When prostaglandin analogue eye drops for glaucoma became available mainstream in the 1990s, they revolutionized glaucoma management and became the first line treatment for most patients. Now Valeant/Bausch and Lomb has submitted a new classification of glaucoma drop treatment to the FDA for fast-track approval: Vesneo, a combination drop of the proven prostaglandin analogue class with the first ever utilization of topical nitric oxide for additional pressure lowering effect.
How aqueous humor travels through the anterior chamber via |
Research has proven the effectiveness of nitric oxide in lowering intraocular pressure (IOP) in multiple animal and human studies. Nitric oxide is a known vasodilator, which can help reduce IOP by decreasing episcleral venous pressure that creates hemodynamic resistance against the flow of aqueous out of the eye. Nitric oxide has an additional benefit of increasing outflow of the aqueous humor through the trabecular meshwork and Schlemm's canal, two of the more prominent drainage structures of the anterior chamber. Prostaglandin analogue category drugs also increase aqueous outflow and drainage, primarily through the uveoscleral pathway (which includes flow across the ciliary muscle and choroid). Theoretically a combination of nitric oxide and prostaglandin analogue medication would cause an additive effect of increased outflow. Studies suggest that as much as 75% of the aqueous humor outflow occurs through the trabecular meshwork through Schlemm's canal, while the remaining 25% is from other tissue. That means our most effective glaucoma drop therapy on the market currently (prostaglandin analogues) targets that 25% of outflow, while if we could target trabecular meshwork outflow (like nitric oxide appears to do in studies) we'd be influencing a much larger area of impact.
No news yet on how much IOP lowering effect we should see from the addition of nitric oxide, but Valeant has targeted a summer 2016 date for FDA testing approval and results should be available at this time.
Time for your next edition! I want to preface this next picture by saying this is a patient with no vision complaints that I had followed for several years previously. I'm just going to start with the picture this time, because you'll spot a few things that are suspicious right away:
1. The most obvious ocular health concern that you'll spot is at the macula. See those yellow color distortions right in the center? Those are drusen consistent with dry age related macular degeneration. This patient came in for her annual exam with a known history of AMD that was being followed, so this macular appearance was expected. But can you see the new issue?
2. Follow the artery (the lighter colored blood vessel) up from the optic nerve and you'll come to a whitish round circle smack in the middle of the artery wall. This is a cholesterol plaque lodged in the arteriole, called a Hollenhorst plaque. Luckily you can see blood passing through the artery to the other side. If the blood vessel is white on the other side of the artery we know we have full obstruction and this would be an artery occlusion instead of just a plaque (occluded arteries are much more serious!). A cholesterol plaque, even when there is blood passing around it, is still a potentially serious threat to vision and systemic health; if there's a blockage in your eye there is likely a risk for cholesterol blockages elsewhere too.
What You Need to Know
Cholesterol blockages or Hollenhorst plaques are often found without causing any vision symptoms, so this is just one more reason why routine ocular health checks with dilation or imaging is a vital part of everyone's preventative health care. The patient above had absolutely no vision complaints, and unless blood flow is being blocked, likely there will be no affect on vision. If there is a plaque limiting blood flow to the retinal tissue, the patient will likely experience blacking out of vision (called amaurosis fugax or transient ischemic attacks) that can last for minutes at a time. Any sudden vision loss is always worth a call to your eye doctor, even when it is painless!
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If your doctor finds carotid stenosis on your ultrasound, it will likely be treated with oral medications like anti-platelet/blood thinners (baby aspirin is a common one) and cholesterol lowering medication like the statin category of meds. Surgical treatment is sometimes required to remove the obstruction -- typically when the carotid is > 60% stenosed surgery is the preferred treatmetn method.
Optos retinal imaging showing a Hollenhorst plaque via |
While you might not notice any problems or changes in your vision, if a Hollenhorst plaque is found during your eye exam it's not to be taken lightly. The Beaver Dam Eye Study found that those with Hollenhorst plaques or any retinal emboli were at a 3 x higher risk of fatal stroke over the next 8 years. This is a finding not to be ignored, and just another reason that when you go to your eye doctor, you need to have retinal imaging and or dilation done every single year, even if you don't notice any problems with your vision. An eye exam is a snapshot of your entire systemic health, and using the retina like a window into your body's inner workings can save your life.
Tips for Making Readers Fashionable
Reading
glasses are a fantastic and inexpensive way to test out eyewear trends to see
if they work for you. But if you’ve been watching eyewear trends emerge from
the Fall 2015 runways, you might be wondering how you can pull off the massive
sizes and bright colors that graced the models from Jonathan Saunders, Zac
Posen, Versace, Emporio Armani and Karen Walker. It’s not always easy to pull
runway fashion off the runway and make it applicable to your daily wardrobe,
but with a little creative thinking, you can translate the essence of fashion
trends into everyday looks.
1. Try
a new shape
Adding
a pair of reading glasses in a fun shape is a super easy way to work fall
trends into your wardrobe. Play up the retro vibe by trying a cat eye, browline
or round style this fall.
Bookworm |
Brit |
Feeling brave? Try an oversized square sun reader for a bit of a glamorous look.
Feeling brave? Try a pair with a bit of glitter or a sassy animal print.
Want more style inspiration? Follow Angie on Pinterest to see all of her favorite eyewear trends -- including boards for looks straight off the runway.
Rue |
2. Focus on
the details
Trends often hide in the details, and this fall is no exception. Look for readers with a plastic front and metal temples, or add a reader with a keyhole bridge to your collection.
Hayworth |
Saginaw |
Dorian |
Roman |
3. Update your
color palette
If you already have an eyewear shape that looks great on you, and you’re not quite ready to add glitter to your glasses, try updating your readers with a new color. This fall is calling for a range of blues, with a splash of olive and a hint of pastels.
Applause |
Catherine |
Sylvia |
Feeling brave? Try a frame in grey, or experiment with a clear frame or any other translucent color.
Countess |
How
do I know what reader power I need?
The
best way to find your correct magnification is to ask your eye care
professional during your examination. Your eye doctor can tell you if OTC
reading glasses are a good choice for your eyes, and they can help you figure
out the correct power for each reading task. We find that our customers are
typically unaware that the reading glasses they use for their newspaper will
often be a different power than the readers they use for computer work, and
that they may need different glasses to get their best visual performance.
If
you have a prescription handy, you can call us for help. Once our optician has
your prescription in front of her, she can do a bit of optical math to
determine the best magnification for your OTC reading glasses. Some prescriptions like those with moderate to high amounts of myopia or astigmatism, or those with significant differences in prescription between their two eyes, aren't great candidates for OTC readers and will need custom prescription reading glasses instead. For a quick check in, you
can always print out a handy guide to give you an idea of what power you need for your reading glasses. When printed out correctly, this guide allows you to hold the paper at your desired distance to see the necessary magnification for each task.
Allergy season is almost upon us, and itchy eyes, nose, skin, and throat is par for the course for many. But there are plenty of people out there that experience itchy, irritated eyelid skin all year round and no amount of Zyrtec or Benadryl is going to help. In fact, they will probably make it worse. That's because allergies can cause itching, but so can dryness and inflammation, both of which are chronic and can cause you to experience red, itchy eyeild symptoms year round.
Why do the eyelids get itchy or irritated? The skin of your eyelid is incredibly thin and delicate, and the blood vessels are quite close to the surface. As a result, any internal inflammation causing the veins to dilate and fluid to pool under the eyelid skin is going to make a bigger impact. The thin eyelid skin swells quickly, giving you that red puffy appearance. Check out this post for more
Another culprit to eyelid irritation is the eyelashes themselves. Think of your lashes like little feather dusters, catching debris and keeping it away from the eye itself. The eyelash follicle is a collection area for tons of microscopic allergens like pollen, dust, dry skin, makeup and even an inviting little home for mites like Demodex that survive off of eating your dry skin particles. Read more here. All of this is going on at a microscopic level that you aren't visibly going to see when you wash your face, and as a result, when was the last time you really cleaned carefully right into your eyelash roots? Scary, right.
Right on the inside of the eyelash follicle in the delicate waterline area are your meibomian glands, oil glands responsible for secreting the top layer of your tear film with every blink. These glands are easily clogged by dry skin and debris, or by anything that can harden oils like cold air, wind, inflamed eyelid skin (inflammation makes the lid margin swell and can block the gland opening), and not blinking frequently enough (like when we use computers, cell phones, or even read for long periods of time). If your oil glands are malfunctioning, your body can even start making soaps along your eyelid margin which foam up and of course cause stinging and burning. Keeping those oil glands open, free of debris, and properly secreting is essential to comfortable eyelids and the eye itself -- if you don't have a good tear film, your body can't blink away debris properly and you'll have worsened ocular allergies! It's all a terrible feedback circle.
Now that we've got the picture for why our eyelids need help, how do we clean them properly to get rid of debris and reduce irritation? Soap and water is often much too harsh for your delicate eyelid skin, and if we are cleaning right into the lash roots, of course it could get into your eye and burn like crazy. That's why baby shampoo was so popular for a while, but if you've ever used baby shampoo regularly for eyelid cleansing, you know it is incredibly harsh and drying for routine use. Instead, we need a product that will clean, but won't strip all the oils from your skin and leave it parched,dry, and irritated all over again.
My Favorite Products:
Blephadex:
If you don't read anything else, just buy this. Hands down this is the best eyelid cleansing product I have ever used. It is coconut oil and tea tree oil based -- great for sensitive skin types and incredibly soothing. The coconut oil will hydrate your skin while it's cleaning, and the tea tree oil is excellent for reducing Demodex colonies and inflammation. It is an excellent eye makeup remover; you can rub it right into your lash follicles and not worry about burning or stinging. For most people, using this product every other night will be enough on a routine basis, but if you have a lot of irritation going on you might want to use it nightly for a week to get things under control.
Ocusoft:
Before I found Blephadex I had been using Ocusoft pads for years and they work wonderfully. Excellent for nightly makeup removal, non-drying, and easy to find over the counter at your local pharmacy, Target, or even grocery store. Ocusoft also makes an excellent pump bottle foam, a spray version for those who do better with a less aggressive approach, and even cooling gel for night time use.
Avenova:
This hypochloric acid spray is all natural and easy to use -- just spritz a few times on a cotton pad, then rub along your eyelids. It's incredibly gentle but cuts debris and dry skin quickly without you needing to rub much at all. This product is gentle enough for use every single day, but it kills the most common strains of skin bacteria (and even MRSA!) in under 1 minute. If you are prone to chronic styes, this is the product for you. I've had several patients using daily Ocusoft still get styes (a bacterial infection of the meibomian gland), and according to their data, Ocusoft can take more than 30 minutes to kill these same bacterial strains. So if you've tried Ocusoft and are still getting styes, this prescription lid cleanser would be a great alternative. Right now Avenova is the only product listed here that is only available with prescription, typically running about $30 at your local pharmacy.
Why do the eyelids get itchy or irritated? The skin of your eyelid is incredibly thin and delicate, and the blood vessels are quite close to the surface. As a result, any internal inflammation causing the veins to dilate and fluid to pool under the eyelid skin is going to make a bigger impact. The thin eyelid skin swells quickly, giving you that red puffy appearance. Check out this post for more
via |
via |
via |
Now that we've got the picture for why our eyelids need help, how do we clean them properly to get rid of debris and reduce irritation? Soap and water is often much too harsh for your delicate eyelid skin, and if we are cleaning right into the lash roots, of course it could get into your eye and burn like crazy. That's why baby shampoo was so popular for a while, but if you've ever used baby shampoo regularly for eyelid cleansing, you know it is incredibly harsh and drying for routine use. Instead, we need a product that will clean, but won't strip all the oils from your skin and leave it parched,dry, and irritated all over again.
My Favorite Products:
Blephadex:
If you don't read anything else, just buy this. Hands down this is the best eyelid cleansing product I have ever used. It is coconut oil and tea tree oil based -- great for sensitive skin types and incredibly soothing. The coconut oil will hydrate your skin while it's cleaning, and the tea tree oil is excellent for reducing Demodex colonies and inflammation. It is an excellent eye makeup remover; you can rub it right into your lash follicles and not worry about burning or stinging. For most people, using this product every other night will be enough on a routine basis, but if you have a lot of irritation going on you might want to use it nightly for a week to get things under control.
Pads or Foam Version via Amazon |
Ocusoft:
Before I found Blephadex I had been using Ocusoft pads for years and they work wonderfully. Excellent for nightly makeup removal, non-drying, and easy to find over the counter at your local pharmacy, Target, or even grocery store. Ocusoft also makes an excellent pump bottle foam, a spray version for those who do better with a less aggressive approach, and even cooling gel for night time use.
Ocusoft pads have been solving eye irritation successfully for years and are easy to find over the counter at your local pharmacy or on Amazon |
The HypoChlor spray or gel is a new product, great for eyes that don't need the intensity of the foaming pad and need a more gentle approach without sacrificing effective bacteria and inflammation control. Applying HypoChlor gel at night is a great soothing way to kill bacteria and reduce eyelid swelling while you sleep. via |
Avenova:
via |