Tips, Questions & Answers

Can I sleep overnight with my contact lenses?”

The short answer — we strongly discourage it.

Studies show that people who sleep with their contacts are almost 20 times more likely to develop eye infections, sometimes leading to permanent corneal scarring and loss of vision.  The odds of getting an infection increases with each consecutive night worn.

Despite the risks and warnings, some patients still sleep with their lenses. If they do wake with redness or irritation, they should, of course, remove the lenses right away. If symptoms continue, I urge them to see me immediately to check for infections or abrasions. Appropriate treatment, if started promptly, will usually prevent serious consequences.

I've got "floaters" -- can they be treated?"

Many people occasionally notice threads or lines moving across their line of vision- “floaters.” They can be distracting, even interfere with performing visual tasks.

Near sighted people tend to see them more often, especially when viewed against a light background like the sky, a light coloured wall, or screen.

• The cause? Opacities (fibres, remnants of embryonic blood vessels) in the vitreous chamber that cast a shadow on the retina when light enters.
• When patients ask if floaters can be treated, my position is — the cure is worse than the disease.
• Treatment would involve a vitrectomy — removing the entire vitreous and replacing it with an artificial substance. Complications can arise.
• Some patients ask about laser treatments. Most retinal specialists I speak with consider laser treatments for floaters too experimental and risky. That may change in the future.
• My advice: unless the floater is debilitating and greatly affecting one’s ability to function, I strongly advise against either a vitrectomy or laser treatment. Time may help: annoying floaters can change position and be less obvious over time.

Tips for Better Night Vision

Patients often tell me that they don’t see as well at night, and have trouble driving. Here’s the technical reason: pupils enlarge under dim lighting conditions. That allows blurrier peripheral rays to enter the eye, which detracts from clear images and increases glare.

Here are tips to minimize these effects:

1. Keep your prescription up-to-date. Even the slightest blur, otherwise not noticeable in daylight, can become annoying in dim lighting.
2. Keep your lenses clean. Dirt and scratches distort light rays that cause glare and blurring, especially at night.
3. For contact lenses: use lubricating/re-wetting drops. Contacts accumulate deposits and dry out by night-time.
4. When driving:
   • Keep your windshield clean, to reduce glare from light scattered by dirt and film.
   • Keep your headlights clean, for better road illumination.
   • Use the night setting on your rear-view mirror, to minimize distracting head lights from behind
   • Concentrate on the road marking lines (Centre or shoulder), to reduce glare and reflection.
   • Direct A/C (or heating) vents away from your face, to prevent moving air from drying your eyes.
   • If you wear contact lenses, use lubricating drops before you start (remember, eye drops may blur your vision for several minutes before taking effect).

My Eyes are Bloodshot: what should I do?

• Many patients use Visine to “get the red out” of bloodshot eyes. Is that a good idea?
• First, a little background. The eyes become red when blood vessels dilate to fight the source of irritation — whether wind, infection, allergy, dryness, smoke, crying, inflammation, alcohol, anything really.
• Visine and similar medicated drops contain a “vasoconstrictor” chemical that shrinks the blood vessels that cause “redness,” for about 45 minutes.
• Such products mask the symptoms of irritation, but don’t address the cause. In fact, prolonged use may even increase redness –a situation called “rebound hyperaemia.” The more you use them, the more you need them.
• There’s no harm in using Visine or similar products sparingly — say, for a photo shoot, an important meeting or public appearance.
• But please don’t use them on a regular basis.
• If red eyes are a reoccurring problem, I’d prefer to see you to diagnose and eliminate the cause — whether it be lubricants for dry or irritated eyes, antibiotics for infection, steroids for inflammation, or other solutions.

Oh, and one more tip — applying a cold washcloth to your eyes for 30 minutes will shrink swollen blood vessels significantly. A chemical-free and relaxing

Applying Eye Drops: Two Essential Tips

If you’re an eye drop user, these two tips will help ensure they work!

TIP #1: ONE DROP ONLY

Sometimes I see my patients squirt multiple eye drops of fluid into their eyes. I then see most of the fluid spill out and run down their cheeks.

I recommend using only one drop per eye. That’s all the eyelid can hold. No need to waste drops – especially when using expensive medication.

TIP #2: PRESS YOUR LOWER LID

In the inner corner of the eyelids are the puncta. These are openings where tears drain out. There is one in the top and one in the bottom. Most tears flow into the punctum of the lower lid.

After you apply your medication (one drop only) press your forefinger into your lower lid, against the base of your nose. That will close off the punctum, allowing the medication deeper penetration of the eye before it drains out.

This technique is especially useful for glaucoma medications and topical steroids for internal eye inflammations.

Pregnancy and the Eye

1. Many pregnant patients ask about what changes in their eyes or their vision could occur during pregnancy. They may have read articles that dry eyes, prescription changes, puffy eyelids, migraine headaches, and increased light sensitivity commonly occur. Should they delay purchasing new glasses or contact lenses until after their pregnancy?
2. It is true that the body undergoes many physiological changes, including hormonal changes that could affect the eyes. In fact, studies have shown that almost every structure of the eye undergoes some change during pregnancy.
3. I have found that these temporary changes do not affect the great majority of patients. Most do not notice changes in their prescriptions, and they are able to maintain normal contact lens wear. A few patients became less comfortable wearing contact lenses and either stopped wearing or reduced their wearing time.
4. If it is time for your eye examination, I would definitely recommend that you come in during your pregnancy. If you are not due for an eye examination, but you notice any changes in your vision or any new symptoms with your eyes you should call and set up an appointment.
5. If you experience discomfort with your contact lenses, I would suggest either reducing or stopping contact lens wear until after giving birth.

How often should I get my eyes examined?

The Optometric Association recommends:

Children:

Birth to 24 months: at 6 months of age2 to 5 years: at 3 years of age6 to 18 years: Before first grade and every 2 years thereafter

Adults:

18 to 60 years: every 2 years61 years and older: annually

If a child has certain risk factors, such as prematurity, oxygen at birth, a difficult or assisted labor with low Apgar scores, or if an adult has diabetes, hypertension, a family history of ocular disease, a history of cancer (especially lung or breast cancer), as well as many other conditions, more frequent eye examinations are recommended. Certain medications may affect the eye or vision, and patients taking these require more frequent eye examinations.

My own office policies and recommendations are:

Children: I feel comfortable examining children’s eyes at age 4 or 5. Paediatricians usually screen for the eye diseases that may affect a newborn and can detect eye problems that tend to develop in the early years.

Things to look out for in infants and young children that may be a problem:

• Cloudy cornea, or cloudiness in the pupil of the eye.
• Tearing of one or both eyes.
• Sitting very close to a television or holding books very close to the eyes.
• Improper alignment of the eyes. (appear crossed) Many children are born with a fold of skin in the inner corneasof the eyes that gives a false impression of crossed eyes. This fold diminishes as they grow and the eyes will develop a normal appearance.

If eye problems are suspected before age 4, a Paediatric Optometrist or Ophthalmologist should be consulted. They have special training and equipment to properly examine and treat problems in very young children.

I think that children and teenagers should be examined on a yearly basis, as these are the years that a prescription is most likely to change rapidly. It is not uncommon to see rapid increases in myopia from the 4th or 5th grade until the 9th grade. If I see a large change in prescription, I recommend to see the child in 3 to 6 months, depending on how much of a change.

Adults (ages 20 to 60): I follow the AOA recommendation of 2 year intervals. Exceptions are patients who have the above mentioned risk factors. I would also like to see an adult sooner than 2 years if their prescription changed more than normal or in an unusual way. Sometimes a patient may develop one of the normal aging problems (examples – cataracts, early signs of macular degeneration, etc.) prior to age 60 and I would want to see them sooner than 2 years.The chance of developing certain eye diseases increase (cataracts, glaucoma, macular degeneration) when a person is over 60 years old, so I would like to see them annually.

Contact lenses wearers are much more likely to develop eye problems and need to be examined more frequently. A contact lens wearer should be seen annually, or more frequently if sleeping overnight in lenses, or if they have conditions making them more likely to develop eye problems.

What to do about Dry Eyes?

Patient: “Doctor, sometimes my eyes seem to tear and water.”
Doctor: “You have dry eyes.”

This paradoxical response tends to confuse patients until the logic behind the answer is explained.

TWO TYPES OF TEARING

There are two types of tearing. One is baseline tearing — a constant release of tears from thelacrimal gland, located in the inner area of the upper lid.

The second type is “reflex tearing,” a sudden outflow set off by irritation, emotions, bright lights, etc. that protects the eye by diluting or flushing out the offending substance.

Aging and some medications or medical conditions can reduce baseline tearing to the point that the eye tissues get dehydrated and irritated, provoking the reflex tearing that offers relief.

MAIN CATEGORIES AND TREATMENT OPTIONS

Dry eyes can be classified into three main categories, each of which require a different level of treatment.

Mild — occasional dryness or grittiness. Symptoms can be relieved by over-the-counter re-wetting drops (also called artificial tears), used as needed.

Moderate — symptoms occur regularly. Re-wetting drops used on a regular schedule (e.g. every 2 or 4 hours; the frequency will vary with the patient) may eliminate or greatly reduce symptoms. Symptoms may vary according to environmental conditions like humidity levels or type of heating or a/c unit.

Severe — Constant irritation and burning with dehydrated eye tissues, sometimes accompanied by ailments like rheumatoid arthritis or Sjogren’s Syndrome. These patients may need stronger prescription medication, both topical and oral, and the constant use of rewetting drops in the daytime and a thicker ointment at night.

CAN DIET HELP?

There is some evidence that increases Omega 3 fatty acids may help improve the quality of the tear film and reduce dye eye symptoms. Omega 3′s can be found in flax seed, cold water fish (salmon, anchovies, sardines) and supplements.

FIRST STEP: EVALUATION

Before treatment can be started, an evaluation of one’s health history should happen, to help determine the nature of the dry eye.

1. Evaluation – determine the extent of the dry eye2. Medical – is there a medical condition that is causing the dry eye?3. Ocular – is there a problem with tear production of any of the layers? Are there any lid or lash problems that may add to the irritation?4. Medications – determine if one is taking any medications (anti-histamines, birth control pills, etc) that may contribute to the problem5. Environmental – is the heating or cooling system removing humidity from the air?

Which brand of artificial tears is best?

Many companies offer different types of artificial tears, but no one brand is considered superior. It’s more a trial and error to find the drop that works the best for you. Symptoms of dry eye can be treated and relieved

Many patients ask me about Lasik surgery. I’m naturally conservative when it comes to surgery; I think that altering any body tissues should never be taken lightly.

Lasik is considered elective surgery and there are risks. Much of the marketing and public relations downplay or ignore the risks and side effects. You’re much more likely to hear from successful patients than from those experiencing problems.

That said, there are several factors I consider when discussing Lasik with patients:

Realistic expectations: Even with the best testing and surgeons, perfect prescriptions are not assured, and glasses or contact lenses may still be needed.

Prescription: Good candidates should have stable prescriptions that haven’t changed much in several years. Even so, there are no guarantees that your prescription won’t change years after surgery. I’ve also found that myopia (near-sightedness) comes out better than farsightedness and moderate to high amounts of astigmatism. Patients with very high prescriptions have a higher risk of side effects, and there’s more tendency for the prescription to change over time.

Type of visual system: I find that some patients have very “precise” vision, and small changes and variances affect them greatly. These patients are more likely to be disappointed by Lasik. Patients who can tolerate a range of prescriptions have a higher chance of being pleased with the results, even if not perfect.

Anatomical considerations: patients with dry eye and/or large pupils are much more likely to experience post-surgical symptoms.

Dependence on precise vision for work: A micro-surgeon who needs precise depth perception to perform his duties would have more trouble than a singer should the results be less than perfect.

Age: Although Lasik is approved for anyone over age 18, many younger patients’ prescriptions continue to change in their twenties. I think that mid to late 20′s should be the earliest age to consider surgery.

Separate prescription: If you need a separate prescription for close-up work than for distance, as becomes common after age 40, Lasik can correct only one of these. Unless one has even more risky monovision surgery, one pair of glasses will still be needed.

When I’m sure the patient is a good candidate for Lasik and has realistic expectations, I recommend they have it performed by an experienced surgeon, preferably with credentials as a corneal or anterior segment specialist.

1. it is rare that a permanent cure can be found.

“Allergies Bother my Eyes”

(If this article sounds familiar, it’s because we it first ran in our newsletter last Spring. But worth repeating this time of year!)

Spring is here – and for some of my patients, that means allergies and symptoms ranging from mild congestion and nasal drip, to swelling, tearing and itching.

Fortunately, good treatments have been developed to provide relief:

For mild allergies, cold compresses on the eyelids can help. So can over-the-counter lubricating drops, which help flush out irritating particles. Artificial tears containing a mild anti-histamine are also now available. The “-A” after the brand name indicates the drops contain an anti-histamine (e.g. Opcon-A, Vasocon-A, Naphcon-A).

Moderate allergies can usually be controlled with more powerful prescription anti-histamine drops, which have a longer-lasting effect than those available over the counter.

Severe allergies require stronger prescription drops, combining anti-histamines and mast cell inhibitors if taken just before allergy season, they can even prevent the onset of reactions. For acute attacks (severely swollen and red lids with extreme itching), the temporary use of prescription steroids may be needed.

Keep in mind, other conditions can also cause these symptoms – although the more itching, the morelikely allergies are the cause.

Please consult with me so we can make a definite diagnosis and the best treatment plan, including prescription medication if called for. (Remember, most of these medications cannot be used while wearing your contact lenses.)

Computers and Your Eyes: 9 tips to avoid strain and fatigue

• Keep your prescription up to date. Strain from computer use sets in faster when your eyes are already straining.
• Position the screen just below your line of sight. Looking downwards decreases dryness and facilitates blinking.
• Don’t put the screen too close to you. The closer the screen, the more work it takes to hold a focus.
• Try to match the brightness of the room to that of the screen. Too much contrast can strain the eyes.
• Avoid screen glare, which can be extremely harsh and distracting.
• Keep your screen free of dust or smudges. The smallest smudge can cause excessive eyestrain.
• Blink! The eyes will dry less and viewing will be more comfortable.
• Take regular breaks: Every 20-30 minutes look away from the screen and as far into the distance as possible.

Sports and Vision

We have a special interest in helping patients see their best while playing sports, because I’ve been playing sports my whole life — from baseball, basketball and bowling for the high school team, to racquet sports, cycling, skiing and golf.

My job is to ensure that you’ve got the best possible prescription for your sport, and recommend protective eye wear when needed. We carry a wide range of sports glasses and goggles — prescription versions, too.

Here are a few situations you might recognize:

Tennis:Slightly blurred vision can affect one’s tennis game. We may be able to tweak your prescription to make a difference.

Racquetball, squash:Hard, fast balls hitting your face is the threat here. Protective goggles are the solution. Because of the close quarters of these courts, fast moving racquets may also hit your face.

Baseball:Especially for outfielders, slightly blurred vision can delay picking up a batted ball when precious split seconds can make the difference on reaching the ball and making the catch.

Cycling/skiing:Goggles are almost essential to protect the eyes from wind. The problem of course is that they can fog or freeze up in bad weather.

MY PRESCRIPTION: if you’re an active athlete and wondering whether your vision is helping or hurting your game, let me know. Optometry can often help.

Of course, there are times — I’m remembering when my sons and I went skiing last year in Vermont on a brutally cold day, futilely trying to scrape ice off goggles — when nature wins out. My best advice then is to find a bar with a fireplace and large screen HDTV!

The one critical thing you need to know when something gets in your eyes

RINSE IMMEDIATELY, FOR AT LEAST 20 MINUTES

Don’t delay, trying to figure out what got in your eye, or seeking more advice first. The longer a foreign substance remains in the eye, the greater the risk of damage. Why 20 minutes? Eyes must be completely flushed. Even the smallest lingering particle can do damage.

Of course, if you wear contacts, remove them first.

WHAT TO RINSE WITH?

Sterile saline is best, followed by distilled water. Otherwise, use tap water from your faucet. Or get in the shower and let a stream of lukewarm water run into the affected eye.

CALL US FOR ADVICE, ONLY AFTER RINSING

Depending on what got into the eye and how you feel, you may need further treatment.

A NOTE ABOUT SUBSTANCES

The most damaging substances are alkaline-based, such as bleaches, detergents, or cleaning agents.

Many contact lens wearers have told me that they mistakenly used a cleaner instead of a wetting drop or saline, and paid a painful price! The good news is that acidic substances, like cleaners, are neutralized more quickly and the effects more superficial.

Macular Degeneration: What you should know

Many patients are concerned when an older relative develops macular degeneration, and worried that they may also develop it.What is macular degeneration?Macular degeneration (also known as ARMD – age-related macular degeneration) is a condition that affects the macula of the eye as one ages. The macula is, by far, the most sensitive part of the retina, and where the clearest central vision takes place.Imagine looking through a lens with a big smear of Vaseline in the centre….Many people as they age develop a harmless amount of  HYPERLINK "http://en.wikipedia.org/wiki/Drusen" drusen in the eye. But an excessive accumulation can cause blurred or distorted vision in the central eye area. That is diagnosed as “dry” macular degeneration.Some people also develop a growth of blood vessels under the macula, which can leak or haemorrhage, causing more severe visual distortion. This is referred to as “wet” macular degeneration.Unfortunately, reduction and distortion of vision from macular degeneration has not been considered treatable or preventable until recent years.WHAT ABOUT PREVENTION?There is much controversy and confusion about whether the effects of macular degeneration can be prevented or lessened.Recent research suggests that excessive exposure to the sun may contribute to macular degeneration, from the ultraviolet light waves and the resulting oxidative products that build-up in the eye.What you can do:1. Wear a good quality pair of sunglasses that totally blocks and filters rays (note: please wear a reputable brand, and avoid inexpensive or “knockoffs” — they can cause more harm than good). If you have any doubts about the quality of your sunglasses you may bring them by our office to inspect them. We now have an ultraviolet meter that can measure how effective your lenses are in blocking these harmful rays.2. Consider foods, vitamins and supplements high in anti-oxidants. It is hypothesized that natural anti-oxidants in the diet may have a protective effect against damaging wavelengths.A study of patients with mild macular degeneration who took anti-oxidants in the form of a pill, delayed the onset, and lessened the eventual severity of the disease. (ARED’s study)Two things to look for: Lutein and Zeaxanthin — abundant in green leafy vegetables like kale, collard greens and spinach. Many supplements also include these anti-oxidative compounds.Vitamins B6 and B12 (folic acid) and Omega 3 and 6 fatty acids may help protect against macular degeneration.There are differences in opinions about the benefits of taking vitamins and supplements. Keep in mind, the data is still inconclusive about the cause and effect of sunlight and diet on macular degeneration. But there’s no doubt that limiting sun exposure and eating foods high in anti-oxidants are smart lifestyle choices in general — and may well help limit or delay macular degeneration.Can macular degeneration be treated?There is no treatment available for dry macular degeneration. However there is evidence that taking the above anti-oxidants may delay or prevent its progression. Chemicals have been discovered that can reduce new blood vessel growth, and have shown success in improving reduced vision in wet macular degeneration. Injections of these chemicals will not bring vision back to normal levels, but may lessen the severity of the loss of vision.

Do you have Mizar-Alcor vision?

Arabic book, The Book of Fixed Stars, written by al-Sufi, an early astronomer is what has been called “the ARAB eye test”. This test was used in ancient Persia, over 1000 years ago to evaluate the vision of elite warriors, as well as by desert Bedouins to test their children’s eyesight.There is a double star, which is really 2 stars (Mizar and the fainter Alcor) separated by 12 minutes of arc, located in the handle of Ursa Major (the Big Dipper). One needs very sharp vision to discriminate that there is a second fainter star next to the brighter one. There is an Arabic saying that, “He can see Alcor but cannot see the full moon”, describing a person who can see trivial details, but not the overall picture.Recent testing has shown that the ability to discriminate between the two stars is almost identical to the more modern measurement of 20/20 vision.