I Don’t Have Allergies But…..
Doc asks, do you have any allergies?
You reply, I don’t normally have allergies BUT….
Laser scan
Transverse view of the retina with an OCT, image courtesy of Russell Neches
Occasionally I send patients to another clinic to get a laser scan of the back of their eye. What is this test, and why do we do it?
The official name of this procedure is called an “optical coherence tomography” scan or “OCT” for short. The machine emits a very short wavelength (~100 nm) laser beam that hits certain structures in the retina. The onboard processor is able to translate the information that the laser records into a topographical profile of whatever structure the doctor wants to see. This affords him the ability to notice any disruptions below the retinal surface.
I take retinal pictures of every single patient in order to examine key anatomical and functional components of the eye. Retinal photos are a brilliant form of technology that allows me to see very detailed things. Occasionally I also utilize special lenses to determine if a problem is present. However, these two techniques are sometimes not detailed enough to examine key hidden structures.
Instead of thinking about the retina, let’s use an apple analogy for a moment. If you take a picture of the side of an apple, you could see that it is red. You could see the outline and perhaps infer that it curves outward towards you. You wouldn’t be able to tell how deep the apple was or what the insides look like. Taking an OCT of the apple would be like cutting it in half and observing a cross section. You would now be able to see that red color is actually a very thin skin. You could also measure the depth of the apple, see that the majority of it’s volume is composed of a fibrous network, and notice a small cavity in the center that’s filled with seeds. If the seeds were displaced to the side, a traditional camera picture wouldn’t notice anything out of the ordinary since the external appearance is untouched. However, an OCT would be able to tell that they are not in their proper position. For almost every patient, a retinal photo is way above the standard of care that’s required to examine their eyes. However, some patients’ eyes either present with abnormalities or have a suspicious appearance. Those patients require the detailed level of imaging and analysis that an OCT can provide.
It’s important to clarify a few misconceptions about getting an OCT:
-Does it hurt?
It doesn’t hurt at all. It’s actually slightly more gentle than a camera flash
-Will it fix my problem.
No. There are many types of lasers that doctors use on the eye. An OCT does diagnostic imaging only. That means that it shows the doctor what is the issue and does not fix it.
-Why didn’t my doctor see what the laser saw?
A doctor only orders an OCT when a known or suspected problem lies in an area of the retina that’s not visible to human eyes and traditional machines. Unless your doctor has x-ray vision, he won’t be able to see the deep hidden retinal layers.
-Come on doc. Is this really important?
Absolutely! With many retinal pathologies the OCT reading is how the doctor determines what treatment or monitoring protocols he will use. Additionally, he now has a snapshot of the retina at a given time and can track it’s evolution in the future.
-Why doesn’t my doctor have an OCT?
Most patients don’t require such a scan. Typically I will see only 1 patient who needs an OCT each week. Although I can perform the scan and interpret the results with ease, I prefer my patients to be scanned by a doctor who does 10 a day and specializes in that type of care.
-You’re sending me to a disease specialist? I must have something really bad.
Needing an OCT does not mean that you have a serious disease. It does mean that your eyes present slightly atypically and an extra scan is the prudent thing to do. Frequently the doctor who does my scanning will say, “It looks okay. We’ll just monitor it. Go see Dr. Ritenour in a year.” Some patients I know are healthy, but have an elevated risk for developing a problem in the future. In theses cases, the OCT scan is a baseline “snapshot” that we can always compare back to in the future.
Leave a comment or email me if you have any questions or concerns.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
“I’m really blind without my glasses”
Blurry vision? Read on. Image courtesy of Emin Ozkan/sxc.hu
“I’m really blind without my glasses.”
Everyday several people come into my office saying those words. What they mean is that they are very nearsighted or myopic. In fact about 41% of the US population (2004 data, ages 12-54) have some degree of myopia. Eye doctors quantify myopia and all other types of prescriptions in units called diopters (D). A diopter is simply a measurement that indicates the degree to which an optical system bends light. Most forms of myopia may be classified into three different categories:
Low myopia: -0.25D to -3.00D
Medium myopia: -3.00D to -6.00D
High myopia: -6.00D and greater
We correct myopia with glasses, contacts, or sometimes procedures like LASIK. For low and medium amounts this is typically the end of the story. However, with high myopia there are some other concerns beyond getting the right prescription. Most people with this type have high prescriptions due to longer axial lengths in the eye. The axial length is the distance from the very tip of the cornea the deepest tissue layers in the back of the eye. This puts a special type of tension on the retina, and statistically gives the patient a higher risk of developing a retinal detachment. That is when the retina pops off it’s supporting basement structures and can lead to severe vision loss.
What do we do about this? Unfortunately there is no way to completely prevent a retinal detachment from happening. However, we can help minimize the risks. Blows to the head are especially risky for high myopes. The sudden shock can cause the already threatened retina to cross a tipping point and detach. Two weeks ago I saw a girl with a -8.00 prescription. She hit her head ice skating and wisely came in to be examined (thankfully she was okay). One can’t live in a padded cage, but it’s important that people with these prescription be vigilant about protecting their head and eyes. If you wear -7.00 glasses then boxing may not be a good hobby. Patients with high myopia must immediately let their doctor know if they ever see flashes of light, experience any changes in their floaters, see “curtains” coming down, or any other odd visual occurrences. Both Dr. Bazan and I believe that it’s important for everyone to get an annual dilated exam. For high myopes, this is not only important – it’s critical. We do a very thorough dilation exam to ensure that the retina is healthy and that there are no signs of any impending detachments. Speed is the name of the game if a detachment is detected. There are a variety of procedures used to heal the retina based on the type and location of the detachment. An eye doctor will ensure that these procedure are done inside an appropriate time frame. With proper care the lasting effects of a retinal detachment can be very minimal.
I will include a special point for high myopes who have had LASIK or are considering LASIK. It’s true that post-LASIK you effectively have no prescription. However, the laser simply compensates for exceptionally long eyes by altering the curves of the cornea. The axial length of the eye never changes. LASIK is a fantastic option for many of these patients and their vision. It does not change the important of being dilated annually or lower the risk of a detachment.
Feel free to contact me if you have questions about high myopia, retinal detachments, or any other eye issues.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
Don’t stretch it out.
Dont' strech your contact lenses!
Some contact lenses are to be changed daily. Others last for 2 weeks. Some last for a month. Why are they all different, and is it important to change them regularly?
Contacts sit on the eyes’ corneas. Light is able to pass through our corneas because they’re clear and don’t contain blood vessels. Consequently, oxygen, water, and other nutrients must be supplied to the cornea via the air, tears, and eyelids. When ANY contact lens is on the eye, the cornea receives dramatically lower amounts of these elements. As you can imagine, this opens the door to a lot of potential issues. Therefore it’s critical that patients and their eye doctors carefully manage the use of contact lenses.
Every type of contact lens differs in it’s physical and chemical properties. The amounts of water and oxygen that permeate through them hinge on the fit, material, prescription, and wearing schedule of the contact lens. The first three are largely concerns of one’s eye doctor. How the contacts should be worn is determined by the doctor, but the responsibility to follow said schedule is up to the patient.
I’ll illustrate by using CooperVision’s Biofinty contact lenses as an example. This lens is approved for 30 days of wear. To arrive at that number, CooperVision worked with many doctors, researchers, and the FDA to determine how long these lenses may be worn safely. Like all contacts, they permit less oxygen to reach the eye as compared to not wearing contacts at all. Experts have found that this is largely not a problem as long as the lenses are worn for 30 days or less and the patient regularly sees her optometrist. After 30 days of wear the story takes a turn for the worse. The amount of oxygen that reaches the eye is lower than professionally determined critical thresholds. This opens the floodgates for a lot of potential complications.
On the low end, wearing a contact lens for too long may cause the eyes to become slightly red. On some patients this can stay at a cosmetic level. However, frequently it’s the first warning sign of serious impending problems. With the eyes defenses reduced, bacterial and/or viral infections are much more likely to occur. It’s somewhat common for the cornea to respond to low oxygen levels by developing “subepithelial infiltrates.” These are inflammatory cells that arrive on the scene when the cornea is threatened. They interrupt a dense network of nerves in the front of the eye and are very painful. In some cases of contact lens overwear, the iris may become severely inflamed. This is a highly uncomfortable condition called iritis or anterior uveitis. The treatment for this condition is weeks of steroid drops and dilated eyes – not anyone’s idea of a good time. If left unchecked, a reduced oxygen level can even lead to ulceration of eye tissue.
The good news about all of these problems is that they are largely avoidable. By wearing your contacts lenses for the prescribed schedule, the risk of all these issues is quite low. Beyond simply wearing your contacts properly, it’s important to have them evaluated at least once a year by your optometrist. It’s his job to ensure that your eyes aren’t showing any signs of being “angry” with the lenses. It’s far better to stay on top of any complications than allowing them to run free.
Feel free to send an email if you have any questions or concerns.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
What is 20/20?
Optometrists love to toss around the term 20/20: “You have 20/20 vison.” or “Gosh, you’re seeing better than 20/20.” Perhaps, you use it at home: “How does this dress look?” “Sorry honey – I don’t see 20/20.” The news program “20/20″ was actually named after the visual measurement. Everyone knows 20/20 is ideal, but few actually know what it means.
To know how well someone sees, we must use a standardized system. This affords doctors the ability to know if someone needs more or less correction and to compare the vision between members of a population. For example, it’s means very little to accurately check the vision of an eight month old girl and then record it as “pretty good” or “seems normal.” It’s far superior to be able to record her vision as 20/60 or 20/80. Then visual changes may be tracked with tighter accuracy, her visual acuity may be compared against what’s normal for 8 month olds, and her vision may be corrected or observed against a quantifiable system.
The 20/xx system is also known as the Snellen visual acuity system. The top number refers to the testing distance in feet. Twenty feet is considered to be “optical infinity” due to how our eyes focus and the behavior of light waves at this distance. However, most offices do not have patients sit 20 feet from a chart due to space constraints. Through the use of mirrors and chart calibrations, the shorter distance is compensated for remarkably well.
The bottom number is a bit more complex. It’s the distance at which each element of a letter has an angular height of 1 minute of arc (or 1/60th of a degree). The letter “E” on an eye chart has 5 elements. There is the top bar, a space, the middle bar, another space, and the bottom bar. When one stands 400 feet from the big E at the top of the chart, each of these elements subtends 1 minute of arc. Therefore the size of the letter is called 20/400. For a letter on the 20/20 line, one must stand 20 feet away for each element to subtend 1 minute of arc.
The neurological processing in the human eye and key areas of the brain allows people to easily discriminate between letters with 1 minute of arc (or smaller) features. With a (compensated or actual) testing distance of 20 feet, optometrists therefore embrace the 20/20 line as a perfect endpoint. Please don’t fret if you can’t see 20/20 without glasses or contacts. That will be the subject of a blog post in the near future. Seeing 20/20 with or without visual correction means that at 20 feet away, your eyes see as well as they are expected see. If you can’t read 20/20, please schedule an appointment, and I’d love to help boost your vision.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
That dang air puff
A lot of people are scared to visit the eye doctor because of the air puff test. What is it? Is it absolutely necessary? Can you avoid it?
The air puff test is what people commonly call the non-contact tonometry (NCT) test. It is used to determine the pressure inside the eye, also known as the intraocular pressure (IOP). Knowing a patient’s IOP is the most important tool that optometrists have to screen for glaucoma. An IOP that’s elevated to an unsafe rage feels very similar to most types of high blood pressure – that is you feel just fine. By the time you begin to notice symptoms it is too late. Consequently it’s important for your doctor to check your IOP at least annually.
I can hear you saying, “Come on doc. That test is horrible!” I totally agree with you. The NCT machine blows a measured amount of air at the eye which deflects the cornea a bit. Infrared sensors measure the corneal deflection and correlate it to the pressure inside the eye. When one puts it that way it doesn’t sound too bad. In fact it works extremely well on a research lab bench. In the real world…well…not so much. Our eyes have a great natural reflex that protects them when something comes close or contacts the eyelashes. That’s why people blink and get nervous about the air puff. In fact, patients typically blink and clench their eyes so much during NCT that the IOP reading frequently is nowhere near the true value. I’m the worst at this. Do NCT on me, and I become as fussy as a toddler without his nap and snack. I dislike doing NCT on patients and having it done on me so much that we don’t even have this machine at Park Slope Eye. It’s a really dated technology.
Fortunately there are alternatives. A very common and extremely accurate way to measure the IOP is Goldmann tonometry (aka the blue light test). With this test, patients get a yellow eye drop that makes the eye glow when exposed to a blue light. The doctor steers an illuminated prism very close to the eye. When the doctor looks in his microscope, the IOP is correlated to the degree that the prism bends the light. This method is considered the gold standard of IOP measurement. It is painless but still scares many patients.
At Park Slope Eye we have an even better way to determine patients’ IOP. We have a special device from Helsinki, Finland that gives just as accurate IOP readings as Goldmann tonometry. A very tiny wand bounces off the tears and the device measures the force at which it returns. It’s very fast, painless, and requires no drops. A few seconds after I explain it to patients, the machine has already measured the IOP three times in each eye! We are one of the few offices in New York that actually has this technology. Ask a friend who comes to Park Slope Eye what they think about it. Stop by the office if you don’t know anyone who is a patient here. I’d love to demo it for you (and make you some coffee)!
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
…but my vision isn’t blurry.
How often do you visit your eye doctor? Annually? Every 5 years? Still haven’t been checked? Perhaps a better question is how often should you visit your eye doctor. For the general population, optometrists recommend a visit at least every 12 months. Still it’s common for people to wait until their vision gets blurry. On the surface that seems sensible, but it overlooks some very important elements of good eye health.
Every eye exam does include a determination of one’s glasses and/or contact lens prescription. While this is important for good vision, it’s just a small component of the examination. When light enters the eye, it gets refocused no less than 12 times before being converted to an electrical signal behind the eye. In most people, the summation of these focusing steps is not quite perfect – leading to a prescription that compensates for the difference. This would be the end of the story if the eyes were simply glass and electronics like a camera lens. Obviously they are living tissue that have special needs and interacts with the rest of the body.
There are disorders that can affect all of the elements that comprise the eye (e.g. the eyelid, tears, lens, retina). Eye specific diseases include glaucoma, cataracts, macular degeneration, and many more. Many systemic conditions such diabetes, hypertension, and high cholesterol may cause ocular complications as well. In fact in certain instances, an optometrist is the first doctor to see these signs in a patient. During a eye doctor’s examination he observes the external eye structures under high magnification. Also he will look inside the eye at the all internal structures. Any abnormalities are treated or aggressively monitored as warranted. In addition to examining the physical structure of the eye, the physiology or functioning of the eye is equally important to check. He will ensure that they eyes are moving properly, working well together and independently, communicating with the brain, and being supplied with blood as they should.
Some people are fortunate enough to not need glasses until about age 40 or maybe never need them. Other people notice that their prescription stops changing in their late teens or early twenties. Regardless of how blurry or clear a person’s vision is, it’s very important to ensure that her eyes are structurally sound and functioning to the max. If a problem is ever detected, it is far superior to catch it in the early stages than to catch it much later. Don’t let “good enough” vision rob you of a lifetime of stellar vision and healthy eyes.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
Computer problems
For a lot of jobs, 99% of one’s workday is spent at the computer. Many people come in to our office complaining of headaches, strain, blurry vision, or general discomfort while staring at their screen. What’s going on is something known as an accomodative spasm. That simply is a nifty term for “your eyes are tired, pal.” It’s very common among lawyers, engineers, college students, accountants, etc. I live to read books, and this problem begins to effect my eyes after a few minutes. Let me explain what’s happening.
Inside the eye is a flexible disc-shaped lens that is surrounded by a circular muscle known as the ciliary body. The ciliary body behaves somewhat differently than most muscles that people think about. A typical skeletal muscle, such as a bicep, moves a bone around a joint similar to an actuator. When a bicep contracts it moves the forearm up. When a tricep contracts it moves the forearm back down. Since the ciliary body is circular, it makes a smaller diameter circle when it contracts and a larger diameter one when it relaxes. During contraction of the muscle, tension is relieved from the lens causing it to bulge. It’s like squeezing your fingers around the center of a balloon so that it bulges outwards at the ends. When the ciliary body relaxes, it adds tension to the lens causing it to flatten. The bulging of the lens helps us to focus at the computer while the flattening action helps us to focus far away.
A person’s nervous system stimulates these dynamic lens changes very quickly and beautifully. In most cases it responds perfectly to wherever we want our eyes to focus. However, when we stare at the computer or a book for extended periods of time, the muscle can become “locked up”. In this state it does not move as quickly or as seamlessly as when it’s fresh. I like to give the analogy of hold a 2 lb. weight with your arm. It’s very easy for nearly everyone, but after holding it for 8 hours one’s bicep is going to be screaming (or at least my tiny biceps would).
What does one do to get past this? My first recommendation is to quit your job and spend your days at the beach. That usually doesn’t go over too well. Aside from that, one simple exercise you can do is take eye breaks. About every 20 minutes, look 20 ft away, for about 20 seconds (20/20/20). Very quickly you’ll feel your eyes and some facial muscles relax. Other strategies are special contact lens or glasses prescriptions or in certain cases reading glasses from the drugstore. I find a solution that is as easy as possible for every particular patient’s needs. No treatment modality will weaken the eyes or make you reliant upon glasses. They simply take the demand that you place on your visual system and transfer it elsewhere. Shoot me an email if you need help or have questions. I’ll be happy to see you.
Spencer Ritenour, O.D.
dr.ritenour@parkslopeeye.com
Stay shaded
Sunglasses do a lot of things. They always make a fashion statement (good or bad). They significantly cut glare. They hide your eyes as you check out your fellow patio diners. They protect the eyes during outside sports. However, good sunglasses have benefits that are more than cosmetic or convenient.
The most important function of sunglasses is to block UV light. This type of light is not visible to the human eye and comes in three forms: UVA, UVB, and UVC. UVC is the most damaging form, but all that is emitted from the sun is filtered by the atmosphere. It’s main application is in industrial sterilization processes. UVA from the sun does reach the Earth’s surface, but it’s effects are generally limited to accelerating aging. A black light emits UVA. UVB from the sun reaches the Earth’s surface in great amounts. It can cause cancer, free radical damage, and disruptions in one’s DNA.
Sun damage to the eye can occur in a variety of areas. A very common location for basal cell carcinoma and squamous cell carcinoma is the eyelid. In fact, the bony ridge above the eye and the eyebrow help to minimize UV exposure to this area of sensitive skin. However, they cannot protect it completely. Being outside on the beach or ski slope with no eye protection frequently leads to photokeratitis, a painful inflamed cornea, due to the intense amounts of sunlight and glare. By far the most prevalent eye effect of the sun is cataracts. Cataracts are an opacity or yellowing of the lens that largely occurs due to accumulated UV damage. The reason they typically occur later in life is that while we are younger, we simply haven’t had enough lifetime UV exposure. Getting in the habit of wearing sunglasses faithfully helps to delay the development and severity of cataracts. Finally, a less common but very severe sun/eye complication is called solar retinopathy. This is effectively a sunburn in the back part of the eye that can lead to temporary or permanent vision loss.
Sunglasses are of little value if they do not block 100% of UVA and UVB radiation. The ophthalmic quality sun lenses that we use at Park Slope Eye always block these wavelengths. Additionally, our optometric stylist and doctors will ensure that they fit your face properly to offer the maximum amount of protection. If you don’t wear contacts, we can even add your prescription to them. Lower quality department store or drug store shades may or may not block all UV light, and they cannot receive prescription lenses. The manufacturers of knockoff sunglasses typically thumb their nose at copyright law and frequently put the same little value on UV protection. They are the one type of sunglasses that you are best to avoid in all cases. Getting in the habit of regularly wearing your shades when you go outside will help keep your eyes healthy throughout your life. Wearing the right kind of shades may even get you a few second glaces from the other folks on the sidewalk.
Happy 40th Birthday!
Blurry vision due to presbyopia
Many people find that they don’t need glasses for much of their early life. Then around age 40, suddenly their near vision begins to progressively worsen. At first they may have to strain to read the paper. Perhaps, they have to hold their phone or watch further away. Many years later, everything within arms reach may be very blurry. What gives?
These visual changes are due to something called presbyopia. It effects the structure and function of some of the internal elements of the eye. It’s a normal part of aging that occurs around 40 years of age. During the Iron Age the average lifespan was about 35 years, and nobody had to worry about presbyopia. Now that average lifespan is close to 80, presbyopic changes impact us for approximately half our lives.
Inside our eye is a lens that allows light to focus on our retinas. Overall it’s responsible for about 25% of the focusing power in the eye. It also allows for small dynamic changes that occur as one looks far away, up close, and at all distances in between. This is very similar to the autofocusing system in a camera. Surrounding the lens is a circular muscle that causes the lens to stretch out or bunch up – creating this focusing ability. Presbyopia is the sum of two natural phenomena with this system. As one ages cellular deposits begin to reduce the natural flexibility of the lens. I often liken this to flexing one’s bicep with a shirt sleeve over it – very easy to do. However, if one wears 20 shirts it becomes much more difficult. If one wears 40 shirts it becomes practically impossible. The second change that occurs is a progressive loss of elasticity in the focusing muscle. So with these changes added together the lens is naturally less flexible and the eye’s ability to drive this flexion is reduced.
What this means for one’s vision is that a little extra help is needed for near visual work. This can come in the form of over-the-counter readers, prescription bifocals, or special bifocal contact lenses. It’s important to clarify that using these devices will not make one’s eyes weaker or more reliant upon them. As mentioned above, presbyopic changes typically begin around age 40, but they continue to increase in magnitude until about age 65. This corresponds to an increase in the strength of the near prescription. One’s eyes will follow the presbyopic progression that they are destined to follow regardless if reading glasses are used or not.
Even if you are lucky enough to not need glasses and haven’t experienced these presbyopic changes there is still great value in getting an annual eye exam. Beyond checking for a glasses prescription, an annual examination includes checking the health of the internal and external eye structures, ensuring that the eyes function well together and independently, and confirming that the neural pathways between the eye and brain are working properly. With a regular exam, presbyopia and any other prescription or health complications can addressed so that one’s eyes and vision may live up to their maximum potential.
Be beautiful. Be safe.
One’s eye can tell a beautiful story. They can hold a mystery. They can relay what’s on one’s mind. There is something very wonderful about decorating them with makeup, but it’s important to ensure that one uses eye makeup in a safe and cautious manner. When used properly, eye makeup can be an excellent complement to one’s face. When used improperly, it can lead to infections, severe irritation, or worse. The 3 major concerns with eye makeup are inhibiting bacterial growth, avoiding toxic ingredients, and removing it safely.
Most people are aware that food and things like handrails or doorknobs are susceptible to bacterial colonization. Makeup is just as susceptible. It regularly contacts the human body; often gets stored in dark, warm, moist areas; and has certain chemical properties that make it a favorite playground for many types of bacteria. Manufactures add preservatives and other chemicals with antibacterial properties to help stem this risk. However, there are things that women may do at home to dramatically reduce their chance of developing an infection:
-Never share makeup. Using another woman’s eye makeup is a great way to pass pathogens back and forth. At the very least, trading eye germs is gross. At the very worst, said germs could transmit serious eye infections.
-Store makeup properly. The bathroom drawer is one of the worst places in the home for one’s eye makeup. The warm humid air from the shower and darkness of the drawer are prime breeding conditions for bacterial colonies. Similar conditions often occur in the car. It should be stored in a dry room with temperatures no higher than 85 degrees.
-Be aware of contamination: Makeup used during an eye infection can be a reservoir for the infectious organism. Using it during or after an infection may cause a need for prolonged treatment and/or a secondary reinfection. Using the same liner pencil on your lips and eyes may lead to greater sensitivity to normal body flora. Using saliva or water to reconstitute dried mascara is far from sterile and is a quick way to introduce new pathogens to the eye.
Makeup for the eye contains many ingredients that help make them the products that women know. There are chemicals used for pigmentation, retarding bacterial growth, creating a given consistency, and many other features that one may or may not consider. The challenge for manufactures is to balance the desired effect with price and safety. Unfortunately, safety is often compromised in the name of making the product cheaper or more desirable. For example, lead, kohl, and neurotoxins are frequently found in many cosmetics. To help detract attention from this, companies may use language like “natural” or “from the Earth” or incorporate packaging that encourages consumer trust. It’s very wise to research all cosmetic products (eye and otherwise) before using them.
Sleeping with eye makeup on opens the door to some complications that can otherwise be avoided. It’s possible for it to enter the tear film which can lead to mild to very severe irritation. I’ve even seen patients with compromised corneas have glittery eye shadow become embedded in the problem area. In other cases, eyeliner and mascara left on overnight commonly leads to clogged eyelid glands. It’s very important for women to effectively remove all their eye makeup before bed. Yet, eye makeup remover can pose similar concerns as the actual makeup does. Be sure to thoroughly research your remover as well.
The eyes and surrounding skin contain intricate networks of blood vessels and nerves. Additionally the eye contains unique structures like the cornea that must be well protected and preserved. With proper usage and a bit of research, makeup can safely beautify a woman’s eyes and pose little threat to long term health.
Start the school year with premium vision.
It’s back to school time yet again. Pencils and notebooks? Check. Fresh kicks? Check. Lunch packed? Check.
–Eyes examined?–
One critical component of preparing your child for the upcoming school year is to make sure that his or her eyes are functioning at their highest level. Many studies have correlated poor vision with a reduction in academic performance. Elementary age children have eyes that grow rapidly – leading to changing prescriptions. In addition to near-sightedness and far-sightedness, kids sometimes have physiological problems with focusing, eye alignment, eye dominance, or binocular vision. In much rarer cases, kids can have eye pathology that isn’t detected until their first exam. I’ve seen several 50-70 year old patients with horrible vision in one eye due to conditions that were left untreated as a child. It’s a sad thing for them, that likely would of been preventable had they been examined as a child.
An annual eye exam is important for everyone. It’s especially important for children due to their developing eye and optic systems. Needing to see the chalkboard across the room, computer screens, and homework places special demands on kids’ eyes. One complication with younger children is that they don’t have a “point of reference” for good vision. I’ve seen numerous third or fourth graders who’ve been struggling to see the board for years but had no idea of their difficulty. They didn’t understand what one was supposed to be able to see well. Many parents express hesitation about subjecting their young ones to all the bright lights and tests that they are used to receiving as adults. Dr. Bazan and I both adapt our examination procedures, tests, and language to the age of patient. We want the eye exam to be a positive experience that doesn’t frighten the child.
Infants/toddlers
Research has shown that key visual issues and developmental patterns can be detected in kids a few months after birth. At Park Slope Eye we can track kids vision and health even at age 1. Other tests and examination procedures are used for toddlers to ensure that they are healthy as well.
Kindergarten
For a 5 year old, leaving mom and dad to go to school can be a difficult time. They shouldn’t have to start with a disadvantage due to visual problems. Getting them checked can let you know that their eyes are normal for their age demographic. If any problems are detected, the interplay between their eyes and brain at this age affords us the ability to treat things much more simply.
Elementary school
As kids’ bodies are growing rapidly, the front and back portions of the eyes frequently grow at different rates. This simply means that their prescription changes…and it can change fast! Parents often think kids complain about their glasses not working because they want new frames or perhaps their best friend just got new glasses. It’s very possible that a prescription that’s less than a year old might be outdated.
Middle school & high school
The addition of sports, new hobbies, and other activities can present new demands on a visual system. Also, typically the amount of homework increases around this age. Often students complain of strain while studying or trying to see the board. It’s usually in this age range that kids develop an interest in contact lenses for social or optical reasons. With many prescriptions, a switch to contacts from glasses can actual improve the over quality of vision and “ease of use” of one’s Rx.
College
It seems like 95% of the college experience is PowerPoint, Facebook, and textbooks. This puts an intense demand on a person’s optic system. While young people’s eyes typically can handle it to a point, they often reach a threshold where they need some help. I routinely prescribe special glasses to help college students with work (and play), drops for dryness and other problems, and simple exercises to relieve fatigue.
If your child hasn’t had an eye exam or it’s been a number of years, now is a perfect time to schedule an appointment. With children we have the ability to take care of their current needs, but we also have a special opportunity to keep their vision and eye health at its highest potential for the rest of their life.
Diabetes and the Eye
Vision with healthy eyes
Vision with moderately severe diabetic retinopathy
Diabetes is a systemic condition that primarily affects the pancreas. It comes in two forms, Type I and Type II. With Type I, the body does not produce enough insulin. While people with Type II produce enough insulin, the body lacks the ability to process it. The chief biochemical result of both forms is an elevation of a person’s blood glucose level. If the glucose level is not tightly monitored and controlled, blood vessels and the tissues that they supply may become damaged.
So what can diabetes do to the eye? Inside the eye are many fragile vessels that operate very well when the blood chemistry is within a normal functional range. When sugar levels are elevated above this range, the eye believes it’s under attack and develops a response. Vessels may begin to leak causing blood to spill across the retina. In more severe cases, the eye secretes a chemical called vascular endothelial growth factor (VEGF). The presence of VEGF triggers a process in the retina known as angiogenesis (growth of new blood vessels in the retina). In some eyes, VEGF is so prevalent that it migrates across the entire eye and causes angiogenesis in some of the structures at the front of the eye. In addition to attacking the eye’s blood vessels, diabetes can damage a key structure known as the macula. This is an area of the retina the corresponds to a person’s sharp, crisp, central vision. If diabetic-related swelling occurs here, a person can have a significant loss of vision that cannot be corrected with glasses or contacts. Some diabetics have visual changes that correspond to a wide and frequent variations in their prescription. In these instances the disease process changes the chemical constituency of the lens leading to large amounts of sugar and water being deposited there. This causing swelling that fluctuates with the body’s blood sugar levels. Although this may seem like a minor inconvenience it can be indicative of blood sugar levels that have the potential to become fatal.
What do you need to do if you develop diabetes? There are 3 major elements that all diabetics MUST follow:
1) Develop a relationship with a family physician or internist to coordinate care. The primary care physician is responsible for ensuring that all treatments are effective and that the disease remains under control.
2) Faithfully control one’s blood sugar through proper diet and exercise. This is absolutely critical. A physician should help determine a safe blood sugar level and direct a patient towards nutritional counseling if necessary.
3) See an optometrist at least once per year for a dilated eye exam. Diabetes is the number one cause of preventable blindness in the United States. With proper care and monitoring, most of the symptoms mentioned above can be avoided.
At Park Slope Eye, Dr. Bazan and I dilate and thoroughly examine every diabetic patient. We take a detailed history on the patient’s condition, look for specific ocular findings of diabetic eye disease, and then develop an appropriate treatment strategy to preserve vision and eye health. We also photograph key areas of the retina to help establish baseline readings and track future disease progression. It’s important that a diabetic’s primary care doctor know of our findings and treatments. At the end of every diabetic exam, we call and fax other the healthcare providers to coordinate care strategies. If secondary or tertiary level care is required, we are fortunate to have excellent relationships with some of the best diabetic eye specialists in New York.
If you or a loved one has diabetes and are not currently under the care of an optometrist, we would be honored to examine your eyes. If you aren’t in the New York area, call the office and we can try to find a doctor in your city. Your eyes and vision are too important to ignore.
Don’t have a bad romance!
Do you love your contacts? Most people do, but Americans are increasingly going gaga over a new cosmetic variety known as circle contact lenses. These are special colored contact lenses that give the illusion of having large “doe eyes.” Despite their innocent appearance, this type of lens can be highly unsafe for one’s eyes. They cause a dangerously low amount of oxygen to reach the surface of the eye which can lead to painful infections, ulcers, or worse. In some cases they can even lead to a permanent reduction in vision. In fact, they are illegal in the United States, but their popularity is increasing.
It’s important to remember that all contact lenses are medical devices and must be prescribed by your eye doctor. Always be sure to follow the proper cleaning and replacement instructions and have your doctor check them annually. If you’re interested in trying contacts for the first time stop by the office, and I’d be happy to fit some on your eyes!
What do donuts and contacts have in common?
Patient said “Doc, I’ve worn my contacts like this for years and never had a problem!”
Eye Doc said “The guy who eats donuts for breakfast every day without a problem eventually has his FIRST heart attack. Just because you’ve never had a problem does not remotely mean that you never will, or that it is the right or smart thing to do.”
Courtesy of Dr. Anthony Clark
Even if one ignored the clinical research data, common sense would lead you to believe the longer your do something that is unhealthy, the riskier it gets. Wearing dirty contacts for long periods of times over the course of many years, just leaves your eyes open to such great risks. The patients who come in with a contact lens related red eye, almost are always contact lens abusers. They often are the ones who do not adequately clean them. They are often the ones who habitually fall asleep in them. They are often the ones who chronically stretch them out beyond their indicated replacement schedule. Its just not worth it!
Should we call the new iPhone the EYEphone? It really is easy on the eyes
I have had the iPhone 4 since launch and I have been really impressed by the screen. I knew something was way different so I began to investigate. It turns out this really is the EYEphone, as they are utilizing retina display technology. Typically print is much easier on the eyes than a computer screen. That has a lot to do with the fact that the jagged pixels are a hard target for our eyes to focus on. The smooth ink fonts provide an easier target for our eyes. However, that may have changed with the iPhone 4′s retina display. Watch this video.
Interesting for sure. Is there any proof to back this up? Here is what Bryan Jones, a retinal neuroscientist discoverd.
“”I’d find Apple’s claims stand up to what the human eye can perceive,” writes Bryan Jones after an exhaustive analysis of the iPhone 4′s 3.5-inch, 960×640 display. Article
As an extreme iPhone user, I can say that this screen is amazing. It has been a pure joy reading iBooks, emails, websites, apps, etc. This super clear and comfortable retina display makes the new iPhone 4 my top EYEphone ever!
Shoot! I feel asleep in my contacts again!
Relax, it happens to all of us from time to time. (even those of us in daily disposables!)
As long as it’s not a habit, you should be fine if you remember a couple of important things.
The first thing to remember is that your eyes get a lot drier at night and that contact is probably stuck very tightly to your eye. In addition to the dryness, there might also be some eye swelling which can cause the contact become very tight on the eye. So even though you are a perfect patient and are eager to get out of the contacts, please do not immediately rush to take the contact off because you run the risk of tearing off the top layer of your cornea along with the contact!
Ideally, use an artificial tear or re-wetting drop to rehydrate the contact which will loosen up the fit enough to safely remove the contact. If you are stuck without drops, just give your eyes 15-20 minutes to produce enough tears to rehydrate the contact naturally.
Your eyes will probably feel temporarily irritated even after the contacts are removed. If the irritation persists more than a few hours, or if your eyes are not feeling, seeing or looking fine, you might have a serious contact lens related complication that your eye doctor needs to see your right away for if you want the best possible outcome.
Keep in mind that you don’t have to be a chronic contact lens abuser for something bad to happen. It really may only take 1 night for an issue to develop. Let your doc examine you and make the call. Do not delay in seeking care as many contact lens related red eyes are time sensitive, and the sooner the treatment, the better the outcome.
So the key take away point to remember if you fall asleep in your contacts:
- Don’t panic. Relax and rehydrate your contacts before removing.
- If you eyes are not looking, seeing or feeling fine after you take out the contacts, let your eye doc prove everything is ok by doing an exam.
There will be a point in your life where this will happen. Keep these 2 tips in mind and things should work out for the best.
Park Slope Eye is located in Brooklyn, NY. For more info contact Justin Bazan, OD, the optometrist of Park Slope Eye, at Dr.Bazan@ParkSlopeEye.com or visit www.ParkSlopeEye.com Also, check us out on Yelp!, Twitter and FaceBook.
My contacts are killing me! These allergies are driving me crazy!
Dr. Bazan’s Top Tips For Keeping Contact Lens Wearers Comfortable During Allergy Season
(Photograph ©2007 John Kimbler.)
It has been a tough last few pollen filled days and I feel like a bee covered in pollen! Here are a few tips to keep your eyes comfortable.
1. Thoroughly clean your contacts….ideally just dispose of them. If you are unable to use a daily disposable contact, the “Rub, Rinse, Soak” method is the best way to do things. See my blog post here: http://tinyurl.com/ydy7eud Remember, a clean contact is a comfortable contact.
2. See you eye doc for help. An appropriately prescribed allergy drop can work wonders at controlling the symptoms. Drop before, drop after contact lens use. For flare ups, the second drop can often go on right over your contact lenses. Use the prescribed medication as directed to ensure the best results.
3. Know the pollen count. Today going to be off the charts? Might be a day to wear your glasses. http://www.pollen.com
4. Id and avoid. Allergists can quickly help you identify exactly what you are allergic to. They can also provide appropriate treatment. Live around NYC? See Dr. Bassett, he is awesome. http://www.nyc-allergist.com/
5. Sunglasses. They help to keep the allergens out of your eyes, make sure you have them before leaving the house.
The 1800 CONtacts Game
February 11, 2010
My Saturday visit to Park Slope Eye was my first trip to the eye doctor in seven years. I don’t have health insurance and my vision didn’t seem to change, so I didn’t see any reason to go until my glasses fell off my face and broke in half.
I wore my contacts to the appointment, and Dr. Bazan was astonished to learn that I have been buying disposable lenses online from 1800Contacts.com without a prescription for seven years. In fact, most people are surprised by this possibility, and most of my broke, uninsured, and vision-impaired friends were delighted with the news.
In fact, it’s not only possible to get contacts from 1800 without a valid rx, but also easy. I learned the secret from one of my crazier friends of all time, a guy who believed he was a reincarnation of the famously evil Aleister Crowley. This friend figured out that 1800Contacts.com is eager to ship your order quickly; they will call your doctor, but if they don’t get an immediate response they will give your prescription the benefit of the doubt and ship the contacts anyway.
For the doctor-less this means choosing a doctor from the convenient drop-down list on the website who sounds unlikely to answer their phone, or too busy to deal with the procedures of online corporations.
The first time I used this method, it worked like a charm and I was an immediate convert. The second time I switched doctors for some reason, choosing a university that I thought would fall into the too-busy category. The next day, a 1800Contacts representative called me and said that the university had no record of me as a patient. “I’m sorry, my mistake,” I said, “Please cancel that order.”
As soon as I got to a computer I re-ordered the lenses, this time choosing a doctor in the unlikely-to-answer category, a doctor with such an improbable name and address that I was cracking up as I placed the order, and I still laugh every time I log in and see his name on my account. I’ve been using this hilarious character ever since; all my order info is saved on the site so all I have to do is log-in, click “reorder,” and the contacts are at my door a few days later.
Sadly, I learned from Dr. Bazan that this mild con game came very close to doing serious harm to my health. I’ve been wearing the very first generation of Acuvue lenses. Made of plastic instead of silicone, these outdated lenses have been cutting off the oxygen to my corneas. If my glasses hadn’t broken when they did, I could have done myself serious damage. As it is, I have to stop wearing contacts altogether for at least 3 months, so I’ve ordered two new pairs of glasses (and one pair of Rx sunglasses) online for $8 each. When my time is up, I’ll finally get the long-overdue contact lens prescription and switch to a more up-to-date model of contacts. But as long as I’m uninsured, I’ll probably continue to let a few years go by between doctor visits. It’s just too cheap and easy.
Emily
I would like to thank Emily for her speaking frankly and openly about her experiences. This situation is more common than I would like to believe. Certainly more common than it has to be. A contact lens is a foreign object that can cause serious changes to your eyes, but leave your vision unaffected. Meaning you do not know if you are doing ok with your contacts unless you have an eye doc use his special equipment and expertise to determine so. An annual exam will help to ensure your eyes stay healthy.
How do you guys really feel about this situation? Have you ever been educated on why an annual contact lens exam is done? Let me hear your thoughts!
Park Slope Eye is located in Brooklyn, NY. For more info contact Justin Bazan, OD, the optometrist of Park Slope Eye, at Dr.Bazan@ParkSlopeEye.com or visit www.ParkSlopeEye.com Also, check us out on Yelp!, Twitter and FaceBook.
Pumkin Pie in Your Eye!
Park Slope Eye Pumpkin Pie in Your Eye
A lot of Thanksgiving dinner’s will include a delicious pumpkin pie. Don’t feel so bad indulging in a slice or two because the pumpkin, is a great source of nutrients that keep your eyes healthy and your vision optimal. Dry Eyes, Cataracts, Night Blindness and Macluar Degeneration are all eye conditions that are believed to be staved off by vitamin A containing foods, such as pumpkins!
Check out some more info here: http://www.verybestbaking.com/products/libbys/pumpkin.aspx and http://www.allaboutvision.com/nutrition/vitamin_a.htm
Park Slope Eye is located in Brooklyn, NY. For more info contact Justin Bazan, OD, the optometrist of Park Slope Eye, at Dr.Bazan@ParkSlopeEye.com or visit www.ParkSlopeEye.com Also, check us out on Yelp!, Twitter and FaceBook.
Do you hate driving at night? Here are some helpful tips!
Driving at night is just about the hardest thing we do with our eyes. Since moving out of Manhattan and into an area where people actually drive their own cars, I have heard the difficulties of night driving commonly vocalized. Let’s do something to make it easier.
What can one do? In order to add ease and confidence to your night driving experiences, start with a basic comprehensive eye exam. Do those lights 
look blurry and glarry because the power of your Rx is less than optimal? Could the natural lens in your eye have developed some cloudiness? Is your vision blurring out because of your dry eyes? A great exam will help ensure that both your eyes and your Rx are perfect. So, for starters, get seen by the best to see your best.
If you choose to fill your Rx in a pair of glasses, choosing the right lenses is crucial to keeping you clear and comfortable while on the road at night. Yasmin Johnson, ABO head optician of Park Slope Eye had this to say:
“Having a good quality anti reflective coating, like Crizal Avance or Hoya Super Hi Vision, is imperative to seeing well at night. Anti reflective coatings allow more light to transmit through the lens and more directly to your retina. Lenses without the coating reflect a lot of light, and therefore the light that reaches the retina is scattered and less focused. For instance, we have patients who complain of car headlights looking like star bursts, and this is easily resolved with this coating.
Having clean lenses that are scratch-free is also very important because it will reduce additional scattered light. Light transmits better through a smooth surface, versus through damaged lenses. To keep your lenses in great shape, we recommend using eyeglass cleaner from Park Slope Eye to clean your glasses, but tap water with lotion-free dish soap also works well. Afterward, use a cleaning cloth or soft cotton cloth (not your clothes) to dry your lenses. You definitely want to avoid using tissue products to dry your lenses and never use window cleaner because the ammonia will destroy your lenses. These tips will not only reduce glare dramatically while driving at night, but also keep your glasses looking great!”
Ok, so now your proven healthy eyes are sitting behind the ideal pair of eyewear and you are now behind the wheel. Its your typical BKNY winter night and the amount of potholes in the road seemed to have doubled, the lane size has halved and of course its raining. You may still feel very uncomfortable behind the wheel but at least we now know its not your eyes Rx or glasses. So what else can one do?
Here is what works for me. Think of your windshield as the lenses in your glasses. Remember what Yasmin said about making sure they are clean, and that they have non-glare coatings? Well your windshield can be optimized the same way.
First, think of you windshield as a pair of glasses. Just like your glasses that have special coatings to help you see better, your windshield should also have a special coating to help you see better. Hit the
car wash, get the windows as clean as possible, then apply a product like RainEx or Aquapel to them. Some car washes even have this as an option, mine does, and its awesome. This greatly enhances your visibility, especially at night in the rain, the toughest condition to drive in for most.
Secondly, get a great pair of wiper blades. I installed Silblades on my car over a year ago and they do a great job of keeping the windshield clean, much in the same way as how Mary informed you about keeping your glasses clean. Also, keep the wiper fluid full and use it frequently. In the winter, I use a deicer fluid, but most of the time I would use the Rainex fluid found here.
Lastly, Windex. You clean both the inside and outside of your glasses right? Do the same thing for your car’s windows. A thorough cleaning of the inside windows with Windex will be the finishing touch on optimizing your roadway visibility and limiting your issues with night driving.
Keep those eyes healthy, Rx updated and make sure your glasses/windshield are appropriately set up for the task and you will find yourself much more confident and calm behind the wheel at night, even in the most trying of road conditions.
Park Slope Eye is located in Brooklyn, NY. For more info contact Justin Bazan, OD, the optometrist of Park Slope Eye, at Dr.Bazan@ParkSlopeEye.com or visit www.ParkSlopeEye.com Also, check us out on Yelp!, Twitter and FaceBook.
VSP has a great post entitled:
Your Child’s First Eye Exam: Six Easy Steps to Prepare for the Eye Doctor
At PSEye, kids get the drops but don’t even realize it! I have 2 spray bottles that we use. They look the same but one is just artificial tears in which we have the kid wash his mom/dad or my eyes to get them all cleaned up. Then I let the person who had their eyes cleaned, clean the kid’s eyes with a spray bottle that has the “real” drops in it. It usually involves a ton of laughter instead of tears!
My Lacrisert Experience
I am sharing my experience with Lacrisert over on the Park Slope Eye Facebook page. Care to share yours? Head over there now and check it out: http://www.facebook.com/ParkSlopeEye
