Color Blind Glasses

Red Green Color Blindness

Red green color blindness is the most common type of color blindness. As the name suggests, it means that a person is unable to tell the difference between green and red. This condition is usually genetic and sex linked. It affects males much more commonly than women. In fact, about 8% of men are color blind.In addition to not being able to make out a different between the red and green colors, patients may also experience variation in how bright colors are. The shades of different colors may also be difficult to distinguish for patients with red green color blindness. Red green color blindness is not something that develops over time. It is present from birth. Because of this, patients may not experience symptoms in the classic way because they are use to the way that they see the world. They do not really know anything different. Many times patients do not know they have this color blindness until it is brought to their attention from a friend, family member or medical professional. In extremely rare cases, color blindness could develop from a brain injury or stroke, but this is a small minority of cases. There are cases of color blindness that may be associated with other eye problems. One of these is diseases is called Achromotopsia. In this disease, children have poor vision and also have very rapid eye movements. The medical term for these involuntary eye movements is called nystagmus. Within red green color blindness, there are different types. The most common type of red green color blindness is Deuteranomaly. In this sub category, green colors appear more red. It is generally a mild type of red green color blindness. The opposite of this is Protanomaly in which red colors appear more green. This is also generally a mild form of color blindness. In the more severe forms of red green color blindness known as protanopia and deuteranopia, a patient is completely unable to tell the difference between red and green.There are simple tests online and in your doctor’s office that can determine if you have red green color blindness. One of the most common is called the Ishihara color plates test. These tests involve looking at a number or a pattern that is hidden inside a circular image. People who are color blind will not be able to figure out what the number is.  There is no treatment and there is no cure for red green color blindness. There are certain digital applications that can help patients identify colors. These are easily available to download on your digital device. Most patients with color blindness function very highly and it does not interfere with their daily life. Sources:Simunovic MP. Acquired color vision deficiency. Surv Ophthalmol. 2016 Mar-Apr;61(2):132-55. doi: 10.1016/j.survophthal.2015.11.004. Epub 2015 Nov 30. PMID: 26656928.https://pubmed.ncbi.nlm.nih.gov/26656928/El Moussawi Z, Boueiri M, Al-Haddad C. Gene therapy in color vision deficiency: a review. Int Ophthalmol. 2021 May;41(5):1917-1927. doi: 10.1007/s10792-021-01717-0. Epub 2021 Feb 2. PMID: 33528822.https://pubmed.ncbi.nlm.nih.gov/33528822/https://aapos.org/glossary/achromatopsia
3 min read
Over The Counter Stye Medication Woman Stye Warm Compress

Over The Counter Stye Medication: Best Options

Be cautious when buying over the counter stye medication. While it is unlikely to harm you, it is also unlikely to really help you. A stye is typically an inflammatory process. This inflammation is a result of the oil glands in your eyelid becoming clogged and irritated. These glands are called the meibomian glands. Because the glands of the eyelid are clogged, putting additional over the counter stye medication is not likely to help. So, what are the best options when it comes to eyelid stye medications? The best thing to do is to start using warm compresses. The warm compresses should not be extremely hot. Aggressive heat on the eyelids can actually make inflammation worse initially. You need enough warmth to try to open the glands, loosen the material that is clogging the glands and express the contents of the stye. This heat mask is a great option because it provides moist heat that actually stays warm, and it is reusable. It is also can be warmed up in the microwave, and stays warm for a 10 to 15 minutes. If you are using a warm washcloth you will notice that it becomes cool very quickly. One over the counter stye medication option is using cleansing wipes for your eyelids. Keeping the eyelids clean can help to prevent styes overall, and also can prevent existing styes from getting worse. Eyelid wipes should be used on your eyelids after a warm compress. Keep some handy at home and at work so that you can keep your lids clean.Another over the counter option for styes, is using artificial tears. This however does not treat the stye itself. Artificial tears only help with any dry eye that may come along with having a stye. The meibomian glands play an important role in the tear film of the eye. When these glands are clogged, the tear film is not optimal and many patients experience dry eye. If you are able to see an ophthalmologist, this eye doctor can actually prescribe an ointment that is a combination of an antibiotic and a steroid that may help. Most ophthalmologists, however, will tell you to try warm compresses first. Because styes are more inflammatory than they are infectious, antibiotics are usually not extremely helpful. The steroid part of the ointment may help to reduce some of the inflammation, but it can not magically unclog your eyelid glands.If you have been trying warm compresses, and have consulted with an ophthalmologist, but, still, your stye won't go away, you have two options. These include laser treatment and surgical removal. Laser treatment for a stye is called IPL laser. It is fairly new and not every ophthalmologist will have this machine in their office. While IPL laser has the ability to reduce the appearance of styes in as little as 3 to 5 days, there are patients who need 2 to 3 weeks to see real results. Laser is a nice option because it doesn't involve making an incision, or a surgical cut, into the eyelid. One of the downsides to laser is that it is not typically covered by insurance. If you do have any flex health spending or an HSA account, you should be able to use that to pay for the procedure.Surgical removal is your second option. Only an ophthalmologist (someone who has gone to medical school and has completed a residency in ophthalmology) should surgically remove your stye. It is typically a procedure that is done in the office with local numbing medication. The surgery is considered minor surgery and should only take a few minutes. This is the most definitive treatment for if your stye won't go away. Styes that don't go away are a very annoying problem for many people. Acupuncture has even been studied for the treatment of styes (but there is no good data to support doing this). If you are having persistent styes, see your local ophthalmologist to have your eyelids evaluated. In some rare cases, a stye that won't go away could be something more serious like cancer. This is why it is important to have a medical doctor like an ophthalmologist involved in your care for persistent styes.Sources:Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev. 2017 Jan 9;1(1):CD007742. https://pubmed.ncbi.nlm.nih.gov/28068454/Zhu Y, Huang X, Lin L, Di M, Chen R, Dong J, Jin X. Efficacy of Intense Pulsed Light in the Treatment of Recurrent Chalaziosis. Front Med (Lausanne). 2022 Mar 1;9:839908. doi: 10.3389/fmed.2022.839908. PMID: 35299836; PMCID: PMC8921764.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921764/Cheng K, Law A, Guo M, Wieland LS, Shen X, Lao L. Acupuncture for acute hordeolum. Cochrane Database Syst Rev. 2017 Feb 9;2(2):CD011075. https://pubmed.ncbi.nlm.nih.gov/28181687/
4 min read
Side Effects Of Latisse Long Eyelashes Woman

Side Effects Of Latisse

Latisse was discovered by accident. Latisse is in the same class of drugs that are used to treat glaucoma. The category of drugs is called Prostaglandin Analogues. When patients used these drugs for their glaucoma, it became apparent that the side effect of this category of drugs was thicker, fuller eyelashes. An undesired side effect of Latisse is a possible change in the color of the iris. The iris is the part of the eye that determines what color your eye is. It is more likely that Latisse changes eye color in patients who have lighter colored eyes, such as blue eyes. This side effect, unfortunately, is not reversible. All patients using this drug should be aware that this could happen. When Latisse changes eye color, the resulting color of the iris is usually a brown darkening. The odds of Latisse changing eye color are higher if you have lighter color eyes, when compared to eyes that already have brown pigment. Most of the studies that have been done regarding prostaglandin analogs and eye color change were when the patient was putting a drop of medication inside the eye to treat glaucoma. Because Latisse should be applied to the upper lid's lash line and is not meant to go inside the eye, the side effects may be slightly different. Given the proximity of the lash line to the eye, it is possible that some of the medication may also get inside the eye. There are other side effects of Latisse that you should be aware of. In some patients, Latisse can cause a darkening of the eyelid skin. The effects of this tend to go away if you stop using the drop. Some people develop also report eye redness after using Latisse, but this usually is temporary. Itching and eye redness happen in about 4% of patients using Latisse. Long term eye redness with Latisse could be a sign of an allergy and should be discussed with your ophthalmologist. If you have a history of eye inflammation (uveitis) or swelling in the back of the eye (macular edema), you should not use Latisse. Always use Latisse under the direction of an ophthalmologist. The generic name for the drug in Latisse is called bimatoprost. Once it was discovered that bimatoprost had this effect on eyelashes, the drug was rebranded and approved for use for the sole purpose of giving people thicker and fuller lashes. Latisse should only be used on the upper eyelid and not on the lower eyelid. Do not use Latisse if you are pregnant or breastfeeding. One irreversible side effect of Latisse is a darkening of the iris in certain patients. It is more likely that Latisse changes eye color in patients who have lighter eyes. Other side effects that are usually reversible include eye redness, eyelid skin darkening, and itching. Do not use Latisse with contact lenses inside the eye.Sources:Priluck JC, Fu S. Latisse-induced periocular skin hyperpigmentation. Arch Ophthalmol. 2010 Jun;128(6):792-3. doi: 10.1001/archophthalmol.2010.89. PMID: 20547960.https://pubmed.ncbi.nlm.nih.gov/20547960/Centofanti M, Oddone F, Chimenti S, Tanga L, Citarella L, Manni G. Prevention of dermatologic side effects of bimatoprost 0.03% topical therapy. Am J Ophthalmol. 2006 Dec;142(6):1059-60. doi: 10.1016/j.ajo.2006.07.019. Epub 2006 Aug 7. PMID: 17157592.https://pubmed.ncbi.nlm.nih.gov/17157592/Filippopoulos T, Paula JS, Torun N, Hatton MP, Pasquale LR, Grosskreutz CL. Periorbital changes associated with topical bimatoprost. Ophthalmic Plast Reconstr Surg. 2008 Jul-Aug;24(4):302-7. doi: 10.1097/IOP.0b013e31817d81df. PMID: 18645437.https://pubmed.ncbi.nlm.nih.gov/18645437/https://www.latisse.com/SafetyAndSideEffects.aspx
3 min read
Can Dry Eye Cause Blurry Vision Woman With Dry Eye Rubbing Eyes

Can Dry Eye Cause Blurry Vision?

Yes! Dry eye causes blurry vision in many people. Patients are often surprised to learn this because dry eye does not seem like a very serious problem. However, depending on the severity of your dry eye, it can reduce your vision. So, how do you know if your blurry vision is from your dry eye? Here are some signs that your blurry vision could be caused by your dry eye. If you start using the computer and can see clearly, but after one or two hours your vision becomes blurry, this could be related to dry eye. A similar situation could also happen if you are reading, studying or looking into a microscope. This is because anytime a person does a focused visual task, they are less likely to blink. As a person's blink rate goes down, the tear film is not being spread across the surface of the eye. Try keeping a bottle of artificial tears next to your computer, and use the tears periodically throughout your work day. This may help to improve your blurry vision. If you notice that you need to blink in order to see clearly, your eye may be dry. Sometimes a person may need to blink several times in order for their vision to become clear. This is likely due to dry eye. Patients who wear contact lenses are more likely to have dry eye and subsequent blurry vision from it. Switching to daily contacts can help and also using preservative free artificial tears can help.LASIK and PRK can cause long term dry eye in patients. Patients may think that their vision correction surgery is no longer working, but in many cases it may just be dry eye. If you are someone that has surgery to correct your vision, you may need to use artificial tears on a long term basis. In order to understand how dry eye causes blurry vision, it is important to discuss the tear film. The tear film of the eye is the first surface that light hits when it it is entering the eye. It is the first refractive surface of the eye. Refraction is the part of the eye exam when a doctor measures the prescription in your glasses. If this refractive surface is not intact, it can affect how you see. It is estimated that nearly 80% of how well you see is determined by the tear film and the front part of the cornea. The cornea is the front part of the eye. When the tear film does not function as it should, dry eye is the result. In fact, eye doctors may measure tear film breakup time in order to figure out if a patient has dry eye. Tear film break up time means the amount of time it takes the tear film to dissipate or break up. When the tear film breaks up, it no longer provides a smooth surface for light to enter. Blurry vision from dry eye is not uncommon. If your vision improves after artificial tears, it is likely that dry eye is contributing to your poor vision. However, not all blurry vision is from dry eye. Therefore, if you are having blurry vision, it is important to see an ophthalmologist. When an ophthalmologist evaluates you, they can determine the cause of your blurry vision. In many cases, blurry vision could caused by dry eye and another medical issue. For this reason, be sure to see an ophthalmologist to have a complete eye exam. Sources:Conrady CD, Joos ZP, Patel BC. Review: The Lacrimal Gland and Its Role in Dry Eye. J Ophthalmol. 2016;2016:7542929. doi: 10.1155/2016/7542929. Epub 2016 Mar 2. PMID: 27042343; PMCID: PMC4793137.https://pubmed.ncbi.nlm.nih.gov/27042343/Tellez-Vazquez J. Omega-3 fatty acid supplementation improves dry eye symptoms in patients with glaucoma: results of a prospective multicenter study. Clin Ophthalmol. 2016 Apr 5;10:617-26. doi: 10.2147/OPTH.S96433. PMID: 27103781; PMCID: PMC4827597.https://pubmed.ncbi.nlm.nih.gov/27103781/Fernández-Jimenez E, Diz-Arias E, Peral A. Improving ocular surface comfort in contact lens wearers. Cont Lens Anterior Eye. 2022 Jun;45(3):101544. doi: 10.1016/j.clae.2021.101544. Epub 2021 Nov 25. PMID: 34840071.https://pubmed.ncbi.nlm.nih.gov/34840071/
4 min read
How To Make Eyelid Swelling Go Down Woman with eye mask for blepharitis

How To Make Eyelid Swelling Go Down

In order to make eyelid swelling go down, it is essential to figure out what is causing the eyelid swelling. Many patients can have eyelid swelling from allergies. There are a few ways that this can happen. The first is from seasonal allergies and pollen. Eyelid swelling from seasonal allergies will usually get worse if you are spending a lot of time outside. If you take over-the-counter allergy medications, this could improve symptoms from seasonal allergiesA contact allergy can also cause eyelid swelling. This means that your eyelid is allergic to something that it has had direct physical contact with. This could be a new makeup product or a new set of bed sheets. If you remove the product that is the irritant, then your eyelid swelling should go down. Because eyelids are often very itchy from allergic reactions, many patients will frequently rub their eyelids. This rubbing itself can make the eyelid swollen. It is important to avoid rubbing your eyes when they are itchy. You can use an over the counter anti itch drop to help with the symptoms so that you do not have to touch your eyelid. If you have eyelid swelling and pain, this could mean you have a stye or a chalazion that is beginning to form. You may feel a small bump or nodule in the eyelid. Sometimes it can take a couple days for this bump to appear. The eyelid swelling and pain from a stye is usually not a bad as the pain that happens with preseptal cellulitis. In preseptal cellulitis the eyelid can become very tight and very red. This may even given it a shiny appearance. In preseptal cellulitis. theeyelid may be hard to open. If this is causing your eyelid swelling, then you will need antibiotics right away. If a stye or chalazion is causing eyelid swelling and pain, you can use warm compresses to help reduce the inflammation. If you are having eyelid swelling and pain, it is a good idea to make an appointment with an eye doctor urgently. If you can not see an eye doctor, then you should seek emergency care in an urgent care center or emergency room. While styes are typically not harmful, preseptal cellulitis can be dangerous. A doctor can help determine what the best treatment is.If your eyelid is swelling up intermittently, you may have something called angioedema. Angioedema can be from a food allergy, it can be an allergic reaction to a medication, it can be something that is genetic, or it can have no clear cause (called idiopathic angioedema). Sometimes patients can also get hives (urticaria) along with angioedema. Angioedema refers more to the swelling that occurs in deeper tissues of the body. If you think you are experiencing angioedema, you should see a doctor as soon as possible.In order to treat eyelid swelling, it is important to determine the cause of the swelling. In some cases you may need antibiotics, in some cases a warm compress. An ophthalmologist can help figure out what is causing the swelling so that you can have it treated properly. Sources:Bernardes TF, Bonfioli AA. Blepharitis. Semin Ophthalmol. 2010 May;25(3):79-83. doi: 10.3109/08820538.2010.488562. PMID: 20590417.https://pubmed.ncbi.nlm.nih.gov/20590417/Gordon AA, Danek DJ, Phelps PO. Common inflammatory and infectious conditions of the eyelid. Dis Mon. 2020 Oct;66(10):101042. doi: 10.1016/j.disamonth.2020.101042. Epub 2020 Jul 1. PMID: 32622681.https://pubmed.ncbi.nlm.nih.gov/32622681/Saini S, Shams M, Bernstein JA, Maurer M. Urticaria and Angioedema Across the Ages. J Allergy Clin Immunol Pract. 2020 Jun;8(6):1866-1874. doi: 10.1016/j.jaip.2020.03.030. Epub 2020 Apr 13. PMID: 32298850.https://pubmed.ncbi.nlm.nih.gov/32298850/
4 min read
Does Air Conditioning Cause Dry Eyes

Does Air Conditioning Cause Dry Eyes?

Many people wonder what environmental factors can affect the health of their eyes. Air conditioning does not cause dry eyes, but there is evidence to show that it can aggravate it or make it worse. Worsening of dry eye symptoms was seen with people who spent more time indoors with their air conditioning on. If the air is more dry and less humid, this can also make dry eye worse. If you are using air conditioning in your car or your home, be sure that there the air is not blowing directly at your face. It is the mechanical blowing that would cause the tears from your eyes to evaporate faster rather than the actual cooling component of the air. Similar to this, very windy conditions can also aggravate dry eyes. Some people are more sensitive to dry eyes than others. For these individuals, they may notice that certain triggers make their dry eye worse. Dry eye symptoms such as tearing and the need to blink frequently in order to see clearly are common among dry eye sufferers. Treating dry eye depends on using artificial tears and also on avoiding situations that may make the symptoms of dry eye worse. Other situations that can make dry eye worse are moving air, low humidity environments, pollution, and focused visual activities such as watching TV or reading a book or tablet. For dry eye patients who spend several hours a day in an office or setting where the air conditioning will be on, it is likely that their symptoms will become worse. In order to help this situation, there are a few things that you can do. The first is to take a break from your environment. If you are able to, take a walk outside to get out of the air conditioning. This may be especially helpful in humid climates where a walk outside in a high-humidity environment can help to ease the dryness. Another easy way to combat dry eye that is happening indoors is to keep a vial of artificial tears by your desk or computer. Remember to use artificial tears every few hours. It is better to use artificial tears before you start to experience dryness rather than waiting until your symptoms become extreme. Finally, if you can not modify your environment (meaning, you can't turn the air conditioning off), then you should think about modifying your activities. If you work in an office where the air conditioning is making your eye dryness worse, then using the computer for several hours a day is also going to have a negative affect. In this case, try to also take screen breaks. This allows your eyes to blink normally and will likely make them less dry. While air conditioning does not *cause dry eyes, it can make it worse. Many people can be in air conditioning without any issues. But, for patients who are more susceptible to having dry eye, air conditioning can cause a worsening or an aggravation of symptoms. Modifying your environment and using artificial tears can help to combat the symptoms of dry eye.Sources:Starr CE, Dana R, Pflugfelder SC, Holland EJ, Zhang S, Owen D, Brazzell K. Dry eye disease flares: A rapid evidence assessment. Ocul Surf. 2021 Oct;22:51-59. doi: 10.1016/j.jtos.2021.07.001. Epub 2021 Jul 22. PMID: 34303844.https://pubmed.ncbi.nlm.nih.gov/34303844/Talens-Estarelles C, García-Marqués JV, Cerviño A, García-Lázaro S. Dry Eye-Related Risk Factors for Digital Eye Strain. Eye Contact Lens. 2022 Oct 1;48(10):410-415. doi: 10.1097/ICL.0000000000000923. Epub 2022 Jul 8. PMID: 36155946.https://pubmed.ncbi.nlm.nih.gov/36155946/García-Marqués JV, Talens-Estarelles C, García-Lázaro S, Wolffsohn JS, Cerviño A. Systemic, environmental and lifestyle risk factors for dry eye disease in a mediterranean caucasian population. Cont Lens Anterior Eye. 2022 Oct;45(5):101539. doi: 10.1016/j.clae.2021.101539. Epub 2021 Nov 14. PMID: 34789408.https://pubmed.ncbi.nlm.nih.gov/34789408/
4 min read
Treatments For Retinitis Pigmentosa

Treatments For Retinitis Pigmentosa?

Retinitis Pigmentosa is a very challenging disease for patients and doctors because there is no currently no cure. There are also very limited treatment options, if any, for the majority of patients with Retinitis Pigmentosa. There was previous thinking that high doses of Vitamin A are helpful in retinitis pigmentosa. Newer research has shown that this is not the case. Most ophthalmologists and retina specialists do not prescribe high-dose Vitamin A anymore. There are risks to high dose Vitamin A and there is no clear benefit in patients with RP taking it.There are many different genetic defects that can cause RP. There may be some value in having genetic testing for retinitis pigmentosa. The disease can be inherited in many different ways. Genetic testing is not something that every eye doctor is able to do. In fact, most ophthalmologists will only treat a handful of RP patients in the course of their career. The genetic testing for retinitis pigmentosa is very specific and is usually done at a large research center. You can ask your ophthalmologist where genetic testing for retinitis pigmentosa is done in your area. Retinitis Pigmentosa is a rare and uncommon disease. It is usually inherited. Genetic testing can be helpful to help a patient better understand their disease and how it may progress or get worse over their lifetime. It can also help patients understand the pattern of inheritance which can provide insight into what other family members should be screened for the disease. Perhaps the most important part of having genetic testing is so that patients can stay informed about any new treatments that may be available to them. If there is a clinical trial being done for a certain rare disease, staying up to date on this may give patients an opportunity to try a novel treatment. Gene therapy is being actively investigated and studied for this disease. Retinitis Pigmentosa is found in one of two ways. The first way is at a dilated eye exam. On a dilated eye exam, an ophthalmologist may see what is called "bone-spicule" changes in the retina. If this is seen, the eye doctor will then order further testing to determine the extent of vision loss if any. The second way RP is found is when a patient comes in complaining of symptoms, and these can start in the adolescent and teenage years. The most common symptom is a loss of vision at night or having a very hard time seeing things at night. The symptoms usually happen in both eyes because it is rare for RP to affect just one eye.If a child is young and can't express themselves, the parent may come in complaining that their child has difficulty in low lighting. In addition to night vision difficulty, patients with RP will also have peripheral vision loss. A visual field is usually done by an ophthalmologist to evaluate and monitor a patient's peripheral vision. Other symptoms of retinitis pigmentosa are sensitivity to bright lights, and loss of color vision. Patients may also develop a cataract, but fortunately this can be removed by a cataract surgeon.Almost all patients with RP will lose their vision entirely. How quickly a patient loses their vision is individual, and likely related to the specific genetic mutation that caused the RP. It is important for patients to start visual rehabilitation early so that they can prepare as best as possible for the visual difficulty they will experience later in life. There is no cure for retinitis pigmentosa. All patients with it will eventually lose most of their vision. How quickly someone loses vision is individual. RP usually happens in both eyes. If your doctor finds suspicion of retinitis pigmentosa in one eye only, you may need to undergo testing and blood work for other causes of your retinal changes. Genetic testing and visual rehabilitation can be helpful for patients with RP. Gene therapy and stem cell therapeutic treatments are currently being investigated. Gene therapy has the potential to treat RP by replacing or silencing the gene responsible for RP.Sources:Fahim A. Retinitis pigmentosa: recent advances and future directions in diagnosis and management. Curr Opin Pediatr. 2018 Dec;30(6):725-733. doi: 10.1097/MOP.0000000000000690. PMID: 30234647.https://pubmed.ncbi.nlm.nih.gov/30234647/Dias MF, Joo K, Kemp JA, Fialho SL, da Silva Cunha A Jr, Woo SJ, Kwon YJ. Molecular genetics and emerging therapies for retinitis pigmentosa: Basic research and clinical perspectives. Prog Retin Eye Res. 2018 Mar;63:107-131. doi: 10.1016/j.preteyeres.2017.10.004. Epub 2017 Oct 31. Erratum in: Prog Retin Eye Res. 2018 Sep;66:220-221. PMID: 29097191.https://pubmed.ncbi.nlm.nih.gov/29097191/https://www.fightingblindness.org/genetic-testing
4 min read
One Pupil Bigger Than Other Anisocoria Patient

One Pupil Bigger Than Other?

When you look in the mirror, are your pupils different sizes? The scientific name for having one pupil bigger than the other is called anisocoria. The word anisocoria means that that the pupils are not the same size. There are different types of anisocoria and it is important to understand the difference between them. Because having different size pupils can be a sign of something dangerous in the brain or body, it is always a good idea to see an ophthalmologist if you notice anything abnormal. Physiologic anisocoria, also called simple anisocoria, means that the pupil is a different size because that is just the way your body is. It is not a sign of something else harmful going on in the body. Even though physiologic anisocoria is usually present for years, people may notice it suddenly and become concerned. Many people have physiologic anisocoria. It is estimated that 1 in 5 people, or 20% of the population has simple anisocoria with a difference in pupil size of less than or equal to 1 mm. Both pupils react to light normally. Interestingly, physiologic anisocoria can be intermittent, which means it is not present all the time. In some cases, it can even completely resolve on its own. An ophthalmologist can diagnose anisocoria during an in person eye exam. The eye doctor will test your pupils in light and in the dark, and also take a close look at your pupils using a machine called a slit lamp. How your pupil reacts in both situations will help determine the cause of the anisocoria. In the light, if the bigger pupil does not constrict, then it is likely that that pupil is the problem pupil. In the dark, if the pupil stays small, when it is suppose to dilate, then it is likely that this pupil is the issue. The doctor may also ask to see an old photo of you or ask to see your photo ID. This is because they want to see if they can notice a difference in your pupil size from years earlier. If you have always had a difference in pupil size then it is more likely that this is not an emergent situation. However, if the difference in your pupil size is new, or if it is accompanied by other symptoms, it may be something they need to send you to the emergency room for. Some concerning signs and symptoms with anisocoria are also having double vision, eyelid ptosis (droopy eyelid) or having abnormal eye movements. Aside from physiologic anisocoria, there are disease in the eye, body and brain that can cause a difference in pupil size. Some of these include Horner’s syndrome, Adie’s Tonic Pupil, stroke, intracranial hemorrhage, and a brain tumor. Sometimes patients may also have anisocoria from eyedrops or medications. This is called pharmacologic anisocoria. If you notice that one pupil is bigger than the other, you should seek medical attention right away. While physiologic anisocoria is not harmful and happens to 20% of people, there are dangerous causes of anisocoria that need to be ruled out by a medical professional. It may be helpful for you to show your doctor old picture of yourself to see if the anisocoria was present at the time you took the photo. Be sure to also tell your doctor about any other symptoms you might be having and if you are taking any medications. Sources:Gross JR, McClelland CM, Lee MS. An approach to anisocoria. Curr Opin Ophthalmol. 2016 Nov;27(6):486-492. doi: 10.1097/ICU.0000000000000316. PMID: 27585208.https://pubmed.ncbi.nlm.nih.gov/27585208/Falardeau J. Anisocoria. Int Ophthalmol Clin. 2019 Summer;59(3):125-139. doi: 10.1097/IIO.0000000000000276. PMID: 31233420.https://pubmed.ncbi.nlm.nih.gov/31233420/Steck RP, Kong M, McCray KL, Quan V, Davey PG. Physiologic anisocoria under various lighting conditions. Clin Ophthalmol. 2018 Jan 4;12:85-89. doi: 10.2147/OPTH.S147019. PMID: 29379269; PMCID: PMC5757963.https://pubmed.ncbi.nlm.nih.gov/29379269/
4 min read
What Is The First Sign Of Cataracts?

What Is The First Sign Of Cataracts?

Cataracts happen to every person at some point in their life. It is a natural part of the aging process. You may be curious as to what the first signs of cataracts are. This can vary depending on the individual person, but typically it is some disturbance of your vision. In early cataracts, you will not be able to see the cataract in a mirror. This only happens in very late stage cataracts. In the earliest stage of cataracts, when a patient has a trace cataract, there may be no symptoms at all. Let's take a look at some early signs of cataracts that patients may notice. Experiencing eye glare is a common symptom of cataracts. What is eye glare? Glare is when a person looks at a light and sees halos (circles) or streaks around the light. Patients with glare have trouble seeing in bright light. This symptom of cataract may be particularly noticeable when you are driving and you have difficulty looking at the headlights coming towards you. A specific type of cataract, called a cortical cataract, is more likely to cause eye glare than a nuclear sclerotic cataract, which is another type of cataract. Glare is also a common symptom of a posterior subcapsular cataract.Patients can have multiple types of cataracts at the same time. Many patients who have cortical cataracts are also likely to have nuclear sclerosis as well. Posterior subcapsular cataracts are also associated with steroid use.In addition, to difficulty with dealing with bright lights, patients with early cataracts can have difficulty in low light also. This may be most noticeable when you are driving at night.Contrast sensitivity reduction is also a common early symptom of cataracts, and can happen in any type of cataract.All cataracts will cause blurry vision eventually, but in most cases, this is not the first sign of a cataract. The exception to this is in the case of posterior subcapsular cataracts which tend to cause blurry vision quicker than sclerotic nuclear cataracts. Blurry vision in nuclear sclerotic cataracts can happen for two reasons. The first reason is that the cataract itself is becoming denser and therefore becoming more difficult to see through. The other reason is that a nuclear cataract can sometimes cause a patient's prescription to change. This means that the glasses or contacts you once saw clearly in are no longer working for you. In some cases, an ophthalmologist can fit you for a new pair of glasses that still corrects you to very good vision, but in other cases, cataract surgery may be the only way to see better.The earliest signs of cataracts can be subtle such as difficulty with glare, trouble with contrast, or difficulty seeing in low light situations. Blurry vision that is present all the time tends to happen later. The best way to be evaluated on if you have a cataract is to see an eye doctor. Sources:Mäntyjärvi M, Tuppurainen K. Cataract in traffic. Graefes Arch Clin Exp Ophthalmol. 1999 Apr;237(4):278-82. doi: 10.1007/s004170050233. PMID: 10208259.https://pubmed.ncbi.nlm.nih.gov/10208259/Palomo-Álvarez C, Puell MC. Capacity of straylight and disk halo size to diagnose cataract. J Cataract Refract Surg. 2015 Oct;41(10):2069-74. doi: 10.1016/j.jcrs.2015.10.047. PMID: 26703281.https://pubmed.ncbi.nlm.nih.gov/26703281/Cho YK, Huang W, Nishimura E. Myopic refractive shift represents dense nuclear sclerosis and thin lens in lenticular myopia. Clin Exp Optom. 2013 Sep;96(5):479-85. doi: 10.1111/cxo.12064. Epub 2013 May 23. PMID: 23700989.https://pubmed.ncbi.nlm.nih.gov/23700989/
3 min read
Preseptal Cellulitis

Preseptal Cellulitis

Preseptal cellulitis is an infection of the preseptal tissue of the eyelid. It can happen in the upper eyelid, the lower eyelid, or in both the upper and lower eyelid. It tends to happen on one side, but there are cases of bilateral preseptal cellulitis.It is called preseptal because the parts of the eyelid that are affected are anterior to a part of the eyelid called the orbital septum. The orbital septum separates the preseptal tissue from the postseptal tissue. If the infection from preseptal cellulitis extends to the postseptal tissue, then the condition is called orbital cellulitis. Orbital cellulitis is a very serious eye condition that often requires overnight hospital admission.Preseptal cellulitis looks like redness and swelling of the eyelid. It can almost appear as if the skin of the eyelid is stretched and shiny. In severe cases of preseptal cellulitis the eyelids could become very swollen, making it hard for someone to open their eyes. The movements of the eyes should not be affected by preseptal cellulitis. This means that a patient with preseptal cellulitis should be able to move their eyeball left, right, up and down. There may be some mild restriction if they eyelid swelling is significant. If eye movements are significantly affected, this could be a sign that the preseptal cellulitis has progressed to orbital cellulitis. A patient’s vision and pupils should not be affected by preseptal cellulitis. If a doctor notes a significant decrease in vision or a pupillary abnormality, this could also mean that the preseptal cellulitis has progressed to orbital cellulitis.In some cases, patients can also have a fever. A fever is a more concerning symptom and these patients should be watched closely for the development of orbital cellulitis.Most patients with preseptal cellulitis will likely report some pain or discomfort. This pain is likely related to the eyelid swelling and any eyelid tightness. In some cases, the swollen eyelid can place pressure on the eyeball and cause the pressure inside the eye to go up. In these cases, some patients may experience pain from the this rise in pressure. It is important to have your eye pressure checked if you have preseptal cellulitis.The signs and symptoms of preseptal cellulitis can sometimes be difficult to distinguish from orbital cellulitis. If this is the case, your doctor may want to order some imaging of your eye and your orbit. A CT scan can help the doctor to see where exactly the infection and inflammation from preseptal cellulitis has extended to. It can also help to locate an abscess (a collection of pus or infection) if there is one. If there is an abscess found on imagine, it means that it is orbital cellulitis.The severity of your preseptal cellulitis will determine how often you are seen by a doctor. In severe cases, the doctor may examine you daily or even multiple times during the day. In less severe cases, the doctor may see you back after one or two days, while on treatment.The majority of preseptal cellulitis is caused by bacteria. Therefore, patients are often on antibiotics. In severe cases, the patient may be hospitalized and given intravenous (IV) antibiotics. In less severe cases, oral antibiotics may be enough to treat the infection. If an abscess is found on an imaging study then it is very likely that the abscess will need to be drained. Sources:Bae C, Bourget D. Periorbital Cellulitis. 2022 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29261970.https://pubmed.ncbi.nlm.nih.gov/29261970/Mouriaux F, Rysanek B, Babin E, Cattoir V. Les cellulites orbitaires [Orbital cellulitis]. J Fr Ophtalmol. 2012 Jan;35(1):52-7. French. doi: 10.1016/j.jfo.2011.08.004. Epub 2012 Jan 4. PMID: 22221713.https://pubmed.ncbi.nlm.nih.gov/22221713/Tsirouki T, Dastiridou AI, Ibánez Flores N, Cerpa JC, Moschos MM, Brazitikos P, Androudi S. Orbital cellulitis. Surv Ophthalmol. 2018 Jul-Aug;63(4):534-553. doi: 10.1016/j.survophthal.2017.12.001. Epub 2017 Dec 15. PMID: 29248536.https://pubmed.ncbi.nlm.nih.gov/29248536/ 
4 min read
Cataract Surgery Lens Options

Cataract Surgery Lens Options

Developing a cataract in both eyes is a normal part of aging. Because of this, cataract surgery is the most commonly performed surgery across the world. In order to see clearly after cataract surgery, the ophthalmologist must place an artificial lens inside the eye. This is because the natural lens of the eye is removed during cataract surgery. Most patients who have surgery for cataracts will have an artificial lens placed inside the eye. There are many choices when it comes to cataract lens options. Because each patient is different in their needs and their lifestyle, the best lens for cataract surgery may be different for different people.If you are a patient with a high level of astigmatism, the best cataract lens for astigmatism is a toric lens. Toric lenses for cataract surgery correct both the sphere part of a prescription as well as an astigmatic component to your prescription. If you are looking at your glasses prescription you will see 3 numbers if you have astigmatism. Here is an example: -2.00-3.00 x 90. In this example the -2.00 is the sphere correction and the -3.00 is the cylinder or astigmatism correction. The number 90 is the axis of the astigmatism, and it is a number between 1 and 180. Astigmatism prescriptions always have an axis associated with it. This axis helps the cataract surgeon to determine the position that the toric lens must be placed in during cataract surgery. Cataract surgery with toric lenses is typically not fully covered by insurance. Usually a patient's insurance will pay for the cataract surgery and a basic lens, but not an upgraded toric lens. Depending on the degree of your astigmatism, a toric lens may be a very worthwhile upgrade for you, and may give you the ability to see clearly in the distance without a pair of glasses. Typically vision after cataract surgery will be clear for distance vision, but not for up close or reading. When having the discussion on lens options for cataract surgery, it is important to know that the lens you choose has an affect on this. Multifocal lenses are a great option for many patients who do not want to wear reading glasses after having cataract surgery. Multifocal lenses, as the name implies, allows a patient to focus at multiple distances. Not every patient tolerates multifocal lenses, so it is important to make an informed decision with your ophthalmologist. These lenses are also usually not covered by insurance. Insurance will usually cover the cost of basic surgery but not the upgrade in the lens.The standard lens for cataract surgery is usually covered by insurance. If you do not have a high level of astigmatism and are willing to wear reading glasses after cataract surgery, this may be the right option for you. A standard lens in cataract surgery will correct the sphere part of a patient's prescription, which in the example above is the -2.00 number. Toric lenses will correct both the sphere and cylinder (astigmatism) correction. In general, cataract surgery is very quick and takes, on average, 20 minutes. If you have a very dense lens, it may take longer, or if you have a very soft lens it could be shorter than 20 minutes. The answer to this question more specifically depends on a few other factors including the lens choice. If you are choosing a lens that is toric, the surgeon will need to ensure that the toric lens is placed at the correct axis. The marking of the eye and the rotation of the lens to the correct position could take an extra couple minutes. In some cases, a cataract surgeon will advise you to have cataract with laser. The laser allows for more precision in the first part of the cataract surgery. The surgery can not be done entirely by laser, but it may be a good option for certain patients. If you have laser assisted cataract surgery, then the procedure could take a few extra minutes since you will need to be moved from one machine which does the laser to then the operating scope where the surgeon will complete the surgery.If you are having an additional procedure, such as a glaucoma procedure, alongside cataract surgery, this could add anywhere from 10 minutes to an hour to your cataract surgery time. Ask your doctor what they anticipate the operating time to be. The general options for choosing a lens in cataract surgery vary between those covered by insurance and those that are not. If you have a strong astigmatism prescription, consider an upgrade to toric lens to help you see clearly. If you want to see clearly at all distances after your surgery, choose a multifocal lens. Always remember to discuss the details with your ophthalmic surgeon since each case is different.Sources:Sachdev MS. Commentary: Toric intraocular lens alignment: Going markerless. Indian J Ophthalmol. 2020 Apr;68(4):587-588. doi: 10.4103/ijo.IJO_1877_19. PMID: 32174574; PMCID: PMC7210851.https://pubmed.ncbi.nlm.nih.gov/32174574/Zhou F, Jiang W, Lin Z, Li X, Li J, Lin H, Chen W, Wang Q. Comparative meta-analysis of toric intraocular lens alignment accuracy in cataract patients: Image-guided system versus manual marking. J Cataract Refract Surg. 2019 Sep;45(9):1340-1345. doi: 10.1016/j.jcrs.2019.03.030. PMID: 31470944.https://pubmed.ncbi.nlm.nih.gov/31470944/
5 min read
Optic Nerve Function

Cranial Nerve 2 : The Optic Nerve

The optic nerve is the second cranial nerve, which is also written at CN II or cranial nerve II. It connects the brain to the human eye. During an eye exam, an ophthalmologist can use a special lens to view the optic nerve's entry into the eye. The optic nerve is considered to be part of your nervous system. The function of the optic nerve is to carry visual information that it receives from the eye to the brain. This allows your brain to form images. There are many different types of visual information that the optic nerve is responsible for transmitting to the brain. This includes brightness perception, color vision, visual acuity or visual accuracy, and the ability to discern contrast or contrast sensitivity. Therefore, if someone has damage to their optic nerve, they will also have difficulties with their vision. Depending on the type of damage, the vision loss from optic nerve damage can be related to peripheral vision, central vision, color vision, contrast sensitivity, or complete vision loss.The optic nerve is also responsible for how your pupil reacts in light and dark and also when you are trying to read fine print. In bright lights, the optic nerve receives a signal that it sends to the brain telling the pupil to constrict or get smaller. When you are reading fine print, the pupil and lens of the eye change to help you read, and this process is called accommodation. These two neurological reflexes are called the light reflex and the accommodation reflex. Certain disease states such as syphilis may affect one of these reflexes but not both.The blind spot in the eye is real. This means there is an area of your visual field that you can not see because there are no photoreceptors there. The blind spot in the eye is caused by the entry of the optic nerve into the eyeball. Damage to the optic nerve and optic nerve function can be determined by several tests which an eye doctor can do in their office. Examining the optic nerve may reveal that one nerve is different in color than the other. Ophthalmologists refer to this as optic nerve pallor. Optic nerve pallor may need testing beyond what a general eye doctor can do and you may need to be referred to a Neuro Ophthalmologist.There are a few different ways to test for optic nerve function. The first is a pupillary exam. An eye doctor will evaluate one pupil first and then the second pupil. They will then also perform a swinging flashlight test where they quickly move the light from side to side to see how the pupils react. Another test is a visual field test which helps to assess if any parts of your visual field have been compromised. Another optic nerve function test is a color vision test. In patients who have optic nerve damage, their color vision may also be compromised. Finally, an OCT or optical coherence tomography test can test the retinal nerve fiber layer and see if there is any thinning of the optic nerve. Cranial nerve II is also called the optic nerve and it is responsible for carrying visual information from the eyeball to the brain. Damage to the optic nerve will likely cause visual problems. Sources:Selhorst JB, Chen Y. The optic nerve. Semin Neurol. 2009 Feb;29(1):29-35. doi: 10.1055/s-0028-1124020. Epub 2009 Feb 12. PMID: 19214930.https://pubmed.ncbi.nlm.nih.gov/19214930/Miller NR. The optic nerve. Curr Opin Neurol. 1996 Feb;9(1):5-15. doi: 10.1097/00019052-199602000-00003. PMID: 8722657.https://pubmed.ncbi.nlm.nih.gov/8722657/
4 min read
Ptosis Of The Eye

Ptosis Of The Eye

Ptosis of the eye is a drooping of the eyelid. It usually refers to the upper eyelid but doctors can also reference ptosis of the lower eyelid, but this is much less common. Ptosis of the eyelid can have many different causes. The cause may be a problem with the muscles in the eyelid or in the upper part of the face and brow, or the problem could be a problem with the nerve that is associated with those muscles. While most cases of ptosis happen in adults, there is a form of ptosis that children can be born with. Symptoms of ptosis are fairly obvious when the ptosis is significant. Usually, the patient or the parent will notice the problem and make the eye doctor’s appointment to address the ptosis. Sometimes if ptosis is subtle, it may be picked up by a doctor during an eye exam. Patients may also complain that their eyes get tired when they are trying to read or watch TV. This is because they may be raising their eyebrows in order to help keep their eyelid open. When you see an eye doctor for ptosis of the eye, the doctor will perform a few tests. The first is a basic eye exam. The doctor will make sure that the ptosis is not associated with any other concerning symptoms. Some worrisome symptoms would be having difficulty to move the eye in a certain direction or having a difference in pupil size, called anisocoria. Anisocoria and ptosis together could mean you have Horner’s syndrome. In addition to doing a complete eye exam, your doctor may also perform a visual field. This test is usually done in the office and it can measure if there’s any degree of visual field loss from the ptosis. The visual field may be done with the eyelid taped up. This can help the doctor to figure out if lifting the eyelid will improve the patient’s field of vision.Depending on the cause, ptosis is treated in different ways. If ptosis is related to a medical condition like Horner’s Syndrome, that must be fully worked up by a doctor. The most common treatment for ptosis is surgical correction. There are many different types of surgeries for ptosis correction and an ophthalmologist who specializes in oculoplastics is the best type of doctor to help you. An oculoplastics specialist can evaluate which muscles in and around your eye and eyelid are causing the ptosis. They will choose a surgical procedure based on their findings.The most common complication of surgical ptosis repair is an undercorrection of the ptosis. This happens in about 10 to 15% of cases. Overcorrection can also happen and in both cases your surgeon will likely wait until any eyelid edema or other post operative changes have stabilized. In cases of overcorrection, patients may be able to massage the eyelid for a mild improvement. Another side effect of ptosis surgery is that the prescription of the eye may change. In 72% of patients who undergo surgical treatment for ptosis, a change in astigmatism may happen. Treatment for ptosis is especially important in children. When children are young, their vision is developing. If a child has a droopy eyelid from ptosis, it blocks their vision. This has a negative impact on a child’s visual development. Ptosis in a child can lead to a disease called amblyopia. In amblyopia, the visual pathways do not develop correctly and a child’s vision is permanently decreased. If your child has a droopy eyelid, see a pediatric ophthalmologist right away.  Ptosis can have many different causes. A nerve problem can cause ptosis. Cranial nerve 3 controls the movement of many eye muscles including the Levator palpebrae superioris, which raises the upper eyelid. If the 3rd cranial nerve is injured or has a palsy, a patient may have ptosis. In the case of a 3rd nerve palsy, patients may also have abnormal eye movements, since the third nerve controls 4 other eye muscles.Other diseases like myasthenia gravis, or myotonic dystrophy can also cause eyelid ptosis. These diseases affect muscles and can cause muscle weakness. The eye muscle itself could be weak and this can also cause ptosis. An injury to the eye muscle itself can also cause ptosis.Ptosis can be a result of a variety of different problems both in the eye and even in the brain and body. The most common way to treat ptosis is through surgery. The type of surgery is usually determined by an oculoplastic surgeon. In children, ptosis that is left untreated can cause amblyopia, and these patients need to be seen by a pediatric ophthalmologist right away. Sources:Díaz-Manera J, Luna S, Roig C. Ocular ptosis: differential diagnosis and treatment. Curr Opin Neurol. 2018 Oct;31(5):618-627.https://pubmed.ncbi.nlm.nih.gov/30048338/SooHoo JR, Davies BW, Allard FD, Durairaj VD. Congenital ptosis. Surv Ophthalmol. 2014 Sep-Oct;59(5):483-92. doi: 10.1016/j.survophthal.2014.01.005. Epub 2014 Feb 5. PMID: 24657037.https://pubmed.ncbi.nlm.nih.gov/24657037/https://eyewiki.org/Aponeurotic_Ptosis
5 min read
Woman Sleeping In Contacts

Can You Sleep With Contacts In?

Sleeping in contacts is a very bad idea. In fact, patients can get an eye infection from sleeping in contacts. Some of these infections are very dangerous and can even result in a loss of vision permanently. When a patient wears their contact lenses during sleep, bacteria are given a chance to accumulate and cause problems. The contact lens also prevents oxygen from reaching the eye. Although there are newer lenses now that have greater permeability for oxygen, most ophthalmologists would advise that you do not sleep in contacts. Here are some of the things that can happen if you do:One of the most devastating complications of choosing to sleep in contacts is developing a corneal ulcer. This is an aggressive and potentially sight-threatening eye infection. Corneal ulcers are usually very painful and will likely cause the eye to look very red. You may see a whitish mark on the front part of your cornea, but also they can be very hard to see without a microscope. If you have been sleeping in contacts, and start having a lot of pain, you should see an ophthalmologist immediately. An ophthalmologist is an eye doctor who has gone to medical school and has then completed a four year surgical residency in ophthalmology. They will be able to look with a microscope and evaluate if you have an ulcer. Corneal ulcer treatment includes antibiotic eye drops that patients usually have to put in every hour, and sometimes even every 30 minutes for several days. The choice of antibiotic and the frequency of treatment depends on how bad the eye infection is. Most patients will not be able to wear contact lenses for several months. Some patients may never be able to wear contact lenses again. There are several other issues that patients can have from wearing contact lenses while sleeping. One of these is corneal neovascularization. This means that new blood vessels can develop over the front part of the eye. Another issue is a called marginal keratitis. Marginal keratitis can cause red eye, blurry vision, and patients will also need to discontinue contact lens wear while they are getting treated for this.Placing contacts in water overnight or during the day is also another very bad idea. Although water may seem "clean" there is an increased chance of developing certain types of infections when mixing water and contact lenses. For this same reason, ophthalmologists will tell you to not shower, swim or use a hot tub with your contact lenses in. If you are looking for a substitute for contact solution overnight, unfortunately, there is no good substitute. The beauty of wearing daily contact lenses is that you can just throw the contact lens pair out at the end of the day.There are some contact lenses that are approved for use overnight. While they may be technically okay, most eye doctors will not advise patients to sleep in their contact lenses. Though many patients who sleep in contacts will not develop corneal infections, there will be some who do, and for some of these patients the outcome could be not being able to wear contact lenses at all. The best type of contact lens to use is one that is a daily contact lens. This means that patients can put in a fresh pair of contact lenses each day. This minimizes the risk of infection and also makes it convenient for patients who find it annoying to place their contacts into solution each night. The downside to daily contact lenses is that they tend to be on the more expensive side. Do not sleep with contact lenses in. It puts you at a much higher risk for infection. Also, do not use water to store your contact lenses or swim in your contact lenses. Daily contact lenses can offer a benefit to patients who may have trouble remembering to store their contacts properly at night.Sources:Alafaleq M, Knoeri J, Boutboul S, Borderie V. Contact lens induced bacterial keratitis in LCD II: Management and multimodal imaging: a case report and review of literature. Eur J Ophthalmol. 2021 Sep;31(5):2313-2318. doi: 10.1177/1120672120968724. Epub 2020 Oct 30. PMID: 33124478.https://pubmed.ncbi.nlm.nih.gov/33124478/Cabrera-Aguas M, Khoo P, Watson SL. Infectious keratitis: A review. Clin Exp Ophthalmol. 2022 Jul;50(5):543-562. doi: 10.1111/ceo.14113. Epub 2022 Jun 3. PMID: 35610943.https://pubmed.ncbi.nlm.nih.gov/35610943/Arshad M, Carnt N, Tan J, Ekkeshis I, Stapleton F. Water Exposure and the Risk of Contact Lens-Related Disease. Cornea. 2019 Jun;38(6):791-797. doi: 10.1097/ICO.0000000000001898. PMID: 30789440.https://pubmed.ncbi.nlm.nih.gov/30789440/
4 min read
Ectropion Eye In Old Man

Eyelid Ectropion

An eyelid ectropion occurs most commonly in the lower eyelid. A person’s lower eyelid will become droopy and it will extend outward. Because the eyelid is not in the correct position, the eyeball is not as protected as it should be. This causes eye exposure. An upper eyelid ectropion is very uncommon and may be related to sleep apnea.The majority of symptoms that patients experience from an eyelid ectropion are due to the fact that when the patient blinks or tries to close their eyes, the eyelids do not close properly. Therefore, parts of the eye itself are exposed and they become dry and irritated.Because of the exposure, symptoms of eyelid ectropion include tearing, eye irritation, eye redness, and in some cases eye discharge. Because a patient may develop severe dry eye due to having a long standing ectropion, their vision can even become blurry over time. An ectropion can happen for many different reasons. One of the most common reasons is getting older. A patient can also develop an eyelid ectropion as a result of eyelid disease. For example, if a patient has an eyelid tumor or eyelid mass in their lower eyelid, this can physically cause that eyelid to become heavier and more subject to the forces of gravity. This mechanical force then pulls the eyelid down causing it to become droopy and rotate outwards.Trauma or eyelid injury can also cause an eyelid ectropion. While most people think of trauma as a big event, even small repeated events over a long period of time can cause an eyelid ectropion. An example of this would be a person who has a habit of constantly rubbing their eyes. Another example is a patient who constantly pulls their eyelid down to insert contact lenses. In less common cases, certain eye drops can cause eyelid ectropion when they are being used for a long time. This is seen with the chronic use of drops like dorzolamide and brimonidine, which are commonly used to treat glaucoma. In some patients, they may develop an allergy or inflammatory reaction to these drops and that can cause inflammation in the eyelid as well. This inflammation can cause the eyelid to droop. Although eye drops for glaucoma are meant to go inside the eye and not onto the eyelid, many patients will have some drops that also touch their eyelid. If you think you have an eyelid problem because of your glaucoma drops, you should talk to your ophthalmologist or glaucoma specialist. It is not a good idea to discontinue any medical eye drops without first speaking to your ophthalmologist. There are also reports of other topical treatments to the eyelid area that can cause an ectropion. In one case report, authors described treatment of a eyelid xanthelasma (accumulation of lipid) that caused an eyelid ectropion. The most definitive treatment for an eyelid ectropion is surgical correction. The surgery to correct an eyelid ectropion is usually done by an oculoplastics specialist. An oculoplastics specialist is an eye surgeon who has completed medical school, a four year residency in ophthalmology, and then additional years of surgical training in oculoplastics.  Sources:Orbit, Eyelids, and Lacrimal System, Section 7. Basic and Clinical Science Course. San Francisco: American Academy of Ophthalmology; 2009.Bedran EG, Pereira MV, Bernardes TF. Ectropion. Semin Ophthalmol. 2010 May;25(3):59-65. doi: 10.3109/08820538.2010.488570. PMID: 20590414.https://pubmed.ncbi.nlm.nih.gov/20590414/Salloum G, Crawford JJ, Dryden S, Meador AG, Wesley RE, Klippenstein K. Lower Eyelid Ectropion Secondary to Over-the-Counter Treatment of Xanthelasma. Ophthalmic Plast Reconstr Surg. 2022 Jan-Feb 01;38(1):e25-e28. doi: 10.1097/IOP.0000000000002070. PMID: 34812179.https://pubmed.ncbi.nlm.nih.gov/34812179/Vallabhanath P, Carter SR. Ectropion and entropion. Curr Opin Ophthalmol. 2000 Oct;11(5):345-51. doi: 10.1097/00055735-200010000-00010. PMID: 11148701.https://pubmed.ncbi.nlm.nih.gov/11148701/https://eyewiki.org/Ectropion
4 min read
Symptoms Of Blepharitis Man With Itchy Eyes

Blepharitis Symptoms And Treatment

Blepharitis is sometimes called “dandruff of the eyelids.” While people use this phrase, it is not the same thing. Under the microscope, an ophthalmologist may see flaky debris that looks similar to dandruff. The difference is that blepharitis is caused by a problem in the meibomian glands of your eyelids. Blepharitis has a wide variety of symptoms. In some patients, blepharitis causes no symptoms. In fact, patients may not know that they have blepharitis or meibomian gland dysfunction until they are told this by an eye doctor. As blepharitis get worse, the symptoms of blepharitis will also get worse. One of the most common symptoms of blepharitis is itchy eyes. Some patients can also experience watery eyes and eyelid crusting. Eyelid crusting is usually more common in the morning after waking up. As blepharitis gets worse it can cause more severe symptoms like burning in the eyes, light sensitivity, foamy tears, severe dry eye, or even swollen red eyelids. While blepharitis itself is not dangerous, severe and chronic blepharitis can be very frustrating and can severely decrease your quality of life. It can also cause other problems like chronic dry eye and even blurry vision. When the meibomian glands of the eyelid become clogged, this results in an irritation and inflammation of the eyelid skin called blepharitis. Blepharitis is usually separated into two categories. The first type is anterior blepharitis. Anterior means in the front, and thus, anterior blepharitis affects the part of the eyelid where the eyelashes are. Anterior blepharitis is usually caused by bacteria called Staphylococcus. Anterior blepharitis is more likely if you have poor lid hygiene, scalp or eyebrow dandruff, or allergies.The second type of blepharitis happens more towards the back of the eyelid, and it is called posterior blepharitis. This is when the oil glands (meibomian glands) of the eyelid are involved. This is the part of the eyelid that touches the eyeball. Under a microscope it is easy to distinguish anterior vs posterior blepharitis. But they are very close together practically speaking. Posterior blepharitis can happen to anyone, but it is more common in patients who have rosacea or scalp dandruff. No, blepharitis is not contagious. While there is no cure for blepharitis, there are many ways to treat it. Eyelid hygiene is important in reducing blepharitis. This involves two things: warm compresses and soapy lid scrubs. When heat is applied to the eyelid, it helps the meibomian glands to open and express any oil that may be stuck. A heat mask can be very helpful in treating blepharitis.After this debris leaves the glands, it needs to be washed away from the eyelid. That is why the lid scrubs are recommended after the heat. Use a mild soap and make a small lather in the palm of your hand. Use one or two fingers to gently clean the margin of your eyelid and eyelashes. Many doctors will recommend this schedule two times a day. If you have untreated dandruff, it could be contributing to your blepharitis. Use an anti-dandruff shampoo to treat your dandruff as well. Artificial tears do not directly help blepharitis. Because blepharitis can also cause dry eye, artificial tears can be helpful to patients who are also having dry eye symptoms.All people have some bacteria on their eyelids. This is totally normal. Some people will either have more bacteria on their eyelids than others, or they are just more sensitive to blepharitis. Especially if they have other conditions like rosacea or meibomian gland dysfunction, they are more likely to have blepharitis. It is also important to clean your eyelids regularly. When people wash their face, they sometimes forget to pay attention to their lids and lashes. This can cause excessive bacteria to build up in those locations. The best way to know if you have blepharitis is to see an eye doctor. Any ophthalmologist will be able to diagnose blepharitis by asking you about your symptoms as well as by examining your eye and eyelids. This exam is usually done at the slit lamp. In some cases of mild blepharitis, diagnosis can also be done via telemedicine through a limited exam and asking about your symptoms. It is important to see an in-person ophthalmologist in the future if you opt for a telemedicine exam for your blepharitis so that the in-person eye doctor can also evaluate the other parts of your eye. Sources:Amescua G, Akpek EK, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK, Varu DM, Musch DC, Dunn SP, Mah FS; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019 Jan;126(1):P56-P93. doi: 10.1016/j.ophtha.2018.10.019. Epub 2018 Oct 23. PMID: 30366800.https://pubmed.ncbi.nlm.nih.gov/30366800/Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database Syst Rev. 2012 May 16;2012(5):CD005556. doi: 10.1002/14651858.CD005556.pub2. PMID: 22592706; PMCID: PMC4270370.https://pubmed.ncbi.nlm.nih.gov/22592706/Onghanseng N, Ng SM, Halim MS, Nguyen QD. Oral antibiotics for chronic blepharitis. Cochrane Database Syst Rev. 2021 Jun 9;6(6):CD013697. doi: 10.1002/14651858.CD013697.pub2. PMID: 34107053; PMCID: PMC8189606.https://pubmed.ncbi.nlm.nih.gov/34107053/
5 min read
Can Cataracts Come Back

Can Cataracts Come Back After Surgery?

You may read about something called a secondary cataract. Because of this terminology, many people wonder, "Can cataracts come back?" The scientific answer is no. Once a cataract is surgically removed from your eye, it can not return. You can not get a cataract twice in the same eye. There are other things that can happen which may require further intervention by your doctor but it is not possible for the cataract to return. In order to understand this, let's first talk about what a cataract is.A cataract is a normal aging change of the eye's natural lens. Most people in the world are born with a natural lens in each eyeball. This lens focuses light onto the retina so that you can see. As a person gets older and ages, the lens ages also. This causes the lens to become less clear. This makes a person's vision also less clear. In order to remove the cataract, the natural lens of the eye is removed and a new artificial lens is placed inside the eye. Because the cataract is removed in its entirety there is no way for it to come back. The new artificial lens does not age the way your natural lens ages, so the new lens can not develop a cataract. If a patient has blurry vision after cataract surgery, there could be a few things going on.The first is that there may still be inflammation inside the eye. Inflammation in the eye after cataract surgery is normal. Your ophthalmologist will give you eye drops to take to reduce this inflammation. Sometimes the inflammation can linger longer than expected and it can cause blurry vision.There can also be some swelling in the retina after cataract surgery. This is more likely to happen to you if you are a diabetic. It is also more likely to happen if your diabetes is not well controlled. There are medications that can help to reduce this swelling.After cataract surgery, your prescription is likely to change, so your blurry vision could be due to this. One to two months after cataract surgery, your doctor can give you a new eyeglasses prescription.Another common occurrence after cataract surgery is the development of something called a posterior capsular opacification. This is what people mean when they talk about a secondary cataract. It is a bit of misnomer, however, because it is not actually the same as a cataract. A posterior capsular opacification happens behind the artificial lens in a part of the eye called the capsular bag. The posterior capsule of this bag becomes hazy due to cellular proliferation of lens epithelial cells after cataract surgery. Luckily, there is a quick solution to this. The eye surgeon who performed your cataract surgery can also perform a laser to eliminate this opacification. While it is a relatively safe procedure, there is a small risk of retinal problems after this laser so it is important to chat with your ophthalmologist about the risks and benefits of having it done. Can you get cataracts twice in the same eye? No. Once surgically removed, a cataract can not come back. If part of the cataract was left behind during surgery, it may need a second procedure to remove it, but a new cataract will not form. A PCO, or posterior capsular opacification, may form and this can be lasered by a Board Certified Ophthalmologist. While a PCO is often referred to as a secondary cataract, it is not the same thing as a cataract since it is not an aging change of the lens and happens in a different part of the eye called the posterior capsule.Sources:Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, Ram J, Auffarth GU. Eradication of Posterior Capsule Opacification: Documentation of a Marked Decrease in Nd:YAG Laser Posterior Capsulotomy Rates Noted in an Analysis of 5416 Pseudophakic Human Eyes Obtained Postmortem. Ophthalmology. 2020 Apr;127(4S):S29-S42. doi: 10.1016/j.ophtha.2020.01.026. PMID: 32200823.https://pubmed.ncbi.nlm.nih.gov/32200823/Wormstone IM, Wormstone YM, Smith AJO, Eldred JA. Posterior capsule opacification: What's in the bag? Prog Retin Eye Res. 2021 May;82:100905. doi: 10.1016/j.preteyeres.2020.100905. Epub 2020 Sep 22. PMID: 32977000.https://pubmed.ncbi.nlm.nih.gov/32977000/
4 min read
Stye Vs Chalazion

Stye Vs Chalazion

Many people think that a chalazion and a stye are the same disease. They are not, but they are related to each other. Another name for a stye is called a hordeolum. Keep reading to learn the differences between a stye and a chalazion. A chalazion is a chronic reaction. Chronic means that the problem is long lasting and tends to happen over and over again. This means if you have had a chalazion in the past, you are more likely to have a chalazion in the future. A chalazion tends to happen over a slightly longer time than a stye. A stye, or hordeolum, tends to show up quick.A chalazion is chronic inflammation. A stye is usually a mix of infection and inflammation. Antibiotics tend to be more effective in treating styes than they are for treating a chalazion. The exception to this is an antibiotic called doxycycline which is often prescribed for patients with chalazia because it can help to thin out the oily secretions in the glands that are causing the inflammation. In a chalazion, the small meibomian glands of the eyelids are clogged and this clogging leads to build up of the body's natural oil. When the oil can not freely exit the eyelid, it backs up and causes an inflammatory reaction. This inflammatory reaction looks like a bump on the eyelid. The picture above is a chalazion. The picture below is a stye.In a stye, there is also a bump on the eyelid. With styes you can sometimes see a whitish area on the bump which is a sign of pus. Pus inside a stye means that there is an infection there. In many cases, if this pus comes out, the stye is likely to get better. A hordeolums can also be more red and tender than a chalazion. The bump associated with a chalazion can be on the eyelid for many weeks and in the later stages is painless.Stye Vs ChalazionOne similarity between the two is that both styes and chalazions tend to happen more in people who have dysfunction of their meibomian glands. The meibomian glands are tiny glands in the eyelids. You can prevent styes and chalazions by keeping your glands open. Make sure your lids and lashes clean by using a mild shampoo over them daily and keep the glands open by using a warm compress to the eyelid twice daily.If you experience a stye or a chalazion, make an appointment with a doctor. You may be eligible to be prescribed an oral medication that can help to thin out the secretions of the meibomian glands. This medication is called doxycycline. This should be used along with warm compresses and eyelid hygiene.1. A chalazion is a chronic process of inflammation. A stye is both infectious and inflammatory. Antibiotics will work better for styes than they will for a chalazion, but both may ultimately need to be removed surgically.2. Both a chalazion and a stye can be prevented by good eyelid hygiene. This means using regular warm compresses to keep the eyelid glands open and also using a mild soapy scrub on the eyelids to keep the eyelids clean.3. If there is a whitish head on the bump, then it is likely a stye. If the bump is painless and has been there for many weeks it is likely a chalazion.4. If at-home remedies using warm compresses are not working, make an appointment with an ophthalmologist for both styes and chalazia. There are treatment options that can help you find relief more quickly.
4 min read
Cataract In Eye

What Is A Cataract In The Eye?

Cataracts are a clouding of the lens inside the eye.  A cataract is what eye doctors call the lens of the eye when it becomes cloudy and difficult to see through. Each eye can develop a cataract at the same time or at different times. Cataracts cannot spread from one eye to the other eye.In most cases, a cataract is caused by simply getting older. It is usually an age-related disease, and it will happen to every single person if they live long enough. There are some other causes of cataracts, such as trauma to the eye and diabetes, but these are not as common as cataracts that are caused by aging. The lens of the eye is responsible for focusing the light which enters the eye onto the retina. That information is then sent via the optic nerve to the brain for processing.  When the eye’s natural lens develops a cataract, it obscures the light and makes vision blurry. Left untreated, cataracts may progress and lead to decreased vision or even blindness. As expected, the most common complaint when a person has a cataract is blurry vision.Depending on the cause and type of cataract, the progression and severity of cataracts can vary. Around age 40, the proteins that make up the lens in the eye start to break down, leading to the formation of cataracts. Although age is the most common risk factor for cataracts, some other common risk factors are exposure to ultraviolet light, radiation exposure or radiation treatment, smoking, excessive alcohol consumption, diabetes, previous invasive eye surgery, traumatic eye injury, genetics, and taking steroid medications. It is estimated that about 95 million people are affected by cataracts (1). 36 million people are blind worldwide, and 13.5 million are blind due to cataracts (2,3). It is the leading cause of preventable blindness in low and middle income countries. Around age 50, about 5.22% of people have cataracts. As people continue to age, that number increases to about 15.45% at age 60, and 36.49% at age 70. By the time people are 80, around 68.30% of people have cataracts(4).Cataracts will begin as cloudy or blurry vision and with time, vision will continue to decrease. Some types of cataracts will also develop a yellow or brown tint which may distort color vision. People also may experience difficulty seeing at night, and may have increasing trouble with nighttime driving due to glare or seeing halos around headlights or stop lights. Sometimes people may experience frequent changes in their glasses prescription and may also experience a phenomenon known as myopic shift due to cataracts. With myopic shift, or “second sight of the elderly”, people may start to realize they no longer need their reading glasses. However, this is not due to an improvement in their sight, but rather a progression of their cataracts which changes the way the light focuses in the eye.Some cataracts may progress very slowly and cause little to no decrease in vision. In these cases, it is acceptable to delay invasive treatment and continue to monitor the progression of the cataract with yearly eye exams until it becomes visually significant. Waiting too long, however, may lead to complications like lens-induced glaucoma and a more difficult cataract extraction surgery. Therefore, when a cataract has matured to the point where decreased vision causes difficulty with daily activities, it may be advised to undergo surgery by an Ophthalmologist. In this surgery, the cloudy lens is taken out and replaced with a new artificial lens.  Thankfully with technological developments and advances in surgical techniques, cataract surgery has become one of the most common surgeries performed worldwide with good outcomes with low rates of complications.
4 min read
Blurry Vision In One Eye

Blurry Vision In One Eye

Having blurry vision in one eye can be a scary thing to experience. What are some of the reasons you might have blurry vision in one eye only? If you have blurry vision in one eye that also is painful, it could be a corneal abrasion. A corneal abrasion is a scratch on the surface of the eye. It can be very very painful. It can happen after something has hit the eye or if you have a contact lens that could have scratched the eye. If you think you have a corneal abrasion you should try to see an ophthalmologist within 24 hours. Another cause of blurry vision in one eye that is also painful, is angle closure glaucoma. This is not quite as common as a corneal abrasion but it could happen. In this situation you may also have a headache or even nausea and vomiting. This is a medical emergency and you need to seek care from an ophthalmologist or emergency room immediately. The longer you wait to see a doctor if you have angle closure glaucoma, the more harmful it can be. Angle closure glaucoma is different from open angle glaucoma which is usually a slow, painless loss of vision.One of the most common causes of blurry vision in one eye is dry eyes. Other symptoms of dry eyes include a gritty sensation inside the eye, or feeling like something may be stuck inside the eye. Dry eyes can also tear, so watch out for this symptom also. You can use some over the counter artificial tears to see if this helps to clear up the blurry vision. If you have blurry vision in one eye that is painless it could be a sign of a problem in the back of the eye. Some problems in the back of the eye include retinal tears, retinal detachments, or a vitreous hemorrhage (a bleed in the back of the eye). The only way to evaluate this is to have a full dilated eye exam with an ophthalmologist. If the blurry vision came on suddenly, you should seek medical care as soon as possible. If you have a retinal detachment, seeing a retina specialist who can evaluate you for surgery is important.Ocular migraines can also cause blurry vision in one eye that is painless. Sometimes ocular migraines are also associated with a headache but it is not always the case. In an ocular migraine the area of blurry vision may also be associated with colors or even the feeling of looking through a kaleidoscope. Ocular migraines tend to resolve on their own but they can happen again. In most cases ocular migraines do not cause long term visual damage. You should still have a full dilated eye exam to ensure that there is no other cause of your eye symptoms. Cataracts can also cause painless blurry vision in one eye, but this change is usually gradual. Cataracts are normal part of aging and eventually need to be removed from the eye with surgery. A change in your eyeglasses prescription can also cause blurry vision in one eye. This is also typically a gradual change that occurs with time. If you experience a sudden change in vision, this is less likely to be from the development of cataracts or a change in your prescription.Experience blurry vision in one eye is not normal, especially if it comes on suddenly. There are many different causes, and sometimes there can be pain associated with the blurry vision. If you experience blurry vision in one eye that happens all of a sudden, you should seek medical care from an eye doctor as soon as possible.
4 min read
best eye drops for dry eye treatment patient with artificial tears

Best Eye Drops For Dry Eye Treatment

The best eye drops for dry eye treatment in most people are artificial tears. If your dry eye is more severe, you may require more than just artificial tears. Artificial tears are exactly what the name suggests. In addition to your body's natural tear production, artificial tears can help to moisten and lubricate your eyes. This can help to relieve dry eye symptoms like stinging, burning, gritty sensation, or feeling like something is in the eye. Artificial tears can be bought at a drug store or online without a prescription. Picking the best artificial tear eye drop can be challenging. There are many different types of drops that treat different types of dry eye. Some drops are over the counter and some require a prescription. Prescription eye drops for dry eye are used in cases of severe dry eye. If you have mild dry eye, start with an over-the-counter artificial tear. You can use it up to 4 times a day in each eye. Two of our favorite dry eye drop brands are Systane and Thera Tears. Both of these options have preservatives in them. Preservatives are well tolerated by most people but not all. Preservatives help prevent bacterial growth in eye drop bottles. However, these preservatives can irritate some people's eyes and symptoms worse.There are two reasons to switch to preservative-free tears. The first reason is that you are not tolerating the dry eye drop. The second reason is that you feel that you need to put the drop inside the eye more than 4 times a day. If you want to use a dry eye drop 6 times a day or even every hour, it is a good idea to switch to preservative-free artificial tears. Preservative-free dry eye drops usually come in packs of 25 or 30 individual vials. They tend to be more expensive than dry eyd drops that have preservatives. If preservative-free artificial tears are not enough for your symptoms, you can discuss adding treatment with your doctor. The next step after artificial tears includes adding a gel tear or eye ointment at night. Gel tears are thicker than artificial tears. Although they are more useful for moderate dry eye, they can take time to work. One of the downsides to gel tears is that when you put them into the eye, they are so thick that they cause blurry vision. This is why you should take gel tears are night. Gel tears are also readily available online. Some of the same brands that make regular artificial tears also make gel tears. Our favorite brands of gel tears areRemember that dry eye treatment is additive. This means that gel tears do not replace the artificial tears you are taking during the day. You will add gel tears to your regimen at night. After gel tears, your doctor may suggest prescription eye drops like Restasis, Xiidra, or Cequa. These drops can take up to 3 months to start working, so you will need to be patients when expecting results. Another problem with these drops is that without insurance, these drops can be very expensive, and some insurances may not cover them at all. Other common dry eye therapies include blepharitis treatment, since untreated blepharitis can make dry eye worse, and punctal plugs. Punctal plugs can be very effective for some patients with dry eye and they are usually covered by insurance. Infrequent blinking, which usually happens when looking at a computer screen for long stretches of time, is a major cause of dry eye. Dry eye can also be caused by contact lenses, a dusty or dry surrounding environment, or as a side effect of other medicines you may be taking. Some medical diseases can also cause dry eyes. These conditions include allergies, hormonal disorders (thyroid, diabetes), autoimmune disorders such as Sjogren’s syndrome, Lupus, and Rheumatoid Arthritis, conditions that cause eye inflammation, and nutrient deficiencies (essential fatty acids, Vitamin A), and dehydration.Visine eye drops are more useful for making a red eye appear white. Some generic versions of Visine may be labeled as "red eye relief." It is important to note that eye drops that make the eye look white are typically not artificial tears. In many situations, some drops that instantly get rid of red eye can cause what is known as "rebound redness." This is when the redness immediately returns after a short period of time when the medication has worn off. This is because these eye drops temporarily constrict the blood vessels in your eyes so that the vessels appear smaller. If your eye redness is from dry eyes, it is a better idea to use artificial tears and dry eye treatment to actually get to the root of the problem. The best eye drops for mild dry eye is a preservative-free artificial tear. The downside is that it can be more expensive. Preservative-free drops have fewer additives, and thus can be used much more frequently: up to every 1 to 2 hours. If your dry eye is very severe, you will need to add more treatment. Treatment for very severe dry eye usually involves artificial tears, a supplement, lid hygiene and prescription medication. Sources:https://www.aao.orghttps://www.mayoclinic.orghttps://eyewiki.aao.org
5 min read
Myopia Of Eyes

Myopia Is Nearsightedness

Myopia is not being able to see clearly at a distance without the help of glasses or contact lenses. This means that you are near-sighted because you can see clearly at a near distance. If you are the opposite, which is far-sighted, you have difficulty seeing clearly up close, but, at a distance, you can see clearly. The opposite is called hyperopia.Many patients wonder how myopia is different from astigmatism. When you have myopia you a negative lens to correct your vision problem. When you have astigmatism you may need a positive or a negative lens to correct this. Astigmatism and myopia can happen independent from one another or they can happen together. Astigmatism correction in glasses is made up of two different sets of numbers. The first number is the level of the astigmatism, meaning how much astigmatism the eye has, and the second number is the axis of the astigmatism. For example, in a prescription -2.00 sph, the patient only has myopia. But, if the prescription were to read -2.00 -1.00 x 180, then the patient has both myopia and astigmatism. This patient has -1.00 astigmatism at the axis of 180. You must have an axis when you are talking about astigmatism.When you have myopia your prescription starts with a negative number. When you have hyperopia, or have farsightedness, you prescription starts with a positive number. For example, someone with myopia may have a prescription of -2.00, while a person with hyperopia, or farsightedness may have a prescription of +2.00. You can not have both myopia and hyperopia in the same eye. You can have myopia in one eye and hyperopia in the other eye. This is not very common but it is possible. An example of this is a patient who may have a prescription of +1.00 in their right eye, but -0.50 in the left eye. Both myopia and hyperopia can be treated with glasses or contact lenses. This is the most common way that myopia is treated. There is also permanent treatment for myopia which involves laser vision correction surgery. There are a few different types of laser vision correction surgery including PRK (photorefractive keratectomy), LASIK (laser in situ keratotomy), and SMILE (small incision lenticule extraction). Depending on your eye and your prescription the eye surgeon performing these surgeries may recommend one surgery over another type of surgery. A less common option for treatment of myopia is orthokeratology, or ortho-k. In orthokeratolgoy, a specially designed contact lens is used to temporarily reshape the front part of the eye, which is called the cornea. Usually these lenses are worn at night and their purpose is to reshape the cornea while you sleep. The vision improvements are usually temporary but it may be possible for longer lasting effects if you continue to use the contact lenses. Laser vision correction and orthokeratology are usually not covered by insurance and they typically cost a few thousand dollars. Some portion of glasses and contact lenses are usually covered by vision insurance plans. If you have myopia, you should consider this when choosing your insurance plan coverage. Myopia is defined by having a negative prescription for your eyes and the inability to see clearly at a distance. The more negative your prescription is, the higher your degree of myopia. Patients who have a prescription of -1.00 can see more than people who have a prescription of -5.00. You can have myopia and astigmatism at the same time, but you can not have myopia and hyperopia in the same eye. Myopia is usually treated with glasses and contacts. Myopia can also be treated with laser vision correction. Laser vision correction is not covered by insurance and usually costs a few thousand dollars per eye.
4 min read
Periphery Vision

Periphery Vision

A person's peripheral vision is what that person sees on the sides without directly looking to the side. In order to measure peripheral vision loss, a person should be looking straight ahead. If think your peripheral vision is blurry it is important to see an eye doctor as soon as possible. A disease called glaucoma causes peripheral vision loss. A doctor will use one of two tests to measure the periphery vision of a patient. These are called visual field tests. The visual field of a patient includes their central vision and the vision in their periphery.The first visual field test is called a confrontational visual field. This is done with a doctor and patient face to face across from each other. The patient covers one eye and looks at the doctor's nose. The doctor then holds up fingers on either side of the patient. While looking directly at the doctor, the patient is asked how many fingers are being held up. If the patient does not answer correctly then there is more of a concern for peripheral vision loss. The second test for peripheral vision is a more formal test called an automated visual field test. The most popular automated visual field test done in many doctor's offices is the Humphrey visual field test. The test takes about 5–8 minutes per eyeThe patient places their chin into a bowl type machine and is asked to look straight ahead. The test is most accurate when the patient can maintain fixation on the central target. The patient is then given a hand held buzzer to press when they see a light is their peripheral vision. One eye is tested at a time, usually right then left. The eye that is not being tested is covered with an eye patch. When taking the visual field test, be sure to blink normally and concentrate on doing the test accurately. If the test shows that the patient was not looking straight ahead for the test, it could affect the accuracy of results. Your doctor may ask you to repeat the test if they feel that the results are not reliable. Glaucoma is a disease of the optic nerve. When a patient has glaucoma their peripheral vision is at risk. Most patients with glaucoma do not even know that they have it. Peripheral vision loss in glaucoma tends to happen very slowly. There are usually no obvious signs or symptoms. It is best to see an ophthalmologist at regular intervals especially if you have risk factors for glaucoma. One big risk factor for glaucoma is race. Populations that are more at risk for glaucoma include persons of African American ancestery, Hispanics, and Asians. If someone in your family has glaucoma, you are also at higher risk for glaucoma. Having certain other diseases can also put you at risk for glaucoma. For example, patients who have sleep apnea are at higher risk for developing glaucoma. The peripheral vision loss that occurs in glaucoma is permanent and irreversible. It is extremely important to see your eye doctor to determine if you have glaucoma. Glaucome is not curable. But, glaucoma is very treatable. there are several medications that exist to treat glaucoma and most of these medications are well tolerated by most people.Testing of your periphery vision involves a visual field test. This can be done by a confrontational visual field or a more formal automated visual field. These tests are non invasive (no needles!) and take a few minutes per eye. Testing peripheral vision is especially important if you have risk factors for glaucoma. Glaucoma is a treatable but not curable eye disease. If it is untreated it can result in permanent peripheral vision loss. Glaucoma can also lead to total blindness and is one of the leading causes of vision loss in the world. Sources:Khoury, Johnny, M.; Donahue, Sean, P.; Lavin, Patric, J.; Tsai, James (1999). "Comparison of 24-2 and 30-2 Perimetry in Glaucomatous and Nonglaucomatous Optic Neuropathies".Journal of Neuro-Ophthalmology.19(2): 100–108.doi:10.1097/00041327-199906000-00004.PMID10380130Ishiyama, Y.; Murata, H.; Mayama, C.; Asaoka, R. (11 November 2014)."An Objective Evaluation of Gaze Tracking in Humphrey Perimetry and the Relation With the Reproducibility of Visual Fields: A Pilot Study in Glaucoma".Investigative Ophthalmology & Visual Science.55(12): 8149–8152.doi:10.1167/iovs.14-15541.PMID25389198McMonnies CW. Glaucoma history and risk factors. J Optom. 2017 Apr-Jun;10(2):71-78. doi: 10.1016/j.optom.2016.02.003. Epub 2016 Mar 23. PMID: 27025415; PMCID: PMC5383456.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383456/
4 min read
What Does Medicare Cover In Cataract Surgery

What Does Medicare Cover In Cataract Surgery?

Cataract surgery cost can be a cause of concern for many people. If you have health insurance, you are in luck. Most health insurances, including Medicare, will cover the cost of basic cataract surgery. Medicare will cover the surgeon's fees, the cost of a basic intraocular lens, and the fees for the place in which you have the cataract surgery. This will usually also include the fees for the anesthesiologist. This is the second doctor that is involved in your care during cataract surgery after the cataract surgeon. The amount of coverage for the surgeon's fees, the lens, and the surgery center will depend on your specific Medicare coverage and if you have secondary health insurance or not. There are also certain upgrades that are available that Medicare may not cover but many people do choose to get these upgrades. More about these upgrades and their benefits are discussed below.The most common cause of cataracts is the aging of your body's natural lens. Because cataracts are a part of the normal aging process, the majority of people who get cataracts are older. Therefore, many of these patients will be eligible for Medicare coverage. If you happen to get a cataract when you are younger, it is important that you have commercial insurance. If you are uninsured and develop a cataract, the cost for cataract surgery can be almost $5,000 per eye if not more. The cost for cataract surgery includes many different things. The first part of the cost for cataract surgery is the cost of the two doctors involved in your care. The first doctor is your ophthalmologist who is your cataract surgeon. The surgeon's fee will include not only the surgery itself but also the testing that is required before surgery. There is important pre-operative testing before cataract surgery that helps the ophthalmologist figure out which lens needs to be implanted into the eye. Additionally, after surgery, a patient will have several post-operative visits. The cost for cataract surgery includes the visits before the surgery, the surgery itself, and the post-operative visits with the eye doctor. Another cost related to cataract surgery is the anesthesia that is required. Every patient will need some level of anesthesia in order to be comfortable during cataract surgery. An anesthesiologist is a doctor that will give you medicine to make you comfortable during the surgery. The anesthesiologist will also monitor your vital signs like heart rate and breathing to make sure you are stable during the procedure.The second major cost is related to where the surgery is done, and the type of staffing and equipment that will be involved. This is likely to be more expensive than the cost of the doctors. If you are generally a healthy person with minimal medical problems, is is likely that you can have cataract surgery done as an outpatient. This means that you do not require admission to a hospital for your surgery. Outpatient surgery centers are the most common place where people have cataract surgery done. If someone has many medical problems they may need to have inpatient surgery. This means they will be an inpatient at a hospital and will likely need to stay at the hospital the night before and maybe even the night after the surgery. As expected, inpatient cataract surgery is far more expensive than outpatient cataract surgery. Finally, the last major cost in cataract surgery is the cost of the lens. Because the natural lens of the eye is being removed from the eye, an intraocular lens must be placed into the eye. This lens is made in several different powers so that it can be closely matched to what your eye needs. There are many different types of lenses. The ones that are generally covered by insurance tend to be less expensive than specialty lenses like toric lenses or multifocal lenses. A toric lens is a special intraocular lens that corrects a patient's astigmatism. It is typically not covered by Medicare or by any medical insurance. A patient that wants a toric lens will have to pay an additional $1500-$2000 for this lens to be placed in the eye. In addition to the cost of the lens itself, a toric lens requires the surgeon to rotate the lens to a specific axis. This means extra time and work for the surgeon. The cost of this is built into the upgrade. Toric lenses can be very valuable to people with high degrees of astigmatism. For these patients, upgrading to a toric lens could mean not having to wear glasses for distance vision. It is important to talk to your doctor about whether cataract surgery with a toric lens is right for you. A multifocal IOL is another specialty lens that is typically not paid for by Medicare or any other health insurance. This lens is special because it has multiple distances at which it can correct vision. That is why it is called a "multi" "focal" lens. Most lenses that are covered by Medicare are those lenses that can only focus light at distance. This means they are single vision lenses. They provide clear vision at distance only. Many patients choose to pay for an upgrade to a multifocal IOL (intraocular lens) because it means they do not have to wear reading glasses. This means they are essentially free from wearing glasses. The cost of a multifocal IOL upgrade can be anywhere from $2500 to $5000 per eye. Cataract surgery can be assisted with laser. Cataract surgery can not be done entirely with a laser. If your doctor is able to use a laser for cataract surgery, there are some added benefits of increased precision and accuracy. The surgical time and healing time may also be shorter when a laser is used in certain steps of cataract surgery. Remember that laser-assisted cataract surgery is not done in all patients, and the majority of patients have very good outcomes in cataract surgery. If it is available to you, it is something to discuss. with your doctor. For some patients who may be more high risk or have a history of previously complicated eye surgery, laser-assisted cataract surgery may be something to consider seriously.Medicare will cover the basic costs of cataract surgery and a single vision intraocular lens. If a patient wants a multifocal lens, a toric lens, or cataract surgery that is assisted by laser, they will have to pay additional fees. The cost of these fees will vary depending on the doctor and the type of upgrade the patient wants.
6 min read
Twitch In Eye

What Causes An Eye Twitch?

There are 3 main eye twitch causes. Fortunately, the most common cause of an eye twitch is the common eye twitch and it is generally harmless. This eye twitch is usually caused by stress, lack of sleep, fatigue, ocular surface irritation, ocular allergies or dry eyes. If a patient complains of an eye twitch that happens once in a while but has no regular pattern, it is likely from other elements in their life. Poor sleep and excessive exhaustion has been known to cause eye twitches. The common eye twitch can happen on one side or it can happen on both. So, you can have a left eyelid twitch or a right eye twitch . Patients also about their eye twitching in pregnancy. This is likely to be the common eye twitch. However, because pregnancy is a vulnerable state, remember to discuss any problems with your Obgyn and your eye doctor. The good news is, that the common eye twitch is likely to resolve on their own if the patient is able to rest and take care of themselves. In addition to getting rest, it's important to lubricate the surface of the eye as well. This can be done easily through artificial tears. Artificial tears can be bought without a prescription and are generally safe to use three to four times a day. Another way to soothe the eyes is through an eye mask. A heated eye mask can help improve dry eye and can provide some relaxation for the patient as well. Cutting down on caffeine can also be helpful. If you have done all these things and your twitch is not improving, it is likely time to make an appointment with an ophthalmologist. Blepharospasm is another one of the eye twitch causes. It is much less common than the common eye twitch. It can also be more serious. It is also called Benign Essential Blepharospasm. Essential blepharospasm is caused by a nerve impulse. This impulse makes the eyelid close involuntarily. It can happen to either eyelid or it can happen to both at the same time. The duration can vary from a few seconds to a few hours in severe cases. For patients with severe blepharospasm, their eyelids may close so tightly that it affects their daily life. These spasms are usually treated by an ophthalmologist with botulinum toxin. After injecting botulinum toxin into the face, the patient can see relief in as quickly as one day. The relief usually lasts about 3 months before it needs to be repeated. This is the least common of the eye twitch causes. It is a rare condition. Hemi means half, so a hemifacial spasm means that the spasm involves half the patient's face. In this spasm, muscles on one side of the face tighten. These spasms may start near your eye and then affect other parts of your face. In advanced cases, a hemifacial spasm can last for several days to a few months. Hemifacial spasms are usually caused by pressure on cranial nerve 7 which is the facial nerve. This is the same nerve that is affected in Bell's Palsy. Botulinum toxin is used to treat hemifacial spasm also.The main eye twitch causes are the common eye twitch, blepharospasm and hemifacial spasm. The common eye twitch is far more common than the other two and is usually from fatigue, stress of caffeine. Lifestyle modifications are the first step in overcoming the common eye twitch. Sources:https://www.aao.org/eye-health/tips-prevention/how-to-stop-eye-twitchingDefazio G, Hallett M, Jinnah HA, Conte A, Berardelli A. Blepharospasm 40 years later. Mov Disord. 2017 Apr;32(4):498-509. doi: 10.1002/mds.26934. Epub 2017 Feb 10. PMID: 28186662; PMCID: PMC5941939.https://pubmed.ncbi.nlm.nih.gov/28186662/Chaudhry N, Srivastava A, Joshi L. Hemifacial spasm: The past, present and future. J Neurol Sci. 2015 Sep 15;356(1-2):27-31. doi: 10.1016/j.jns.2015.06.032. Epub 2015 Jun 16. PMID: 26111430.https://pubmed.ncbi.nlm.nih.gov/26111430/
4 min read
Eyelid Swollen And Red

Eyelid Swollen And Red

Is your eyelid swollen and red? A red eyelid that also has swelling could be from a few different things. Some causes of a swollen and red eyelid are not very harmful, and others are more concerning.Eyelid inflammation can cause an eyelid that is red and swollen. Eyelid inflammation is most commonly from a disease called blepharitis. Sometimes eyelid inflammation can also be from a stye or a chalazion. In this situation you may feel a discrete bump on the eyelid. The bump may not appear right away. It could appear one to two days after the eyelid becomes swollen and red. In order to treat blepharitis, it is important to make sure that the eyelid glands (called the meibomian glands) are functioning properly. Applying a moist heat mask two to three times a day can be extremely helpful. This will help to unclogg the meibomian glands which could be causing the Allergic eyelid swelling is one of the most common reasons to have a puffy eyelid. Fortunately, in most cases this is due to seasonal allergies, and tends to resolve as allergy season is over. Many patients may also take over the counter allergy medication that can help with this problem. If the allergic eyelid swelling is due to a true allergy to a food, plant or something else that can also cause a more severe reaction, it is important to seek out medical care as soon as possible. While allergic eyelid swelling from eating food is uncommon, it is possible. Allergic eyelid swelling can also happen from physical contact with a potential allergen. If you have recently changed your brand of eye make up or you have started using a new laundry detergent for your bedding, you may want to stop what is new and see if there is an improvement in your symptoms. Preseptal cellulitis is a more serious cause of a red eyelid that is also swollen. Preseptal cellulitis is caused by a bacterial infection in the eyelids. Sometimes the infection can be from a stye. In other cases the infection can be from an extension of an infection inside a person's sinuses. Preseptal cellulitis can be dangerous and needs urgent medical evaluation and treatment. Treatment for preseptal cellulitis 1600/6 is usually oral antibiotics. The bacteria usually responsible for preseptal cellulitis are Staphylococcus aureus, and bacteria in the Streptococcus family. If preseptal cellulitis advances to orbital cellulitis, a person may need to be admitted to the hospital for intravenous antibiotics. Is your eyelid swelling up randomly? If you are having random eyelid swelling, it may be nothing, or it could be something called urticaria. In most cases of patients who have random eyelid swelling that is not red, painful or itchy, it is likely because they slept on their face causing their eyelid to become puffy. However, if your eyelid swelling happens constantly and it does not go away quickly, it is important to talk to an ophthalmologist and also an allergy doctor. Depending on the cause of your red eyelid and the severity of the swelling, you may or may not need urgent medical attention. Allergic eyelid swelling and blepharitis are less concerning, but preseptal cellulitis is a much more serious condition that needs antibiotic treatment. If you have a red and swollen eyelid, be sure to see an ophthalmologist right away. Sources:Amescua G, Akpek EK, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK, Varu DM, Musch DC, Dunn SP, Mah FS; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019 Jan;126(1):P56-P93. doi: 10.1016/j.ophtha.2018.10.019. Epub 2018 Oct 23. PMID: 30366800.https://pubmed.ncbi.nlm.nih.gov/30366800/Williams KJ, Allen RC. Paediatric orbital and periorbital infections. Curr Opin Ophthalmol. 2019 Sep;30(5):349-355. doi: 10.1097/ICU.0000000000000589. PMID: 31261188.https://pubmed.ncbi.nlm.nih.gov/31261188/Papier A, Tuttle DJ, Mahar TJ. Differential diagnosis of the swollen red eyelid. Am Fam Physician. 2007 Dec 15;76(12):1815-24. Erratum in: Am Fam Physician. 2008 Jun 1;77(11):1505. PMID: 18217520.https://pubmed.ncbi.nlm.nih.gov/18217520/
4 min read
Diabetes In Eye Glucose Reading Doctor

Diabetes In Eye: Who Is At Risk?

Diabetic retinopathy is the medical terminology for diabetes eye problems. It is one of the leading causes of irreversible blindness in the world. Diabetic eye disease can happen from Type 1 or Type 2 diabetes, but the risk with Type 1 is much higher. This is because Type 1 Diabetes tends to happen earlier in life and a person has to live with it for many years. A study was done to evaluate the rates of diabetic retinopathy. This study was The Wisconsin Epidemiologic Study of Diabetic Retinopathy, abbreviated as WESDR. This study showed that after having diabetes for 20 years, 99% of patients with type 1 diabetes will some level of diabetic retinopathy. Type 2 diabetics are also likely to develop diabetic retinopathy, but are less likely than people who have Type 1 Diabetes. The WESDR study showed that after 20 years, 60% of type 2 diabetics will have some degree of diabetic retinopathy in the eye.If you developed diabetes during your pregnancy (called Gestational Diabetes Mellitus, or GDM), you have a 70% chance of going on to develop Type 2 diabetes in your life. If you already have diabetes and become pregnant, your diabetes could become much worse during pregnancy so it is important to control your blood sugars so that you do not have pregnancy-related complications or any eye problems from diabetes.There are a few risk factors for developing diabetic eye disease. The first major risk factor is how long a patient has had diabetes. Since Diabetes Type 1 develops earlier in life, it is not surprising that nearly all patients with Type 1 Diabetes will have some degree of retinopathy after 20 years. Poor blood sugar control is another major risk factor for developing diabetes eye problems. Blood sugar control is measured in two ways. One is through a daily prick with an at-home glucose monitor. This gives you your blood sugar level at that moment. There is a blood test for Hemoglobin A1C which gives your doctor an average of how your blood sugar has been doing over the last 3 months. This level is important because it is not just about one point in time but rather has 3 months of data. High hemoglobin A1c (HbA1c) levels increase your risk of diabetic eye disease. Also, high blood pressure is associated with an increased risk of diabetic retinopathy. There is more than one way diabetes can affect the eye. In some patients, diabetes can cause swelling in the central part of the retina. This is called macular edema. In other cases, patients may have bleeding in their retina, or can even develop a retinal detachment from their diabetes. Some patients with diabetic eye problems will have new vessels that grow in different parts of their eyes. While new blood vessels do not seem like a bad thing, having new blood vessels grow inside the eye is very dangerous. These vessels can disrupt the way the normal eye works and cause bleeding, increased pressure, and vision loss. In most cases, early diabetic eye diseases are not very symptomatic. In fact, most patients have no idea that their eye is being negatively affected by diabetes until they go to see an eye doctor. It is important to see an ophthalmologist at least once a year for a dilated eye exam if you have diabetes. If you have poorly controlled diabetes, then your ophthalmologist may even want to see you every 6 months. One late symptom of diabetic eye disease is blurry vision, which may be from macular edema but also could be from bleeding in the eye (vitreous hemorrhage). Another symptom can be total vision loss or severe blurry vision. This may be from a retinal detachment. In less common cases, eye pain and eye redness can be a result of diabetes if the diabetes is causing a high eye pressure. This is called neovascular glaucoma and it is a very serious and late-stage complication of diabetes. Good blood sugar control is the number one factor in preventing diabetic eye problems. Once diabetic retinopathy develops it causes many other problems in the eye like retinal detachments, bleeding, and even glaucoma. It is very important to control your blood sugar and to see an ophthalmologist for a dilated eye exam every year if you have diabetes. Once you lose vision from diabetes, it is very hard, even with modern treatment, to recover all of the lost vision.Sources:Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. doi: 10.1016/S0161-6420(03)00475-5. PMID: 13129861.https://pubmed.ncbi.nlm.nih.gov/13129861/Sabanayagam C, Banu R, Chee ML, Lee R, Wang YX, Tan G, Jonas JB, Lamoureux EL, Cheng CY, Klein BEK, Mitchell P, Klein R, Cheung CMG, Wong TY. Incidence and progression of diabetic retinopathy: a systematic review. Lancet Diabetes Endocrinol. 2019 Feb;7(2):140-149. doi: 10.1016/S2213-8587(18)30128-1. Epub 2018 Jul 11. PMID: 30005958.https://pubmed.ncbi.nlm.nih.gov/30005958/Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010 Jul 10;376(9735):124-36. doi: 10.1016/S0140-6736(09)62124-3. Epub 2010 Jun 26. PMID: 20580421.https://pubmed.ncbi.nlm.nih.gov/20580421/
5 min read
Lasik Surgery For Eyes

LASIK Surgery For Eyes: Seeing Without Glasses?


What is LASIK?

If you are an adult who has had a stable eye prescription for many years, you may be a candidate for a laser eye surgery known as LASIK. It has the potential to replace or reduce your need to wear glasses (or contacts). The FDA approved LASIK surgery in 1998 and about 700,000 Americans have this procedure annually. LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a surgical procedure that changes the shape of your cornea permanently. The cornea is the front part of your eye and it bends light entering the eye.

If you do not have good vision naturally, you will need glasses or contacts. Glasses help your eyes in bending (refracting) light, so it properly strikes the retina in the back of your eye. If you need glasses, that means your eyes have what is called a “refractive error." Glasses correct your refractive error. With LASIK, your ophthalmologist uses a laser to adjust the shape of the cornea. After LASIK, your eye refracts light onto your retina with little to no help of glasses or contacts.
LASIK treats myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (imperfect cornea). Myopia is when your eyeball has a steeper curvature than normal. Myopics can see objects nearby but cannot see those that are far away. Hyperopia occurs when your eyeball is flatter than normal. As a result, nearby objects appear blurry. Astigmatism is an irregular curvature of your cornea, hindering nearby and far away vision. People requiring glasses often have combinations of myopia/hyperopia and astigmatism. It's important to know that LASIK cannot reverse presbyopia, which are the vision changes associated with aging.
LASIK surgery can improve the life of many people with refractive errors, but it is not for everyone. Your ophthalmologist will review your medical history and lifestyle goals to see if you may be a good candidate. Generally, if you are an adult with healthy corneas and an eye prescription that hasn’t changed, LASIK may be appropriate for you. LASIK will temporarily cause dry eyes and visual problems such as glare, which self-resolve after a few months. Around 90% of people who have LASIK end up with vision between 20/20 and 20/40.

Cost For LASIK Eye Surgery
Laser eye surgeries are considered to be an elective procedure by most insurance companies. Unfortunately, this means that LASIK is usually not covered by insurance. and you are responsible for providing the full cost of the surgery. The average price for LASIK surgery in the US in 2020 was $2,632 per eye. Thus, LASIK surgery for both of your eyes will be about $5,000 out of pocket. It is important to understand that LASIK is usually only a one-time cost. From a financial perspective, there may be significant savings in the long term as you will save on the cost of recurring prescription glasses and contact lenses.
REFERENCES
https://www.aao.org/eye-health/treatments/lasikhttps://www.aao.org/Assets/e890eb55-9bfa-465a-8422-8fdbd828518e/635854347414670000/lasik-patient-guide-pdf?inline=1https://www.forbes.com/health/body/how-much-does-lasik-cost/
3 min read
Optometry Vs Ophthalmologist

Optometry Vs Ophthalmologist

With the names of Ophthalmologist, Optometrist, and Optician, it can be difficult to know which person to visit and who is the best person to manage your eye problems. The basic difference is an Ophthalmologist is a medical doctor (degree of MD or DO) who goes to medical school, and an optometrist practices in the field of optometry, but does not go to medical school and does not complete a surgical residency. An optician is not an eye doctor. In many offices, ophthalmologists, optometrists and opticians will work together.An ophthalmologist is a fully licensed medical doctor (MD or DO) who has completed extensive education and comprehensive training to treat all eye conditions. They are trained surgeons and are licensed to prescribe medications in the treatment of eye diseases.  An Ophthalmologist is different from an optometrist given their increased training and a broader scope of practice. Ophthalmologists are able to perform comprehensive eye exams, provide a variety of vision tests, provide a diagnosis, and treat all eye conditions with medication or perform surgery if needed. They are also able to prescribe glasses, and contacts to treat vision problems. Ophthalmologists are the eye professionals who are specially trained to manage all eye conditions, simple or complex, that other eye care professionals cannot treat. To become an ophthalmologist, one must receive an undergraduate degree before matriculating to medical school. After completing medical school for 4 years and earning an MD or DO degree, these doctors must undergo further specialty training and apply for a competitive spot in Ophthalmology residency. Ophthalmologists then complete ophthalmology residency for 4 years, during which they practice surgery and prescribe medications for all types of eye diseases. After completing residency, an ophthalmologist can then decide to complete further subspecialty training by applying and competing for a position in a fellowship program for 1 or 2 years. Some of the most common subspecialty areas in Ophthalmology are Glaucoma, Cornea, Uveitis and Immunology, Ophthalmic Plastic and Reconstructive Surgery, Retina, Neuro-ophthalmology, Pediatric ophthalmology and Strabismus, Pathology, and Ocular Oncology. A fellowship-trained Ophthalmologist will have completed 9 or 10 years of education after college. Optometrists practice optometry and have a Doctor of Optometry (OD) degree. This is different from an MD or a DO, which are both degrees that an ophthalmologist can have, and they mean that the ophthalmologist has both medical and surgical training in ophthalmology. An optometrist is not a medical doctor. They do not go to medical school and do not complete surgical residency training as an Ophthalmologist does. An optometrist is able to do comprehensive eye exams, vision tests, and can prescribe glasses and contacts. Optometrists are able to diagnose certain eye conditions and prescribe medications for the basic treatment of some eye conditions like dry eye, glaucoma, and iritis. They are not surgically trained to do lasers or other complex procedures or surgery on the eye. An optometrist will usually refer to an ophthalmologist for lasers, procedures, and surgery. Optometrists may also refer to ophthalmologists in the case of more complex disease such as glaucoma, cataracts, and diabetic eye disease.Education: To become an optometrist, one must complete either 2-4 years of undergraduate education before attending optometry school. By attending and completing optometry school for 4 years, an individual will obtain a Doctor of Optometry (OD) degree. Optometrists can then choose to undergo optional specialty training for one year. The categories of optometric specialty training are primary care optometry, pediatric optometry, cornea and contact lenses, vision rehabilitation, and ocular disease. An optometrist will have completed 4 or 5 years of education after college. An optician is not an eye doctor. An optician is a technician who provides care to patients by helping to fit patients with glasses or contacts. They do not provide comprehensive eye exams, diagnose, or treat any medical conditions. Opticians will take measurements of the patient’s pupillary distance, vertex size, eye size, and temple length and use the glasses or contacts prescription written by Optometrists or Ophthalmologists to find the correct fit of glasses or contacts for a patient.When starting training to become an optician, most applicants have a high school degree or GED; however, this is usually not a requirement across the nation. Individuals may then obtain qualifications via three routes. The first route is by earning an optician certificate through a post-secondary school program which usually lasts one year. The second route is by attending a two year program in a college accredited by the commision on Opticianry Accreditation. This will award the individual an Associate’s Degree in Ophthalmic Dispensing. The third route is by obtaining an apprenticeship under the supervision of an Ophthalmologist or Optometrist. Although there are a certain number of hours required for satisfactory completion of an apprenticeship, the requirements vary across the nation. The eyes are the organs responsible for vision and arguably the most important sense, sight. Unfortunately, there is no replacement for the eye. Therefore, staying up to date with eye health and visiting an eye doctor at regular intervals is important. Each eye care professional has a different level of training, expertise, and a different scope of practice (what each person can and can not do) which gives them the ability and knowledge to treat a specific eye problem. An ophthalmologist is a general eye doctor and an eye surgeon who can do lasers, eye surgery, as well as basic eye exams for glasses and contacts. An optometrist is an eye care professional who usually does general eye exams but does not have surgical training or training to perform lasers. Depending on your needs, you can make the decision to see an optometrist or an ophthalmologist. An optician is not a doctor and is a professional that can help you get fitted for the right pair of glasses. An optician can not perform an eye exam. 
6 min read
Glaucoma Narrow Angle

Narrow Angle Glaucoma

Glaucoma damages your optic nerve, which normally sends signals to your brain so you can see. Glaucoma is the leading cause of irreversible blindness. Glaucoma comes in many varieties. One serious but rare type of glaucoma is Narrow Angle Glaucoma which sometimes is also called Angle Closure Glaucoma. Narrow angle glaucoma is different from the most common form of glaucoma, known as open angle glaucoma. While open-angle glaucoma unfolds over years, narrow angle glaucoma can be acute, where it happens suddenly, or it can also be chronic, where it happens over a longer time.  The difference between narrow angle glaucoma and open angle glaucoma is the way in which a person's eye is shaped.Everything that happens in narrow-angle glaucoma can be understood by understanding the name. Your eye's "angle" rests between the eye's natural drainage system, known as the trabecular meshwork, and the iris. Narrowing or closure of this angle results in a clogging of the drainage system. As a result, fluid pressure builds up in the eye. This rapidly alters one's vision and can progress to blindness within a day.Symptoms of acute narrow-angle glaucoma include sudden eye pain, red eye, blurry vision, rainbows, nausea, vomiting, and headaches. This is a medical emergency that could result in permanent vision loss if not treated quickly. If you have these symptoms, you should see an eye doctor immediately, or go to an emergency room where you can get medications to lower your eye pressure.Chronic narrow angle glaucoma occurs over time. It does not usually present with the above sudden symptoms. Instead, it presents asymptomatically on routine exam. The doctor may see tissue adhesions (known as synechiae) formed between your iris and trabecular meshwork. They may also note an increasing eye fluid pressure (known as "intraocular pressure," or IOP). If you have the above symptoms, your eye doctor will want examine you further. They will first want to take a look into the front part of your eye to visualize your eye drainage angle. This is done with an instrument called a gonioscope. The angle of the eye is the part of the eye that drains the fluid from the eye. When the angle is narrow, you have an anatomically narrow angle. This shape of the drainage system can then lead to narrow angle glaucoma.Some people just have an anatomically narrow angle. Other people may develop one over time or due to trauma. With age, the lens within our eyes enlarges, and this can push up on the iris, which narrows the angle. Physical injury to the eye can also dislocate the lens, causing narrow-angle glaucoma. Some patients are born with anatomic differences that decrease their eye angle. Patients at risk for narrow angle glaucoma include those with smaller eyes (resulting in far-sightedness), older age, female sex, Asian and Native American ethnicity, or having a family history of angle-closure. Chronic narrow-angle glaucoma may occur over time in patients when tissue adhesions form between the iris and trabecular meshwork. The eye doctor will do a gonioscopy exam, in which they place a large lens onto your eye to take a direct look at the angle of your eye. Your doctor will also peer through a slit-lamp microscope to look at the entire front part of your eye. They will use a ophthalmoscope to look at your optic nerve to see if there is damage. Doctors may also check how good your peripheral vision is through a testing of your visual fields. They can also in office scan, called an OCT, or an ultrasound (UBM) of your eye to look at your optic nerve or eye angle. In healthy eyes, IOP is 10-21 mm Hg. Glaucoma is defined by elevated IOP. Acute narrow-angle glaucoma usually presents with a sudden increase in IOP >40 mm Hg due to the obstruction of the drainage angle. As mentioned above, such increased pressure in the eye may damage the optic nerve. Medical treatment for acute narrow-angle glaucoma should first quickly lower your fluid pressure levels (IOP) to prevent further damage to the optic nerve. Your doctor can use topical eye drops including various classes of beta blockers, selective alpha agonists, carbonic anhydrase inhibitors,  amongst others. They may also use systemic therapy like mannitol or oral osmotic agents.The next step in the treatment of narrow-angle glaucoma, both acute and chronic, is a laser iridotomy. An eye surgeon will use a laser to make a small pinhole in your iris. Fluid flows through this hole and fixes the drainage problem. If you have a narrow angle in one eye, your other eye is also at risk. Your surgeon will perform the same procedure in the other eye as well to prevent future attacks. Your IOP will be routinely monitored as an extra method of prevention.


Sources: 
https://glaucoma.org/are-you-an-angle-closure-glaucoma-suspect/https://glaucoma.org/what-is-angle-closure-glaucoma/?print=printhttps://eyewiki.aao.org/Primary_vs._Secondary_Angle_Closure_Glaucomahttps://www.aao.org/munnerlyn-laser-surgery-center/angleclosure-glaucoma-19https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/glaucoma?sso=y 
5 min read
Symptoms Macular Pucker Image Of Amsler Grid

Epiretinal Membrane (Macular Pucker): Causes, Symptoms, and Treatment

A macular pucker is a more casual name for what ophthalmologists call an epiretinal membrane. The phrase “epi” means to be above, and “retinal” refers to the retina of a patient. This essentially means that an epiretinal membrane, abbreviated as ERM, is abnormal tissue that lies above the retina. The part of the retina that this usually happens in, is called the macula. The macula is the center part of the retina. Because this membrane can pull onto the macula and it can also wrinkle and crease, the more casual term for it is macular pucker. In order for a person to have clear central vision, it is important that the macula lies flat. If the macula is puckered, pulled or wrinkled it can cause visual problems. If you have an ERM, you have two options. One is to monitor it, and the other is surgical intervention. Surgery for epiretinal membrane is done when the macular pucker is causing issues.So, what causes an epiretinal membrane? Before we get into what causes an ERM, let’s talk a little bit about the anatomy of the eye. In the simplest terms, the eye is a ball that is filled with liquid. One of these liquid substances is called the vitreous. The vitreous sits between the lens of the eye and the retina. As all people get older the vitreous begins to change. It will shrink, break up and also start to pull away from the retina of the eye. This pulling or traction can then lead to the formation of an epiretinal membrane. Risk factors for this happening include previous eye surgery like repair of a retinal detachment, age above 50, and also having a PVD (posterior vitreous detachment). In some cases if you have a macular hole, scar tissue can form over it resulting in an epiretinal membrane. In some cases, there is no specific cause leading up to an ERM.As mentioned above, the most common symptoms of macular pucker or of an epiretinal membrane are blurry vision or visual distortion. Because the macula is responsible for seeing fine detail and seeing distance, the blurry vision can be constant. In addition to blurry vision, patients may experience visual distortion. Visual distortion means that a straight line may appear wavy to someone who has an epiretinal membrane. A patient may cover their abnormal eye and see the line as straight with the eye that is normal. But when they switch to cover the normal eye and only look at the line with the eye that has the ERM, the line may appear wavy or crooked. Because the macula is in the center of your retina, an epiretinal membrane does not affect a person’s peripheral vision. Less common symptoms of macular pucker are a blind spot in the center of the vision or a graying of the central vision. The symptoms that are not associated with a macular pucker or ERM are pain and redness. If a patient is having eye pain or eye redness, it is likely due to an issue that is unrelated to an ERM. An epiretinal membrane can only be seen by an eye doctor. The most skillful eye doctor to evaluate and treat an epiretinal membrane is an ophthalmologist and if you have one in your area, a retina specialist. It is important to note that the symptoms of a macular pucker tend to happen gradually. This is different from eye problems like retina detachments where the vision can become very blurry over the course of a few hours. In macular pucker, the vision may become blurry over weeks to months. If you think you are experiencing symptoms of macular pucker, it is important to see an ophthalmologist. Your ophthalmologist can be a general ophthalmologist or a more specialized ophthalmologist called a retina specialist. In order to get the best view of your retina, the ophthalmologist will need to make your pupil bigger through a process called dilation. Two dilating drops called Phenylephrine and Tropicamide are usually used to make your pupil bigger. Dilating drops typically take 20 to 40 minutes to dilate your eye. After dilation, the ophthalmologist will use a special lens to look at the retina and more specifically at the macula (where your central vision comes from).After examining your macula, there will be a special test performed called an OCT. OCT stands for optical coherence tomography. This test takes a photographic scan of the retina. It does not hurt and only takes a few seconds to complete. It is important to follow the doctor or technicians instructions so that a high quality study can be obtained. If you have an ERM, the doctor should be able to see in on the OCT scan. It is important to remember than most vision insurance plans do not cover advanced medical testing. You may need to use your medical health insurance in order to have your OCT done. In some cases, a macular pucker may cause no symptoms or very little symptoms. In many of these patients, it is reasonable to monitor the patient closely. If visual symptoms begin to develop or the ophthalmologist sees changes that are concerning, they may advise surgery. There is no eye drop that can treat macular pucker. The only option is surgery. The name of the surgery is called a vitrectomy. The first part of this word stands for vitreous, the gel like substance that fills the eye. The second part of this word stands for removal. Thus, in a vitrectomy, the vitreous is removed. By removing the vitreous it is no longer able to pull on the retina. After the vitreous is taken out, the epiretinal membrane is peeled off the eye. Then, the eye is filled with a combination of air and special gas.Although this surgery should improve your vision over time, the recovery will not be immediate. In many cases the vision may not be as good as it was before you had the ERM to begin with. This is why some mild cases of macular pucker are monitored by ophthalmologists and retina specialists. Only when an ERM becomes a problem is when it is operated on. Sources:Hirakata T, Hiratsuka Y, Yamamoto S, Kanbayashi K, Kobayashi H, Murakami A. Risk factors for macular pucker after rhegmatogenous retinal detachment surgery. Sci Rep. 2021 Sep 14;11(1):18276. doi: 10.1038/s41598-021-97738-x. PMID: 34521926; PMCID: PMC8440624.https://pubmed.ncbi.nlm.nih.gov/34521926/Kanukollu VM, Agarwal P. Epiretinal Membrane. 2022 Mar 16. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32809538.https://pubmed.ncbi.nlm.nih.gov/32809538/Yusuf AM, Bizrah M, Bunce C, Bainbridge JW. Surgery for idiopathic epiretinal membrane. Cochrane Database Syst Rev. 2021 Mar 24;3(3):CD013297. doi: 10.1002/14651858.CD013297.pub2. PMID: 33760235; PMCID: PMC8095007.https://pubmed.ncbi.nlm.nih.gov/33760235/
6 min read
Why Is My Eye Itchy

Corners Of Eye Itchy

Is your eye itchy? There are a few things it could be. The diagnosis depends on what other symptoms you may be having in addition to the eye itching. A swollen itchy eyelid may be different than if the eye is itchy and red. So, if you are asking yourself, "why is my eye itchy?" keep reading to learn about the different causes.If your eye is itchy only in the corner, it is likely from a mild allergy or it could be from blepharitis. A mild allergy to something in your environment can cause make the corner of your eye itchy. It may or may not be associated with eye redness. Blepharitis usually does not cause eye redness. If you have blepharitis, the corner of your eye may be itchy along with having itchy eyelids. Blepharitis is an inflammatory problem of the eyelid, and it can cause the corners of the eye to be itchy along with the eyelids as well. Another reason the corner of your eye may be irritated is if there is something stuck in that area like an eyelash. This however is more likely to cause pain rather than itching. If your eye is itchy and red, there are three common things eye doctors will check you for. (1) The first is ocular allergies. Ocular allergies can happen seasonally and this is usually the most common reason for them. As mentioned above, ocular allergies may or may not have a red eye. (2) Another reason you may have an eye that is itchy and red is if you have an allergic reaction to something specific. Some common causes include being allergic to an eye drop that you are taking or maybe you started using new make up that is causing you to have an eye that is both itchy and red. If you have symptoms like sneezing and the allergy is triggered when you go outside, it may be a seasonal allergy. If the eye is itchy and red when you use a certain product on your face, then that is likely causing the problem. (3) A third reason to have an itchy eye that is also red that is more concerning is conjunctivitis. Conjunctivitis typically has discharge also. It also tends to be contagious. If you have conjunctivitis in one eye it is likely to spread to the other eye. Viral conjunctivitis is usually caused by a virus called adenovirus and it tends to be very contagious. If you have viral conjunctivitis, it may appear after you have had a cold. There is usually no prescription treatment for viral conjunctivitis. An ophthalmologist will advise you to wash your hands frequently and use artificial tears for comfort. Viral conjunctivitis can take 2 to 4 weeks to resolve. Bacterial conjunctivitis is different from viral conjunctivitis. Bacterial conjunctivitis can be more concerning depending on the bacteria that is causing it. Some bacteria are more dangerous than others. Bacterial conjunctivitis can be treated with an antibiotic eye drop prescribed by your ophthalmologist. The eye discharge in bacterial conjunctivitis can be yellow or even have a slightly greenish tinge to it. (4) In extremely severe cases of blepharitis, the eye may also be red and itchy at the same time.The corners of your eyes may be itchy from a seasonal allergy, an environmental allergen, an allergic reaction to an eye drop or makeup, blepharitis, bacterial conjunctivitis, or viral conjunctivitis. If you have having eye pain or eye redness, you should see an eye doctor as soon as possible. An ophthalmologist can look under the microscope and figure out what is causing the corners of your eye to be itchy. Sources:Michael A. Lemp, Kelly K. Nichols, Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Treatment, The Ocular Surface, Volume 7, Issue 2, Supplement, 2009, Pages S1-S14, ISSN 1542-0124,https://www.sciencedirect.com/science/article/abs/pii/S1542012412706201https://eyewiki.org/Bacterial_ConjunctivitisFriedlaender MH. Ocular allergy. Curr Opin Allergy Clin Immunol. 2011 Oct;11(5):477-82. https://pubmed.ncbi.nlm.nih.gov/21822130/
4 min read
What Eye Color Is The Rarest

What Eye Color Is The Rarest?

Eye color is determined by the color of your iris. The iris is the tissue of the eye that makes a circle to form your pupil. The pupil gets bigger or smaller depending on the contraction of the iris. The color of the iris is what determines a person's eye color.The rarest eye color is actually not a color at all. The American Academy Of Ophthalmology conducted a survey in 2014 of eye colors and the findings are as below (1) :In the United States:If you don't count the last line, then the rarest eye color is green according the survey done by the AAO above. The most common eye color is brown. In the United States, almost half the population has brown eyes.Did you know that blue eyes are not actually blue? Blue eyes are blue because the tissue scatters light so more blue light reflects out. This is similar to how the sky is perceived as blue by the human eye. On the other hand, brown eyes are actually brown. Brown eyes are brown because of melanin which is a pigment. Melanin is the same pigment that makes some skin darker than others. For the other eye colors like green or hazel, the level of pigment is somewhere between brown eyes and blue eyes. There are some parts of the iris that have no melanin like blue eyes and some that do have pigment like brown eyes. The interaction between the blue light and the brown pigment makes the eye look green, hazel, or even speckled. The best way to "change" your eye color is to use colored contact lenses. Even if you don't have the need for a prescription to see clearly there are colored contacts available without a prescription. If you haven't worn contacts before you will need to go in to see an eye doctor who can help fit you for your first pair and also teach you how to take your contacts in and out of your eye. Iris impants have been done in some countries to change a person's eye color but they are often associated with inflammation and can cause may eye issues. Due to the potential for vision threatening eye problems, ophthalmologists in the United States generally advise against iris implants. Currently, there are no FDA approved iris implants for the purpose of changing your eye color. The rarest eye color is green and the most common eye color is brown. Brown eyes are brown because of the pigment melanin. If you don't like your eye color, you can change it by using colored contact lenses. Colored contacts are available for people even if they don't need a prescription for glasses to see clearly. You should see an eye doctor to get initially fitted for contact lenses and for them to teach you how to put in and take out a contact lens from the eye. Sources:(1) https://www.aao.org/eye-health/tips-prevention/your-blue-eyes-arent-really-blue(2) https://my.clevelandclinic.org/health/articles/21576-eye-colors#:~:text=Brown%2C%20which%20is%20the%20most,combination%20of%20brown%20and%20green.
3 min read
Chalazion Treatment

Chalazion Treatment : Top 5 Methods

A chalazion is a common but very frustrating eyelid problem. It can cause a bump on the eyelid and this bump can take weeks or even months to go away. A chalazion is an inflammatory condition of the eyelid. It can happen on either the upper or lower eyelid. It is a result of a clogged meibomian gland. Meibomian glands are sebaceous glands in the eyelids. Their main function is to produce the fatty layer of a person's normal tear film. In the upper eyelid, there are approximately 25 to 40 glands and in the lower eyelid, there are about 20 to 30 meibomian glands. When these glands become clogged, a chalazion can happen. This is important to understand because chalazion treatment involves keeping the meibomian glands unclogged. Here are the 5 best practices on how to treat a chalazion.(1) Prevention is important. If you have had a chalazion in the past, it's likely that you will have one in the future. So, preventing them is the best way to treat your problem. This means keeping the meibomian glands open so that they do not become clogged. Heat helps to keep the meibomian glands open. Ideally, this should be moist heat, but even dry heat can be helpful. When you are in the shower, you can use warm soapy water to clean and rinse the eyelids two times a day.(2) Use warm compresses and soapy lid scrubs. Once you already have a chalazion, you will want to do more heat. Warm compresses 2 times a day is likely not enough to treat a chalazion once it has formed. Warm compresses help the inflammatory tissue to break up and allows the clogged fluid to be released from the glands. Using a soapy scrub after the warm compress is important also. This clears away the clogged fluid that has been released from the clogged glands. Use a warm compress at least 6 times day for 10 minutes each time for the treatment of chalazion. (3) Your ophthalmologist may consider prescribing prescription medications, such as a steroid eye drop, or an oral medication called doxycycline. Steroid eye drops can help to reduce the inflammation in a chalazion. However, they should not be used as primary treatment. Most doctors will always recommend that steroids are used alongside warm compresses. If your eye doctor prescribes a steroid eye drop, you will likely have to go back in a few weeks to have your eye pressure checked. Steroid eye drops in some cases can cause a rise in eye pressure. Do not use a steroid eye drop unless you are under the care of an ophthalmologist who can monitor for any side effects. Doxycycline is an oral medication that can help thin out the secretions of the meibomian glands. This may be helpful in expressing the glands. Doxycycline should be used under the direction of your physician. (4) Some ophthalmologists are able to perform eyelid laser. This is called IPL or intense pulsed light therapy. It is a newer form of treatment that is gaining popularity with ophthalmologists. It is not invasive, painless and can be done in a matter of minutes. It is not covered by insurance and can cost anywhere from $150 to $400. (5) If conservative chalazion treatment is not working, you may need to have chalazion surgery. This is usually done by an oculoplastics specialist. An oculoplastics specialist is an ophthalmologist who has had 4 years of residency training and then one or two years of specialty training in diseases of the eyelid. The best chalazion treatment is prevention. After that it is warm compresses and good lid hygiene. Some people may also benefit from prescription medications and intense pulsed light therapy. If nothing seems to be working, see an ophthalmologist for chalazion surgery.Sources:https://eyefacts.com/article/Stye-Vs-Chalazion
4 min read
Stuck Contact Lens In Eye

Contact Lens Stuck In Eye? What Should You Do?

For contact lens wearers, one of the most stressful things is having a contact lens get stuck in their eye. The good news is, in most situations, this is more of an annoyance and once the contact lens is removed, you are unlikely to have any long term issues. If you are just starting to wear contact lenses, it is a good idea to try getting them in and out of your eye during normal business hours so that if you do have a problem, you can easily get in touch with your eye doctor. No, it can not get stuck behind the eye. This is a common myth / misconception. The part of the eye where a contact lens is placed does not directly connect to the tissue that is located behind the eye where the optic nerve is. So, while the contact lens can get stuck under the lower eyelid or under the upper eyelid, a contact lens is not able to travel behind the eye.As long as you can have the contact lens removed in a timely fashion (within a few hours), a stuck contact lens is unlikely to cause any major eye problems. If you are new to wearing contact lenses, this is why it is important to try taking them in and out of your eye during normal business hours. This way if you are unable to take your contact lens out, your eye doctor is likely to be available in the office. If you are not confident in your ability to take your contact lenses in and out of your eye, do not try to this over a weekend when someone may not be available to help you. If a contact lens stays in the eye for too long, there are some dangerous things that can happen to your eye. Some of the things that can occur if the stuck contact is in the eye too long include a corneal abrasion (scratch on the eye), and in a more severe case, patients can even get a corneal ulcer. The first step is to call an eye doctor. An eye doctor can use a special microscope called a slit lamp to examine your eye and figure out where the contact lens is. The eye doctor may use a special yellow dye called fluoroscein to help locate where the contact lens is. The eye doctor may also have to flip your eyelid in order to get a better view if they think the contact lens is hiding under the eyelid. If the ophthalmologist finds a scratch on the eye, which is called a corneal abrasion, they will likely give you antibiotic eye drops for this.
3 min read
Cataract Causes

What Causes Cataract?

Most cataracts are caused by aging. A cataract is a natural clouding of the lens of the eye that happens to everyone with time. Every eye has a lens that is located right behind the iris (or the colored part of the eye). The natural lens of the eye helps to focus the light to the back of the eye and create a clear image. Over time, usually due to aging and sometimes from other causes, the lens can become cloudy. This change is called a cataract.  It affects the way the light is focused to the back of the eye and, therefore, affects the eye’s ability to see a clear image. There are several different factors that can cause a cataract to form. The most common reason for cataract formation is aging. Over time the lens becomes cloudy and develops a yellow color. This is typically a very slow process that happens over many years or even decades. These cataracts are called nuclear cataracts or nuclear sclerosis. This change in the lens causes a very gradual blurring of the vision and often leads to a yellow tint to the vision. Due to the slow, progressive change symptoms are often not noticeable until they start interfering with daily activities.  Other common symptoms include glare from bright sunlight or headlights when driving at night and need for more light with fine vision like reading. Factors that have been found to contribute to formation of nuclear cataracts are UV exposure, smoking and previous eye surgeries.  A posterior subcapsular cataract (PSC) is another type of cataract. This occurs when a haziness forms on the back side of the lens and causes many of the same symptoms as nuclear cataracts including blurred vision, glare with lights and need for better lighting. PSC often forms much faster than nuclear cataracts and patients often notice progressive worsening of the vision over months or years. PSC cataracts can occur as a result of aging but can also be associated with other medical conditions including diabetes, use of oral steroids, and other eye diseases such as retinitis pigmentosa. Trauma to the eye or head is another cause of cataract formation.  Unlike other types of cataracts, traumatic cataracts often form instantly or very quickly after the injury and cause a dramatic decrease in vision.  Traumatic cataracts can form after both blunt trauma (such as a fist or fall) and after trauma which penetrates the eye (for example, from a knife or nail).  Damage to other ocular structures at the time of injury can sometimes increase risk of complications during removal of traumatic cataracts.Cataracts can also form prior to or shortly after birth and these are called congenital cataracts. These cataracts are less common than the cataracts which present in adults, however, they can interfere with important eye development in the first few years of life and lead to permanent vision loss if not corrected. Congenital cataracts are sometimes associated with other medical conditions, however, they can also be inherited or appear without a known cause.  Treatment for cataracts requires cataract surgery which removes the clouded natural lens of the eye and replaces it with an artificial lens implant. This surgery is performed in a surgery center or hospital as an outpatient, meaning the patient is sent home the same day as surgery.  Significant vision improvement is commonly noticed after cataract surgery and some people are eligible for upgraded lens implants which reduce glasses dependence after surgery.  An evaluation with an ophthalmologist will determine if cataracts are affecting vision in a significant way to need cataract surgery.SourcesBasic Clinical Science Course (BCSC) of the American Academy of Ophthalmology. Section 11. 2006 - 2007Cataract in the Adult Eye: Surgery and Diagnostic Procedures. Preferred Practice Patterns.American Academy of Ophthalmology. September 2006
4 min read
Myopia Vs Hypermetropia

Myopia Vs Hypermetropia

Hypermetropia (also called hyperopia) and myopia are both words used to describe a person’s need for glasses to see better. When someone is hyperopic (has hypermetropia) it means that they are far-sighted and when someone is myopic it means they are nearsighted. Nearsighted people see clearly up close and have blurry vision at a distance, and for far-sighted people, the opposite is true. Patients with myopia will have a negative sign in front of their prescription, such as -4.00. Patients with hyperopia or hypermetropia have a plus sign in front of their prescription, such as +4.00. These terms are related to how and where the light rays are focused when they enter the eye.  This is called the focal point.  The focal point of an eye is determined by how light is bent as it passes through the eye structures including the cornea, aqueous humor, lens and vitreous.In hyperopia, without corrective lenses the light is focused posterior to the retina.  This causes the focal point of the eye to be past infinity which will cause blurred vision at near greater than at distance. Correction for hyperopia uses plus power (or convex lens) glasses or contact lenses to correct the focal point to exactly infinity (also called emmetropia).  Plus power lenses are thicker in the center of the lens and thinner on the outer rim of the lens.  In myopia, the light is focused anterior to the retina without corrective lenses.  This causes the focal point of the eye without correction to be closer than infinity. The location of the focal point is based on the amount of myopia. Someone with low amounts of myopia will have a focal point 15 or 20 feet away whereas someone with high myopia may have a focal point just a few inches away from their eye. Correction for myopia involves minus power (or concave) glasses or contact lenses. Minus power lenses are thinner in the center of the lens and thicker on the outer rim of the lens.An eye doctor can determine the level of hyperopia or myopia by performing a refraction.  This involves a patient looking through a machine called a phoropter which holds a large number of different powered lenses.  These lenses are shown to the patient one at a time to determine the lens which provides the best vision and, therefore, determines the lens power to put in that patient’s glasses.  In nonverbal patients a glasses prescription can also be found through a technique called retinoscopy.  This involves shining a thin beam of light into a patient’s eye while looking through a lens of a specific power.  The reflection of light can be used to determine the correct lens power needed to provide the patient with emmetropia.  There are certain medical conditions that are more prevalent in patients with myopia versus hyperopia.  The risk of these medical conditions is mostly related to the size of the eye. Hyperopes have shorter eyes on average and are at higher risk for conditions related to having a short eye including angle closure glaucoma and accommodative esotropia.  Myopes have longer eyes on average and are at higher risk for conditions related to having a long eye including retinal detachment, posterior vitreous detachment, open angle glaucoma and cataracts.Treatment for myopia and hyperopia is most commonly done with glasses, contacts or both. Before the advances of modern surgery, glasses and contacts were the only ways to treat myopia and hyperopia. However, there are now procedures available known as refractive surgery which can correct certain levels of myopia and hyperopia.  These include procedures like laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE).  Eligibility for refractive surgery will depend on a number of factors including a patient’s prescription, corneal thickness and type of refractive surgery.  A full evaluation should be performed by a refractive surgery specialist to determine an individuals refractive surgery options.When you can not see far, a person is usually has myopia. People with myopia usually have a negative prescription. The opposite is true for people who have hypermetropia, also called hyperopia. Patients with hyperopia have difficulty seeing up close and their prescriptions are positive, or have a plus sign in front of them. You can correct both of these eye problems with glasses, contacts, or refractive eye surgery.Sources:Moore BD, Augsburger AR, Ciner EB, Cockrell DA, Fern KD, Harb E. Optometric Clinical Practice Guideline: Care of the Patient with Hyperopia. St. Louis, MO: American Optometric Association; 1997:1-29American Association of Pediatric Ophthalmology. Retinoscopy. http://www.aapos.org/terms_faqs/faq_list/retinoscopy. [May 2010]American Association of Pediatric Ophthalmology. Refractive errors. http://www.aapos.org/faq_list/refractive_errors . [May 2010]. 
4 min read
Glaucoma Open Angle

Glaucoma Open Angle

Glaucoma that has an open angle, more commonly referred to as Open Angle Glaucoma, is the most common type of glaucoma. Primary Open Angle Glaucoma, abbreviated POAG, affects around 68 million people in the world! The following people are at greater risk for this type of glaucoma: Older individuals, Blacks, African-American, Hispanics, and people who have a history of sleep apnea (1-3). The first step in treating Open Angle Glaucoma is either eye drops or SLT laser by an ophthalmologist.Glaucoma is a disease of the optic nerve. The optic nerve is a cranial nerve that connects your brain to your eye, and allows you to see. While glaucoma is affected by high pressure in the eye, there are also types of glaucoma in which the eye pressure is normal. It is important to note that eye pressure is not necessarily related to blood pressure. Patients often think that if they have high blood pressure, they will have high eye pressure. This is not true. There are many different types of glaucoma but two of the broad categories of glaucoma include open angle glaucoma and closed angle, or narrow angle, glaucoma. These two terms refer to the shape and configuration of the drainage system of the eye. The drainage system of the eye is found in the anatomic angle of the eye, hence the names “open angle” and “narrow angle.” When a patient has open angle glaucoma, their eye pressure is high despite the drainage system being anatomically “open.” When someone has narrow angle glaucoma, it is the shape and configuration of the drainage system, or angle, that is contributing to the patient having high pressure in the eye.The eye is a dynamic structure that is filled with fluid called aqueous. This fluid is constantly being cycled in and out of the eye through the angle of the eye. In open angle glaucoma, the “back-up” of fluid typically happens in the small microscopic structures that are beyond the angle. In narrow angle, the shape of the drainage system itself is contributing to high pressures. There is also an entity called normotensive glaucoma in which the eye pressure is not particularly high, but damage to the optic nerve is still happening. In order to figure out what type of glaucoma you have, your doctor will do a series of tests and exams. Some of these exams will be at a microscope called a slit lamp. A gonioscopy lens is used by your ophthalmologist to view the angle of your eye to see if it is narrow or open. Your doctor may also use certain machines to take images of your optic nerve. No matter which type of glaucoma you have, you will have to take a visual field test. This test measures your peripheral vision. Glaucoma typically causes loss of a person’s side vision or peripheral vision. It is important to pay attention closely and take this test to the best of your ability for accurate results. Both patients with diagnosed glaucoma and suspected glaucoma have to take visual field tests. If you already have a diagnosis of glaucoma you will typically take a visual field test more often than someone who is just a glaucoma suspect. There are several treatment options for open angle glaucoma. Typically, the patient is offered eye drops or laser by their ophthalmologist. In some states, an optometrist may be able to prescribe eye drops, but laser surgery for glaucoma is best handled by an ophthalmologist who has gone to medical school, and has had surgical training in residency to perform eye lasers. If you or your family member has glaucoma, consider also seeing a fellowship trained glaucoma specialist once a year. Depending on the severity of your glaucoma, you may or may not need a glaucoma specialist. Most general ophthalmologists are capable of managing early to moderate glaucoma, but if it becomes more severe, usually a glaucoma specialist is consulted for their opinion. If your doctor has told you that you are a glaucoma suspect, you will likely have to see the eye doctor once every six months. If your pressure is high, or your corneas are thin, or if you have other risk factors like a strong family history, the ophthalmologist may ask to see you at 4 month intervals. If you have already been started on treatment for glaucoma, you will usually see the doctor every 4 months or every 6 months. Some glaucoma suspects who are very low risk can be followed on a yearly basis. Glaucoma is not a straightforward disease and there are many factors that play into how often a patient should be followed and tested. Sources:https://doi.org/10.1016/j.ophtha.2020.10.022https://www.aaojournal.org/article/S0161-6420(20)31024-1/fulltext
5 min read
Freckle In The Eye

Freckle In The Eye

A freckle in the eye is called a nevus in medical terminology. The word nevus (the plural form of this is nevi) is a medical word that refers to a mole or freckle. It is an area of your body that is typically darker in color or more pigmented than the rest of the surrounding cells of the body. We most commonly see freckles or moles on our skin, but you can also get a freckle in the eye. A nevus is a benign lesion meaning it is not a cancer and it does not grow significantly or cause harm. Just how a freckle on your skin can happen in many different places, a freckle in the eye can also happen in different parts of the eye including the iris, the conjunctiva (the white part of your eye), the choroid, and the retina.  The choroid and retina are tissues in the back of the eye that only an eye doctor can see during a dilated eye exam. In the vast majority of cases, a nevus, or freckle in the eye, is not dangerous. It is important that they are monitored for change in size or other characteristics with regular dilated eye exams.Nevi in the eye are most common in the choroid which is in the back of the eye, close to the retina. A nevus is formed by a collection of cells (called melanocytes) which produce a substance called melanin that gives color or pigment to the skin. These nevi are called choroidal nevi and can only be viewed by an eye doctor during a dilated eye exam.  In the choroid a nevus can be different colors including brown, gray and yellow and may have a speckle appearance.  As with all nevi, they are typically benign but should be monitored to ensure there is no significant change in size or other characteristics.  Nevi are often monitored by an eye doctor using regular eye exams and photographs of the retina to watch for signs of possible progression to a choroidal melanoma, although this is uncommon.  A choroidal melanoma is a malignant or cancerous lesion which needs treatment to prevent it from spreading.  Signs which may be concerning for progression to a melanoma include a lesion that is raised or elevated, associated with fluid or swelling, or orange in color.It is common to have pigmented, or darker colored, areas on the colored part of the eye, also known as the iris.  Pigmented areas of the iris are more noticeable in people with light colored eyes like blue or green.  They are seen as brown areas on an otherwise light colored eye.  Small pigmented areas on the iris are likely freckles which are caused by a collection of melanin (a brown colored pigmented) in that area.  These areas are benign with no risk of turning into a cancerous lesion.  Larger pigmented areas are potentially iris nevi which are a collection of melanocytes causing the increase in pigment.  Nevi are also benign with a small chance of turning into a iris melanoma and should be monitored by an eye doctor for changes in size or shape.  An eye doctor will typically monitor a nevus with periodic photographes and/or measurements to ensure there are no significant changes.The conjunctiva is the clear covering or “skin” of the eye which covers the white part of the eye (called the sclera). The conjunctiva can also develop areas of pigment or nevi due to a collection of melanocytes within the conjunctiva.  These typically appear as differing shades of brown but can sometimes be a lighter yellow color.  Like nevi in other areas of the eye, these lesions are typically benign but should be monitored by an eye doctor with periodic examinations and/or photographs to ensure there are concerning signs for transformation into a cancerous lesion, or melanoma.Nevi are benign lesions and typically require only observation.  Treatment is not recommended unless they transform to a more dangerous malignant lesion which is uncommon.  If transformation to a melanoma does occur treatment may include surgery, laser, radiation or sometimes removal of the eye.  The treatment recommended will depend on the size and location of the melanoma.  SourcesShields CL, Shields JA, Kiratli H, et al. Risk factors for growth and metastasis of small choroidal melanocytic lesions. Ophthalmology 1995;102:1351–1361https://pubmed.ncbi.nlm.nih.gov/9097773/Shields CL, Furuta M, Berman EL, et al. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Arch Ophthalmol 2009;127:981–987https://pubmed.ncbi.nlm.nih.gov/19667334/Kliman GH et al. Am J Ophthalmol. 1985;100(4):547-548
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PRK Surgery Eye

PRK Surgery

Photorefractive keratectomy (PRK) is a form of refractive eye surgery which aims to reduce the need for correction with glasses or contacts.  PRK uses a specific type of laser (called an excimer laser) to reshape the cornea and correct near sightedness, far sightedness and/or astigmatism. During PRK the outer layer of the cornea, called the epithelium, is removed and a laser called an excimer laser is used to remove a portion of the cornea. The epithelium is then allowed to heal and regrow which usually takes 3-7 days. The vision will initially be blurry and gradually improve as the epithelium regrows.  Often, a bandage contact lens is placed on the eye to aid in healing and to help reduce discomfort after the procedure. The amount and location of the cornea removed is determined by preoperative measurements. Removal of this section of the cornea changes the corneal curvature and the overall refractive power of the eye with an overall goal of reducing the patient's need for glasses. PRK is typically performed in an outpatient surgery center or medical office with a special room for performing refractive surgery. After surgery you will need to use eye drops to help prevent infection and reduce inflammation.  It is also typical to need lubricant eye drops or artificial tears.  During the postoperative period there will be restrictions on certain activities including but not limited to touching/rubbing the eyes, wearing makeup, and/or swimming.  Specific instructions will be given to by the surgeon at the time of surgery and these should be followed to ensure proper healing. Only an ophthalmologist is trained to know if you are a good candidate for PRK, so you will need to  schedule an evaluation with a refractive surgery specialist.  Refraining from contact lens use for a specific period of time prior to the evaluation will be required to ensure accurate measurements, this period is usually two weeks.  A complete eye exam including refraction, corneal topography, dilated exam and corneal thickness measurement will determine if a patient is eligible for PRK. Criteria which make a patient a good candidate for PRK include myopia in range of -1 diopter to -10 diopters, hyperopia in the range of +1 diopter to +6 diopters and/or astigmatism in the range of 1 diopter tp 5 diopters, generally healthy eyes, age 22 or older with a stable refraction. There are certain medical conditions or eye characteristics which will make a patient a poor candidate for PRK.  These include thin corneas, visually significant cataracts, advanced glaucoma, uncontrolled diabetes, excessive scarring or keloid formation, or women who are pregnant or nursing.Unlike LASIK, PRK does not involve creating a flap prior to lasering the corneal bed.  This allows PRK to be an option for some patients that are not good candidates for LASIK due to thin corneas. However, there are still criteria which must be met regarding refractive error and corneal thickness to ensure PRK can be done safely.  There is also evidence that PRK can result in fewer damage to corneal nerves resulting in fewer dry eye symptoms.  Due to there being no fap creation, PRK does not pose a risk for a dislodged flap from eye trauma after surgery.  PRK is an elective procedure to reduce the need for glasses and contacts. For this reason, it is typically not covered by vision or medical insurance. The cost of PRK varies but is often in the range of $1,000-$3,000 per eye. Sources:Somani SN, Moshirfar M, Patel BC. Photorefractive Keratectomy. 2021 Nov 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31751077.Li SM, Kang MT, Wang NL, Abariga SA. Wavefront excimer laser refractive surgery for adults with refractive errors. Cochrane Database Syst Rev. 2020 Dec 18;12(12):CD012687. doi: 10.1002/14651858.CD012687.pub2. PMID: 33336797; PMCID: PMC8094180.
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SMILE eye surgery

SMILE Eye Surgery : What Is It? What Does It Cost?

Small incision lenticule extraction (SMILE) is a form of refractive eye surgery. Refractive eye surgery is a type of eye surgery that reduces the need for glasses or contacts.  SMILE eye surgery has the ability to correct myopia (near sightedness) and/or astigmatism. There may be options for correcting hyperopia (far sightedness) with SMILE, however, this has been less studied.  The cost of SMILE varies depending on location, however, typical costs are $2500-$3500 per eye which is overall comparable to LASIK.  SMILE is an elective procedure and it is typically not covered by medical or vision insurance.  SMILE is performed by separating a small section of the cornea using a laser.  This cornea is then removed from the cornea through a small incision, also created by the laser.  The size and shape of the cornea removed is determined by pre-operative measurements.  These will measure the amount of prescription that needs to be corrected and calculate how much cornea to remove.  When the cornea section is removed it changes the curvature of the cornea which in turn changes how the cornea bends light.  This change in cornea shape is what changes the patient’s need for glasses or contacts.  Only a trained ophthalmologist can know if someone is a good candidate for SMILE.   A thorough evaluation with an ophthalmologist will include checking a glasses prescription (refraction), measuring the thickness of the cornea, and measuring the curvature of the cornea (topography) along with performing a complete eye exam.  Contact lens use prior to being evaluated for SMILE will affect the measurement and most ophthalmologists will prohibit using contacts for at least 2 weeks prior to an evaluation.  Criteria which make a patient a good candidate for SMILE include near sightedness (myopia) in the range of -1.00 diopter to -10.00 diopters and/or astigmatism in the range of 1.00 diopter to 3.00 diopters, generally healthy eyes, age 22 or older with a stable glasses prescription. Certain medical conditions or eye characteristics can make a patient a poor candidate for SMILE.  These include thin corneas, visually significant cataracts, advanced glaucoma, uncontrolled diabetes, excessive scarring or keloid formation, or women who are pregnant or nursing.If someone is found to be a good candidate for SMILE they will be scheduled for the procedure.  SMILE is typically performed at an outpatient surgery center or a medical office with a specialized procedure room.  During the procedure a specialized laser (called a femtosecond laser) is used to create a 2-3mm incision and separate the cornea to be removed from the rest of the cornea.  Once the laser has finished, the patient is moved to a microscope where the cornea is removed through the incision.  The incision will typically self-seal and no sutures are needed during the procedure.  After surgery, it will be necessary to use eye drops to help prevent infection and reduce inflammation.  It is also typical to need lubricant eye drops or artificial tears.  During the postoperative period there will be restrictions on certain activities including but not limited to touching/rubbing the eyes, wearing makeup, and/or swimming.  Specific instructions will be given to by the surgeon at the time of surgery and these should be followed to ensure proper healing.  Vision outcomes from SMILE are comparable to outcomes from LASIK.  There is also evidence that SMILE may result in a lower side effect profile, including improved corneal sensation and a better tear film compared to LASIK.  This could result in fewer symptoms from dry eye after the procedure.  SourcesReinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis (Lond). 2014 Oct 16;1:3. doi: 10.1186/s40662-014-0003-1. PMID: 26605350; PMCID: PMC4604118.https://pubmed.ncbi.nlm.nih.gov/26605350/Zhang Y, Shen Q, Jia Y, Zhou D, Zhou J. Clinical Outcomes of SMILE and FS-LASIK Used to Treat Myopia: A Meta-analysis. J Refract Surg. 2016 Apr;32(4):256-65. doi: 10.3928/1081597X-20151111-06. PMID: 27070233.https://pubmed.ncbi.nlm.nih.gov/27070233/Denoyer A, Landman E, Trinh L, Faure JF, Auclin F, Baudouin C. Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology. 2015 Apr;122(4):669-76. doi: 10.1016/j.ophtha.2014.10.004. Epub 2014 Nov 22. PMID: 25458707.https://pubmed.ncbi.nlm.nih.gov/25458707/
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