Wondering what the top trend for eyewear is this fall?  Look no further than Raf Simmon's sunglasses for Dior for a trend that the most fashion forward celebrities are embracing.  Dior's So Real sunglasses are an architectural rethinking of the clubmaster, a look that is incredibly futuristic in appearance despite its retro inspiration.  Celebrities like Olivia Palermo and Rihanna have embraced the look for recent fashion week appearances around the globe.

Rihanna via

Olivia Palermo via

The color options are just as inspiring as the unique frame shape.  Just check out this black version with the bright blue nosepads.  This is a trend I can really see taking off.  Neon nosepads with a more basic frame in a solid black or brown could be great.
Not convinced yet?  Supermodel Karina Kurkova sported a great pair of Dior So Real sunglasses for a recent spread in Vogue Spain.

via

 And you know that they are seriously trending in the eyeworld if Dr. Glover at Eye See Euphoria is posting about it.

Dior So Real Sunglasses via Eye See Euphoria

Not sure your pocket book can support this trend?  Look for similar options at your local high end optical by embracing the mix of plastic and metal.  Architectural details like browbars or oversized metal bracketing can elicit this same retro turned futuristic feel.  And if you can find frames with colored nosepads, then take a risk.  This touch of detailing can elevate your frame selection into what is styling into 2015!

Shop the Style (images are clickable!)

When checking someone's dilation, there can be a number of findings in the outer periphery of the eye that have no affect on the person's vision.  That's why dilation or fundus photography like Optos are so important to the ocular examination -- changes in the eye don't necessarily cause changes in vision.  Today we explore a relatively common ocular finding, congenital hypertrophy of the retinal pigment epithelium (or CHRPE for short).

An impressive Optos image of CHRPE just outside of the posterior pole via

CHRPE as viewed by off-axis fundus photography.  This picture was taken by me which explains why it is not that great. All of the white spots are artifact.

If you are going to buy one pair of glasses, please buy tortoise shell, black, or a a blendable neutral. But if you are going to buy two (or more) pair of glasses, then this post is for you.  I wear glasses at least 5 days a week, so having a few fun pair in my rotation is essential.  I honestly don't think you can make a better choice on your second pair of glasses than to go bold on color -- and red glasses are my statement of choice for fall and winter 2014.

Prodesign 1705 via

Red eye? Time to see your eye doctor via

It's that time of year again -- red eye time of year.  For every red eye patient that comes through the door I have a differential list going of 3 most likely suspects.

1) Do they wear multiple wear contact lenses?  Corneal ulcer is my first thought until I see otherwise

2) Do they itch?  Allergies and itching are almost always hand in hand

3) Is there crusting?  Viral conjunctivitis or pink eye as it is commonly called is so prevalent this time of year because of the number of viral colds going around.  Plus with back to school time, being around children is a really common infection source.  That means parents and teachers are at higher risk of coming to my office with a viral infection.

The reason that it is so important to see an eye doctor for a red eye is that your primary care doctor does not have the equipment to differentiate any of the above.  And the treatments for each of the above issues are vastly different!  You need a high powered ocular microscope to find a corneal ulcer (unless it is visible just looking at the person, in which case we are in a very emergent situation where there will almost certainly be permanent vision loss).  But the most important thing that is necessary when determining is this virus, allergies, or bacteria is a close microscopic evaluation of the under eyelid (tarsal) conjunctiva. Viruses typically have a follicular reaction in the conjunctiva, and bacteria and allergies classically have papillary reactions. Without a microscope, seeing this subtle difference is impossible.

Differentiating Papillae from Follicles

Papillary Reaction

A great example of papillae via

Giant Papillary Conjunctivitis -- Due the the chronic nature of inflammation, the papillary reaction is larger as the areas of irritation expand into each other.

Bacterial infections are very rare by comparison, so the most likely culprit when I see papillae under the eyelid is allergies.  Papillae are signs of chronic irritation, where the conjunctival tissue has become elevated and swollen due to repeated exposure to an irritant.  There are two important distinctions that are hallmark signs of papillae:

1. Red Center =  Papillae are elevations of the vascular conjuncitval tissue so there will be a red central vascular core to the lesions
2. Distinct Elvations = The conjucntival tissue has fibrous connections that limit the size and expanse of swelling.  This means distinct, well separated bumps in the papillary reaction.  The only time this logic doesn't fully apply is when the inflammation has been around for so long that the bumps begin to coalesce, creating the large cobblestone appearance we associate with giant papillary conjunctivitis.

Follicular Reactions

Follicular reaction via

While papillae are consistent with a local irritation, follicles are a sign of an immune reaction in the area.  This finding is almost always an indication of a viral infection of the eye.  Follicles have a larger appearance than papillae, and have a white central core since they are really accumulations of cellular level inflammatory agents -- lymphocytes, lymphoblasts, and macrophages if you remember your microbiology.   The big tell-tale sign of follicles are:

1. White Center = look for that inflammatory matter filling the center of the bump

Take Home

Having a hard time seeing the difference?  That's understandable because it takes doctors that are trained in this numerous patient encounters to develop a quick sense of which is which, and there are still some reactions that have questionable appearances with characteristics of both.  My real take home for any non-OD readers of this post is that a red eye takes a specialist to properly diagnose. The tell-tale anatomy is so nuanced, it is impossible to see without the proper equipment.  So please, see your eye care provider for any eye care needs so that you get the proper treatment without delay.

There is definitely no denying that daily disposable or single use contact lenses are taking the marketplace by storm.  If you are a regular blog reader, you know that I am passionate about the unparalleled comfort and health benefits of wearing single use contact lenses.  And for many people that are part-time contact lens wearers, dailies have the added benefit of being markedly less expensive; you only use the lenses that you need, and you never have to buy solutions.  With the unparalleled explosion of single use lenses on the market, this year has seen a lot of growth in the multifocal daily contact lens realm.  Multifocal contact lenses are designed to help the wearer focus in a range of  visual needs, from far distance, to computer, to cell phone reading.  Many people that need multifocal lenses spend significant amounts of their day battling dryness -- either due to extended computer use or due to hormonal and body chemistry changes occurring as we enter our forties and fifties.  Daily wear lenses can maximize lens comfort by offering the least risk of dryness with contact lens wear, and also now provide that vision flexibility that we need as our eyes enter presbyopia (or what many people will just call "tired eyes" and trouble focusing up close).  If that sounds like you, here are some great new lens options to explore with your doctor:

Proclear 1-Day Multifocal

The near center progressive design can give wearers variable vision depending on their pupil size, so what power each person needs to achieve their visual needs is dependent to a large degree on their anatomy via

This was the first readily available daily disposable multifocal on the market, and the Proclear 1-Day line of lenses tends to be very comfortable for most wearers.  The design is a bit challenging since finding the right power of the lens is not intuitive.  Luckily CooperVision has provided a detailed fitting guide to get you off to the right start.

8.7 BC
Power Range = +6.00 to -10.00
The lens is not add power designated which makes the fitting process less intuitive.  I always discuss with patients that I do not expect the contact lens prescription for this lens to match in any way what their glasses or previous contact lens prescriptions have been because of this disconnect in the way the lens is fit.





Dailies Aqua Comfort Plus Multifocal

A schematic of the design: near center, with rings of intermediate and then distance fanning out. via

When this lens launched earlier this year it was a great alternative option because it offered a design that doctors are already comfortable and familiar with fitting.  This lens uses the exact same multifocal design set-up to Air Optix Multifocal, and it is easy to transition patients that have worn the Air Optix lens into this daily version if they need the added comfort benefit without expecting to lose any vision.  You can follow the Air Optix Multifocal Fitting Guide to get started.



Biotrue ONEday for Presbyopia
This lens is just hitting the market in a limited initial roll out, and I am very excited to have it in my arsenal.  Using the same "3-Zone Progressive" design that is found in the Purevision2 Multifocal lens, I am especially happy to have this design as a daily option because I have found that this lens has been very effective for many of my patients.  Again, if you have patients happily wearing the Purevision2 lens, changing to Biotrue ONEday will be a seamless transition in vision if they need the added comfort of a daily lens.

8.6 BC
Power Range = +6.00 to -9.00
Add power = Low only at this time, with additional roll-out of High add power next year

1-Day Acuvue Moist Multifocal
This lens is slated to hit the market in late 2015, but we don't know much about what it will bring to the dailies multifocal market.  The 1-Day Acuvue Moist material is one of my favorites for all day comfort, so this fact alone is worth being hopeful.  Previous Acuvue multifocal designs (Oasys for Presbyopia, anyone?) have been left behind as newer options with better optics emerged, but Johnson and Johnson is introducing a brand new multifocal design for this lens.  Not much is known about the characteristics of this design at this time, but I will continue to keep you updated as we learn more!

This week I am excited to attend Vistakon's Women in Optometry Focus Group, and it is excellent timing that so much is going on within the company this year.  On October 6th, Johnson and Johnson launched broadened parameters in its popular 2 week lens brand, Acuvue Oasys for Astigmatism. For those of you with higher amounts of astigmatism this lens could help you attain better vision without the need for more expensive custom lenses.

via

What's New:
The Oasys for Astigmatism lens is now available in 10 degree axis options around the clock in all cylinder ranges up to -2.75.  In the past, only the older generation Soflens 66 Toric offered -2.75 cyl options without being custom order, and this brand's -2.75 range is now limited to minus spherical powers.   Acuvue Oasys Astigmatism now offers up to -2.75 cyl in powers from +6.00 to -9.00 to cover a broad spectrum of lens wearers.

Eyewear has had one thing hold true the last few years: big and bold. Whether it was oversized geek chic frames or bright blasts of color, glasses were all about making a statement.  So this season's trend took me a bit by surprise: neutrals are back in a big way.  Whether you prefer your frame to be metal or plastic, soft browns and pale peaches are the color of choice.  Here's a look at what's trending: