Hand held tonometers (or intraocular pressure measurers) can be used on people and animals too to find dangerous eye pressure ranges!  via

We are in the last few days of Glaucoma Awareness Month, so I have dedicated today's post to one of the most commonly asked questions in my exam room: what is eye pressure?  Eye pressure or intraocular pressure (which means the pressure inside your eye) is something that is measured at every comprehensive eye examination, but in the general population it's very poorly understood.
Here's an easy guide to what eye pressure is and why your doctor measures it!

Think of your eye like a basketball.  The inside of the ball is "pumped up" to a certain pressure to achieve the shape and properties desirable for the ball's performance.  While we don't need our eye to bounce, we do need it to have enough of its own pressure to keep its shape.  The eye is a relatively soft tissue after all.  In addition to having enough pressure to keep the eye's shape and structure, the pressure in the eye also helps with the distribution and flow of nutrients to the intraocular tissue.  The eye needs a certain pressure to keep its structural channels open for nutrients to pass through and blood to flow to various areas.  So we do need a minimal eye pressure (typically 4 mmHg or more is required for the eye to function), but too much can result in structural damage too.  Too little pressure and your basketball deflates, too much and it bursts.  Your eye won't burst, but too much or too little can both be devastating to your ocular health and vision!

The front section of the eye is the anterior chamber.  Aqueous humor is made in the ciliary body, and then flows around the lens, through the pupil, and bathes the back surface of the corneal to deliver nutrients before draining out. via

Common question -- eye pressure is not blood pressure.  They are actually completely unrelated (but can interact to put you at higher risk for damage like glaucoma!). The pressure inside the eye comes not from blood flow, but from a clear fluid called the aqueous humor. The front of your eye (or anterior chamber as it is called scientifically) is the area of the eye from your lens forward.  This part of your eye needs nutrients and oxygen just like all other parts of your body, but there is a problem: anything between your iris and your cornea (the clear surface dome) has to be clear.  If blood vessels covered these

Aqueous humor fluid drains out at the anterior chamber angle.  The angle needs to be open for fluid to properly drain.  If the tissue is blocked here, your eye pressure will acutely spike really highly! via

areas you would be looking through red lines all the time in your vision.  Instead the body uses a clear fluid called aqueous humor to deliver nutrients to the anterior chamber structures.  At any moment you have aqueous humor entering the front of the eye and exiting, passing nutrients through the system. The aqueous humor is made by the ciliary body (a structure that surrounds the iris), and is then drained through channels where the iris and cornea meet inside the eye (the anterior chamber angle).  If too much fluid is being made, or not enough is draining out, your eye pressure will rise.

This fluid is entirely inside of your eye, so even though we check your pressure by measuring externally, we are reading the internal eye pressure.  Just like the pressure inside of the baskteball.  If your eye is watering a lot people will often ask me if their pressure is too high.  Watering and eye pressure are almost always unrelated, since the fluid that causes high eye pressure is an internal eye fluid and not your tear film that is an external eye fluid.

When intraocular pressure is too high, the long term result is glaucoma, or death of the optic nerve.   If fluid is getting backlogged in the eye, it can change and shift the direction of that nutrient flow, even altering the flow of nutrients in the blood vessels in the back of the eye.  In time, this destroys the delicate nerve tissue that delivers information from the eye to the brain.  Glaucoma is typically a slow process -- you can have acute spikes in pressure that cause sudden damage (acute angle closure glaucoma is an example), but typically glaucoma takes years or decades to cause blinding vision loss.  And because in most people it's not the result of an acute high spike in pressure but years of chronic, mild elevation, you would not have any symptoms if you have glaucoma.  That's right, you won't feel different; you won't have red eyes; you won't have eye pain; and you won't notice vision problems.  Until you do and it is too late.  That's why glaucoma is something that we all need to be screened for yearly.  Unless your doctor is checking your eye pressure and optic nerve health, you won't know something is wrong until it is too late for us to restore your vision!

What's normal?
Normal eye pressure is typically under 21 mmHg.  Normal can vary from person to person however, so for some people even readings in the teens are too high and still damaging their eye.  Glaucoma is multifactorial, and there are so many different kind of glaucomas -- some have high pressure and some have perfectly normal pressure readings. As a general rule, if your eye pressure is in the high 20s or 30s, you probably have glaucoma or at least the strong risk of it.  Don't expect to feel a pressure sensation in your eyes unless your pressure is in the high 40s or 50s (at risk of acute and rapid vision loss!!).  Typically that pressure sensation you feel around the eyes towards the end of the day is actually just eye fatigue from tired eye muscles, but always best to get things checked.

For more information about glaucoma, check out What is Glaucoma? and How Does Your Doctor Check for Glaucoma?  for more patient-friendly reading!

We're just starting to see the new spring eyewear compaigns hit the internet, and once again this year tinted lenses are a major trend.  For a bold look that reinvents tinted lenses for 2015, designers have gone monochromatic, matching lens tint with frame color.  Where two tone styles have been the trends in years past, this year is about embracing color in a major way.  Not for the faint of heart.

Red mirrored lenses in red frames from French designer Premiere Classe via

Juicy Couture pairs blue mirrored lenses with royal and turquoise frames in their Spring 2015 collection via

Missoni embraced the color of the year, Marsala, in a bold tinted lens that matches the same hue as the patterned temples.  via

For their spring runway, Gucci embraced 70s inspired oversized shapes and a gradient yellow tint that lightened from top to bottom in both the lenses and frame color via

For a look that embraces being over the top -- try these Moschino sunglasses featuring rose tinted lenses in a bedazzled rose cat-eye frame. via

These orange Felder Felder cat-eyes have been trending across pinterest for the past few weeks.  Orange not your speed?  They also come in a bold rose on rose and a black frame with gray tinted lenses for the more subtle approach via

Atypical Choroidal Nevus by eyedolatry This patient has perfect 20/20 vision, and has been assessed for several years by ocular oncologists and believed to NOT have ocular melanoma but just a suspicious nevus at this time.

If you have a freckle inside your eye (or choroidal nevus in its technical term), your doctor has talked with you about the need to monitor its appearance.  Choroidal nevi are present in around 5-8% of the Caucasian population, and do not cause any changes to vision since they are present in the tissue underlying the retinal cells.  That means that you will not know if you have one unless you are getting routine dilated eye examinations or retinal photography!  Eye exams are essential for those with normal vision too.

Unlike choroidal nevi, choroidal melanoma are exceedingly rare--present at a rate of around 6 per 1 million individuals.   The overwhelming majority of choroidal nevi will never become a melanoma.--only about one in over 8,000 nevi have a malignant transformation.  At every eye exam, your doctor will assess your nevus for malignant suspicion, ruling out any potential risks or referring you to a specialist if further investigation is necessary.  Since both nevi and early melanomas typically have no associated pain or vision loss, the best way to determine your risk is to have your doctor look with dilation or retinal photography for suspicious characteristics.  How does your doctor determine risk? Here are the key factors we look for:

A confirmed ocular melanoma with autofluorescence of lipofuscin (as seen on right) and peripapillary position. via

To Find Small Ocular Melanoma  (Mnemonic and information credited to Dr. Carol Shields)

Thickness: suspect melanoma if the thickness is > 2 mm

• The only true way to assess thickness is to run an B scan ultrasound of the area in question.  Your doctor will typically try to determine based on vessel bend if the lesion is flat or elevated.  If elevation is expected, then they will likely refer you for a ultrasound to determine the exact amount of thickening

There is never a shortage of hope in the pharmaceutical world, and the recent reports on anti-LINGO-1(Biogen Idec) are full of promise for patients that have suffered vision loss from optic neuritis events.  The drug targets the LINGO-1 protein that is found in the human central nervous system and is known to inhibit myelination of axons and regeneration of axons.  Myelin is the important sheathing found along axons to speed transmission of information along the nerve.  By blocking LINGO-1, the medication hopes to promote myelin production and potentially regenerate axon tissue -- a benefit that if successful could find uses in medical conditions from MS to Alzheimer's.

LINGO-1 protein via

VEP testing is used to measure transmission of information from the eye to the brain based on responses to patterned images at the level of your visual cortex.  If your brain responds to the image (measured with electrodes placed in the area), then we know exactly when your brain "sees" the image  via

Time for a round up of the best looks from last night's Golden Globes.  The eyewear this year was decidedly understated, with stars bucking the trend that we've seen for most designers to use vintage inspirations and bold architectural details.  Black, brown, and gray plastics won the night, but there was still plenty to talk about:

Lupita Nyong'o donned this perfectly sized pair of glasses as a presenter.  I would have loved to see her in something a bit edgier in the color palate, but this frame shape is very flattering for her, and her understated glasses let her dress take front and center. via

Golden Globe winner Jeffrey Tambor actually had one of the boldest statements of the night with these tortoise frames in a round eyeshape. via

Award winner Kevin Spacey's glasses are a classic style -- rimless frames have long been a go-to if you want a subtle look.  But the bright silver frame and almost cat eye angle of the temples added a new twist.  Definitely one of the best eyewear looks for the night!  via

Winner Patricia Arquette donned these light gray or possibly lilac reading glasses to read her acceptance speech.  Even in this she is reminding us of what its like to be a real human being.  via

Meryl Streep stayed true to her eyewear signature -- oval shaped metal frames are her go-to for award shows.  I appreciate her always wearing glasses, but her black and white architectural dress would have been perfectly paired with a bold pair of black or white plastic frames this year.  via

Of course leave it to a surprise appearance from Prince to bring the biggest fashion trends to the night -- he wore throwback round shades that have been having a major fashion rebirth since  the end of 2014 via

If you wear specialty contact lenses, the normal techniques that work for soft and even rigid gas permeable lens wearers don't really work for you.  I've put together some tips from across the internet and the expert lens fitters on the topic to help you out if you are having trouble at home after leaving your doctor's office.

Synergeyes Lenses:

Synergeyes are hybrid contact lenses that fuse a rigid contact lens center with a soft contact lens "skirt" that provides additional comfort and a "soft lens" feel.  Traditionally, inserting and removing these lenses was nothing like what you were used to as a soft lens wearer.  With the new changes to the products, certain Synergeyes lenses can now be applied much more like a regular soft lens.

• Synergeyes Duette (including Duette Multifocal or Duette Progressive)
• You can insert the lens straight onto the eye, just like a soft contact lens with the new guidelines for the product. 
• Because the lens is larger, it is easiest to hold it with a two or three finger "tripod" approach as you insert the lens for balance.
• Filling the lens with solution before insertion is not required. 
• Synergeyes UltraHealth, ClearKone, or if you are having dryness or comfort issues with Synergeyes Duette products above

A DMV inserter has no suction since there is an open hole through the unit, so you don't have to worry about it sticking to your contact lens.  via

• Because the lens is so large, it can be more comfortable to fill the lens with a moisturizing solution to create a comfortable cushion layer between your cornea and the lens.  For lenses with excessive vault, like the UltraHealth and ClearKone lenses for keratoconus, filling the lens is essential for all- day comfort.  See below for the best filling solutions
• Since you are filling the bowl of the lens completely and don't want to loose all of that solution before getting the lens on your eye, you may prefer using a tool to aid in insertion like the DMV inserter (should be able to get this from your doctor's office) or EZI Lens Applicator for extra balance versus using the finger balance approach.  Make sure the DMV has a hole in the bottom to prevent the inserter from suctioning to your contact lens.

  Another great insertion tool is the EZI Lens Applicator; a ring device with a cup designed to hold your lens so that you can fill it with solution and bring it to your eye without spilling too much fluid.  You can purchase the EZI lens applicator in a variety of specialty lens sizes here.

• To prevent spillage, you will need to insert the lens by keeping it parallel to the counter top surface so that you don't tip all of the fill solution out.  You can either bend over at the waist or tuck your chin into your chest to achieve the right position.  The key is having your contact lens and your face horizontal for the entire process. Putting a small mirror on your counter may help with seeing what you are doing for this method.
• Do not press too hard!  The soft lens skirt can flex and almost turn inside out with too much force, causing all that liquid to escape out the sides and creating excessive suction between your eye and the lens (thus reducing comfort).  Shoving the lens into your eye will really reduce your end of day comfort.
• Bubbles are always an insertion error with this lens, so if you have a bubble, remove the lens, refill, and reinsert.

Gazal and Saeed Tabrizipour are the designers behind Atlanta-based Gazal Eyewear via

Let's kick 2015 off right by featuring the innovative, local eyewear designers of Gazal Eyewear.  This husband and wife team just launched their brand in June 2014, and with Gazal's past as an Atlanta-based optician, their focus is on quality and performance with a unique personality.  Gazal views eyewear in the same vein as jewelry -- an accent for expressing your personality.

Q & A

What is the inspiration for your designs?

"A need for functionality and fashion combined.  I never liked my glasses growing up so I stuck with contacts, but I always wanted to design something that was comfortable, durable, and still looked great."

Any specific trends that your designs center around in the new winter collection?

"No trends because they come and go.  I design based on inspirations in my life.  I draw different types of inspiration from each journey and each frame has a unique story behind it."

The High Flyer in Crystal is a highlight of the sunglasses collection, shifting the aviator trend into futuristic appeal with clean lines and a stripped-down color story.

Details on the mens' line of ophthalmics include leather temples and the woven detailing seen here in the His Eyeglasses

The cleverly two-toned cat eye style of the SyeAhMeez women's frame features two layers of acetate to create the pop of color peeping out at the edge of the eyepiece.

What sets your product apart for the independent optometrist to offer in their optical?

"We've created a win-win situation for everyone involved.  A product designed in Atlanta, GA which cuts out the middle men.  This leaves the practice owner with a product at a fair price to patients while delivering great return of investment over traditional big box frames and names."

How can optometrists interested in carrying your frame line get in touch?

"Email us at info@gazaleyewear.com or visit our social media pages on facebook, instagram, twitter, or pinterest!"

Pancreas beta cells produce insulin, helping the body process blood sugar.  Damaged beta cells are unable to produce insulin at the needed rate, resulting in excessively high levels of blood sugar, and diabetes. via

Exciting study results in the world of diabetic research were published at the end of last year by a group out of UAB investigating Verapamil as a potential cure for diabetes.  Verapamil is a commonly prescribed calcium channel blocker that is effectively used in treating high blood pressure, irregular heart rate, and even cluster headaches and migraines. Researchers targeted Verapamil after a secondary function was discovered -- Verapamil also reduces the amount of a protein called TXNIP in cells.  TXNIP is a protein that has been isolated in the pancreas beta cells; the amount of TXNIP increases as the the beta cells try to process higher levels of blood sugar.  At a certain level, TXNIP can be toxic to the beta cells and result in beta cell dysfunction and even death.  That means the body can no longer process high blood sugar effectively, leading to the effects of diabetes that we are so familiar with.

In mice studies at UAB, Verapamil was used to reduce the amount of TXNIP proteins within the pancreas beta cells, effectively "reversing" diabetic damage to the pancreas and preserving beta cell function.  They report that diabetes "was eradicated" in the treated mice who had blood sugar levels above 300 mg/deciliter.

Since the safety of Verapmil for human use has been verified by its previous uses on the market as a blood pressure treatment, UAB is set to enroll its first human study to begin testing its effects on human pancreas beta cells.  Enrollment is set to begin in early 2015, and UAB researchers are looking for patients aged 19 to 45 with type 1 diabetes.  The study will run over one year and will compare Verapamil versus placebo in a randomized distribution.  Insulin pumps will be used as directed throughout the study for both groups and a continuous glucose monitoring device will be used to accurately report hourly readings of sugar levels.

Non Proliferative diabetic retinopathy

With diagnosis of diabetes growing at a rapid rate in this country, any new research in the area is promising.  In addition to the systemic health effects, ocular side effects from diabetes are prevalent and can result in permanent blindness.  In patients with type 1 diabetes, 90% of patients have some form of ocular microvascular damage or retinopathy when living with the disease for 15 years or longer.  25% of these people have proliferative retinopathy which is a huge risk of permanent vision loss.  Annual eye examinations are essential in diabetic care to preserve vision and assess systemic health related to blood sugar control.  

For more information concerning the UAB study or to enroll, contact Kentress Davison at 205-934-4112 or 205-975-9308.