:

  • Lattice degeneration – thinning of the retina.

  • High myopia (nearsighted) - can result in thinning of the retina.

  • History of a previous retinal break or detachment in the other eye.

  • Trauma.

  • Family history of retinal detachment.

Tractional retinal detachments: These are caused by scar tissue that grows on the surface of the retina and contraction of the scar tissue pulls the retina off the back of the eye. The most common cause of scar tissue formation is due to uncontrolled diabetes.

Exudative retinal detachments: These types of detachments form when fluid accumulates underneath the retina. This is due to inflammation inside the eye that results in leaking blood vessels. The visual changes can vary depending on your head position because the fluid will shift as you move your head. There is no associated retinal hole or break in this type detachment. Of the three types of retinal detachments, exudative is the least common.

Diagnostic tests

  • A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the eye to examine the peripheral retina.

  • A scan of the retina (optical coherence tomography) may be performed to detect any subtle fluid that may accumulate under the retina.

  • If there is significant blood or a clear view of the retina is not possible then an ultrasound of the eye may be performed.

Treatment

The goal of treatment is to re-attach the retina to the eye wall and treat the retinal tears or holes.

In general, there are four treatment options:

  • Laser: A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment.

  • Pneumatic Retinopexy: This is an office-based procedure that requires injecting a gas bubble inside the eye. After this procedure, you need to position your head in a certain direction for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is performed around the retinal break. This procedure has about 70% to 80% success rate but not everyone is a good candidate for a pneumatic retinopexy.

  • Scleral buckle: This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure. Vitrectomy: In this surgery, the vitreous inside the eye is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place. The gas bubble will slowly dissipate over several weeks. Sometimes a scleral buckle is combined with a vitrectomy surgery.

Prognosis

Final vision after retinal detachment repair is usually dependent on whether the macula (central part of the retina that you use for fine vision) is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that patients with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

With the legalization of medical marijuana in 29 states as of April 2017, the question of whether marijuana is a good treatment for glaucoma has resurfaced.

Glaucoma is a common eye disease that affects the optic nerve and results in loss of peripheral vision. The treatment for glaucoma is to lower the pressure - intraocular pressure - inside the eye. This can be accomplished by laser, eye drops, or surgery.

The idea that marijuana can be used to treat glaucoma dates back to the 1970s. Smoking marijuana does lower intraocular pressure but the effect lasts only 3-4 hours. In order for marijuana to be an effective treatment, a person would have to smoke marijuana every 3 hours. Since marijuana also has psychoactive effects, consistently smoking it could prevent a person from performing at maximum mental capacity, and frequent use can cause problems with short-term memory.

Marijuana not only lowers intraocular pressure but also blood pressure and blood flow throughout the body. There is, however, evidence that decreased blood flow to the optic nerve may cause further damage. Therefore, it is possible that the lower intraocular pressure is negated by the decreased blood pressure to the eye.

Other ways of administering the active ingredient of marijuana, tetrahydrocannabinol (THC), include oral and topical administration. These forms avoid the potentially harmful compounds that could damage the lungs from marijuana smoke. However, the oral form would not avoid the systemic effects of marijuana.

There has been a research program that enrolled nine patients to take either oral THC or inhaled marijuana. None of the patients could sustain treatment for more than 9 months due to side effects such as distortion of perception, confusion, anxiety, depression, and severe dizziness. (https://www.ncbi.nlm.nih.gov/pubmed/12545695)

Alternatively, though eye drops may potentially avoid systemic effects, there is no formulation currently available to introduce a sufficient amount of the active ingredient into the eye.

The position by the American Glaucoma Society and American Academy of Ophthalmology is that marijuana is not recommended in any form for treatment of glaucoma at the present time.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

The Background

Over the last several years, research has indicated a strong correlation between the presence of Obstructive Sleep Apnea (OSA) and glaucoma. Information from some of these pivotal studies is presented below.

Did you know

  • Glaucoma affects over 60 million people worldwide and almost 3 million people in the U.S.
  • There are many people who have glaucoma but have not yet had it diagnosed.
  • Glaucoma is the second-leading cause of blindness in the U.S. behind macular degeneration.
  • If glaucoma is not detected and goes untreated, it will result in peripheral vision loss and eventual, irreversible blindness.

 

  • Sleep apnea is a condition that obstructs breathing during sleep.
  • It affects 100 million people around the globe and around 25 million people in the U.S.
  • A blocked airway can cause loud snoring, gasping or choking because breathing stops for up to two minutes.
  • Poor sleep due to sleep apnea results in morning headaches and chronic daytime sleepiness.

The Studies

In January 2016, a meta-analysis by Liu et. al., reviewed studies that collectively encompassed 2,288,701 individuals over six studies. Review of the data showed that if an individual has OSA there is an increased risk of glaucoma that ranged anywhere from 21% to 450% depending on the study.

Later in 2016, a study by Shinmei et al. measured the intraocular pressure in subjects with OSA while they slept and had episodes of apnea. Somewhat surprisingly they found that when the subjects were demonstrating apnea during sleep, their eye pressures were actually lower during those events than when the events were not happening.

This does not mean there is no correlation between sleep apnea and glaucoma - it just means that an increase in intraocular pressure is not the causal reason for this link. It is much more likely that the correlation is caused by a decrease in the oxygenation level (which happens when you stop breathing) in and around the optic nerve.

In September of 2016, Chaitanya et al. produced an exhaustive review of all the studies done to date regarding a connection between obstructive sleep apnea and glaucoma and came to a similar conclusion. The risk for glaucoma in someone with sleep apnea could be as high as 10 times normal. They also concluded that the mechanism of that increased risk is most likely hypoxia – or oxygen deficiency - to the optic nerve.

The Conclusion

There seems to be a definite correlation of having obstructive sleep apnea and a significantly increased risk of getting glaucoma. That risk could be as high as 10 times the normal rate.

In the end, it would extremely wise if you have been diagnosed with obstructive sleep apnea to have a comprehensive eye exam in order to detect your potential risk for glaucoma.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

EyeMotion Animations

There are several different variations of Glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the Glaucoma like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which will be discussed in another article, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of Glaucoma we treat.

Glaucoma is a disease where the Optic Nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP).  Most - but not all - people diagnosed with Glaucoma have an elevated IOP.  Some people have fairly normal IOP’s but show the characteristic deterioration in the Optic Nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP. We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications or laser treatments. There are other places in the world where Glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications - most often in the form of eye drops - or a laser treatment.

Drops

There are several different classes of medications used to treat Glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s.  The PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes; they are reasonably well tolerated by most people; and they are dosed just once a day, while most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option as initial treatment is a laser procedure.

The two most common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT).  These treatments try and get an area inside the eye called the Trabecular Meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year.  Both laser treatments can be repeated if the pressure begins to rise again in the future but the SLT works slightly better as a repeat procedure compared to the ALT.

Article contributed by Dr. Brian Wnorowski, M.D.

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Fall brings a lot of fun, with Halloween bringing loads of it.

But did you know that some Halloween practices could harm your vision? Take Halloween contacts for instance. They are wildly fun with everything to monster eyes, goblin eyes, cat eyes, sci-fi or a glamour look. If properly fit by an eye care professional, they can be just the added touch you need for that perfect costume. However, some people do not realize that the FDA classifies contact lenses as a medical device that can alter cells of the eye and that damage can occur if they are not fit properly.

Infection, redness, corneal ulcers, hypoxia (lack of oxygen to the eye) and permanent blindness can occur if the proper fit is not ensured. Another concern that ICE, FTC, and FDA have are the illegal black market contacts that come into the country unchecked. Proper safety regulations are strictly adhered to by conventional contact lens companies to insure that the contact lenses are sterile and packaged properly and accurately.

Health concerns arise whenever black market, unregulated contacts come into the US market and are sold at flea markets, thrift shops, beauty shops, malls, convenient stores and the likes. These are sold without a prescribers prescription, and are illegal in the US. Buyer beware because these are the contacts that cause concern, after all, you don’t want to bargain shop on parachutes OR your eyes! There have also been reports of damage to eyes because Halloween Spook houses ask employees to share between shifts the same pair of Halloween contact lenses as they dress up for their costume.

So the take home message is, have a great time at Halloween, and enjoy the flare that decorative contacts can bring to your costume, but get them from a reputable venue and be fit by a eye care professional with a proper legal prescription. 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Now that you have picked up your new pair of prescription eyeglasses, your focus becomes taking care of them. A task many disregard, it is absolutely imperative that you make sure you are following a couple simple steps to keep the quality of your vision where it is with your new spectacles.

We are all guilty of using a garment of clothing when in a rush to wipe away a pesky smudge on our glasses. This act is, unfortunately, the worst thing you can do for your lenses.

No matter how clean your clothes are, dust particles and even small bits of sand and debris cling to them. Since eyeglass lenses are not made of diamonds, these tiny little particles can do tremendous amounts of damage to your new lenses. The smallest little crumb can grind an inconspicuous scratch directly in your line of vision, which in turn can render your glasses almost useless.

Most of us know what it feels like trying to concentrate on the world in front of you when there is a little scratch distorting and distracting your vision. A majority of the time, these little scratches can be avoided by following a few simple steps.

You may have noticed when shopping in your favorite store that they sell a variety of eyeglass cleaners. You need to be careful because the sprays and wipes that you can purchase in retail stores are not necessarily approved for all types of eyeglass lens materials.

This factor makes them fall under that category of products that many eye care professions cannot recommend. Most of these liquids contain a form of acetone or other cleaning agents that are too harsh for plastic lenses. Many years ago, when all eyeglasses were actually made out of crown glass, these products would have worked just fine. Now, during a time where they have developed thinner, lighter materials like cr-39 plastic and polycarbonate, these products have proven to be too hard on the lenses.

Over time, the lenses will start to break down if exposed to the chemicals used in these sprays, causing a fogging effect. Once again, you are left with a pair of glasses that are now unable to be worn.

Now that we have gone over the two main culprits in the destruction of eyeglass lenses other than accidents, let’s focus on some tips to extend the lifetime of your glasses.

Most importantly, you should use an eyeglass case. For the large portion of patients who wear their glasses all day, it’s understandable how awkward it can be to carry a case around. But it’s nowhere near as frustrating as realizing the new pair of eyeglasses you just purchased are becoming scratched and ruined.

Also, you do not need to carry the case with you everywhere you go. Strategically leaving a case on a bedside table, in your car, or in a purse is the difference between “life or death” for your glasses.

This is also a simple way to clean your glasses that does not require you to purchase anything you probably don’t already have at home. Using lukewarm water at the sink, place a small, pea-sized dab of dish soap on your fingers. Gently rub the soap on both lenses from side to side, and then rinse with warm water. A disposable paper towel is recommended to dry the glasses.

Disposable towels work because they are just that, disposable - which guarantees they are not carrying dirt or sand from a prior use.

Taking care of your glasses today means you have them for clear vision tomorrow and into the future.

 

Article contributed by Richard Striffolino Jr.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

It is safe to say that many people prefer shopping online to shopping in stores for many of their needs.

With technology constantly improving and evolving, people tend to take advantage of the convenience of shopping online. Whether it’s clothing, electronics, or even food, you can easily find almost everything you need on the Internet.

Eyeglasses, unfortunately, are no different. Many online shops have been popping up in recent years, offering people that same convenience. But what they don’t tell you is that it comes at a price, and this article’s purpose is to shine a light on the negatives of shopping online for eyeglasses.

Here are some important reasons to avoid the temptation of ordering glasses online.

  1. Accuracy- Instead of saving the most important point for last, we will focus on the main reason that ordering eyeglass online is a bad idea first. Product accuracy is a huge reason that the online market has not completely taken off. Every person who needs eyeglasses needs to understand the process for how their prescription is obtained in order to truly understand why shopping online is a bad idea. It is called an eyeglass prescription for a reason. Your ophthalmologist or optometrist is prescribing your lenses as if they were prescribing any form of medication. To take that prescription and hand it over to a website that does not require licensed workers to interpret the prescription is not the wisest choice. Equally as important as the prescription itself are the pupillary distance (PD) measurement, and the optical centers. These measurements are not given at the time of the examination by the ophthalmologist or optometrist, but instead are administered by the optician at the point of sale. Not having these measurements done accurately will negatively affect the quality of vision as much as an error in the prescription.
  2. Quality- Similar to the accuracy of the lens, the quality of the product you are purchasing is affected when making the decision to purchase online. The saying “too good to be true” is the case more times than not, and this purchase is no exception. When you see enticing advertisements for pricing that seems to be too good, there is a reason. This product is often not inspected or handled by a state-licensed optician. These websites rely on mass production in order to operate. Factory workers operating machines pale in comparison to the experience you will receive in a professional office. Skilled opticians licensed to interpret and manufacture your eyeglass prescriptions and are held to a much higher standard than factory workers.
  3. Warranty- Due to their low prices, most of these websites do not include any form of product warranty or guarantee. Opticians, however, stand behind your purchase. If there are issues with adjustment or a patient not being comfortable in a specific lens or product, professional opticians are willing to work with you. This personal experience is not attainable on the web.
  4. Coordination with your doctor- With the complexity of eyeglass lenses, the ease of working in house is always a benefit worth keeping in mind. Eyeglass lenses can be very complex products. Having the benefit of being able to work directly with the doctor gives the optician the best chance to put you in the exact lenses you need. There is a substantial difference in the percentage of error between shopping online and the care you get in a private practice.
  5. Personal Experience- Probably the most important factor for many people, the personal experience you get when shopping in person is something you cannot obtain by using the Internet. Dealing with the same opticians year in and out is something patients emphasize and appreciate. Just like people tend to keep the same doctors over the years, patients like knowing that the same people will be in charge of making their glasses. Shopping online will not offer that experience.

All of these factors should be carefully weighed when making the decision to shop online. While the initial price difference could entice you at first, know that it does come at a price. Whether it be a warranty, quality, or convenience all of these are very important factors when buying glasses. People sometimes tend to discount how intricate eyeglasses are.

Purchasing eyeglasses is handled best in person by professionals who can provide you with the utmost care and quality.

 

Article contributed by Richard Striffolino Jr.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Choosing a new pair of eyeglasses can be a daunting task.

Making a decision on what style glasses you will be wearing for the next year until your vision is checked again can be stressful. This is one of the many reasons opticians are here for you. In many ways, this may be the most important task for the optician, because keeping you happy motivates you to wear your glasses daily.

Most people’s reaction is to play it safe with new glasses and stick with something relatively similar to what they are currently wearing.

While not necessarily a bad decision, this isn’t something opticians try to promote. Opticians often spend time meeting with frame representatives and browsing the Internet to keep up with the ever-changing trends in the world of eyeglass frames. And it’s a great feeling to successfully “update” your image with a new set of frames. Many patients are amazed at the difference a well-fit and -styled pair of glasses makes on their overall look.

There are many simple tips and tricks to consider when starting to browse for your next pair of frames.

The goal of this article is to improve your starting point when beginning to choose frames. That way, once the optician gets involved, the process is already well under way. Keep in mind that these are guidelines and “outside the box” thinking can be good as long as it fits within the required parameters of your prescription.

The first step is successfully identifying what face shape category you seem to fit into.

This image shows the most common face-shape categories. These are a great guidelines to help decide which frames will most likely appear to fit the best.

Oval - Oval faces are considered to be the “most versatile” because most frame styles and sizes fit well on this face type. As a general rule, and especially for oval faces, avoid choosing frames that extend past the widest part of your face. Stick with moderate-sized frames.

Upside Down Triangle - To even out the proportions of this face shape, choosing semi-rimless frames is always a positive. Less attention to the bottom half of the frame helps enhance the natural curves of this face shape. Frames that stay wide at the bottom and do not taper inward will also help even out this face.

Oblong - Being longer than it is wide, this face shape enjoys having larger frames on it. A lower bridge will help shorten the nose, and solid dark colors are a positive as well.

Square - A strong jaw line is the focus of this face shape, so to work with that, choosing smaller, narrow frames is a positive. Ovals and rounds work better than squares.

Diamond - Broad cheekbones are the focal point of this face shape. Being quite rare, the best style of frames to put on these faces are in the cat eye family. Following the face’s contours, flare-top frames, semi-rimless frames, and fun colors tend to work well with this shape.

Round - Rectangular frames work best on round faces. Wide bridges help separate the eyes and bring symmetry to the face. Make sure the frames are wider than they are deep.

Triangle - Cat eye frames work exceptionally well with this face shape also. Frames that have a lot of style and accents to the upper part of the frames and temples are a plus as this brings attention to the naturally narrow forehead.

Along with shapes and styles, some believe that certain colors work best with certain faces.

All people are considered to have either cool (blue) or warm (yellow) skin tones. Some people feel customers should stick within their family of coloring. Again this is only a recommendation since you should wear what you like. This is just strictly a guideline for those struggling to choose a frame for themselves. Based on experience, eye color can make a difference as well. People with lighter eyes tend to prefer lighter frame colors, and vice versa for people with darker eyes. Also, hair color can be considered. Patients with lighter or grey hair tend to shy away from darker frames unless looking to make a statement.

At the end of the day you have to choose what is most comfortable for you. Opticians’ suggestions and educated opinions can help steer you in the right direction. There is much to consider, but always keep in mind that comfort and functionality are the priorities.

Some people believe plastic or zyl frames are more comfortable than metal or semi-rimless. Having nose pads, metal frames feel “heavy” to some. Others cannot wear plastic due to oily skin. Plastic frames may slide as the day progresses so metal may be better suited.

Don’t be overwhelmed. Follow some simple guidelines, and remember to enjoy the process. There are infinite styles and options to get you seeing well and looking great. And while you’re considering lenses for your regular lenses, don’t forget to look for sunglasses frames!

 

Article contributed by Richard Striffolino Jr.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

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