tag:blogger.com,1999:blog-52271004154609099472024-03-28T23:29:51.510-04:00EyedolatryOptometry Blog, Glasses Fashion, Patient Friendly Eye Health Guides, Contact Lens Fitting Guides, Practice Tips for New ODsDr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.comBlogger461125tag:blogger.com,1999:blog-5227100415460909947.post-80200614896510692542024-03-20T15:07:00.001-04:002024-03-20T15:07:06.723-04:00A New OD's Guide to Fitting Rose K RGP Lenses for Irregular Corneas<p>Whether your patient has keratoconus, pellucid marginal degeneration, or irregular cornea post-corneal graft surgery, standard contact lens solutions are likely not going to provide the best vision. While scleral lenses have become a go-to for irregular corneas over the past decade, some patients struggle with insertion and removal of a larger lens, and a smaller RGP option is more ideal for them. Luckily the <a href="https://roseklens.com/practitioners/lens-types/">ROSE K</a> family of RGP lenses gives us a range of options and is available from a number of different specialty contact lens manufacturers across multiple countries. </p><p>I highly encourage you to visit the <a href="https://roseklens.com/practitioners/lens-types/">ROSE K</a> practitioner website for in depth fitting guides, FAQs, and even videos. But if you are looking for a quick beginner's reference guide for getting started with this lens, this post is for you!</p><p><b>ROSE K lens selection</b></p><p>For each type of irregular cornea, well there's a Rose K lens for that. Each fit set has different fitting protocols for selecting initial lens base curve, so the first important step to a good Rose K fit is to choose the right fit set for your patient. </p><p><u>Rose K2 KC:</u> for keratoconus patients and more oval cones - most of your keratoconus fits (around 70%) will use this lens</p><p><u>Rose K2 NC</u>: for keratoconus patients with very central "nipple" cones. This is where the center of the cone is within 1 mm of the visual axis</p><p><u>Rose K2 PG:</u> for post-graft patients with more oblate corneas</p><p><u>Rose K2 IC</u>: for more diffuse irregular corneas like pellucid marginal degeneration patients</p><p><u>Rose K2 XL</u>: a corneoscleral lens for larger diameter irregularities</p><p><u>Rose K2 Oblate XL</u>: a corneoscleral lens for larger diameter irregularities post-surgical oblate corneas</p><p>Most of the irregular corneas a practitioner will be fitting are keratoconus patients, and most keratoconus patients would fall under the Rose K2 KC lens so that's likely the fit set you'll use most. I say this as a practitioner that only has the Rose K2 IC fit set and have wondered why the base curve fitting guide always seems to be wrong for me - after further education I know now it's because I was trying to fit a lens design that wasn't made for this specific patient group. Don't make my mistake - use the right fit set for the right patient category.</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVc2mZnYhMheAPtwKIvduVvu22kEVCYAjceVa8nDtqOrkiTb1GpyfzfV4LfJ8wK1gc0RkrKAqpYFU-j5FKW3v6pb03EQs9CkbrVNiOoezH4Sltk92M7One7RwOFTZGJcwD0gXiWL0V5nCPTZDGtj_cYc7UUvEocu2iDvr4nrALJCd7r7azknO1LD38rdbQ/s1498/Rose%20K2%20diameters.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Rose K2 Lens Types" border="0" data-original-height="512" data-original-width="1498" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVc2mZnYhMheAPtwKIvduVvu22kEVCYAjceVa8nDtqOrkiTb1GpyfzfV4LfJ8wK1gc0RkrKAqpYFU-j5FKW3v6pb03EQs9CkbrVNiOoezH4Sltk92M7One7RwOFTZGJcwD0gXiWL0V5nCPTZDGtj_cYc7UUvEocu2iDvr4nrALJCd7r7azknO1LD38rdbQ/w640-h219/Rose%20K2%20diameters.png" title="Rose K2 Lens Types" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.meniconamerica.com/professional/articles/blog/the-breakthrough-lenses-for-irregular-corneas/">via</a></td></tr></tbody></table><p><b>ROSE K FUNDAMENTALS OF A GOOD FIT</b></p><p>There are 5 steps to a good Rose K fit - after you've selected the right fit set for the patient you have in front of you of course.</p><p>1. <b>Central Fit - base curve selection</b></p><p>Follow the fit guide for how to convert your patients K readings to initial diagnostic lens selection. Place the lens on eye and instill NaFL dye to assess the pattern. You only need to wait a minute or so for settling - the lens will reveal how it fits very quickly. Judge the fit relationship immediately after a blink. Look for a "light feather touch" over the steepest apex of the cornea. What is a light feather touch? If you go just 0.1 mm steeper, then you'll get no touch. Bracketing the fit steeper and flatter until you find that point of just barely touch is ideal.</p><p>What happens if you fit a lens too flat (with more than a "light feather touch")? If the lens is rubbing on the cornea you can create punctate keratitis or even scarring issues. The lens will be uncomfortable or even painful to wear. </p><p>If you fit a lens too steep (too far off the cornea) you will get vision issues with halos, ghosting, and fluctuating vision. You can even have "dimple veiling" on the cornea where bubbles under the too-steep lens cause distortion to the corneal surface. </p><p>Both too flat and too steep cause problems, so it's important to spend extra time getting that initial base curve selection nailed down by bracketing until you find the most ideal lens fit where just 1 step steeper is too steep.</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgtrM66aU3fyRx0DWjVe8yxeWRxqeqjmhwkm-oULUPETTPK_t2WlXzyV2G1UZxKRXKljk8057zTRAaMQ4qvNzhxvP5M3v26ZXFTYDN6p6MF74h14yfUqFTO-ZQFSyuagu0Ytp3wtRwG4Qj6SeITigUklkdoc3VqTZDVazQxA5TIc6uxrgs4-BN327W3EUS/s800/light%20feather%20touch.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="RGP with light feather touch" border="0" data-original-height="533" data-original-width="800" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgtrM66aU3fyRx0DWjVe8yxeWRxqeqjmhwkm-oULUPETTPK_t2WlXzyV2G1UZxKRXKljk8057zTRAaMQ4qvNzhxvP5M3v26ZXFTYDN6p6MF74h14yfUqFTO-ZQFSyuagu0Ytp3wtRwG4Qj6SeITigUklkdoc3VqTZDVazQxA5TIc6uxrgs4-BN327W3EUS/w640-h426/light%20feather%20touch.jpg" title="RGP with light feather touch" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A "light feather touch" over the apex of the cone is ideal. <a href="https://www.no7contactlenses.com/kerakone/">via</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPLoPNPkZnLNBDQZEU4Vxxl6JfVxefrGxsDuSg102Sx11Sdl9KC_6280OfY-mq8tHGSoV7FToRUsscjg7qmE9E_JEOfXqfmfB8LfRndZas9NnyGIDuGQRVJhbGXz7q0iMwDOoec3z6y4ocGAwz2SPi5d_PKmahgLtGPH52TwOcG6UBW8PhUIWGQ7HHY7Ut/s800/flat%20fit%20RGP.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="RGP too flat" border="0" data-original-height="533" data-original-width="800" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPLoPNPkZnLNBDQZEU4Vxxl6JfVxefrGxsDuSg102Sx11Sdl9KC_6280OfY-mq8tHGSoV7FToRUsscjg7qmE9E_JEOfXqfmfB8LfRndZas9NnyGIDuGQRVJhbGXz7q0iMwDOoec3z6y4ocGAwz2SPi5d_PKmahgLtGPH52TwOcG6UBW8PhUIWGQ7HHY7Ut/w640-h426/flat%20fit%20RGP.jpg" title="RGP too flat" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">this fit is too flat - need to increase the base curve! <a href="https://www.no7contactlenses.com/kerakone/">via</a></td></tr></tbody></table><p><br /></p><p><b>2. Peripheral Fit - edge selection</b></p><p>All of the diagnostic lenses in your fit set come with a standard edge lift. When evaluating the lens edge focus on the 3 + 9 o'clock position because that is usually the flattest meridian of the cornea. Ideally you should see 0.6-0.8 mm band of NaFL dye at the edge. If the edge is too tight (barely any NaFL dye) then increase the edge lift to flatten the periphery. If the edge is too loose (excessive NaFL dye) then decrease the edge lift to steepen the periphery. A loose edge your patient will tell you how uncomfortable it is!</p><p><b>3. Overall Diameter</b></p><p>Per fitting gurus you want "the smallest diameter needed for good centration and movement". The larger the irregularity of the cornea, the larger your diameter will need to be. A central nipple cone patient will need a smaller diameter lens; a patient with pellucid where the irregularity is really far from the visual axis will need a larger diameter lens. </p><p>Your diagnostic lens set comes in specific diameter ranges for each type. So for example the Rose K NC has much smaller diameter than the Rose K PG where the irregularity would be more peripheral. This takes us back to the original point where you need to pick the right Rose K fit set for the type of patient you are fitting. </p><p><b>4. Location - is the lens centered?</b></p><p>You can adjust lens centration by adjusting 1) edge lift, 2) base curve, and 3) diameter. Make adjustments in that order until each element is maximized to ideal fit relation as outlined above. </p><p><b>If a lens is riding high:</b></p><p></p><ul style="text-align: left;"><li>Decrease the edge lift</li><li>Steepen the base curve</li><li>Decrease the diameter</li></ul><p></p><p><b>If a lens is riding low:</b></p><p></p><ul style="text-align: left;"><li>Increase the edge lift</li><li>Flatten the base curve</li><li>Increase the diameter</li></ul><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb61fAFd67Vb-Ui5qfzzD0bgOaxPy_vgekds2okwYYYEcys__TSz3dvQmD1LB46BHiagWChNxWNkfN2eFkfQHP3VLVMgxD0oarGheMbS20KYBWDNuBnE7s0zhX3viYgHBFbtitd1xt8s50aiVaQkTEZvZu4OcUnqpz7GMXoBbDqupQ6rSOS5jFV_HDX69N/s450/lens%20is%20riding%20low%20with%20excessive%20edge%20lift.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="450" data-original-width="358" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb61fAFd67Vb-Ui5qfzzD0bgOaxPy_vgekds2okwYYYEcys__TSz3dvQmD1LB46BHiagWChNxWNkfN2eFkfQHP3VLVMgxD0oarGheMbS20KYBWDNuBnE7s0zhX3viYgHBFbtitd1xt8s50aiVaQkTEZvZu4OcUnqpz7GMXoBbDqupQ6rSOS5jFV_HDX69N/w510-h640/lens%20is%20riding%20low%20with%20excessive%20edge%20lift.jpg" width="510" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">This is a really great lens to troubleshoot. Obviously it is riding low. At first glance you might think there is excessive edge lift, BUT remember you should judge edge lift and 3+9. At 3+9 you actually see there is minimal edge lift, so our initial change to fix this lens centration issue would be step 1 on the guide above: increase edge lift. <a href="https://www.sciencedirect.com/science/article/abs/pii/S136704840900068X">via</a></td></tr></tbody></table><div><br /></div><p></p><p><b>5. Lens Movement</b></p><p>Movement is important for tear exchange under the lens and healthy oxygen flow to the cornea, but excessive movement can also lead to discomfort and lenses easily decentering or even falling out. Ideal lens movement is 1-2 mm with blink. Edge lift is the main element that controls movement. </p><p>Increase edge lift to increase movement; decrease edge lift to decrease movement</p><p>If a patient tells you the lens is very hard to remove and is "tight" on the eye - that's a sign to increase the edge lift.</p><p><a href="https://roseklens.com/practitioners/lens-types/">Check out the Rose K practitioner website for more great education!</a> And don't forget that your reps in the consultation department are skilled at troubleshooting these lenses and can help guide you in what questions to ask yourself when designing changes to a fit. </p>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0North Carolina, USA35.7595731 -79.0192996999999913.8737894734725522 -114.17554969999999 67.645356726527439 -43.863049699999991tag:blogger.com,1999:blog-5227100415460909947.post-7738474787972137352024-01-25T12:17:00.002-05:002024-03-20T15:09:15.407-04:00The Lasting Dryness Effects of Eyelash Extensions<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLSFNefIw4kYMqDvRP0hhlMEZ2-tyR8nhPQbRgZfb0R6A_JJzaO-S85f0oPvbPeiwDapyaVyUGAyauqVKYk7lNkZ-_yCOaz_y3mq7B6aEq-MMz1urEdE-r4PaiE7DUP81compCPHVydYn9I6xOBDpVlCaGEIPDw9tfQwXaj-b5FPH2hS7OUfmQhcUNwS4P/s1640/Discontinued%20Lens.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="False Eyelash Extensions and Dry Eye" border="0" data-original-height="924" data-original-width="1640" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLSFNefIw4kYMqDvRP0hhlMEZ2-tyR8nhPQbRgZfb0R6A_JJzaO-S85f0oPvbPeiwDapyaVyUGAyauqVKYk7lNkZ-_yCOaz_y3mq7B6aEq-MMz1urEdE-r4PaiE7DUP81compCPHVydYn9I6xOBDpVlCaGEIPDw9tfQwXaj-b5FPH2hS7OUfmQhcUNwS4P/w640-h360/Discontinued%20Lens.png" title="False Eyelash Extensions and Dry Eye" width="640" /></a></div><br />Are your eyes prone to dryness, redness, irritation, or watering? Eyelash extensions should definitely not be on your to do list. <a href="https://www.contactlensjournal.com/article/S1367-0484(23)00350-8/fulltext">A new study</a> followed the self-reported comfort and ocular surface health of 32 healthy, young adults (average age was 25) with no previous history of dry eye or ocular surface discomfort after eyelash extension application. Lashes were applied using a standard protocol: ethyl cyanoacrylate glue was used to adhere false lashes to the upper eyelid eyelashes 1 mm from the eyelid margin, and then the glue was set using a fan. The patients symptoms and ocular health was monitored over 1 hour, 1 day, 1 week, and 1 month after getting eyelash extensions. <div><br /></div><div>The majority of patients (84%) experienced ocular irritation within 1 hour of getting eyelash extensions, the most common of which was reported as foreign body sensation (59.38%). These discomfort symptoms resolved at the 1 week follow-up for most patients. </div><div><br /></div><div>Ocular surface evaluation showed corneal staining (superficial punctate keratitis or erosions) was highest within 1 hour of lash extension application. While this corneal staining improved over the rest of the observation period, tear break up time (TBUT) was it's lowest compared to baseline at 1 week following lash extension application, and remained reduced even at the 1 month follow-up compared to baseline. </div><div><br /></div><div><b>Why do eyelash extensions cause dry eye?</b> There are several theories:</div><div><ul style="text-align: left;"><li style="box-sizing: border-box;">the cyanoacrylate glue causes irritation and damage to the corneal tissue when lashes are applied (<a href="https://www.medicalnewstoday.com/articles/allergic-reaction-to-eyelash-extensions">in some people it can even cause an allergic reaction</a>!)</li><li style="box-sizing: border-box;">the fan used to set the glue causes the cornea to dry out</li><li style="box-sizing: border-box;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592309/">the extra weight of the false lashes causes reduced blink rate and poor overnight eyelid closure</a></li><li style="box-sizing: border-box;">the extra length of the eyelashes effectively creates a wind tunnel fanning the eye, drying the surface of the eye</li><ul><li style="box-sizing: border-box;"><a href="https://royalsocietypublishing.org/doi/10.1098/rsif.2014.1294">this study </a>gives exact mathematical calculations of how eyelash length changes air flow dynamics</li><li style="box-sizing: border-box;">to reduce shearing wind tunnel effects, the optimal eyelash length is 0.35 mm +/- 0.15 or <a href="https://www.scientificamerican.com/article/your-eyelashes-should-be-this-long-science-says/">1/3 the width of your eye</a></li></ul></ul></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0North Carolina, USA35.7595731 -79.0192996999999917.4493392638211517 -114.17554969999999 64.06980693617885 -43.863049699999991tag:blogger.com,1999:blog-5227100415460909947.post-45098051133389906472023-12-06T13:40:00.002-05:002023-12-13T09:33:36.862-05:00Yes America, Playing Video Games Does Cause Dry EyeBurning, red, and watery eyes: that's what I've always experienced just a short time into video game play. And with <a href="https://www.statista.com/forecasts/997154/hours-spent-on-playing-video-games-per-week-in-the-us">27% of Americans playing video games at least a few hours each week</a>, it's no surprise that dry eye syndrome is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666567/">increasingly prevalent across all ages</a>. <a href="https://glance.eyesoneyecare.com/press-releases/myze-funded-first-of-its-kind-study-in-gamers-reveals-prolonged-video-game-vision-effect-on-development-of-dry-eye-symptomatology/">Newly published research</a> has confirmed what many eye doctors hypothesized to be true: video game play does result in dry eye, even among young and healthy individuals. <div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDDrMddwGT5rZFv0lRoEHxvskffzFYcgsEqfU5UjQFbLzdX5xE9IL-D7D-lIt5YgaFPyFlTsE14mGXEG5QvKctmmYMtHN9A03ihQLXp4MIQkQ5bysIqB5mHzaCDQp0BlCj2P0PACvyb_fC_ImQdKP860tO0q-rTXTmw4pYDfZmxddEnee7YRntt8hAVIFI/s1156/Add%20a%20heading.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Video Games Cause Dry Eye" border="0" data-original-height="1156" data-original-width="1080" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDDrMddwGT5rZFv0lRoEHxvskffzFYcgsEqfU5UjQFbLzdX5xE9IL-D7D-lIt5YgaFPyFlTsE14mGXEG5QvKctmmYMtHN9A03ihQLXp4MIQkQ5bysIqB5mHzaCDQp0BlCj2P0PACvyb_fC_ImQdKP860tO0q-rTXTmw4pYDfZmxddEnee7YRntt8hAVIFI/w374-h400/Add%20a%20heading.jpeg" title="Video Games Cause Dry Eye" width="374" /></a></div><br /><div><br /><div><br /></div><div><a href="https://www.eastwesteye.org/about-us/posters/">The study</a> evaluated 41 college students who played video games over a 4 hour time window, with a 5 minute break every hour and fluid intake of "no more than" 2 cups during that time frame. All study participants played the game within a dedicated lab room which was monitored for consistent temperature and humidity to make sure that was not a confounding factor. Dry eye tests were performed before video game play and after; these tests included <a href="https://www.reviewofoptometry.com/cmsdocuments/2022/05/speed-questionnaire.pdf">SPEED</a> and <a href="https://www.bergfeinfield.com/wp-content/uploads/OSDI-questionnaire.pdf">OSDI </a>questionnaires, Snellen Visual Acuity at distance and near, Tear Film Osmolarity (Tear Lab), Schirmer test without anesthesia, and Matrix-Metalloproteinase-9 (MMP-9) levels (Quidel). </div><div><br /></div><div>At the end of the 4 hours of video game play, there was a statistically significant worsening in SPEED score index and MMP-9 levels for participants. The average SPEED score for participants nearly doubled at the end of the gaming window, with average soreness and irritation increasing 3x compared to baseline, and the frequency and severity of eye fatigue complaints doubling compared to baseline. Of the participants who had normal MMP-9 levels before gaming, 36% of participants had elevated levels after gaming. MMP-9 is an inflammatory biomarker found in the tear film that is elevated in patients with dry eye syndrome. </div><div><br /></div><div>This is the first known study to prove that video game play specifically causes dry eye symptoms. Based on the 36% of participants who had changes in their MMP-9 levels after game play, in some individuals video game play can even trigger inflammatory changes to the eye. Because dry eye syndrome is so multi-factorial, it's important to understand the environmental situations that create more risk for your eyes so that if you suffer from chronic or severe dry eye syndrome you can appropriately modify your exposure to these high risk environments. <a href="https://www.tearfilm.org/conferences-lifestyle_report/7374_7374/eng/">The Tear Film and Ocular Surface Society Lifestyle Report</a> identified environment and lifestyle as major contributors to dry eye/ocular surface disease - with windy environments, higher levels of air pollution, and digital screen use all being identified as exacerbating factors. Check out the full TFOS Lifestyle Report to learn more. </div></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.comtag:blogger.com,1999:blog-5227100415460909947.post-55846156536991688132023-09-25T16:33:00.006-04:002024-03-20T15:09:48.909-04:00Everything You Need to Know About MIEBO for Dry EyeRedness, pain, blurry vision, gritty sensation, watering - all of these are the common signs of ocular surface disease, better known as dry eye syndrome. Until this year, the only FDA-approved eye drops to treat dry eye were focused on the anti-inflammatory pathway (<a href="https://www.restasis.com/">Restasis</a> 0.05% cyclosporine, <a href="https://www.xiidra.com/?utm_source=google&utm_medium=cpc&utm_campaign=Xiidra.com_Branded_Google_3.2021&utm_term=Brand_Exact%20%7c%20xiidra&gclid=CjwKCAjw38SoBhB6EiwA8EQVLgTi4mCe1T5fqioRLtNNxUwDwjuraKrnWHXjqY5dqNca28Lqsg6vthoChcUQAvD_BwE&gclsrc=aw.ds">Xiidra</a> 5% lifitegrast, and <a href="https://www.cequa.com/?utm_source=Google&utm_medium=ppc&utm_campaign=CEQUA%20DTC%20-%20Branded%20-%20General%20-%201.26.2021&utm_content=Branded%20-%20General%20-%201.26.2021&utm_term=cequ&gclid=CjwKCAjw38SoBhB6EiwA8EQVLrStey8kVTb_pJ-5EpsfFRpQ6uR_0OSZ50xYhahTx269IzPgJGfrdRoCDIEQAvD_BwE&gclsrc=aw.ds">Cequa</a> 0.09% cyclosporine). If you're reading this article, chances are you have tried one or more of these treatment options. Each of these drops have had varying levels of success in helping patients control their signs and symptoms of dry eye, and have common side effects that include redness and burning with drop use. What's more, these drops have to be used long term to achieve symptom reduction and <a href="https://pubmed.ncbi.nlm.nih.gov/31819353/">studies show</a> that up to 60% of patients with dry eye syndrome using cyclosporine or lifitegrast discontinue drop use within a year of starting treatment. Whether due to side effects, inconvenience, or ineffectiveness, this research suggests that many dry eye patients aren't finding lasting relief with the available prescription options for treatment. <div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgirg27DllzkoygdpdBdyFEkvAVugqTKKW-XSUitb8JY21DvJ2hbC5dYXUquW4e_ZwUF5Q3FbEYI4QE4jqyxIUwiol92pqtYk3cjjTeH-8WkhF5UtWdtOeSM4kDZY-uFxvv3vkWbLZskC2FYP-JfvvJjUsDkn90M_mb_tzMK5ukK3hw91iGXfgdtG5w74ow/s1640/Discontinued%20Lens.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Miebo for Dry Eye" border="0" data-original-height="924" data-original-width="1640" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgirg27DllzkoygdpdBdyFEkvAVugqTKKW-XSUitb8JY21DvJ2hbC5dYXUquW4e_ZwUF5Q3FbEYI4QE4jqyxIUwiol92pqtYk3cjjTeH-8WkhF5UtWdtOeSM4kDZY-uFxvv3vkWbLZskC2FYP-JfvvJjUsDkn90M_mb_tzMK5ukK3hw91iGXfgdtG5w74ow/w400-h225/Discontinued%20Lens.png" title="Miebo for Dry Eye" width="400" /></a></div><br /><div><br /><div><br /></div><div>In June 2023 a new drop got FDA approval for treating the signs and symptoms of dry eye disease: <a href="https://www.miebo.com/">MIEBO </a>(100% perfluorohexyloctane). Instead of targeting inflammation as a pathway to dry eye relief, MEIBO targets tear film evaporation. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072157/">Studies show </a>that excessive tear evaporation is the most common cause of dry eye disease, with 86% of patients with dry eye experiencing some form of <a href="https://www.eyedolatryblog.com/2017/06/diagnosing-meibomian-gland-disease.html">meibomian gland dysfunction</a>. The meibomian glands are oil glands located in our top and bottom eyelids, and every time we blink they release the topcoat oil layer of our tears. If the glands are clogged, damaged, or inflamed, the oil cannot be released properly onto the eye's surface and our tears very quickly evaporate away. </div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi05pTxmDEUTHVS2SFXwBarIP2ZrIM_aF7jSXgrogPtSsI7u-iZ1BLM9tmTlMfCbB3XhmQXJ89vJkSuwZu8nQNO2HOJI-rAa7CclXwcdauLTsXQIAHJgYxdyQ4EhHu3wkXMEvaqIwyeV3lrcHOrhAEvz0FqqO1aoOOBcb70VXPo-aH_QiyukESFuXO3fhcd/s1418/MGD.jpg" style="margin-left: auto; margin-right: auto;"><img alt="Meibomian Gland Dysfunction" border="0" data-original-height="1058" data-original-width="1418" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi05pTxmDEUTHVS2SFXwBarIP2ZrIM_aF7jSXgrogPtSsI7u-iZ1BLM9tmTlMfCbB3XhmQXJ89vJkSuwZu8nQNO2HOJI-rAa7CclXwcdauLTsXQIAHJgYxdyQ4EhHu3wkXMEvaqIwyeV3lrcHOrhAEvz0FqqO1aoOOBcb70VXPo-aH_QiyukESFuXO3fhcd/w640-h478/MGD.jpg" title="Meibomian Gland Dysfunction" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">The meibomian glands run vertically through the top and bottom eyelid and the openings of the glands can be seen at the water line of the eyelid. This is a photo of my patient that has significant inflammation around the meibomian glands, causing congestion and clogging. </td></tr></tbody></table><br /><div><b><span style="color: #990000;">How Does MIEBO Work?</span></b></div><div>MIEBO works by targeting evaporation; it mimics the natural meibomian gland-released oil layer on the eye by spreading evenly across the eye's surface and reducing evaporation of the tear film. The drop gained FDA approval based on the outcomes of 2 multicenter, placebo-controlled studies: <a href="https://pubmed.ncbi.nlm.nih.gov/36574848/">GOBI </a>and <a href="https://pubmed.ncbi.nlm.nih.gov/36948372/">MOJAVE</a>. In these studies MIEBO showed statistically significant improvement in dry eye symptoms (measured by the Ocular Surface Disease Index [OSDI] and the Visual Analog Scale) and signs (measured by corneal staining - this is where dry and broken corneal cells are visualized using a sodium fluorescein dye). Full resolution of corneal staining was seen as early as day 15 using the MIEBO drop treatment!</div><div><br /></div><div>MIEBO is </div><div><ul style="text-align: left;"><li>preservative free</li><li>water free (which greatly reduces the risk of microbial growth!)</li><li>to be used 4 x a day for maximum efficacy</li><li>should not be used with contact lenses; wait 30 minutes after using Miebo before inserting a contact lens<div><br /></div></li></ul></div><div><b><span style="color: #990000;">Side Effects</span></b></div><div>The side effects of MIEBO were very minimal in the Phase 3 clinical studies: 0.05% of patients reported pain with drop insertion, 2.1% of patients reported blurry vision with drop use, and 0.8% of patients reported redness with drop use. MIEBO has not been studied in patients who are pregnant or nursing, or for use in children under the age of 18. </div><div><br /></div><div><b>Other Interesting Science</b></div><div><a href="https://www.readcube.com/articles/10.3389/fmed.2021.709712">Perfluorohexyloctane</a> (F6H8) as a molecule has been studied extensively in dry eye both in Europe and the US before the release of MIEBO as an FDA-approved treatment for dry eye, and this research has sparked plenty of buzz for eye doctors who have been highly anticipating a new approach to dry eye. <a href="https://www.readcube.com/articles/10.3389/fmed.2021.709712">Research on</a> F6H8 shows it increases tear film thickness by 10 mm after insertion, reduces the friction between the eye and eyelids when you blink, and actually causes slight changes to the eye's surface temperature. Have you ever noticed how your eyes water in really cold air? We have cold thermoreceptor nerve cells on the eye's surface, and by activating these nerves you will increase the release of tears and increase the rate of blinking (which would thus also increase the rate of Meibomian gland oil release!). Within 5 minutes of F6H8 drop insertion, ocular surface temperature measured by infrared video imaging decreased by an average of -0.7 degrees Celsius. Saline drops had no impact on corneal temperature. </div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1iTfzOkt0GR1VBPBtyQPp_jX0Hqw6-B4try_y_QHZOq8rwRUtXuEms0KUTEJZRBOUaNI0Q6ZqaifEFBlIBC4jPZg7XzZmOsJOtEByZwEgIPivkIvnEe3dDS2K9M8RcxP4lv7v2GxaXtraKfKmUTXtaBMdR1Ui4z6Xguc2N_3qOPRju7ywCloIogzKPsqI/s1167/temperature%20control%20F6H8.png" style="margin-left: auto; margin-right: auto;"><img alt="Cooling Temperature effect of Perfluorohexyloctane Drops" border="0" data-original-height="467" data-original-width="1167" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1iTfzOkt0GR1VBPBtyQPp_jX0Hqw6-B4try_y_QHZOq8rwRUtXuEms0KUTEJZRBOUaNI0Q6ZqaifEFBlIBC4jPZg7XzZmOsJOtEByZwEgIPivkIvnEe3dDS2K9M8RcxP4lv7v2GxaXtraKfKmUTXtaBMdR1Ui4z6Xguc2N_3qOPRju7ywCloIogzKPsqI/w640-h256/temperature%20control%20F6H8.png" title="Cooling Temperature effect of Perfluorohexyloctane Drops" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Infrared images showing the cooling effect of perfluorohexyloctane (F6H8) drops <a href="https://www.readcube.com/articles/10.3389/fmed.2021.709712">via</a>. In Row A The right eye was given F6H8 drops and the left eye was given saline eye drops (which showed no temperature effect). In Row B, both eyes were given F6H8 drops. The cooling temperature effect was seen within 5 minutes of drop instillation and continued through 30 minutes after drop instillation. </td></tr></tbody></table><br />Another interesting discussion regards the category of MIEBO as a PFAS (per- and polyfluorinated substance), which has come under some scrutiny as the European Union has investigated changes and potential bans to how these chemicals are used in over the counter and prescription products. <a href="https://www.eyedolatryblog.com/2023/05/contact-lenses-and-pfas.html">Check out this article for a deeper dive into PFAS and the possible risks</a>. In a statement from Bausch and Lomb, MIEBO is by definition a PFAS molecule, but that definition does not "inform whether a compound is harmful or not." Perfluorohexyloctane (MIEBO) is <a href="https://go.drugbank.com/drugs/DB17823">"physically, chemically, and physiologically inert, and is practically immiscible in water."</a> The <a href="https://www.bausch.com/globalassets/pdf/packageinserts/pharma/miebo-package-insert.pdf">molecule has also undergone "extensive genotoxicity, mutagenicity, and toxicology studies with no significant adverse effects.</a>" Perfluorohexyloctane has been used with a high safety profile for many years as an eye drop in other countries, and for intraocular injections in the treatment of retinal detachments without incident. </div><div><br /></div><div>Because the drop is not water soluble, the risk of it being absorbed into the body is reported as minimal. <a href="https://pubmed.ncbi.nlm.nih.gov/37389230/">Studies show</a> the main route of elimination of perfluorohexylocatane is evaporation off the ocular surface.</div><div><br /><div>As of writing this article, <a href="https://www.miebo-ecp.com/savings-support/">MIEBO drops are most readily available through the mail-order pharmacy, BlinkRx</a>. Consult with your eye doctor to learn more!</div></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0North Carolina, USA35.7595731 -79.0192996999999917.4493392638211517 -114.17554969999999 64.06980693617885 -43.863049699999991tag:blogger.com,1999:blog-5227100415460909947.post-67228144781633714512023-09-06T15:01:00.005-04:002023-12-06T13:42:18.905-05:00Kids and Screens: An Eye Doctor's Review of the Science<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg06yqxnr-NiONUREj_AILIiHg75V8jRnCyvWoKzDrht9Yb7PNZ5ebBM7mVZNcIUFbsxudePTvOPEgm6e0Mf_a74up-afaCKe6ewJCPv3QQ4Bw7c-kmfQh77mLHXN8wcWXw39r-yh-evwjWXgP0YKQPU0MTsYfQqAsrz-k4awd_14fVEt7AKE9zziLDwYuv/s1356/Discontinued%20Lens%20-%201.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Kids Eyes and Screens" border="0" data-original-height="924" data-original-width="1356" height="437" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg06yqxnr-NiONUREj_AILIiHg75V8jRnCyvWoKzDrht9Yb7PNZ5ebBM7mVZNcIUFbsxudePTvOPEgm6e0Mf_a74up-afaCKe6ewJCPv3QQ4Bw7c-kmfQh77mLHXN8wcWXw39r-yh-evwjWXgP0YKQPU0MTsYfQqAsrz-k4awd_14fVEt7AKE9zziLDwYuv/w640-h437/Discontinued%20Lens%20-%201.jpeg" title="Kids Eyes and Screens" width="640" /></a></div><br /><div><br /></div><div>As a doctor and a parent, I know how worried we are about the amount of screen time our kids are exposed to. <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2798256?guestAccessKey=2bb83659-b469-4a2f-b60e-9480451e3616&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=110722">Research published in JAMA pediatrics in 2022 </a>shows worldwide the average child spends 4.1 hours per day in front of a screen - a 52% increase from pre-pandemic levels. Studies looking at American children's use of screens show even more staggering numbers; <a href="https://www.cdc.gov/nccdphp/dnpao/multimedia/infographics/getmoving.html">the CDC reports</a> the average American 8-10 year old is spending 6 hours in front of a screen, and the average 11-14 year old is spending 9 hours. Should we be concerned?</div><div><br /></div><div>The good news is that there is no scientific data showing that a human eye could be permanently blinded or the retina tissue permanently damaged by looking at digital devices. Let's review what we do know about screen time and it's risk for our children:</div><div><br /></div><div><b>The Question of Blue Light</b></div><div>Much has been made about the high energy blue light emitted from device screens, but the amount of blue light exposure from a screen is actually much less than that of sunlight. <a href="https://news.osu.edu/blue-light-isnt-the-main-source-of-eye-fatigue-and-sleep-loss---its-your-computer/">Research from Ohio State University</a> found that even a cloudy day outside has 10 x the amount of blue light exposure than that emitted from a screen, and a sunny day would have 100 x the amount of blue light exposure. Because of a lack of research finding that blue light from a screen could actually damage the retina, <a href="https://www.aao.org/eye-health/tips-prevention/are-computer-glasses-worth-it">the American Academy of Ophthalmology does not recommend blue light glasses for health protection of the eyes.</a> </div><div><br /></div><div>While blue light blocking glasses have been reported by some to reduce glare and light sensitivity, there is a lack of consistent literature showing any meaningful benefit.<a href="https://pubmed.ncbi.nlm.nih.gov/29044670/"> A recent study</a> reported that blue light glasses were no more effective at reducing computer-related glare, eye strain, or light sensitivity than simply dimming the screen brightness or using "night mode" settings on devices.</div><div><br />In my own practice, I offer patients samples of anti-reflective coatings, tinted lenses, and blue blocking lenses to try while looking at their own devices. Some patients notice a difference; some do not. If this technology helps your eyes feel more comfortable, then having it in your glasses makes great sense, but we also discuss focusing on<a href="https://www.eyedolatryblog.com/2014/01/computers-and-your-eyes-ergonomics.html"> good computer ergonomics</a> - reduce screen brightness, sit at least an arm's length away, take frequent breaks, position yourself so the screen is no higher than your eyebrow height - as essential for reducing the risk of eye strain and discomfort.</div><div><br /></div><div><b>What Concerns Do Exist</b></div><div><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057686/#:~:text=The%20American%20Optometric%20Association%20(2017,day%20on%20their%20digital%20devices.">Research from nearly 2,000 children aged 8-14 </a>showed that more smartphone and device use was associated with more self-reported complaints of eye strain and discomfort. The most common symptoms included:</div><div><ul style="text-align: left;"><li>blurry vision or double vision (fluctuating - not permanent vision damage)</li><li>irritation, burning, redness</li><li>eye strain or tired eyes feeling</li></ul><div>Using devices > 4 hours per day was associated with the highest rate of symptoms: 60.2% reported eye strain/tired eyes, 46.3% reported blurry distance vision after screen time or studying, 41.9% reported burning/irritation/redness, and 38.1% reported headaches. </div></div><div><br /></div><div>Screen use does make eyes feel uncomfortable - and one of the core reasons is because it makes our eyes drier. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439964/">Studies show we blink as much 42% less often when we are using a device.</a> Blinking is essential for the release of tear film from our eyelid meibomian glands onto the eyes' surface - when we don't blink, we don't release tears, and the result is drier eyes. The best way to help reduce the risk of discomfort with screen use is to take frequent breaks. The <a href="https://www.aoa.org/AOA/Images/Patients/Eye%20Conditions/20-20-20-rule.pdf">20/20/20 rule</a> has been popularized to help guide device users in better ocular comfort - every 20 minutes, take a 20 second break to blink and look 20 feet away (out a window, down a hallway, etc). </div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUI3LnTdsaxxL6qbImE2VAyUnNanW3CeGwgju3Jjntuu7XJ2PDTThE8BZZC2I3xubMpMOHXOYsIiOa1z8sSuJlNtLa3Slis3Cl59J_D3o6HBOqolxtPKErZ3Vxa4Wyr2IADvyL5aw8UF8ALTjWmoR6L4EnKRKauhofxx2hZh6nX66dPiXreQ_xiooc-6Z9/s973/202020rule.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="20/20/20 Rule" border="0" data-original-height="508" data-original-width="973" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUI3LnTdsaxxL6qbImE2VAyUnNanW3CeGwgju3Jjntuu7XJ2PDTThE8BZZC2I3xubMpMOHXOYsIiOa1z8sSuJlNtLa3Slis3Cl59J_D3o6HBOqolxtPKErZ3Vxa4Wyr2IADvyL5aw8UF8ALTjWmoR6L4EnKRKauhofxx2hZh6nX66dPiXreQ_xiooc-6Z9/w640-h334/202020rule.png" title="20/20/20 Rule" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.aoa.org/AOA/Images/Patients/Eye%20Conditions/20-20-20-rule.pdf">via</a></td></tr></tbody></table><br /><div>Dry eye is more than just temporary discomfort - if the meibomian glands become blocked or damage it can lead to a lifetime of battling ocular discomfort. <a href="https://www.reviewofoptometry.com/article/excessive-screen-time-causes-meibomian-gland-atrophy">Research</a> has found even very young children now often have signs of meibomian gland damage. This study looked at 172 children between the ages of 6-17 and found that 86% of patients that reported 4 or more hours of screen use had "severe" meibomian gland atrophy. </div><div><br /></div><div><b>What About Myopia?</b></div><div>Can screen use increase the risk of your child becoming near sighted (myopia), or their near sightedness worsening? Research does suggest a correlation, though it's hard to separate the impact of screen use specifically versus overall time spent indoors. When school-aged children were doing mostly virtual and online schooling (resulting in a significant increase in screen time usage), <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9512310/#:~:text=found%20that%20the%20prevalence%20of,%2D0.3D%20%5B16%5D.">one study</a> found a 10.49% increase in the rate of myopia among their population versus pre-COVID levels. <a href="https://pubmed.ncbi.nlm.nih.gov/31943280/">It is unclear</a> if screen use specifically increases the risk of myopia, but we do know that spending more time outdoors and having better sleep schedules is correlated with a reduced risk of myopia. To help reduce the risk of developing myopia, parents should strive for their children to get:</div><div><ul style="text-align: left;"><li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170055/">2 hours/day on average of outdoor time</a></li><li><a href="https://www.reviewofoptometry.com/news/article/irregular-sleep-schedule-associated-with-myopia#:~:text=The%20researchers%20observed%20a%20higher,%2Fday%20(OR%3D1.27)">regular sleep schedules with 8 hours of night-time sleep duration</a></li><li><a href="https://reviewofmm.com/why-binocular-vision-matters-in-myopia-management/#:~:text=Even%20though%20it%20is%20debatable,the%20patient's%20binocular%20vision%20status.">regular eye exams to detect and treat binocular vision insufficiencies</a></li></ul></div><div><b>What Can Parents Do? </b></div><div>Limiting screen time and setting frequent break intervals is essential to reducing this eye strain and dry eye damage. Excessive screen use has been associated with a number of concerns for children's overall well-being, above and beyond their ocular health and vision. Studies have found increased screen time to be correlated with:</div><div><ul style="text-align: left;"><li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769928/">increased risk of obesity</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/25193149/">inadequate sleep</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/30753173/">developmental delays in speech and language for young children</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/20603258/">attention and focusing issues</a> -- Children who exceed the American Academy of Pediatrics (AAP) recommendations for daily screen use are 1.67 times more likely to have attention problems as reported by their teachers</li><li><a href="https://pubmed.ncbi.nlm.nih.gov/30406005/">anxiety or depression</a> -- studies show14-17-year olds who spend <u>></u> 7 hours/day using screens are 2 times more likely to be diagnosed with anxiety or depression</li></ul><div><div>The <a href="https://www.aoa.org/news/clinical-eye-care/public-health/screen-time-for-children-under-5?sso=y">World Health Organization</a> recommends:</div><div><ul><li>no screen time for children 1 year old or less</li><li>no more than 1 hour for children ages 2-4 </li><li>for children 5 and older set limits for screen use and encourage frequent breaks</li></ul></div></div></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-88354042163379676882023-08-02T10:47:00.004-04:002023-09-25T16:37:07.926-04:00Could a Medication Reverse Vision Loss After Stroke?Vision loss is one of the most common side effects of a stroke, occurring in 65% of stroke survivors according to the <a href="https://www.stroke.org/-/media/Stroke-Files/Lets-Talk-About-Stroke/Life-After-Stroke/Lets-Talk-About-Stroke-and-Vision-Sheet.pdf">American Stroke Association</a>. And for 20% of those people, the visual field loss is permanent. But could a medication help recover lost visual field? New studies show the this may be possible.<div><br /></div><div><b><span style="color: #990000;">Stroke and Vision Loss</span></b></div><div>A stroke occurs when blood flow is blocked or greatly reduced to the brain, resulting in reduced oxygen and nutrient flow to the delicate brain tissue. It takes only a matter of minutes of disrupted blood flow to cause devastating damage to brain tissue. The majority of strokes (<a href="https://www.nhlbi.nih.gov/health/stroke">around 90%</a>) are a result of blocked blood vessel flow (called ischemic stroke) and the rest are from internal bleeding (called hemorrhagic stroke). <b>A stroke is a medical emergency, so if you experience any of these symptoms call 911 immediately:</b></div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy5dwTlBOqiTXa_82OAK-sM9sjctM7P6JxcHZfQ4hFKVoqcuY63qFLGMqI0d15-1oE6L_rgeBv3NzM0jdaz1aUxrk-k7AYnxlSoD5sIwpmfOVF-aAYkOUN_3d-pfo4YZwmm231DlWbenScBtpVqOzm7CoS2KJSxm2toVA1_nrpBqFbnXRm9Lwci6INzMC2/s1359/spotting%20a%20stroke.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Spotting a Stroke BE FAST" border="0" data-original-height="605" data-original-width="1359" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiy5dwTlBOqiTXa_82OAK-sM9sjctM7P6JxcHZfQ4hFKVoqcuY63qFLGMqI0d15-1oE6L_rgeBv3NzM0jdaz1aUxrk-k7AYnxlSoD5sIwpmfOVF-aAYkOUN_3d-pfo4YZwmm231DlWbenScBtpVqOzm7CoS2KJSxm2toVA1_nrpBqFbnXRm9Lwci6INzMC2/w640-h285/spotting%20a%20stroke.png" title="Spotting a Stroke BE FAST" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>image via <a href="https://www.dukehealth.org/blog/know-signs-of-stroke-be-fast" target="_blank">Duke Health</a></i></td></tr></tbody></table><br /><div><span style="font-family: inherit;">When a stroke affects the vision areas of the brain (typically the occipital or parietal lobes), permanent vision loss can result. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782154/">A 2013 study </a>of 915 patients who had suffered a stroke revealed that 52% of them had visual field loss, causing difficulty reading, double vision, blurry vision, and visual perception difficulties. Traditional treatments for patients who experienced stroke-related vision loss are focused on helping patients adapt to their changed visual world. Specialists in vision therapy or low vision can help patients with visual search and visual awareness training, prism glasses, occlusive patches, or even low vision aids.<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782154/"> </a><span style="background-color: white; color: #212121;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782154/">In this UK based study,</a> of the patients who saw a vision specialist following their stroke only 7.5% had full recovery, 39% had improvement, and 52% had no recovery. Two patients (1%) had further decline of visual field.</span></span></div><div><span style="font-family: inherit;"><span style="background-color: white; color: #212121;"><br /></span></span></div><div><span style="font-family: inherit;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gJUZt4rf_rtxukf50n3nWtkSZlazltG6K6OGpzDa0wExrA0KX_D3FAF2gf7qDtutqATs_I6XCuHk4ZbghGb8ueDWTfviW98gu5Oc34tmel35gQ0cVGjZfWhO_Zk1YOFNq81w81dMuahtDyav4ByfRAPWHRHq7DdbUIRhFwooQKrEZKw0_rQt0aDeIjaM/s1125/visual%20field%20defects%20in%20stroke.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Visual Field Defects By Stroke Location" border="0" data-original-height="1125" data-original-width="993" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gJUZt4rf_rtxukf50n3nWtkSZlazltG6K6OGpzDa0wExrA0KX_D3FAF2gf7qDtutqATs_I6XCuHk4ZbghGb8ueDWTfviW98gu5Oc34tmel35gQ0cVGjZfWhO_Zk1YOFNq81w81dMuahtDyav4ByfRAPWHRHq7DdbUIRhFwooQKrEZKw0_rQt0aDeIjaM/w564-h640/visual%20field%20defects%20in%20stroke.jpg" title="Visual Field Defects By Stroke Location" width="564" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Associated visual field loss (in black) related to part of the brain where injury or stroke caused damage. <a href="https://neurovascularmedicine.com/vision.php">via</a></td></tr></tbody></table><br /><b><span style="color: #990000;">Could A Medication Improve Visual Field Loss?</span></b><br /><span style="background-color: white; color: #cc0000;"><br /></span></span></div><div>New studies have raised awareness that there may be more doctors can do to increase the chance of visual field recovery than therapy programs alone. Two medications have shown possible improvement in visual fields if they are initiated soon after the stroke occurs.</div><div><br /></div><div><b>Fluoxetine</b></div><div><span style="font-family: inherit;"><span style="font-family: inherit;">In a <a href="https://journals.lww.com/jneuro-ophthalmology/Abstract/2023/06000/FLUORESCE__A_Pilot_Randomized_Clinical_Trial_of.15.aspx">June 2023 study published in the Journal of Neuro-Ophthalmology</a>, 17 patients who had </span><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;">homonymous hemianopia (visual field loss in both eyes) following a stroke were enrolled in a double blind, placebo controlled study within 10 days of their stroke event. Half of study participants were given 90 days of 20 mg fluoxetine daily, and half were in the placebo group</span>. The results showed statistically significant benefit of fluoxetine despite the low number of patients in this study; when visual field was rechecked in 6 months <b>t</b></span></span><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><b>he original blind field completely recovered in 60% receiving fluoxetine and in only 14% receiving placebo. </b></span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><b><br /></b></span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKzeVW0j_SzcmdtVRTkdiAP75Xa5tTu0QsdcG6GYhjD1vsv3FHe63spPpXZjjqY2Q8Zpqi5k_isPXPG8xuJv7eT19aM_uFPip9OmgitY8Vvg5u7QBuCADZWKMG-yJkVkIbe8yIkJGMf7skMmBAYnRkNn_5Yh_QJ4_UnSrwDMG8YI5Yv3jkPgnhjCIkUzkc/s736/fluoxetine.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Fluoxetine Improves Visual Field Loss After Stroke" border="0" data-original-height="472" data-original-width="736" height="410" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKzeVW0j_SzcmdtVRTkdiAP75Xa5tTu0QsdcG6GYhjD1vsv3FHe63spPpXZjjqY2Q8Zpqi5k_isPXPG8xuJv7eT19aM_uFPip9OmgitY8Vvg5u7QBuCADZWKMG-yJkVkIbe8yIkJGMf7skMmBAYnRkNn_5Yh_QJ4_UnSrwDMG8YI5Yv3jkPgnhjCIkUzkc/w640-h410/fluoxetine.png" title="Fluoxetine Improves Visual Field Loss After Stroke" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>Look at the fluoxetine group (in the yellow box) to see the visual field improvement from baseline to 6 months. Some patients had significant improvement, some had minimal or none. Despite very low study numbers, compared to placebo the patients taking fluoxetine did have statistically significant better rates of visual field recovery. </i><a href="https://www.ophthalmologytimes.com/view/vlog-new-hope-for-visual-field-loss-from-stroke">Check out this Ophthalmology Times video podcast to hear MDs discuss the results!</a></td></tr></tbody></table><br /></span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;">Fluoxetine (brand name: Prozac, Sarafem, Rapiflux, Selfemra) is a selective serotonin reuptake inhibitor (SSRI) that is typically prescribed for anxiety, depression, or obsessive compulsive disorders. Fluoxetine is commonly prescribed for patients with post-stroke depression, and the mechanism of why using this medication could potentially increase the chance for visual field loss improvement is not fully understood. The <a href="https://www.aau.edu/research-scholarship/featured-research-topics/can-drugs-prozac-restore-vision-after-stroke">working hypothesis</a> is that fluoxetine increases the brain's neuroplasticity, allowing it to more easily rewire around damaged tissue and form new connections that would help the person recover more of their lost visual field. </span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><br /></span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;">More research with larger study groups will be needed to confirm this effect, but if confirmed, these results have the potential to overhaul our current management of patients who suffer visual field loss after a stroke!</span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><b><br /></b></span></span></div><div><span style="background-color: white; color: #2f2f33;"><span style="font-family: inherit;"><b>Minocycline</b></span></span></div><div><span style="color: #2f2f33;"><span style="background-color: white;">Several case reports have shown that starting minocycline soon after stroke can also increase the chance of visual field recovery. Minocycline is a tetracycline antibiotic, but it also has known anti-inflammatory properties with high penetration through the blood-brain barrier. <a href="https://pubmed.ncbi.nlm.nih.gov/17909152/">In 2007 </a>researchers studied 152 patients who had suffered acute ischemic stroke. Patients were given an initial dose of 200 mg of minocycline within a 6-24 hour window of their stroke, and then a daily 200 mg dose for the next 5 days. </span></span><span style="font-family: inherit;"><span style="background-color: white; color: #212121;">P</span><span style="background-color: white; color: #212121;">atients were then evaluated on days 7, 30, and 90 using the modified <a href="https://www.researchgate.net/figure/The-National-Institutes-of-Health-Stroke-Scale-form-used-by-Providence-Health-System_fig1_6805731">Rankin Scale, Barthel Index, and National Institutes of Health (NIH) stroke scale </a>which scores items like level of consciousness, visual field loss, facial paresis, language, and motor abilities. The minocycline-treated group showed significant improvement over the placebo at every assessment time and with all monitoring endpoints. </span></span></div><div><span style="font-family: inherit;"><span style="background-color: white; color: #212121;"><br /></span></span></div><div><span style="background-color: white;"><span style="color: #212121; font-family: inherit;">Since that time there have been several case reports of patients with visual field loss experiencing recovery after minocycline use soon after their initial stroke event. </span><a href="https://www.healio.com/news/optometry/20120225/case-report-minocycline-use-restores-visual-field-in-ischemic-stroke-patient#:~:text=It%20appears%20the%20anti%2Dinflammatory,as%20driving%20a%20motor%20vehicle)." style="color: #212121; font-family: inherit;">One patient even had benefit with minocycline dosed 3 weeks after his stroke.</a><span style="color: #212121; font-family: inherit;"> He reported vision and </span><span style="color: #212121;">cognition</span><span style="color: #212121; font-family: inherit;"> subjectively seemed to improve within a few days of starting his minocycline 100 mg twice daily treatment for 5 days. </span></span></div><div><span style="font-family: inherit;"><span style="background-color: white; color: #212121;"><br /></span></span></div><div><span style="font-family: inherit;"><span style="background-color: white; color: #212121;"> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSvbjcVJXJ7XRzt2gVFvaEt1nl61NcDxzOvKVd815wqFhRz7tIrTk6kR7tfJPdJy0CGbMS8FF-YPNjjX1p9z6BrtlYSeoWw0SsKZxa5vMbJau3CAMSzYkIQNLPe_WsIzzPJgyY9Uo7T6b4dotoRTNS1GL-ZSqqmQOTuu8xuw_lOuH-Xm0ehXCu7PivFE9Q/s1640/Discontinued%20Lens%20(3).png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Visual Field Improvement with Minocycline Use After Stroke" border="0" data-original-height="924" data-original-width="1640" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSvbjcVJXJ7XRzt2gVFvaEt1nl61NcDxzOvKVd815wqFhRz7tIrTk6kR7tfJPdJy0CGbMS8FF-YPNjjX1p9z6BrtlYSeoWw0SsKZxa5vMbJau3CAMSzYkIQNLPe_WsIzzPJgyY9Uo7T6b4dotoRTNS1GL-ZSqqmQOTuu8xuw_lOuH-Xm0ehXCu7PivFE9Q/w640-h360/Discontinued%20Lens%20(3).png" title="Visual Field Improvement with Minocycline Use After Stroke" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.healio.com/news/optometry/20120225/case-report-minocycline-use-restores-visual-field-in-ischemic-stroke-patient#:~:text=It%20appears%20the%20anti%2Dinflammatory,as%20driving%20a%20motor%20vehicle).">via</a></td></tr></tbody></table><br /></span></span></div><div><span style="color: #212121;"><span style="background-color: white;">Larger clinical trials to assess the role minocycline may have in improving visual field loss after stroke are <a href="https://classic.clinicaltrials.gov/ct2/show/NCT05367362">currently enrolling through the NIH. </a></span></span></div><div><span style="color: #212121;"><br /></span></div><div><b><span style="color: #990000;">Take Home</span></b></div><div><span style="color: #212121;">More research is needed, but these small studies and case reports show a possible benefit from well tolerated and inexpensive medication options. The key to any benefit appears to be in early treatment. If you or a loved one has suffered a stroke and have symptomatic vision loss, consideration of these treatments early into your stroke recovery process is worth consideration and a discussion with your doctor!</span></div><div><span style="color: #212121;"><br /></span></div><div><span style="color: #212121;">For optometrists that are often monitoring post-stroke patients with visual field testing, or providing vision therapy for stroke rehabilitation, consideration of discussing these treatment options with the patient's medical care team early after the initial stroke event may also be warranted. </span></div><div><span style="color: #212121;"><br /></span></div><div><span style="color: #212121;">Where historically we have been able to give little hope for true visual field recovery, there is a lot of potential excitement if these treatments or others prove to be efficacious and become the new standard of care for patients who have suffered a stroke. </span></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-2673212524691703422023-05-25T13:11:00.003-04:002023-09-25T16:36:45.878-04:00Contact Lenses and PFAS<i><span style="font-family: inherit;">I had my first patient ask me about new research questioning the presence of PFAS chemicals in contact lens materials only two days after first learning of the news myself from the American Optometric Association newsletter. This article will likely continue to be updated as more research is published, but with more and more news outlets picking up the discussion, I thought it important to start a conversation written by a doctor to help better contextualize what we know, what we don't, and to pool together some broader research on contact lenses and their chemical make up. </span></i><div><i><span style="font-family: inherit;"><br /></span></i></div><div><span style="font-family: inherit;"><b>What is this new research?</b><br /></span><div><i><span style="font-family: inherit;"><br /></span></i></div><div><span style="font-family: inherit;">The study in question was performed by researchers in partnership with <a href="https://www.ehn.org/">Environmental Health News</a> and published on the <a href="https://www.mamavation.com/health/pfas-contact-lenses.html">Mamavation website</a>- a group dedicated to finding possible toxic or hormone-disrupting chemicals in every day products. They sent 18 different popular soft contact lenses to an EPA-certified lab and ALL contact lenses tested were positive for organic fluorine which the research team explained "is linked to the presence of PFAS molecules".</span></div></div><div><span style="font-family: inherit;"><br /></span></div><div><b><span style="font-family: inherit;">What are PFAS and Why Should we Care?</span></b></div><div><span style="font-family: inherit;"><a href="https://www.niehs.nih.gov/health/topics/agents/pfc/index.cfm">Since the 1950s</a>, per- and polyflouroakyl substances (or PFAS) have been used in manufacturing in many every-day products, from cookware to plastics to clothing. There are thousands of different types of these molecules used in manufacturing, made up of chains of carbon and fluorine atoms which are long lasting and strong to help accomplish a variety of goals like improve product durability, resist stains, and make products more resistant to heat, oil, or water damage. According to the <a href="https://www.epa.gov/pfas/pfas-explained">US EPA</a> there are roughly 9,000 different types of PFAS molecules that humans are exposed to every day in our water, air, soil, and food, and in fact a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483690/">2015 study</a> found that 97% of Americans have PFAS in their blood. Unfortunately we are just learning what all of this PFAS exposure might do to our environment and the health of the humans, animals, and plants living within it. <a href="https://www.niehs.nih.gov/health/topics/agents/pfc/index.cfm#footnote1">The National Institure of Enivonmental Health Sciences (NEIHS) has and is conducting research to learn more</a>; to date studies have reported "there are possible links between human exposure to PFAS and altered metablolism, fertility, reduced fetal growth, increased risk of some cancers, and reduced ability of the immune system to fight infections."</span></div><div><span style="font-family: inherit;"><br /></span></div><div><b><span style="font-family: inherit;">PFAS in Contact Lenses</span></b></div><div><span style="font-family: inherit;">Europe has in many ways led the way in environmental safety and recognition of the dangers of toxic chemicals. </span><a href="https://www.theguardian.com/us-news/2019/may/22/chemicals-in-cosmetics-us-restricted-eu" style="font-family: inherit;">For e</a><a href="https://www.theguardian.com/us-news/2019/may/22/chemicals-in-cosmetics-us-restricted-eu" style="font-family: inherit;">xample, the EU bans more than 1,300 chemicals used in everyday cosmetics as potentially hazardous; the United States bans only 11</a><span style="font-family: inherit;">. Upon researching this article, I discovered that European doctors had been </span><a href="https://www.degruyter.com/document/doi/10.1515/polyeng-2022-0189/html?lang=de" style="font-family: inherit;">researching</a><span style="font-family: inherit;"> the effects of removing PFAS present in rigid gas permeable contact lenses due to a proposed ban of PFAS materials. Their research found extremely detrimental results on the comfort, breathability, and safety of contact lens wear with non-fluorinated materials. In contact lens manufacturing, fluorinated molecules are used to increase the oxygen transmission (breathability) of contact lenses, stability and durability of the contact lens material, and the ability to resist surface deposits of lipids and proteins. </span><a href="https://www.degruyter.com/document/doi/10.1515/polyeng-2022-0189/html?lang=de" style="font-family: inherit;">When the fluorinated materials were removed in favor of non-fluorinated materials, the result was an unsafe 87% reduction in oxygen transmissibility.</a><span style="font-family: inherit;"> The researchers proposed that "at this time there is no acceptable </span>substitute<span style="font-family: inherit;"> for fluoro-silicone acrylates [in modern contact lens materials] to achieve the combination of high oxygen transmission rates, acceptable </span>wettability<span style="font-family: inherit;"> and wearing comfort, mechanical structure and </span>stability<span style="font-family: inherit;">, and deposit resistance." </span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;">Another point raised by European researcher <a href="https://www.researchgate.net/profile/Dmitry-Mirsayafov">Dr. Dmitry Mirsayafov </a>in response to this discussion was that the PFAS used in contact lens manufacturing are hard molecules; not water soluble. So the question becomes just how much is it possible for them to be absorbed into the environment or the human body? </span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;">According to research published by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380916/">National Institutes of Health</a>, "human exposure to PFAS occurs <span style="background-color: white;">through ingestion of contaminated drinking water and seafood, inhalation of indoor air, and contact with other contaminated media." Drinking water contaminated with water soluble PFAS has been cited as the "most substantial" source of PFAS exposure. I could not find any research regarding how hard molecule PFAS like those found in contact lens materials could be absorbed through a human eye while wearing a contact lens in writing this article, though hopefully this is a subject that will be researched by someone going forward.</span></span></div><div><br /></div><div><b>Still More Questions</b></div><div><span style="background-color: white;"><span style="font-family: inherit;"><br /></span></span></div><div><span style="font-family: inherit;"><span style="background-color: white;">To turn back to the research on US soft contact lenses published by Mamavation, the study was done to test the presence of fluorine in contact lens materials, which per the researchers was <a href="https://www.mamavation.com/health/pfas-contact-lenses.html">"l</a></span><span style="background-color: #fcfcfc;"><a href="https://www.mamavation.com/health/pfas-contact-lenses.html">ikely to show the presence of PFAS".</a> The researchers disclose this importantly to remind you that the test results they are sharing are not the presence of PFAS themselves, and it is important to keep that in mind as they report their results. As an optometrist I found the results very confusing because lenses of the same material had very different fluorine results published. For example Acuvue Oasys 1 Day (Senofilcon A) was listed in the "not one of our favorite" contact lens categories for having higher amounts of detected fluorine, but Acuvue Oasys 2 week (also Senofilcon A) was listed as "one of the best contact lenses" for having low amounts of detected fluorine. Similarly, Dailies Total 1 spherical was listed in their medium tier fluorine level labeled "better contact lenses", while Dailies Total 1 toric and multifocal were listed in the lowest fluorine level "one of the best contact lenses" tier. Yes, they are all Dailies Total 1 (delefilcon A), just with a different prescription in the lens.</span></span></div><div><span style="background-color: #fcfcfc;"><span style="font-family: inherit;"><br /></span></span></div><div><span style="background-color: #fcfcfc;"><span style="font-family: inherit;">The researchers made no attempt to explain why the same contact lens materials were testing with such big differences within their own study, it did make me question just what was truly being revealed since the same lens material that was "one of the worst" was also "one of the best". </span></span></div><div><span style="background-color: #fcfcfc;"><span style="font-family: inherit;"><br /></span></span></div><div><b><span style="font-family: inherit;">The Response</span></b></div><div><span style="font-family: inherit;">Due to these unexplained discrepancies in the published research, <a href="https://www.visionmonday.com/eyecare/article/contact-lens-companies-respond-to-report-of-forever-chemicals-in-soft-contact-lenses/">manufacturers of contact lenses have challenged the results</a> and its implications to the millions of contact lens wearers worldwide. An Alcon representative stated that the company "<span style="background-color: white;">questions the results of that report. For example, Dailies Total1 and Total30 contact lenses do not contain organic fluorine in their formulation. Alcon is requesting a copy of the report to better understand how it reached its conclusions." </span></span></div><span style="font-family: inherit;"><br style="background-color: white; box-sizing: content-box;" /><span style="background-color: white;">A spokesperson for </span><a href="https://coopervision.com/" style="background-color: white; box-sizing: content-box; text-decoration-line: none;" target="_blank">CooperVision</a><span style="background-color: white;"> said, “PFAS (per and polyfluoroalkyl substances) may be used in a wide range of products for important chemical and physical properties. Like thousands of other companies, we are learning as much as possible about this issue—and are committed to acting responsibly in the interests of our customers and sustainable practices.</span><br style="background-color: white; box-sizing: content-box;" /><span style="background-color: white;"> </span><br style="background-color: white; box-sizing: content-box;" /><span style="background-color: white;">"In addition to significant speculation and opinion masked as science," the CooperVision spokesperson said, "the blog post creating this discussion tested a marker, which it readily admits is not a direct assessment of PFAS inclusion. We have not been provided with its data and have not been contacted by the organization. There are multiple definitions of PFAS around the world, with no universal consensus.”</span><br style="background-color: white; box-sizing: content-box;" /></span><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;">The Contact Lens Institute released <a href="https://www.contactlensinstitute.org/news/cli-statement-may2023/">this statement:</a> "T<span style="background-color: white;">he Contact Lens Institute is aware of a recent blog post regarding our category that is prompting news reports and social media discussion. Soft contact lenses—which are recognized medical devices—are required to meet rigorous health and safety standards and are reviewed by FDA prior to clearance for U.S. sale. It’s important to remember they have demonstrated safety and efficacy over several decades since their introduction, earning the trust of thousands of medical professionals and millions of people around the world who rely on their sight-giving power."</span></span></div><div><span style="background-color: white;"><span style="font-family: inherit;"><br /></span></span></div><div><span style="font-family: inherit;"><span style="background-color: white;"><b>What You Should Do Right Now</b></span></span></div><div><span style="font-family: inherit;"><span style="background-color: white;">Understand that the data shared by Mamavation is meant to be raising questions, and not giving answers. There are many discrepancies in the published report that remain unexplained, and the authors intended their report to encourage readers to ask questions - not to make a decision by itself. They are calling for more research to be done, and doctors and patients agree and amplify that call. If you are one of the millions of Americans who enjoy contact lens wear, the overwhelming body of evidence supports that contact lenses are safe and provide improvement in vision and quality of life to many of us who prefer them as our primary vision correction, not to mention for the many Americans with corneal scarring, keratoconus, or corneal deformities who depend on contact lenses as their only way to see.</span></span></div><div><span style="font-family: inherit;"><span style="background-color: white;"><br /></span></span></div><div><span style="font-family: inherit;"><span style="background-color: white;">Research has shown that drinking water is by far the biggest risk of our exposure to PFAS chemicals, so there is one thing that you can do as a contact lens wearer to help. <a href="https://www.bbc.com/news/science-environment-45222865">An estimated 15-20% of contact lens wearers in the US throw their contact lenses away in a sink or toilet. </a> Stop! These millions of contact lenses are contributing to microplastic waste in our environmental water supplies, and <i>if</i> there is a chance that the small amounts of hard molecule PFAS found in contact lens materials could somehow become water soluble and end up in our drinking water, that would be an additional problem! You can learn more about recycling your contact lenses for free with the Terracycle program <a href="https://www.terracycle.com/en-US/brigades/bauschrecycles#@40.77027075200147:-95.93705549677736zoom:4">here</a>.</span></span></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-88588237062657523302023-03-09T09:03:00.001-05:002023-03-09T11:31:20.114-05:00Can An Eye Drop Prevent Myopia?<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRVLdVGXJ8saUFjH6mO8NDivG67XXpRYkyvWqk31HII4NSnzxL5Jk5iApQpWKyYZRjAeP9tiaytgkoEhECXCzkiwcz_Xm4UPBypdCiXhydEwyRTMkW7leeSUnpFmvX6jcf54yYch8uRhTHkKn9TiV-C4qLsCEuBlOCu-Yqu6YSXQp93k5zC-zQjFRQhQ/s1640/Discontinued%20Lens%20(2).png"><img alt="could an eye drop prevent myopia?" border="0" data-original-height="924" data-original-width="1640" height="362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRVLdVGXJ8saUFjH6mO8NDivG67XXpRYkyvWqk31HII4NSnzxL5Jk5iApQpWKyYZRjAeP9tiaytgkoEhECXCzkiwcz_Xm4UPBypdCiXhydEwyRTMkW7leeSUnpFmvX6jcf54yYch8uRhTHkKn9TiV-C4qLsCEuBlOCu-Yqu6YSXQp93k5zC-zQjFRQhQ/w640-h362/Discontinued%20Lens%20(2).png" title="could an eye drop prevent myopia?" width="640" /></a></div><br /><p>For decades doctors have used <a href="https://www.eyedolatryblog.com/2015/12/atropine-and-myopia-control-atom-2-study.html">low concentration atropine eye drops</a> to slow down progression of myopia (or near-sightedness) in children, but what if you could use those drops to prevent myopia from ever developing? A <a href="https://jamanetwork.com/journals/jama/article-abstract/2801319">new study</a> published in JAMA shows promising results!</p><p>The LAMP 2 study is an ongoing randomized, placebo-controlled, double-masked trial researching the effects of atropine on incidence and progression of myopia. In this new arm of the trial, 474 children between the ages of 4 and 9 who had no myopia at the time of the study were split into three different randomized treatment groups: placebo eye drops nightly (n=155), 0.01% atropine drops nightly (n=159), or 0.05% atropine drops nightly (n=160). At the time of enrollment, the children had a prescription between +1.00D and 0.00D and less than -1.00D of astigmatism. These children were followed over a 2 year time period with routine eye examinations to monitor any change to their prescription. </p><p>At the end of 2 years, there was a statistically significant reduction in the incidence of myopia amongst children using low dose 0.05% atropine every night versus those using the placebo eye drop. 53% of the children using the placebo drop developed myopia; 45.9% of those using 0.01% atropine developed myopia, and only 28.4% of those using 0.05% atropine developed myopia at the end of 2 years. The incidence of myopia between 0.01% atropine users and the placebo group was not statistically significant. Axial length elongation also showed significantly lower progression in the 0.05% atropine group; 0.24 mm/year on average with 0.05% atropine versus 0.32 mm/year with 0.01% atropine and 0.35 mm/year with placebo. </p><p>The side effects of low dose atropine were reported as very mild; in this study photophobia (or light sensitivity) was the most common reported side effect, with 12.9% of children using 0.05% atropine reporting this issue. Interestingly, 18.9% of participants using lower concentration 0.01% atropine and 12.2% of patient using placebo eye drops (which had no pupillary dilation side effect) also reported photophobia. </p><p><b><span style="color: #cc0000;">The Take Home</span></b></p><p>Study authors concluded that "a<span style="color: #333333; font-size: 16px;"><span style="font-family: inherit;">mong children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia at 2 years." </span></span></p><p><span style="color: #333333;">More research will continue to be reported from the ongoing LAMP 2 trial, and it will be interesting to see if this preventative effect with 0.05% atropine continues year after year. Based on this strong data, for parents who are concerned about their children being at high risk of developing myopia the use of 0.05% atropine as a preventative treatment before myopia develops is absolutely worth considering. The only FDA approved treatment options of myopia control, including <a href="https://coopervision.com/contact-lenses/misight-1-day">MiSight</a> soft multifocal contact lenses and <a href="https://www.jjvision.com/press-release/johnson-johnson-vision-announces-fda-approval-acuvuer-abilititm-overnight-0">orthokeratology</a> lenses, require the child to already be myopic before starting treatment, so the incorporation of atropine as an option to use before myopia even begins is a novel new advancement for doctors in our goal to keep children's vision as clear as possible and reduce both dependence on glasses and contact lenses and the potential health risks associated with high levels of myopia. </span></p>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-82504888425813736282022-12-21T13:30:00.000-05:002022-12-21T13:30:03.802-05:00Can Glasses Slow Down Myopia?<p>At the time of writing this article, only 2 treatments are FDA approved for myopia management and both are contact lenses. Myopia management is the process of slowing down the worsening of near-sightedness in children. <a href="https://iovs.arvojournals.org/article.aspx?articleid=2370367">Studies</a> show that on average, children with myopia will worsen by -0.50D per year (and -0.75D per year for children of Asian descent) until they are done growing (around age 17 for most). This prescription worsening is associated with actual elongation of the eye ball, called axial length. <a href="https://clinicaltrials.gov/ct2/show/NCT00000169">Faster axial length growth (0.2 mm or more in childhood) is considered rapidly progressive</a> and associated with the risk of much higher prescriptions and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688422/#:~:text=The%20risk%20of%20developing%20a,myopia%20(OR%20%3C4).&text=People%20with%20high%20myopia%20have,prone%20to%20peripheral%20retinal%20tears.">higher risks for associated eye diseases</a>, including retinal detachment, glaucoma, and myopic maculopathy. You can read more about the FDA approved myopia management contact lens options here: <a href="https://www.misight.com/">MiSight </a>soft multifocal contact lenses and <a href="https://www.seeyourabiliti.com/patients/abiliti-portfolio/abiliti-overnight">Abiliti orthokeratology lenses</a>. But not every parent (or child) is eager to start contact lens wear; are there approaches to slow down myopia progression with glasses? </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje7Kh_Es2AWMB2YFm9m3FdjL5vJtIQlMSbrPCwTZ0dqWo3eU_7r_LkwEZBiQsctXtHej8zvFquu5fKGAThC32QjdgqfcNXU-Ko1OuwyrusxJgTLQvvqRPfXR2lEGHWV-Im0EGly4c4tu7dzuflwia2sdk-k0TvrJHWf9jr2NxcsIkmLvYTj-s7HXfUIw/s600/img_16252504760157452_photo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Glasses for Myopia Control in Kids?" border="0" data-original-height="507" data-original-width="600" height="540" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje7Kh_Es2AWMB2YFm9m3FdjL5vJtIQlMSbrPCwTZ0dqWo3eU_7r_LkwEZBiQsctXtHej8zvFquu5fKGAThC32QjdgqfcNXU-Ko1OuwyrusxJgTLQvvqRPfXR2lEGHWV-Im0EGly4c4tu7dzuflwia2sdk-k0TvrJHWf9jr2NxcsIkmLvYTj-s7HXfUIw/w640-h540/img_16252504760157452_photo.jpg" title="Glasses for Myopia Control in Kids?" width="640" /></a></div><br /><p><b>Bifocals and Progressive Addition Lenses (PALs)</b></p><p>Childhood myopia is caused by a complex combination of factors, including genetics, reduced outdoor time, and increased near work. When prescribing glasses for children, doctors measure not just what it takes to make distance vision clear, but also the strength of the focusing system of the eye. Children with reduced accommodation (ability to focus on near tasks like reading) or with convergence inefficiencies (eyes that can't comfortably maintain coordination of gaze when looking at near tasks) have increased strain on their eyes when performing near tasks, and theoretically could be at more risk of worsening myopia, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083074/">research shows it's much more complicated than this.</a> </p><p>With this theory of near strain being a potential factor in worsening myopia, several studies have investigated if there is any benefit to prescribing glasses with a near addition to reduce strain on the eyes with reading or close tasks through the use of bifocals or progressive glasses. <a href="https://pubmed.ncbi.nlm.nih.gov/24435660/">A 2014 study</a> of 135 children with at least -0.50D of myopia between the ages of 8 and 13 showed that those who wore +1.50 add executive bifocals experienced statistically significantly less myopia progression and axial elongation over a 3 year period than their peers who were prescribed normal single vision distance glasses. Average myopic progression over 3 years was -2.06D for the control group and -1.25 D for the bifocal group (a myopia control rate of 39.3%); average axial length progression over 3 year was 0.82 mm of the control group and 0.57 mm for the bifocal group (a myopia control rate of 30.4%). Note that these myopia control rates are less than those reported by the FDA approved contact lenses for myopia management (59% control of spherical prescription change), but still statistically significant.</p><p>Interestingly this study found that the myopia management rate was slightly more effective if the children who were prescribed bifocal glasses also had a lower lag of accommodation (more strain on their eye muscles at near) and were also prescribed 3 prism units of base in prism on eye eye. The prism cohort of children had a myopia progression rate of -1.01D over 3 years (a 51% myopia control rate) and 0.54 mm of axial length growth over 3 years (a myopia control rate of 34%). The study authors concluded that executive lined bifocals were effective for myopia management, and that prism lined bifocals were more effective if the child also had accommodative dysfunction. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPO5xhx-rBg7bWX9ipJ91H7sCWyZ8pgO3Sr4fR6N-w79WNe3n0og9F1WjrTpQiJmqDVLZUIFAUL6cicz82NsXKOgMw_mjsnfsjS_Utf4hbFk2dGQWl-6nCTP-D42owo4B3pQBS-KWBR43GfPNROSj-NGfCQD59y25dvko6z33gIpjAR9uW9ZTYpOkJKA/s1640/Discontinued%20Lens.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="bifocal versus progressive" border="0" data-original-height="924" data-original-width="1640" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPO5xhx-rBg7bWX9ipJ91H7sCWyZ8pgO3Sr4fR6N-w79WNe3n0og9F1WjrTpQiJmqDVLZUIFAUL6cicz82NsXKOgMw_mjsnfsjS_Utf4hbFk2dGQWl-6nCTP-D42owo4B3pQBS-KWBR43GfPNROSj-NGfCQD59y25dvko6z33gIpjAR9uW9ZTYpOkJKA/w640-h360/Discontinued%20Lens.png" title="bifocal versus progressive" width="640" /></a></div><br /><p><b>So we know executive lined bifocals have some effect, though less than the FDA approved contact lens options. But what if your child doesn't want a huge line going across the middle of their glasses? Would an invisible line bifocal (called a progressive addition lens or PAL) work as well?</b></p><p>The <a href="https://iovs.arvojournals.org/article.aspx?articleid=2162828">Hong Kong Progressive Lens Myopia Control study</a> investigated just that: 153 myopic children between the ages of 7 and 10.5 were followed over a 2 year time frame. Half were prescribed progressive glasses with +1.50 D of near add, and the other half were in the control group, prescribed normal single vision distance glasses. Over the 2 year study period, the control group had an average -1.26 D increase in myopia and the progressive group had a -1.12 D increase (a modest 11.11% myopia control effect that was not statistically significant). Axial elongation was also measured and the control group had an average 0.63 mm increase in axial length after two years versus a 0.61 mm increase in the progressive group; again not statistically significant. </p><p>The<a href="https://iovs.arvojournals.org/article.aspx?articleid=2390655"> COMET (Correction of Myopia Evaluation Treatment) Study</a> also explored the benefit of progressive lenses. This study followed 469 'ethnically diverse' patients with myopia (-1.25 to -4.50 D) between the ages of 6 and 11 for 5 years. The children were randomly assigned to either progressive addition lenses with +2.00D of add or single vision distance lenses. After 3 years, the average amount of myopia worsening was -1.48D in the control group and -1.28D in the progressive group, a modest but statistically significant myopia control effect of 13.5%. Axial length elongation was on average 0.75 mm in the control group and 0.64 mm in the progressive group, a modest but statistically significant 14.67% myopia control effect. </p><p>The largest myopia management benefit was experienced in the first year, and as the study progressed the effect dwindled more and more. After 5 years, the average amount of increased myopia was -2.10D in the control group and -1.97D in those wearing progressives - not statistically significant. </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKCrA1-N643_EaVksinE_nLkLuoIoKtDtnG5hPN78HEkjHfBl-b3Phzhs5o2Hku6lmeuaS7aL1VhACu3tjeIlfln9DEL3lAJajpwybdTI5U4HnyP68UojRsMl-vZVQiEVR68E4e5PFte7oj2HH8nXxs2qDZRqrNo6KnG3Z6v7G0mcY9s9weOsLLQZxTg/s1511/MyopiaFig9.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="COMET Study Myopia Management" border="0" data-original-height="851" data-original-width="1511" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKCrA1-N643_EaVksinE_nLkLuoIoKtDtnG5hPN78HEkjHfBl-b3Phzhs5o2Hku6lmeuaS7aL1VhACu3tjeIlfln9DEL3lAJajpwybdTI5U4HnyP68UojRsMl-vZVQiEVR68E4e5PFte7oj2HH8nXxs2qDZRqrNo6KnG3Z6v7G0mcY9s9weOsLLQZxTg/w640-h360/MyopiaFig9.jpg" title="COMET Study Myopia Management" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/">via</a></td></tr></tbody></table><br /><p>Researchers concluded that even the small benefit seen early in the study was not significant enough to warrant a change in clinical management of myopic patients away from single vision glasses to progressive lenses. </p><p><b>Myopia Management Glasses Are Coming to the US</b></p><p>While not yet available in the United States, glasses that are specifically approved for myopia management are coming and are already available in Canada, Europe, and Asia. Studies have shown these glasses work very effectively at reducing myopic progression both of prescription and axial length! Both of these technologies work by incorporating high plus power 360 degrees throughout the lens and maintaining clear central distance vision. With executive bifocal and progressive addition lenses, the high plus power is only being processed by the eye with inferior gaze and is thus more limited in it's ability to actually induce peripheral defocus (see <a href="https://www.eyedolatryblog.com/2015/06/whats-happening-to-our-vision.html">this blog post </a>for more insight into how peripheral defocus is essential to myopia control). </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA32Dcto8XVbyQ-nW573ojy2UZDxM-flDo2gICq29MRnrgIAqpObvX9cBFafE9Ytu8fc1P8ZD2mwX2cCEQwdX1m6S_-Fv7K6eeXX5V-X2QG0bzU7m_KSQjo_S97sJwV58BsaW04I_gVrku5yZpImkAxTfk-44GSTRgIihCJpJXE69EbyBp17HTNKlpVQ/s1640/Discontinued%20Lens%20(1).png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Stellest versus Miyosmart" border="0" data-original-height="924" data-original-width="1640" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA32Dcto8XVbyQ-nW573ojy2UZDxM-flDo2gICq29MRnrgIAqpObvX9cBFafE9Ytu8fc1P8ZD2mwX2cCEQwdX1m6S_-Fv7K6eeXX5V-X2QG0bzU7m_KSQjo_S97sJwV58BsaW04I_gVrku5yZpImkAxTfk-44GSTRgIihCJpJXE69EbyBp17HTNKlpVQ/w640-h360/Discontinued%20Lens%20(1).png" title="Stellest versus Miyosmart" width="640" /></a></div><p><u>Defocus Incorporated Multiple Segments (DIMS):</u> This unique design found in <a href="https://www.hoyavision.com/en-ca/discover-products/for-eye-care-professionals/specialty-lenses/myopia-management/">Hoya's MiyoSmart</a> myopia management lenses uses 400 individual peripheral lenslets of +3.50D scattered throughout the lens. A <a href="https://bjo.bmj.com/content/104/3/363">study published in 2020</a> followed 183 Chinese children between the ages of 8 and 13 with -1.00 to -5.00D of myopia. On average the control group wearing single vision glasses progressed -0.85 D in that time, and the DIMS group progressed -0.4 D, a 52% myopia control effect. There was also a 62% reduction in axial length progression in the DIMS group compared to control. </p><p>Unlike the COMET study of progressive glasses outlined above where there was waning benefit, studies have shown that DIMS technology continues to achieve statistically significant results. <a href="https://pubmed.ncbi.nlm.nih.gov/33731364/">In a 3 year follow-up study</a> of 128 children, kids that had been wearing the DIMS lenses for the prior 2 years continued to do so, and kids that had been wearing single vision distance lenses now switched into DIMS. This study proved that the myopia control effect achieved in myopic prescription change and axial length was stable and maintained over time. Children that switched from control to DIMs group also achieved the same myopia management effect as children enrolled initially in the DIMs group in their first year. The repeatability and consistency of results has garnered a lot of attention that this technology has become our first truly effective glasses option for myopia management. </p><p><u>Highly Aspheric Lenslet Target (HALT):</u> This unique design is found in <a href="https://www.essilor.com/en/brands/stellest-lens/">Essilor's Stellest myopia management lenses</a> and uses 11 concentric rings of over 1000 lenslets with varying powers.<a href="https://reviewofmm.com/essilors-two-year-clinical-trial-data-on-stellest-lenses-published-in-jama-ophthalmology/"> 2 year study data</a> was published in March 2022 following 157 Chinese children between the ages of 8 and 13 with -0.75D to -4.75D of myopia. On average the control group wearing single vision glasses progressed -1.04 D in that time, and the HALT group progressed -0.66D, a 55% myopia control effect. There was also a 51% reduction in axial length progression in the HALT group compared to control. Interestingly, kids who wore their HALT glasses more had an even better myopia management effect. Children who wore their HALT glasses 12 hours or more per day, every day achieved a 67% reduction in myopic progression and a 60% reduction in axial elongation. </p><p><i>Stay tuned! While neither of these myopia management glasses solutions are available in the United States now, they should be coming soon!</i></p>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-59602648991710910512022-11-17T15:49:00.005-05:002022-11-17T15:52:38.385-05:00Discontinued Contact Lens Update: Acuvue Oasys for Astigmatism and Acuvue TruEye<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-4rnLDQyTeNoPOplCkWmu-5ekQhoixeT52NKmBUfNzFjWuFuuOqv3AzOqspJ_XESARO9HQC5Zp2LEV4R8PULEHPuL_K-RWvJgVWGN6OSTrLRCbWkdpbZbYXFu-HYUnpNcU-Iuq0ACCKzX1lfpdHgH546f91F_3JRalc1S05SifMCUcUEEjeWvq6a1HQ/s621/CL%20Update.png" style="margin-left: 1em; margin-right: 1em;"><img alt="discontinued acuvue contact lens update" border="0" data-original-height="327" data-original-width="621" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-4rnLDQyTeNoPOplCkWmu-5ekQhoixeT52NKmBUfNzFjWuFuuOqv3AzOqspJ_XESARO9HQC5Zp2LEV4R8PULEHPuL_K-RWvJgVWGN6OSTrLRCbWkdpbZbYXFu-HYUnpNcU-Iuq0ACCKzX1lfpdHgH546f91F_3JRalc1S05SifMCUcUEEjeWvq6a1HQ/s16000/CL%20Update.png" title="discontinued acuvue contact lens update" /></a></div><br /><p><a href="https://www.jjvision.com/">Johnson and Johnson Vision</a> has announced the discontinuation of several prescription ranges for it's popular <a href="https://www.jnjvisionpro.com/products/acuvue-oasys-2-week-contacts-astigmatism">Acuvue Oasys for Astigmatism</a> brand of lenses. Please note, the Acuvue Oasys for Astigmatism contact lens is still available in the majority of the power ranges; only specific prescriptions are affected. <a href="https://www.abboptical.com/sites/default/files/pdf/ACUVUE_Portfolio_Discontinuation.pdf">In a letter to practitioners</a> across the United States, Johnson and Johnson Vision cited the decision was based on a number of factors affecting industries around the world in 2022: short staffing at their distribution and contact center, supply chain issues, and increased product demand. The <a href="https://www.acuvue.com/contact-lenses/acuvue-oasys-max-1-day">Acuvue Oasys MAX 1 Day</a> brand of lenses recently launched in summer of 2022. In order to divert resources to the most needed prescription ranges (the company serves 43 million people globally with their Acuvue brand contact lens products), the discontinued parameters listed below were chosen because they were the least ordered prescriptions currently offered by the company. </p><p>The following powers are no longer available:</p><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">➡️ Plus Powers (+0.25D to +6.00D)</span><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">All -2.25D & -2.75D Cylinder</span><div><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">All Oblique axis in -0.75D, -1.25D, & -1.75D Cyl (x30, 40, 50, 60, 120, 130, 140, 150)</span><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">➡️ Low Minus Powers (0.00D to -6.00D)</span><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">All Oblique axis in -2.25D & -2.75D Cyl </span><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">(x30, 40, 50, 60, 120, 130, 140, 150)</span></div><div><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">➡️ High Minus Powers (-6.50D to -9.00D)</span><br style="background-color: white; color: #262626; font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-size: 14px;" /><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">All Oblique and against the rule axis in </span><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">-1.75D, -2.25D & -2.75D Cyl (</span><span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif" style="background-color: white; color: #262626; font-size: 14px;">(x30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150)</span></div><div><div><br /></div><div>Effective as of October 3rd, 2022, diagnostic (trial) lenses for the impacted parameters will no longer be available. Boxes in these prescriptions can be purchased as supplies last. Effective January 2, 2023 these impacted
parameters will no longer be available for purchase.<br /></div><div><br /></div><div>Additionally, Johnson and Johnson Vision announced the complete discontinuation of the <a href="https://www.acuvue.com/contact-lenses/acuvue-trueye-1-day">Acuvue TruEye</a> brand of daily disposable products. As of October 3rd, 2022 no diagnostic (or trial) lenses are available for order, and boxes are as supplies last. No boxes of this product can be purchased after April 1st, 2023. </div></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-57490981661053985692021-07-08T14:50:00.004-04:002021-07-08T14:50:50.499-04:00The Science of Fitting Soft Contact Lenses<p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigLgBE4aYgKts3auk_98TmaBJJkc1ek2-UVmmskycckpAzJ-wQQvny6JRZyHILdMhARjSSPqCNVCHiI1X3ysqlE5WQs5pgjQnjjc3Dw0uSXXZzj4wRroTr5iO2d8lkLnoBrU0JMN7sonoA/s1080/Eyedolatry+%25281%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="science of contact lens fitting" border="0" data-original-height="214" data-original-width="1080" height="126" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigLgBE4aYgKts3auk_98TmaBJJkc1ek2-UVmmskycckpAzJ-wQQvny6JRZyHILdMhARjSSPqCNVCHiI1X3ysqlE5WQs5pgjQnjjc3Dw0uSXXZzj4wRroTr5iO2d8lkLnoBrU0JMN7sonoA/w640-h126/Eyedolatry+%25281%2529.png" title="science of contact lens fitting" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;">With so many different contact lens brands and materials on the market, it might be tempting to assume that these medical devices are one size fits all. But there is a very specific science to contact lenses fitting correctly on the eye, without being to loose (in medical terminology this is called flat) or too tight (or steep). A well fit contact lens will provide stable and clear vision, be centered across the cornea, fully cover the cornea, and adequately move with a blink (</span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972800/" style="text-align: left;">defined as 0.2 to 0.4 mm of vertical movement with a blink</a><span style="text-align: left;">.) </span></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><br /></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEoq_aermQNf-I_zPFsdWYigeUrhgr9uUNeHITPB1wXXuk2NTuLcf00jyPlqmGUXrfruH6ETwSA1C0nTczfw6MDg60FDyvRB92WmGZWnPZwKnmo5lpQkxrF8EzK8wT4MsyWOy7hAUiHOS7/s1947/TrueVision+Social.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Well fit contact lens" border="0" data-original-height="1947" data-original-width="1162" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEoq_aermQNf-I_zPFsdWYigeUrhgr9uUNeHITPB1wXXuk2NTuLcf00jyPlqmGUXrfruH6ETwSA1C0nTczfw6MDg60FDyvRB92WmGZWnPZwKnmo5lpQkxrF8EzK8wT4MsyWOy7hAUiHOS7/w239-h400/TrueVision+Social.png" title="Well fit contact lens" width="239" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;">A. A well fit contact lens showing good centration and full corneal coverage <a href="https://www.clspectrum.com/issues/2019/april-2019/custom-soft-corner">via</a>. B. A poorly fitting contact lens showing inadequate corneal coverage and fluting of the edge <a href="https://www.jnjvisioncare.ae/sites/default/files/public/ae/documents/soft_contact_lens_fiting.pdf">via</a></span></td></tr></tbody></table><br /><p>Prior to disposable contact lenses <a href="https://www.reviewofcontactlenses.com/article/manufacturing-a-brandnew-industry">entering the market in 1987 with the introduction of Johnson & Johnson Vision Care's Acuvue</a>, soft contact lenses were custom designed for a patient's unique corneal shape, size, and prescription. When we average out corneal shape and size for most patients, we do find that the majority of patients fit into an "average" shape, which is why mass-produced soft contact lenses have become the predominant modality of soft contact lens wear. In fact, a<a href="https://pubmed.ncbi.nlm.nih.gov/28099240/"> 2017 mathematical analysis</a> revealed that a 8.6 base curve and 14.2 mm diameter contact lens achieved a successful fitting relationship in 90% of patients. </p><p><br /></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVqdTmbJKymslJis8v2LADr9drX0PNYbCrz02JHUMm9n7-Swl56jJsNPTclFxXyVfgG3DPJz2gb8xw7M4tb70qqy0bx2D0hjJEMKZYomFPiQdn_jPMAlJkh55H1Rp_TGRTtABaeQ29Yhzc/s564/contact+lens+SAG.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="distribution of average cornea size" border="0" data-original-height="330" data-original-width="564" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVqdTmbJKymslJis8v2LADr9drX0PNYbCrz02JHUMm9n7-Swl56jJsNPTclFxXyVfgG3DPJz2gb8xw7M4tb70qqy0bx2D0hjJEMKZYomFPiQdn_jPMAlJkh55H1Rp_TGRTtABaeQ29Yhzc/w400-h234/contact+lens+SAG.jpg" title="distribution of average cornea size" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;">Most patients fall into an "average" range of eye size and shape that provides a successful contact lens fit from an average contact lens shape of 8.6 mm base curve and 14.2 mm diameter. <a href="https://www.clspectrum.com/supplements/2017/november-2017/contact-lens-spectrum-special-edition-2017-your-g/the-science-and-skill-of-fitting-a-soft-lens">via</a></span></td></tr></tbody></table><br /><p>To better understand the factors at play, we need to define the two measurements listed on your prescription contact lens box that dictate how a contact lens will fit. Base Curve is the curvature of the lens, and diameter is the overall size of the lens. </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZDVS98eYUiWbO85K-STDRB9DwuuE39QkiP7O5OdS-VwgfnBYeYH7nNqY74kcv5RFoEgGq7Gp6pwrlZo-f88baLxRsl6tFRrBzqD7UjFnRQLtUXume9k22WI5__tp8a6S-kx8Lk16vGufc/s884/base+curve.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Base Curve" border="0" data-original-height="884" data-original-width="601" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZDVS98eYUiWbO85K-STDRB9DwuuE39QkiP7O5OdS-VwgfnBYeYH7nNqY74kcv5RFoEgGq7Gp6pwrlZo-f88baLxRsl6tFRrBzqD7UjFnRQLtUXume9k22WI5__tp8a6S-kx8Lk16vGufc/w273-h400/base+curve.png" title="Base Curve" width="273" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;">Base Curve of the contact lens. In this example, base curve is 8.5 mm </span></td></tr></tbody></table> <br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRWGfZuUWPlqhHYBdCbh73IfUgprWCvuy6IEz0VAgmumn_N-068bkWcVMY1d4PPtwBClpLv90rEUI2iS017_bxsYquAe-Z04TGVEwJYkxAQPlTWjkR5Q0-VTGpLGxaNSoGHGqmplAPJg40/s889/diameter.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Diameter Contact Lens" border="0" data-original-height="889" data-original-width="610" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRWGfZuUWPlqhHYBdCbh73IfUgprWCvuy6IEz0VAgmumn_N-068bkWcVMY1d4PPtwBClpLv90rEUI2iS017_bxsYquAe-Z04TGVEwJYkxAQPlTWjkR5Q0-VTGpLGxaNSoGHGqmplAPJg40/w275-h400/diameter.png" title="Diameter Contact Lens" width="275" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;">Diameter of the contact lens. In this example, diameter is 14.3 mm</span></td></tr></tbody></table><p><br />It is tempting to think that the base curve number will define how tight or loose (steep or flat) a contact lens will fit, but in actuality, how a contact lens fits is dictated by a relationship between the base curve and the diameter together, called the <a href="https://www.clspectrum.com/issues/2017/september-2017/how-important-is-the-soft-lens-fit-anyway">sagittal depth</a>.<a href="https://www.clspectrum.com/issues/2017/september-2017/how-important-is-the-soft-lens-fit-anyway"> Research shows</a> that the base curve number written on a box of contact lenses is actually a poor predictor of how a contact lens will truly fit on the eye, and to complicate matters, t<a href="https://www.clspectrum.com/issues/2017/september-2017/how-important-is-the-soft-lens-fit-anyway">he labelled base curve of a lens on the box many not even truly reflect the curvature of the lens</a> as manufacturers often incorporate mathematical modifications to adjust how a contact lens fits in the periphery versus in the center. <a href="https://www.clspectrum.com/issues/2017/september-2017/how-important-is-the-soft-lens-fit-anyway">Base curve can also change</a> as you wear a contact lens based on environmental factors like the lens drying out, temperature changes, and <a href="https://www.eyedolatryblog.com/2019/12/cosmetics-can-permanently-change-fit.html#:~:text=Sometimes%20makeup%20or%20facewash%20residue,surface%20of%20the%20contact%20lens.">exposure to makeup or soaps.</a></p><p>As a doctor, selecting a contact lens for best fit is also challenging because the sagittal depth of any contact lens is not notated on the packaging. Additionally, <a href="https://www.clspectrum.com/issues/2021/may-2021/is-this-the-new-norm">research shows</a> that base curves and diameters as they relate to sagittal depth is not universal across contact lens manufacturers. You would assume that two lenses made by two different companies but both with a 8.6 base curve and a 14.2 diameter would be nearly the same, but that is not always the case. Luckily <a href="https://www.contactlensjournal.com/article/S1367-0484(20)30200-9/abstract">research done in 2021</a> has shed some light as to the actual sagittal depth of popular daily disposable contact lenses on the market.</p><p>To use this data as a tool for improving contact lens fitting outcomes, there are a few key take-aways:</p><p></p><ul style="text-align: left;"><li>Smaller corneal diameters (smaller than 11.7 mm) are associated with <u>lower </u>sagittal depth</li><li>Larger corneal diameters (larger than 11.7 mm) are associated with <u>higher</u> sagittal depth</li><li><u>Troubleshooting poor vision</u></li><ul><li>A lens that is moving excessively or rotating with an astigmatism lens will exhibit better stability with a <u>higher</u> sagittal depth</li><li>A lens that is too tight may be warping or vaulting as the patient blinks. In this case you would see minimal to normal lens movement, and a toric lens for astigmatism would look stable with no visible rotation. You can check for vaulting by using an autorefractor, topographer, or keratometer to assess the mire rings as the patient blinks. If the mires alter between blinks, the lens is vaulting and you need a <u>lower</u> sagittal depth lens.</li></ul></ul><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxj0NCjAzEYXu6riqrSgmhTNGuO6mhyb1piGqYNy8RIZxW4bruG-IRh2d1KW-xD6AJsyhta1IjtII2u16koB6fr13xq1umj0sapypFAdPaVMUzsb7429trtB25yWNWdgnInT4y88YY-E2w/s772/sagittal+depth+contact+lenses.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Sagittal Depth of daily disposable contact lenses" border="0" data-original-height="403" data-original-width="772" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxj0NCjAzEYXu6riqrSgmhTNGuO6mhyb1piGqYNy8RIZxW4bruG-IRh2d1KW-xD6AJsyhta1IjtII2u16koB6fr13xq1umj0sapypFAdPaVMUzsb7429trtB25yWNWdgnInT4y88YY-E2w/w640-h334/sagittal+depth+contact+lenses.jpg" title="Sagittal Depth of daily disposable contact lenses" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.clspectrum.com/issues/2021/may-2021/is-this-the-new-norm">via</a></td></tr></tbody></table><b><br /></b><div><b>The Take Home:</b> Contact lenses are not one size fits all, and the numbers listed on the contact lens box are not truly indicative of how a contact lens will fit. New research is helping doctors understand the important fitting relationship between corneal size and shape and the available contact lens options on the market to provide the best fitting relationship and optimize both vision and comfort.</div><p></p>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-1621483902383646612021-01-01T15:12:00.004-05:002021-01-01T15:12:38.209-05:00Which Screen is Best for Your Eyes?<div>Whether you are working, reading, or mindlessly scrolling social media, screens are our constant companion these days. If you've noticed your eyes are feeling more tired, dry, and irritated than ever, that's because of our new best friend the screen as well. In order to keep our eyes hydrated, our body is internally wired to blink roughly every 13 seconds, releasing the oil that makes up our tear film with every blink. But when we are looking at screens, <a href="https://pubmed.ncbi.nlm.nih.gov/22051780/">our blink rates plummet by as much as 66%</a>, meaning less tear film released onto the surface of the eyes, and thus drier eyes. As expected, studies show that people working and reading on screens report significant discomfort. <a href="https://www.ipinnovative.com/media/journals/IJCAP-6-1-68-72.pdf">In a 2018 study</a> of 100 medical school students, screen time caused 58.8% of participants to experience eye strain and fatigue, 23.3% reported headaches, and 13% reported blurry vision. In this same study, 75% of the medical students involved stated they would reduce their screen time as a measure to prevent dry eye. </div><div><br /></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMTaj4ANU1zVmElxA44aLQ0WiuqIHP5knq9LrFjQvIYRP82dpB0FeY37WGbPPI46aldRFBCz349hsvKwfqRMkSxSAUfCZUrR7jnmvjBV1p5hl6Rei-96RD9cEzm-8RIy_P2mY9l6L9Nnpl/s2048/IMG-3140.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Best screen for your eyes" border="0" data-original-height="2048" data-original-width="1983" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMTaj4ANU1zVmElxA44aLQ0WiuqIHP5knq9LrFjQvIYRP82dpB0FeY37WGbPPI46aldRFBCz349hsvKwfqRMkSxSAUfCZUrR7jnmvjBV1p5hl6Rei-96RD9cEzm-8RIy_P2mY9l6L9Nnpl/w620-h640/IMG-3140.jpg" title="Best screen for your eyes" width="620" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Which screen is the best for your eyes? Studies show that smaller screens with lower brightness settings, like e-readers or smartphones are the best for visual comfort and ocular surface health!</td></tr></tbody></table><br /><div><br /></div><div>But reducing screen time may not be that easy. Since the onset of the COVID19 pandemic, average screen time use in the United States has skyrocketed, with <a href="https://eyesafe.com/covid-19-screen-time-spike-to-over-13-hours-per-day/">reports indicating that the average American adult (age 18+) is spending over 13 hours per day looking at screens.</a> That's up from roughly 10 hours per day reported in 2019 and 8.4 hours per day in 2018. Knowing that cutting screen time when we're being asked to work from home, attend school from home, and entertain ourselves from home is extremely difficult, can we potentially reduce our symptoms of dry eye by at least choosing the least irritating device to look at?</div><div><br /></div><div><b><a href="https://journals.lww.com/optvissci/Abstract/2020/12000/How_Do_Different_Digital_Displays_Affect_the.10.aspx">A new study published in <i>Optometry and Vision Science</i></a> explored just this and found that the screen that you use does in fact matter</b>! The study looked at the ocular surface health and comfort of 31 healthy adults between age 20 to 26 after reading on a variety of different devices. Baseline measurements of each participant's ocular surface was taken before using any screen time, including the <a href="http://www.supereyecare.com/resources/OSDI.pdf">Ocular Surface Disease Index </a>(OSDI) questionnaire, the Computer Vision Syndrome Questionnaire, tear meniscus height, Schirmer test, noninvasive tear break-up time, tear film osmolarity, bulbar injection (redness), and pupil size. Participants were then asked to read for 15 minutes on a laptop computer screen, tablet, e-reader, or smartphone and the ocular surface measurements and questionnaires were repeated. </div><div><br /></div><div><b>The Results</b></div><div>The very best ocular surface health and reported comfort were found when participants read on e-readers or smartphones. <span style="color: #990000;"><b>Reading on the laptop computer produced the worst disturbances of both ocular surface findings and questionnaire indices</b>.</span> Statistically significant differences were seen between computer use and e-reader/smartphone use in both the OSDI and the CVS-Q questionnaire, tear meniscus height, Schirmer test results, and tear break up time. Tear film osmolarity (a measurement of inflammation) and conjunctival injection (redness) was highest after computer use, followed by e-reader use, and then smartphone use. </div><div><br /></div><div>Interestingly, the study also compared these results with and without the use of artificial tears. Using artificial tears had <b><span style="color: #990000;">no</span></b> statistically significant effect on any of the ocular surface findings. </div><div><br /></div><div><b>Why does using an e-reader or a smartphone help reduce dry eye signs and symptoms over reading on a computer?</b></div><div><br /></div><div>Study author Cristian Talens-Estarelles, MSc <a href="https://www.healio.com/news/optometry/20201215/smartphones-screens-are-least-disturbing-to-ocular-surface-vs-other-devices">writes that </a>the improved dry eye results with e-readers and smartphones are most likely "attributed to a lower gaze angle and the enhanced optical properties of the e-reader," noting that "the e-reader reflects rather than emits light from behind the screen, similar to how a printed paper behaves." </div><div><br /></div><div><span style="color: #990000;"><b>The advantages of reading from a smartphone or e-reader on the comfort and ocular surface health of our eyes include:</b></span></div><div><ul style="text-align: left;"><li><b>Smaller screen size. </b>While it may be tempting if your eyes are bothering you to request a larger or even second monitor for work, thinking that a bigger viewing area will make things easier, the science actually shows making monitors larger or using multiple screen monitors is much more uncomfortable for the eyes. <a href="https://time.com/4171966/digital-device-eye-strain-screens/">In a survey of more than 10,000 adults</a>, only 53% of Americans working on a single screen experienced digital eye strain symptoms, compared to 75% of Americans who used multiple screens. Larger or multiple screen monitors require our eyes to be open wider and slow blink rate down as our brain focuses on peripheral vision to scan between multiple displays.</li><li><b>Lower angle of gaze. </b>Research shows that viewing screens with a downward gaze is the most comfortable for the eyes because it encourages a more natural blink rate. <a href="https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y">Ergonomic research suggests and optimal screen height of 15-20 degrees below eye level.</a> A disadvantage of larger and multiple screen monitors is that they are typically positioned directly at eye level instead of in this downward position of gaze which increases discomfort significantly.</li><li><b>Lower brightness levels. </b>Reflections from our screens can cause significant visual discomfort, and <a href="https://www.reviewofoptometry.com/CMSDocuments/2016/5/ro0516i.pdf">studies show</a> the screen we are looking at should never be brighter than the ambient room lighting. E-readers and smartphones, especially when Night-Shift mode is enabled, are superior options at reducing reflections and screen brightness to create a more natural viewing environment. </li></ul><div>And with any screen use, don't forget <a href="https://www.reviewofoptometry.com/CMSDocuments/2016/5/ro0516i.pdf">taking breaks is the most important thing you can do</a>. For every 20 minutes that you are working, reading, or playing on a screen, you should take a 20 second break to blink and look down a hallway or out a window (20 feet away). This is called the <b>20/20/20 Rule</b> and research shows it's our best protection to keep eyes comfortable and blinking more naturally!</div></div><div><br /></div><h4 style="text-align: left;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHVxmUkqG-nLBOOol3BvhsoaRKnSFJaYPCHaqsRHA2ddi5xnDMsyFZrncYAhRgQx_6ZP9k4dMEGetUxX_QaK_htKgC2SJ2pG_319KnWHQiUP_lsrO2yqVCKg-_z833DWlYpARHCYNs_tAn/s400/blink+rate.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="How Often Should You Blink?" border="0" data-original-height="130" data-original-width="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHVxmUkqG-nLBOOol3BvhsoaRKnSFJaYPCHaqsRHA2ddi5xnDMsyFZrncYAhRgQx_6ZP9k4dMEGetUxX_QaK_htKgC2SJ2pG_319KnWHQiUP_lsrO2yqVCKg-_z833DWlYpARHCYNs_tAn/s16000/blink+rate.gif" title="How Often Should You Blink?" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">It's all about the blinking when it comes to keeping eyes happy. <a href="https://www.reviewofophthalmology.com/article/breaking-down-the-blink">Study link here</a></td></tr></tbody></table></h4><br /><div><br /></div>Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-38662067697921149182019-12-14T19:04:00.000-05:002019-12-14T20:09:21.966-05:00Cosmetics Can Permanently Change the Fit, Feel, and Vision of Your Contact LensesHave you ever had the experience of leaving the doctor's office with a great contact lens - excellent comfort and perfect vision - only to have the vision and comfort take a marked turn for the worse a few days or weeks later? As an optometrist, I've seen this issue present itself many times. The lenses perform and move beautifully on the eye in office, but a few days later I'll get a phone call from the patient that they need to be seen because their lenses "don't fit." What changed? New research shows that the products we use around our eyes, from makeup to facewash and makeup remover, can cause significant changes to both the physical shape and performance of contact lenses.<br />
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<b>How Does Makeup or Makeup Removers Come in Contact With Your Contact Lenses?</b><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlwCBvB7ebgshz4xfNgPS9Ty5Qv8iDHgJ6wRP9SNAfrO1PojsATtNA5b1hXR0vylqsQEcZ5yD4HDNZP26MLnh4iKgX9RhIT2tGaia0e0SQbNC-CsAbpvHTXU6Ksj27r_kZ3uIzrUVl73_L/s1600/makeup+on+waterline.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="429" data-original-width="625" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlwCBvB7ebgshz4xfNgPS9Ty5Qv8iDHgJ6wRP9SNAfrO1PojsATtNA5b1hXR0vylqsQEcZ5yD4HDNZP26MLnh4iKgX9RhIT2tGaia0e0SQbNC-CsAbpvHTXU6Ksj27r_kZ3uIzrUVl73_L/s400/makeup+on+waterline.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Makeup applied to the waterline can easily transfer onto your contact lenses. The waterline is where our tear glands (called Meibomian glands) sit, so every time you blink, these glands release oils that spread over the surface of the eye, transferring any makeup applied to the area with them. <a href="https://fashioninspire.net/beauty/make-up/makeup-tutorials-makeup-tips-rimming-the-waterline-great-eyeliner-tips-for-makeup-junkies/">image via</a></td></tr>
</tbody></table>
You may be surprised to hear that contact lenses can be affected by your normal skincare products, because they typically aren't coming into contact with each other directly. No one rinses their contact lenses with makeup remover, or coats them with mascara purposefully (or if you do, you'd expect them to be extremely uncomfortable as a result!). The overwhelming majority of the time, contact lenses are exposed to makeup and soaps by accident when you are either inserting or removing your contact lens. Sometimes makeup or facewash residue is still on our hands when we touch our lenses, or if you are wearing your contact lenses when you apply eye makeup like mascara or eyeliner, small amounts of it can easily transfer into your eye and stick to the surface of the contact lens. The majority of monthly and biweekly disposable contact lenses are made from materials called silicone hydrogel, and the silicone in these lenses that helps make the contact lens more breathable is also very attracted to oils. Makeup and makeup removers are primarily oil based products, and once they come into contact with a contact lens, they bind tightly and are next to impossible to remove even with the strongest contact lens cleaners.<br />
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To best prevent makeup from sticking to your contact lens and causing blurry vision, redness, or build up on the lens, try this technique:<br />
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1. Apply all of your makeup<br />
2. Wash your hands thoroughly<br />
3. Instill a rewetting drop to rinse makeup particles off your eye.<br />
4. Insert your contact lens.<br />
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By applying your makeup first and then using an artificial tear drop to rinse stray makeup particles away from the eye's surface, it's less likely that you'll inadvertently transfer makeup onto the contact lens.<br />
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<b>The Science of What Makeup And Facewash Can Do to Your Contact Lens</b><br />
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<div>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/25719434">In 2015</a>, researchers tested 7 different silicone hydrogel contact lenses with different common skincare and makeup products, including hand cream, makeup removers, and mascara. Lenses were exposed to each beauty product, and then dark-field microscopy was used to see how much the product deposited on the contact lens. The lenses were then cleaned with a hydrogen peroxide solution and deposits were measured again. Researchers found that mascara was far and away the makeup product that deposited the most on contact lenses. While non-waterproof mascara deposits improved significantly after cleaning the contact lens with a hydrogen peroxide solution,<b style="color: #990000;"> waterproof mascara deposits remained firmly stuck to the contact lens, even after a cleaning cycle! </b></div>
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<div>
In June 2019, a<a href="https://www.ncbi.nlm.nih.gov/pubmed/31232789"> new study </a>exploring this same topic was performed looking more specifically at the changes these makeup and skincare products can have on the physical size, shape, and optical properties of a contact lens. Three different brands of contact lenses were tested with exposure to mascara and eye makeup removers as outlined below. All lenses were newly opened from the package and have never been worn previously. Each lens was only exposed to one product. A -3.00D lens was used for each contact lens to minimize differences between lenses outside of the product material itself. </div>
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The contact lenses used were: </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim5xbem8UHbsNvhvgduzVVYzAEjRgH-botJQ2oygVurb9if3lbJwywT5YaSj18LoffS_2wL_uQ7wFBdsTHGO4KX0TGAvM1fYVRS5X_JezRYi3NT1Lvzn8dytlIDbufcjgaSVSvLW80X3ak/s1600/Contact+Lenses+in+Study.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="701" data-original-width="1600" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim5xbem8UHbsNvhvgduzVVYzAEjRgH-botJQ2oygVurb9if3lbJwywT5YaSj18LoffS_2wL_uQ7wFBdsTHGO4KX0TGAvM1fYVRS5X_JezRYi3NT1Lvzn8dytlIDbufcjgaSVSvLW80X3ak/s640/Contact+Lenses+in+Study.png" width="640" /></a></div>
<div>
<br /></div>
<div>
<b>The Results:</b><br />
Statistically significant contact lens changes were found in both diameter (or size) of the lenses, base curve (or shape), and power (or prescription) of the lenses in this study. The degree of change relative to the baseline measurements was compared with the <a href="https://www.iso.org/standard/51051.html">ISO standards for contact lenses</a>, which suggests tolerance limits of +/-0.20 mm for lens diameter, +/-0.20 mm for base curve, and +/-0.25 D for lens power.</div>
<div>
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<div>
<u>What Problems Do Makeup Removers Cause?</u><b> </b>Research shows these products primarily affect the fit of the contact lens by changing base curve and diameter. </div>
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The makeup removers used were:</div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2u7XlA3qVdiqP6yFd_ipE-eKHwrDbdrgTGTdiLxWaM11vZ6Uxoy8RzHLzZ-aD-hPmbJAO9koboAtYV5LkZqL4UUUOCYQfOgB8V5DekniQRpf9eV3pw8o1I46Ikma-C6jRH0eCSiNDmVTN/s1600/Makeup+Removers+in+Study.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="808" data-original-width="1600" height="322" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2u7XlA3qVdiqP6yFd_ipE-eKHwrDbdrgTGTdiLxWaM11vZ6Uxoy8RzHLzZ-aD-hPmbJAO9koboAtYV5LkZqL4UUUOCYQfOgB8V5DekniQRpf9eV3pw8o1I46Ikma-C6jRH0eCSiNDmVTN/s640/Makeup+Removers+in+Study.png" width="640" /></a></div>
<div>
<br /></div>
<div>
<ul>
<li><u>Diameter Changes:</u> The makeup removers, specifically the liquid products (L'Oreal Gentle Makeup Remover and
Neutrogena Oil-Free Makeup Remover), resulted in an increase in lens diameter and lens
edge distortions. </li>
<ul>
<li>L'Oreal Gentle Makeup Remover caused diameter increases in senofilcon
C (Acuvue Vita) and samfilcon A (Bausch and Lomb Ultra) of 0.26 mm </li>
<li> Neutrogena Oil-Free Makeup Remover showed a mean increase of
0.35 mm for samfilcon A (Bausch and Lomb Ultra)</li>
<li>Lotrafilcon B+EOBO (Air Optix Plus Hydraglde) was less affected
compared with senofilcon C and samfilcon A</li>
</ul>
<li><u>Base Curve Changes</u>:</li>
<ul>
<li>Liquid makeup removers resulted in an increase in contact lens base curve.</li>
<ul>
<li>L'Oreal Gentle Makeup Remover resulted in an increase in base curve for senofilcon C (Acuvue Vita) of 0.36 mm</li>
<li>Neutrogena Oil-Free Makeup Remover resulted in an increase in base curve for samfilcon A (Bausch and Lomb Ultra) of 0.35 mm</li>
<li><b>Because most of these changes exceeded the tolerance of the ISO standard of +/-0.20 mm, it is possible that lens movement and centration of the contact lens on the eye could be affected</b></li>
</ul>
</ul>
</ul>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdgBD76r_MBiT8eNRgyqnXM6ZWnCmsofsxIm6j3RZ64vKk4U2kWfd2rjjVXKNGAlgFL3nZAAwX9sv_ZL3p_tBLVxn5hsOSADpkTHyBWKlQoZIGjubbKwlvM9DsVEGU2MkYYUcgkgBp_TQ5/s1600/lens+edge+distortion+of+Ultra+with+Neutrogena.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="423" data-original-width="484" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdgBD76r_MBiT8eNRgyqnXM6ZWnCmsofsxIm6j3RZ64vKk4U2kWfd2rjjVXKNGAlgFL3nZAAwX9sv_ZL3p_tBLVxn5hsOSADpkTHyBWKlQoZIGjubbKwlvM9DsVEGU2MkYYUcgkgBp_TQ5/s1600/lens+edge+distortion+of+Ultra+with+Neutrogena.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Contact lens edge distortion caused by exposure of samfilcon A lens to Neutrogena Oil-Free Makeup Remover <a href="https://www.ncbi.nlm.nih.gov/pubmed/31232789">via</a></td></tr>
</tbody></table>
<u><br /></u>
<u>What Problems Do Mascaras Cause?</u> These products primarily effect image quality and vision.<br />
<div>
<br /></div>
<div>
The mascaras used were:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZWcs3hLTFt04urygvnowXALpj-IKtEv1FiHeS1M_ZwyxlKPNKziH81sanBkbEBpBeH7olm7_8ZAKV6RXpTmp-gpnBVwE1F46JiUa9ctGqYrBpdzRqXjMTSqgEHhKCUbmSL9MEd4sMTKx/s1600/Mascaras+in+Study.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="794" data-original-width="1600" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqZWcs3hLTFt04urygvnowXALpj-IKtEv1FiHeS1M_ZwyxlKPNKziH81sanBkbEBpBeH7olm7_8ZAKV6RXpTmp-gpnBVwE1F46JiUa9ctGqYrBpdzRqXjMTSqgEHhKCUbmSL9MEd4sMTKx/s640/Mascaras+in+Study.png" width="640" /></a></div>
<div>
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<div>
<ul>
<li><u>Deposition Changes</u>: Mascara caused significant deposits on the contact lenses, and in some brands these deposits did not improve even after a 1 hour soak in purified buffer solution. </li>
<ul>
<li>Maybelline Great Lash Waterproof Mascara deposited thickly on all lens types and did not slough off
during the 1-hr soak</li>
<li>Rimmel Wonder'Lash Waterproof Mascara and L'Oreal Luminous Original Mascara did not deposit as thickly and sloughed off more readily
after cleansing</li>
</ul>
<li><u>Optical Image Quality:</u> This was measured using the Contest
Plus II (Rotlex, Israel) lens analyzer.</li>
<ul>
<li>all contact lens types were adversely affected by mascara</li>
<li>samfilcon A (Bausch and Lomb Ultra) was affected similarly by all brands</li>
<li>senofilcon C (Acuvue Vita) and lotrafilcon B+EOBO (Air Optix Plus Hydraglyde) were most affected by Maybelline Great Lash Waterproof Mascara</li>
</ul>
<li><u>Base Curve Changes</u>:</li>
<ul>
<li>Of the mascaras tested, only Maybelline Great Lash Waterproof Mascara caused a statistically significant change in base curve</li>
<ul>
<li>The application of Maybelline Great Lash Waterproof Mascara caused a steepening in base curve for all
lens types of 0.24 mm for senofilcon C (Acuvue Vita) and samfilcon A (Bausch and Lomb Ultra) and
0.19 mm for lotrafilcon B+EOBO (Air Optix Plus Hydraglyde)</li>
</ul>
</ul>
<li><u>Lens Power Changes: </u></li>
<ul>
<li>The exposure of makeup removers caused a change in power of
less than or equal to 0.09 D which was not statistically significant</li>
<li>Overall, mascaras differed significantly in their impact on lens
power</li>
<ul>
<li>Maybelline Great Lash Waterproof Mascara caused an apparent decrease in power of -1.18 D for senofilcon C (Acuvue Vita)</li>
</ul>
</ul>
</ul>
<div>
<b>Take Home</b></div>
</div>
<div>
During the normal course of wear, contact lenses can be exposed to numerous facial and cosmetic products that can significantly impact the comfort and visual performance of the lens. Properly cleaning your contact lenses may help recover some of the parameter changes caused by different cosmetics to some degree. However, particularly mascara may still affect image quality and liquid
eye makeup removers may affect lens fit. If you are struggling with contact lens performance, changing to a daily disposable contact lens and limiting exposure of the lens to cosmetic products may greatly increase lens comfort, vision, and wearing time. Avoiding waterproof mascaras and tightlining with eyeliner can also help minimize contact lens contamination.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7wJMzKriYNuzsGU_26AR6Yfdy7AvvYUP0RsniDk6rbjWARJwr9Wr8W35h4T_PPXuaXDLweLua39NIALKnWQFjyf6gDrCwbhfbHCglF6gvJpnv0Xsk7TJ3s59VOy1kv6o4kJtzL8p86Wgh/s1600/daily+disposable+lenes.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="898" data-original-width="1600" height="358" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7wJMzKriYNuzsGU_26AR6Yfdy7AvvYUP0RsniDk6rbjWARJwr9Wr8W35h4T_PPXuaXDLweLua39NIALKnWQFjyf6gDrCwbhfbHCglF6gvJpnv0Xsk7TJ3s59VOy1kv6o4kJtzL8p86Wgh/s640/daily+disposable+lenes.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The best solution? Changing to daily disposable lenses can make sure that your contact lenses perform the same every day!</td></tr>
</tbody></table>
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Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-79641070463004166542019-08-13T14:48:00.001-04:002019-08-13T14:51:07.949-04:00What Can Baby See Part 2: Vision Development in the First 2 Months<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgKOLXzf4nyYk8TYmnNGdmMXbiD1qEq6255AI-BfNzH43JVbm2swrjZM4mEX1s4NOdxjK-04TdlaXFUiV2ThxhuTHhqS7q1VnzBfqghqavPPxx40dVTD9H30NfYu6wD-YrzVThqj-a2F_1/s1600/IMG-1222.JPG" imageanchor="1"><img alt="" border="0" data-original-height="1600" data-original-width="1284" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgKOLXzf4nyYk8TYmnNGdmMXbiD1qEq6255AI-BfNzH43JVbm2swrjZM4mEX1s4NOdxjK-04TdlaXFUiV2ThxhuTHhqS7q1VnzBfqghqavPPxx40dVTD9H30NfYu6wD-YrzVThqj-a2F_1/s640/IMG-1222.JPG" title="Vision Development in 1 to 2 month old" width="512" /></a></div>
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When a newborn first opens their eyes to the world, vision is a sense that is mostly dedicated to recognizing mom and dad (<a href="http://www.eyedolatryblog.com/2019/07/what-can-baby-see-ods-guide-to-newborn.html?m=0">see Part 1 of this series about newborn vision</a>). But as new parents know, babies develop rapidly over the first few weeks of life, and vision is no exception! In the first 1 to 2 months of life, your baby is learning how to focus and move their eyes to visually process the world around them. InfantSEE providers refer to this stage of visual development as <a href="http://www.infantsee.org/x3638.xml">"Learning to Look"</a>. Your baby is actively learning how to use their eyes for the first time, and at this stage eye muscle movement development includes:<br />
<ul>
<li>Pursuits: slow, tracking movements </li>
<li>Accommodation: focusing on near objects</li>
<li>Convergence: eyes turning inward as near objects are brought closer</li>
</ul>
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A 1 to 2 month old baby's eyes should be actively moving and exploring, but the eyes won't always work together. <b>It's very common for parents to notice that their child's eyes are sometimes misaligned (or crossed) during this developmental stage.</b> Unless the misalignment is constant, seeing your child's eyes cross from time to time is completely normal and expected from six to eight weeks old. If you are concerned about misalignment, your eye doctor can assess the alignment of your child's eyes by using the <a href="https://www.eyedolatryblog.com/2015/05/hirschberg-testing.html">Hirschberg test</a> where a light is used to determine if the eyes are fixating equally or if an inward or outward eye turn is occurring. </div>
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<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243010/"><b>By six weeks of age, most infants can make stable eye contact with their parents.</b></a> Avoidance of eye contact is commonly cited as a hallmark of autism, but interestingly, <a href="https://www.nature.com/articles/nature12715">research</a> shows that infants that are later diagnosed with autism typically make <u>normal</u> eye contact at 2 months of age. Infants that go on to be diagnosed with autism then experience a gradual decline in eye contact from age 2 to 6 months. If your child is not making good eye contact by the end of 2 months, it is more likely that your child has a visual health or developmental issue that requires immediate attention. Infants that are born with high amounts of hyperopia or farsightedness can have difficulty holding eye contact because their high prescription makes it impossible to focus clearly on their parents' faces.<br />
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<tr><td class="tr-caption" style="text-align: center;">At 2 months old, my daughter is making eye contact with her grandmother and smiling back when grandma smiles!</td></tr>
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<span style="background-color: white; font-family: "times new roman" , "stixgeneral" , serif; font-size: 15.9991px;">Infants at this age pay extra attention to faces and the motions involved in creating different facial expressions like smiles and frowns. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243010/#CR33">Research</a> has shown that by 3 months of age, infants have adult-like abilities in global motion sensitivity, meaning they can see the movements of your changing facial expressions as well as you can when you look at other people. Interestingly, studies have shown that young infants respond more strongly to pictures of smiling females than males. Study authors theorize that this is because infants on average spend more time looking at female faces (mom's especially). <a href="https://www.ncbi.nlm.nih.gov/pubmed/24285109">Using head-mounted cameras revealed that between 1 and 3 months of age, infants looked at faces 25 % of the time, primarily female faces (70 %) of adult age (81%) of their own race (96 %)</a>.</span></div>
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<b>Activities for 1-2 Month Old Babies to Aid in Vision Development</b></div>
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<ul>
<li>Help your child develop awareness of their own body by moving their arms and legs. Simple activities like clapping your baby's hands together, or bicycling their legs are great for development. </li>
<li>Making faces at your baby can be a building block for language development and visual communication. </li>
<li><span style="color: #990000;">Developing Pursuit Movements</span>: </li>
<ul>
<li>Have baby visually track an interesting toy or your face from side to side and up and down with their eyes. Try clucking or cooing to grab your baby's attention if they lose their gaze. </li>
</ul>
</ul>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr05C_gW7fUaDQefGoZSC6gC2oL02le6GymHKll6E8dpbdaDkwy64sVU1fe954St3kLyh_PzR4m4aKJMPPYYR00pjKRWwH-l-kwDpgcF66KB3Gh7SdwBrzpmvk7Ccw0P8SwI9MxGAhF5Rb/s1600/IMG-2129.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" data-original-height="1600" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr05C_gW7fUaDQefGoZSC6gC2oL02le6GymHKll6E8dpbdaDkwy64sVU1fe954St3kLyh_PzR4m4aKJMPPYYR00pjKRWwH-l-kwDpgcF66KB3Gh7SdwBrzpmvk7Ccw0P8SwI9MxGAhF5Rb/s640/IMG-2129.JPG" title="Vision Development in 1 to 2 month old babies" width="480" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Our N.C. State Mobile has high contrast black, white, and red mascots - perfect for young infants to focus on!</td></tr>
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<li><b>Mobiles</b> are excellent at this age to begin stimulating eye muscle movements. Place your baby flat on his or her back underneath the mobile, ideally no further than 2 feet away to make sure your baby can clearly see the moving objects. A low hanging mobile also encourages your baby to have to move their head from side to side to track the movement of the mobile, which can help reduce the risk of plagiocephaly (flat head syndrome). Using high contrast black and white or red objects for the mobile increases visibility. Your baby will not only be developing ocular muscle skills by tracking the mobile as it spins, but as they swing their arms and legs, they are also developing the first stages of balance and core muscle strength that will help them eventually learn to roll and crawl in the coming months. </li>
</ul>
<li><span style="color: #990000;">Developing Accommodation and Convergence</span>: </li>
<ul>
<li>Hold your baby up above your face, making eye contact, and then bring them slowly towards you. Maintain eye contact the entire time. You should see your baby turn their eyes inwards as they move closer to your face (convergence). Then move baby back away from your face again by extending your arms. You should see baby's eyes move back to straight ahead alignment. </li>
<li>You can vary this exercise by doing diagonal movements (hold baby up and to the right and bring them to your face, and then up and to your left and bring them to your face). This helps build "asymmetrical convergence" and cross-body awareness. </li>
</ul>
</ul>
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Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com3tag:blogger.com,1999:blog-5227100415460909947.post-14910454416832783042019-07-20T17:41:00.001-04:002019-08-13T14:52:36.381-04:00What Can Baby See? An OD's Guide to Newborn Vision<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9Xp3c-D9XkCKMzyWqiHuEngNLrt1sLX55C61SbfHPCR8i6ELiOItYAnpXiLhXrwENoDUgNspsGK4h9YZhHd4d0_Mk2zaWJ_N1yXaUuWBTonOQG20R3YbY1gblsj-8UQT6ensD4I5AcLhF/s1600/Peony_Newborn-14.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1068" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9Xp3c-D9XkCKMzyWqiHuEngNLrt1sLX55C61SbfHPCR8i6ELiOItYAnpXiLhXrwENoDUgNspsGK4h9YZhHd4d0_Mk2zaWJ_N1yXaUuWBTonOQG20R3YbY1gblsj-8UQT6ensD4I5AcLhF/s640/Peony_Newborn-14.JPG" width="426" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. L and her newborn daughter. photo credit to <a href="https://www.melissadelormephotography.com/">Melissa DeLorme Photography</a></td></tr>
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Try to picture what the world is like for a newborn entering the world. Suddenly they go from the warm, cozy, darkness of mother's womb to a loud, cold world of bright lights and blurry shapes. And yet, research suggests that newborns are not paralyzed by sensory overload, but their visual skills that have been developing throughout their time in the womb immediately are ready to kick into gear! <a href="http://academyofneonatalnursing.org/NNT/Nervous_PANBehavioralAssessment.pdf">Full term and even some premature infants can fixate their eyes on a near object immediately in the delivery room.</a> This early visual alertness is used by doctors and nurses in the delivery room to assess the robustness and function of the central nervous system.<br />
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<b><span style="color: #990000;">We can separate visual development in infancy into <a href="http://www.infantsee.org/x3638.xml">5 main stages</a>:</span></b><br />
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<b>1. <a href="https://www.eyedolatryblog.com/2019/07/what-can-baby-see-ods-guide-to-newborn.html">Awakening to the World</a> </b><br />
Visual alertness occurs in the first hours/days/weeks of your newborn's life. What your baby can see, and what you as parents can do to support visual development in this stage is the subject of this article!<br />
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<b>2. <a href="https://www.eyedolatryblog.com/2019/08/what-can-baby-see-part-2-vision.html">Learning to Look</a></b><br />
In the first 1-2 months the eyes are learning to move and work together by following and tracking objects.<br />
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<b>3. Eyes/Brain/Hands</b><br />
Around 4 months old, your baby is integrating vision into motor control. Hand-eye coordination and balance are all being developed at this stage.<br />
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<b>4. Adjusting Focus</b><br />
At 6 months old it's time for the baby's first trip to the optometrist! At this visit, the doctor will use retinoscopy to assess how your child is focusing on objects near and far, check for any differences between the two eyes, and determine if a prescription is needed to prevent against lazy eye (amblyopia) or strabismus (eye turn).<br />
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<b>5. See to Move</b><br />
At ages 8 months to 1 year old, babies are actively moving and navigating their world using visual cues like depth perception.<br />
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<b><span style="color: #990000;">How can doctors tell what babies truly see?</span></b> </div>
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Since you can't ask an infant what they can see, and you can't get them reading letters off a chart, the way doctors assess vision in infants is a bit more complicated. There are several different methods that scientists and doctors use to determine what a baby is capable of seeing: </div>
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1. <u>Fix and Follow:</u> Does a baby make eye contact with an object or light, and will they follow that object with their eyes? <a href="https://cdn.ymaws.com/www.covd.org/resource/resmgr/ovd37-3/99-103groffmaneditorial.pdf">Studies show infants even a few minutes old can fixate and follow a stimulus with their eyes.</a></div>
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2.<u> Resistance to Occlusion:</u> If a doctor tries to obstruct vision by blocking the eyes, will the baby move or bat the blocking object away to try to be able to see again? <a href="https://www.ncbi.nlm.nih.gov/pubmed/7963225">Studies have shown that more interesting visual stimuli will elicit a stronger resistance to occlusion. </a></div>
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The above methods are very basic and only establish the the infant has vision. Neither can determine the degree of vision or how clearly the baby can see. To assess the brain's visual perception in greater detail, researchers use:</div>
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3. <u>Forced Preferential Looking Technique</u>. This technique was established by psychologist Robert Fantz in the 1960s. In this method, an infant is given two visual choices, one with a pattern or interesting stimulus like a face, and the other with a blank field. If the infant spends a longer time looking at the patterned stimulus, it is assumed that the infant is able to visually perceive the pattern versus the blank field.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0OALrqvzxgqmgQOJavjNsInpfu1k6MsQg6X0L9dEpck7Ow5Bvb1oFTajFs-vRVZYtkh1tAzF5DF8uPGZnI5P_d369qb0K3YNHNJosmiGpWHS14hJIXSxC2oa21d3pu8Kx66OpDfeOJbuo/s1600/lea-paddles.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="541" data-original-width="812" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0OALrqvzxgqmgQOJavjNsInpfu1k6MsQg6X0L9dEpck7Ow5Bvb1oFTajFs-vRVZYtkh1tAzF5DF8uPGZnI5P_d369qb0K3YNHNJosmiGpWHS14hJIXSxC2oa21d3pu8Kx66OpDfeOJbuo/s640/lea-paddles.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Optometrists can use Lea Acuity Grating Paddles during infant eye exams to assess vision using Forced Preferential Looking techniques. <a href="https://visionhelp.wordpress.com/2016/04/29/the-importance-of-just-look/">via</a></td></tr>
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4. <u>Visual Evoked Potential (VEP)</u>. This method actually measures how the brain reacts to visual input using a series of electrodes placed on the baby's head. If the infant has an intact visual pathway (eye to brain), when they are shown a patterned stimulus that is large enough to be seen a VEP response will be generated.</div>
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<b><span style="color: #990000;">Stage 1: Awakening to the World</span></b><br />
<b>What Newborns Can See</b></div>
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A newborn's visual system is wired to process and recognize human faces right from birth. In fact, r<a href="https://www.cell.com/current-biology/fulltext/S0960-9822(17)30580-8">esearch suggests that the brain's visual system is attuned to recognizing the T-shaped pattern of faces (2 eyes on top, and a mouth underneath) while the baby is still in the womb</a>! Infant vision is clearest at a range of 8-12 inches from their face, the perfect distance to look at their parent's faces and to memorize what mom and dad look like. Long distance vision is much blurrier than in adults at this age, somewhere in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243010/">range of 20/200-20/400</a>. </div>
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Recognizing mother's face is actually one of the first things that infant vision excels at. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723815/">Multiple studies have shown that newborns will spend a longer time looking and "studying" their mother's face than that of a stranger</a>. In addition to the T-shaped facial pattern that is specific to mom (distance between mom's eyes and from her eyes to her mouth), the high contrast outline of her face and hair also plays into recognition. <a href="https://www.allaboutvision.com/parents/infants.htm">If mom is wearing a shower cap for example, the newborn's preference for mother's face versus a stranger's face goes away. </a></div>
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Earlier research had indicated that newborns may be able to mimic their parents making facial gestures like sticking out their tongue, but those studies have been called into question. <a href="https://www.sciencedaily.com/releases/2016/05/160505133848.htm"> Newer science</a> suggests that babies won't truly be able to mimic facial gestures until they are a few months in age. Why the confusion? Parents will actually mimic their baby's facial expressions once every two minutes on average, so who was copying who in those early studies?<br />
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In addition to facial recognition, infants as young as 2 days old are already understanding and processing the natural world around them. <a href="https://www.pnas.org/content/105/2/809">Multiple studies have shown that newborns prefer "biological motion" over random motion patterns.</a> When a point motion light display of a walking hen (biological motion) is shown versus a random light motion patterns, newborns preferentially looked at the moving hen. If the motion of the moving hen was turned upside down (which would be unnatural movement in the order of the world), the preference disappeared. Interestingly, this phenomenon of preferring to view and track movements that would occur in the natural world is seen in more than just humans; baby chicks, cats, dolphins, and monkeys have all shown this preference in other studies. </div>
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<b><span style="color: #990000;">Promoting Visual Development in the Newborn</span></b></div>
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In the first few weeks of life, visual development is focused on the baby making connections with you as the parent and observing and processing the world around them from the security of their parent's love and protection. This is the groundwork for developing higher order skills like hand-eye coordination and depth perception which will start developing in the coming months. The best way to get vision off to the right start for your newborn is:</div>
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-<b>Change sides when you nurse</b> between each feeding so that both of baby's eyes are given a chance to develop equally. When a baby is nursing, one eye's vision is often obscured against your chest. If vision is routinely blocked in one eye versus another, it is possible that this eye could become amblyopic (or a lazy eye) with time. </div>
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-<b>Make eye contact </b>and interact with your baby. As a newborn, infants spend the overwhelming majority of their time in one of two states: sleeping or eating. It's essential during that eating and awake time that they are receiving visual stimulation from mom and dad. When nursing, put down the phone and make eye contact with your little one. Stimulate baby by making faces and talking to them, even if its just babbling noises. Watching your mouth movements and integrating vision with sound will start them on the path towards language skills down the road.<br />
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-<b>Don't leave your baby "contained"</b> in swings or cribs for extended periods while they are awake. Research shows that for vision to develop properly at this early stage, babies need a wide range of visual stimulation from different angles, views, and positions. <a href="https://cdn.ymaws.com/www.covd.org/resource/resmgr/ovd37-3/147-155valentiessay.pdf">Research with newborn kittens that were raised in a room with only vertical stripes for just 30 hours showed significant visual impairment</a> and reduced motor skills.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaogxEEBq0Q-Nq-Rqm6XWfWS6cfneQIBDpjdR_7a7h4Jgvnn10tD44CaIOQZYEU1EPkx9Qt_YNUBkezZIwzKvJFGs5Rl34dB1ggP1Q_h1PwYKlz5-1yxwVLQZ84yWqLUzoZL5seQhg4DyJ/s1600/Peony_Newborn-58.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1068" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaogxEEBq0Q-Nq-Rqm6XWfWS6cfneQIBDpjdR_7a7h4Jgvnn10tD44CaIOQZYEU1EPkx9Qt_YNUBkezZIwzKvJFGs5Rl34dB1ggP1Q_h1PwYKlz5-1yxwVLQZ84yWqLUzoZL5seQhg4DyJ/s640/Peony_Newborn-58.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The American Medical Association recommends that babies sleep only on their backs to reduce the risk of SIDS, so when baby is awake it is very important that they spend time in different positions - side lying, tummy time, held, or worn. photo credit <a href="https://www.melissadelormephotography.com/">Melissa Delorme Photography</a></td></tr>
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-<b>Wearing your baby</b> is a great way to let their visual system experience different positions and movement, and reduces the amount of time that baby spends flat on their back, which can lead to positional plagiocephaly (flat head syndrome). When positioning your baby in a wrap, make sure they are sitting high enough that they can comfortably view your face with both eyes and that you can make great eye contact with baby by comfortably looking down. This video is a great tutorial that works for any brand of wrap!<br />
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-How do you play with a newborn?<b> High contrast toys or books</b> will be best to keep baby's attention at this stage! Look for black and white patterned toys or board books, but no toy will be more interesting than looking at mom and dad. Despite conflicting reports online, <b>babies are not born colorblind but they do not have mature, adult color vision. </b><a href="https://www.sciencedirect.com/science/article/pii/0163638387900294">In a 1987 preferential looking study</a>, newborns were shown red, yellow, green, blue and gray squares. Newborn infants preferred looking at any of the color squares over the gray (achromatic) square, but had no preference between colors. By 3 months of age however, infants preferred red and yellow (long wavelength) colors over blue and green (short wavelength).<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn8BOzBHvn1d49BwBLYpd31XjfzpBiWYV5CLekmOBsnSvvgSWBJ-mURxIBcguLxwdJIh0AuKmMxTlUBhWi7OP00eu8A8agTrc5d8aZzU7Asb9hodeyVx5l7VYNKXPUoJ9QYdaNbVhhVz__/s1600/Usborne+Books+Black+and+White.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn8BOzBHvn1d49BwBLYpd31XjfzpBiWYV5CLekmOBsnSvvgSWBJ-mURxIBcguLxwdJIh0AuKmMxTlUBhWi7OP00eu8A8agTrc5d8aZzU7Asb9hodeyVx5l7VYNKXPUoJ9QYdaNbVhhVz__/s640/Usborne+Books+Black+and+White.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Usborne Baby's Very First Black and White Books are designed with high contrast images to draw baby's attention. <a href="https://usborne.com/browse-books/catalogue/series/1/644/babys-very-first-black-and-white-books/">via</a></td></tr>
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-<b>Start tummy time activities right away</b>, even if your baby can only tolerate it for a minute or two. A great way for newborns to do tummy time is to place baby on your chest and make eye contact and talk to baby from this position. <a href="https://www.nytimes.com/2018/06/18/well/the-benefits-of-tummy-time.html">Studies show</a> that tummy time is a core fundamental to developing visual motor skills. Infants that don't spend as much time on their stomachs are more likely to skip crawling, and can even have trouble later in elementary school with handwriting and fine motor control. Creating a strong foundation for vision development from those very first days is essential to subsequent childhood developmental milestones.<br />
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For tummy time ideas and tips, check out occupational therapist Rachel Coley of <a href="http://www.candokiddo.com/">Can Do Kiddo</a>:<br />
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-Parents of newborns will be taking lots of pictures of their new little one, but did you know that you could use this photography to help your doctor find ocular health issues? <b>Alert your doctor if you notice a white reflex from your child's pupil. </b> Infant pupils are often large enough for a strong red reflex to occur with photography. Seeing that red reflex is great! What you shouldn't see is a white reflection coming from your inside your child's eye. A white reflex could indicate a serious visual issue that could result in blindness or even death, like congenital cataracts, a retinal tumor, or an optic nerve anomaly. Let your doctor know right away if you have any concerns about your child's appearance of behavior so they can investigate things further.</div>
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Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com1tag:blogger.com,1999:blog-5227100415460909947.post-79069192306086289582019-04-28T18:00:00.000-04:002019-04-28T18:00:31.376-04:00Change Your Glasses Style in a Snap: Funoogles EyewearOne pair of shoes doesn't go with every outfit, so why should we be restricted to making one pair of glasses work every single day for our personal style? As a glasses-wearing adult, I have a total of 6 pair in my current prescription - from versatile clear plastic to a bold black and white tortoise with red details for when I want my eyewear to make a statement. But for kids, whose prescriptions can often change dramatically from year to year, investing in multiple pairs of glasses for stylistic purposes often seems like a luxury that can be hard for parents to justify.<br />
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<tr><td class="tr-caption" style="text-align: center;">Founder and President <b>Jessica Darcy</b> shares her Funoogles collection at <a href="https://west.visionexpo.com/">Vision Expo West </a></td></tr>
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Ella-Jane Darcy is one such glasses-wearing kid that craved variety in her day to day look. Born with congenital cataracts, she depended on her glasses to be able to achieve the vision needed to enjoy a normal life. Her eyewear was an essential part of her personal identity - none of her friends, classmates, or family ever saw her without her glasses on - but she was relegated to wear the same frames every day with no chance to express her personal style, emotions, or feelings. She complained to her mom about the issue, and her wish to be able to have a pair of glasses that she could mix and match depending on her outfit so she felt less confined and defined by her eyewear, and more like she owned her personal appearance.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgCWBGTAruRbPls8MgvemQXQnUpAu0GX-w9PjNzvrIM3Wl70uHc13fJXwCYvMVlRflYbzXDkXQGBG1ZMTSmCO8JRceWLs7bY9PJYn8d5bAY5BK9ZAlnuhNlhsfJPNIxCqJuzm6Ix6AYyTe/s1600/Funoogles+Ella+Jane.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="696" data-original-width="606" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgCWBGTAruRbPls8MgvemQXQnUpAu0GX-w9PjNzvrIM3Wl70uHc13fJXwCYvMVlRflYbzXDkXQGBG1ZMTSmCO8JRceWLs7bY9PJYn8d5bAY5BK9ZAlnuhNlhsfJPNIxCqJuzm6Ix6AYyTe/s1600/Funoogles+Ella+Jane.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;">Ella-Jane clearly has a strong sense of fashion and self identity, and her eyewear style is always on point as evidenced by the <a href="https://www.instagram.com/funoogles">@Funoogle</a>s Instagram account.</span></td></tr>
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<br />With a wish so moving, her mom went to work with a big idea. Jessica Darcy is the creator and president of <a href="https://www.funoogles.com/">Funoogles Eyewear</a>, an innovative children's eyewear line manufactured in partnership with <a href="https://www.cvoptical.com/">ClearVision Optical</a> (who celebrates their 70th anniversary in the industry this year!). I had the chance to meet with Jessica at <a href="https://west.visionexpo.com/">Vision Expo West</a> back in the fall, and her personal zeal for bringing her daughter's inspiration to life was so contagious! She was also very thrilled to find a partner in Hauppauge, New York-based ClearVision Optical and to be able to share with her customers that her eyewear line was not only locally owned, but designed and distributed in the USA.<br />
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<tr><td class="tr-caption" style="text-align: center;">Jessica Darcy demo's how to change out different frame add-ons at Vision Expo West.</td></tr>
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<br />The concept of Funoogles is deceptively simple: you start with a base frame in clear plastic, and then you can switch out colorful add-on's like temples or face plates to create a personalized frame that could be different every day. Each accessory to personalize the frames is <b>affordably priced at $20</b> so investing in just one pair of glasses easily becomes many different looks without a financial burden.</div>
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<b><span style="color: #990000;">Step 1: Choose Your Base Frame</span></b></div>
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<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.funoogles.com/pages/how-it-works">via</a></td></tr>
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All base frames are clear plastic made from a flexible and durable material. They come in two sizes (small or 46mm eyesize and medium or 48 mm eyesize). An optician will be able to fit your child in the proper size for their eyewear to make sure the frames aren't too big or too small for their face. </div>
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<b><span style="color: #990000;">Step 2: Choose Your Temples</span></b></div>
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Temples easily snap on and off from the base frame! There are currently <b>17 different colors</b> to choose from.</div>
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<b><span style="color: #990000;">Step 3: Add a Full Frame Clip, Eyebrow Clip or Outline Clip</span></b></div>
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These different accessories attach to the front of the base frame to create a whole new appearance, and can be easily snapped on or off. </div>
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<tr><td class="tr-caption" style="text-align: center;">For more great style inspiration on how to make your Funoogles pop, head to <a href="https://www.instagram.com/funoogles/">@funoogles</a> on Instagram</td></tr>
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Besides the fun colors and the affordable price point, the whole system is easy for kids to change out by themselves so they can be in control of their eyewear style and look forward to wearing their glasses and seeing the world clearly every single day!</div>
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Looking for an optical near you that carries Funoogles eyewear? <a href="https://www.funoogles.com/pages/store-locator">Head to the store locator here</a> or contact the company directly by emailing <a href="mailto:hello@funoogles.com">hello@funoogles.com</a>.</div>
Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-52384276484073500482019-01-04T20:52:00.003-05:002019-03-04T15:38:58.897-05:00Best Contact Lens Solutions for Hard Rigid Gas Permeable or Scleral Contact LensesFor the roughly <a href="https://www.clspectrum.com/issues/2018/january-2018/contact-lenses-2017">11% of all contact lens wearers</a> that wear hard or rigid gas permeable (RGP) contact lenses, finding the right cleaning and storage solution is a lot more complicated than just grabbing something off the shelf at the drug store. Most readily available contact lens cleaning solutions are meant to clean soft, disposable contact lenses and won't clean and disinfect RGP lenses thoroughly enough to be safe. Because RGP and scleral contact lenses are replaced much less frequently than soft lenses (yearly to every few years, depending on the patient), keeping the contact lens surface clean of debris and protected against infections, chips and scratches is essential to both comfort and clear vision!<br />
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The biggest risk with contact lens wear, whether you wear soft or RGP lenses, is corneal infection. Unfortunately it's possible to be blinded by contact lens wear, so proper hygiene and care is essential. For patients wearing RGP or scleral lenses, the risk of infection is extremely low <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423374/">with only 2 cases per 10,000 patients reported</a>. Compare that to soft contact lens wearers who have an incidence of 25.4 cases per 10,000 patients for those who wear monthly disposable overnight wear soft contact lenses! Even though the risks of infection are much lower when you wear daytime wear RGP lenses than overnight wear soft contact lenses, because patients wear these lenses for much longer, up to a few years at a time, the repeat exposure to bacteria can cause significant risk.<br />
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<b>So which solutions are the best to use? Here are the top options on the market:</b><br />
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<b><span style="color: #990000;">Multipurpose Systems: </span></b>All-in-one solution systems (sometimes abbreviated MPS solutions) are super convenient because in just one bottle you can clean, disinfect, store, and condition your contact lens overnight. Many RGP contact lens solutions will mention "conditioning" -- that means improving the wettability of the contact lens so that it stays better hydrated on your eye to maintain great comfort and clear vision.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV8orAzhaUlBfCYVYeb_k3cIjCih2CHWcxpaaeHUkoEn9OXL5TtMspBxywgRQY1gmrKsw5i-VX6XFKRNuz7oIR1CjSE962FzvCLgOD1mQWfMg4Gpa0idmP_UiE2jWzijlo7mvx7S5x8rgn/s1600/Boston+Simplus.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" border="0" data-original-height="450" data-original-width="450" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV8orAzhaUlBfCYVYeb_k3cIjCih2CHWcxpaaeHUkoEn9OXL5TtMspBxywgRQY1gmrKsw5i-VX6XFKRNuz7oIR1CjSE962FzvCLgOD1mQWfMg4Gpa0idmP_UiE2jWzijlo7mvx7S5x8rgn/s200/Boston+Simplus.jpg" title="Boston Simplus" width="200" /></a><a href="https://shopstyle.it/l/XLCi"><br /></a>
<b><a href="https://shopstyle.it/l/XLCi">Boston Simplus</a>: </b>This cleaner and storage solution has protein deposit removal that is comparable to more abrasive cleaners on the market with the pro of being an all-in-one solution. For best results, the manufacturer recommends storing the contact lens in the solution overnight, then rubbing and rinsing the lens in the morning before putting on the eye. No night time rub required.<br />
Preservatives: clorhexidine gluconate and PAPB<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHo06U3OWzBUnP1sBQd8uiXlHTEOqgiHPVgeqbJRYQa1iTlmpiPJ30S2iPWFUU0PgWkf9mpLkCT4p7F0iuKQ7fze80mN9LMeJ8hM5AmFQLQzicL39j4BQo_ZaPJ99zFyMUS7mt1I-V5etN/s1600/Unique+pH.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="900" data-original-width="900" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHo06U3OWzBUnP1sBQd8uiXlHTEOqgiHPVgeqbJRYQa1iTlmpiPJ30S2iPWFUU0PgWkf9mpLkCT4p7F0iuKQ7fze80mN9LMeJ8hM5AmFQLQzicL39j4BQo_ZaPJ99zFyMUS7mt1I-V5etN/s200/Unique+pH.jpg" title="Unique pH RGP cleaner" width="200" /></a><b><a href="https://shopstyle.it/l/XLCs">Unique pH</a>: </b> This solution is an all-in-one cleaner and storage solution that works to hydrate or condition the contact lens by adjusting to the natural pH of the tears on the surface of your eye. As your tear film pH decreases (becomes more acidic), the solution becomes thinner to help maintain comfort and visual performance.<br />
Preservatives: polyquaternium-1 and EDTA<br />
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<u>The Cons:</u> These solutions are extremely popular due to convenience, but if you get a lot of deposits or build up on your contact lenses, these are typically not the best option. The cleaners in these contact lens solutions are necessarily very mild since they must be gently enough to come in contact directly with the eye. If you have significant protein build-up, adding a daily cleaner (below) is likely necessary.<br />
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<b>2. Hydrogen Peroxide Based Cleaners</b><br />
These solutions use hydrogen peroxide as one or two-step cleansing options to both disinfect lenses, clean the surface of debris and build-up, and store overnight. They both require 6 hours of cleaning time to fully disinfect the lenses.<br />
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<b><a href="https://www.walgreens.com/store/c/clear-care-triple-action-cleaning-%26-disinfecting-solution/ID=prod362473-product">ClearCare</a>: </b>This peroxide based cleaner is an all-in one option that cleans lenses overnight (6 hours). The hydrogen peroxide solution is converted to saline via an enzymatic reaction in the special case design. This solution can be used for both RGP and soft contact lenses. To properly disinfect RGP lenses, <a href="https://www.clearcaresolution.com/docs/ClearCare_us_en.pdf">the manufacturer recommends</a> putting 2-4 drops of ClearCare directly on the contact lens and then rub the lens with your finger tips. Place the contact lens in the appropriate right and left sides of the case basket, and then rinse the lenses with ClearCare directly for 5 seconds. Only after this manual rub and rinse can you fill the case with solution, close the lid, and let the contact lenses clean overnight.<br />
Preservative Free<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghSlj2LlMxxT4D7n7MVHXWbRXuZrFuCftO_JjyrlJvRThK4aoex6O9sMVDBRufx6F38BHEo3mT_MiVl-l7woMi9hO0HopmYq7gZkbxflqVI7T8c5T_u9UqjbcskrbQCV7wFEO0EeenR1RI/s1600/oxycept.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" border="0" data-original-height="1000" data-original-width="1000" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghSlj2LlMxxT4D7n7MVHXWbRXuZrFuCftO_JjyrlJvRThK4aoex6O9sMVDBRufx6F38BHEo3mT_MiVl-l7woMi9hO0HopmYq7gZkbxflqVI7T8c5T_u9UqjbcskrbQCV7wFEO0EeenR1RI/s200/oxycept.jpeg" title="Oxycept UltraCare Cleaner" width="200" /></a></div>
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<b><a href="https://shopstyle.it/l/XLCM">Oxycept UltraCare</a>: </b>This 2-step peroxide based system uses an enzyme tablet to neutralize the hydrogen peroxide solution. The tablets contain cyanocobalamin (vitamin B12) to create a pink hue so you can visibly tell that neutralization is happening. The lenses must soak in solution 6 hours or overnight. Once weekly, an <a href="https://shopstyle.it/l/XLCN">UltraZyme Enzymatic</a> tablet can be added at the same time as the peroxide neutralizing tablet for an extra strength clean.<br />
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<u>The Cons:</u> These solutions must be allowed a full 6 hours or overnight to convert, otherwise they will cause significant discomfort and toxic corneal burn if hydrogen peroxide directly contacts the cornea. If you have had this happen to you, the pain can be severe but luckily the damage is superficial and won't cause any permanent harm to the cornea.<br />
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While these solutions have strong disinfecting properties, once the hydrogen peroxide has been converted, there is no preservative coverage to prevent contamination if you leave the lenses sitting in the storage container for days at a time. Manufacturers advise not to leave a lens stored for more than 7 days. If you have back up lenses, it is always safest to store them dry and then clean them again before their next use.<br />
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<b>3. Daily Lens Cleaners:</b><br />
These are extra-strength cleaners that are either surfactant (soap) based to remove build up and debris or abrasive cleaners to remove more stubborn deposits. This category of cleaner will come with a <b><span style="color: #cc0000;">red cap</span></b> to warn users not to get the solution directly in contact with the eye. After using a daily cleaner, a separate solution will be necessary to rinse and then store the contact lenses.<br />
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<a href="https://shopstyle.it/l/XLCZ"><b>Boston Advance Cleaner:</b></a> This abrasive daily cleaner uses silica gel to physically scrub off proteins and deposits. To use, place 2-4 drops of cleaner on the contact lens and then rub between your fingers for 20 seconds. Thoroughly rinse off the cleaner, and then store the contact lens overnight with <a href="https://shopstyle.it/l/XLC5">Boston Advance Conditioning Solution. </a><br />
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<b><a href="https://shopstyle.it/l/XLC8">Lobob ESC</a></b>: This surfactant based cleaner is self-preserved and contains no abrasive particles that could change the shape or design of the RGP lens over time. After a digital rub, it must be rinsed off thoroughly like Boston Advance Cleaner above.<br />
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<b><a href="https://shopstyle.it/l/XLA8">MiraFlow Extra Strength Cleaner:</a></b> This daily cleaner is <b>compatible with both RGP and soft contact lenses</b>, and is popular among eye doctors for its' ability to remove stubborn lipid-based deposits like makeup and lotions. It's formula contains isopropyl alcohol so not only is it an excellent deposit-buster, but it has strong antimicrobial effects as well.<br />
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<u>The Cons:</u> Daily lens cleaners require that extra step of needing a second solution to rinse and store the lenses. Because of the chemical properties of salines or multi-purpose solutions, rinsing the lenses with these options requires a steady stream of solution and a thorough rinse to both sides of the lens. Historically, many RGP wearers were taught to rinse off daily cleaners with tap water, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921294/">but studies have shown</a> this could increase the risk of blinding microbial infections from <i>Acanthamoeba</i>. Many daily cleaners still mention rinsing with water on their instruction labels, however. As the FDA considers making changes to these instructions, it's safest to avoid using tap water with contact lenses all together, and if you do rinse daily cleaner off your RGP lenses with water, make sure you then immediately use a multipurpose disinfecting solution to clean your lenses and help reduce the risk of contamination and infection.<br />
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<a href="https://www.eyedolatryblog.com/2018/09/cloudy-with-chance-of-fog-todays-best.html">Also of note is that RGP lenses with Tangible Hydra-PEG coatings should NOT be cleaned with abrasive daily cleaners like Boston Advance due to the risk of damaging the surface coating.</a><br />
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<b>4. Storage, Disinfecting, and Conditioning Solutions</b><br />
These solutions are designed for overnight storage. They improve RGP lens wettability by hydrating the surface of the lens and improving it's ability to adhere to your tear film for best vision stability and on-eye comfort. They also have disinfectant abilities to prevent contamination of the lenses while being stored overnight or over several days.<br />
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<b><a href="https://shopstyle.it/l/XLDi"><span id="goog_830602262"></span>Boston Original Conditioning Solution:</a><span id="goog_830602263"></span></b> For conditioning and disinfecting, soak lenses for at least 4 hours. This is a tried and true formula is getting harder to find and has been largely replaced in favor of the Boston Advance Conditioning Solution below.<br />
Preservatives: chlorhexidine gluconate and EDTA<br />
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<b><a href="https://shopstyle.it/l/XLBd">Boston Advance Conditioning Solution</a></b>: This conditioning solution is made for disinfecting, storage, and improved wettability. It's designed to partner as the 2nd step after using the Boston Advance Daily Lens Cleaner.<br />
Preservatives: chlorhexidine gluconate, polyaminopropyl biguanide, edetate disodium<br />
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Always check with your doctor about the most appropriate cleaning and storage solutions for your eyes. It's possible for patients to have allergic reactions to specific preservatives, and that's why I've listed them here for quick reference. Taking the extra time to properly clean (with a rub!), rinse, and condition your lenses overnight can not only prevent potentially blinding infections, but can greatly improve your entire contact lens experience by keeping your RGP and scleral lenses comfortable and clear all day long.<br />
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<i><span style="font-size: x-small;">This post contains affiliate links to the products listed </span></i><br />
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<br />Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-40605608946774247512018-11-25T17:33:00.000-05:002018-11-25T17:33:36.754-05:00Want to Delay Needing Reading Glasses? Put on Your Sunglasses!In their 40s, the average American begins noticing some significant changes to their vision. When anything is held too close to the face, it's harder to focus on -causing eye strain and blurry vision. It might feel like you need bright lights to see fine print. It might take longer to adjust your focus from cell phones, screens or tablets to objects across the room or down a hallway. All of these changes have one culprit: <b><a href="https://www.eyedolatryblog.com/2011/10/patients-guide-to-refractive-error-part.html">presbyopia</a>.</b><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_sC_wp_8h5QpVKMbTer3Bmb4ZUbUI2CS2mBQ0u9l72P-TLT1itqBzRHIqw1IpXTXTEBHqcIaN6d6JYFRU_JRADcGkqeQ2cP0RDDfKf5zwDtNcvuR_elxMtFJG6-4tTWk9wNFwsPYKZK5m/s1600/Human+Lens.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="837" data-original-width="1599" height="335" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_sC_wp_8h5QpVKMbTer3Bmb4ZUbUI2CS2mBQ0u9l72P-TLT1itqBzRHIqw1IpXTXTEBHqcIaN6d6JYFRU_JRADcGkqeQ2cP0RDDfKf5zwDtNcvuR_elxMtFJG6-4tTWk9wNFwsPYKZK5m/s640/Human+Lens.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">The human lens seen here from above. The front curved structure (top) is the cornea. The lens here is slightly yellowed, consistent with an early cataract. Arrows labelled "4" point to the zonules, the fibrous connections that link the lens to the ciliary muscles which contract and release so that we can adjust the focus of the lens from distance to near and back again. <a href="http://ucsfcme.com/minimedicalschool/syllabus/fall2014/Osher%20Mini%20Med%20Chiu%202014.pdf">via</a></span></td></tr>
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Presbyopia is a normal age-related change to vision that results from a stiffening and loss of flexibility of the eye's focusing system. The human lens sits behind the iris (the colored part of the eye) and is responsible for focusing light clearly onto the back of the eye. Much like a camera lens, it moves in and out to focus. The lens inside our eye is attached to muscles by hundreds of fibers (called zonules), so our muscles squeeze in and out to move the lens in and out of focus.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUTVdg8rlbvVSOQcV3TBomspy5xQXV5xDZKdmZ1yzTBo4oGxwrW4y92SsbgKnTFC7WCd64edpv3pWz-f5fZUaguZFtvYn5Jn4fKmBj9DiKHyLdXqOx_Uj3TwJw1rKM008SuaTXM9MJ-LD4/s1600/Lens+thickness+increases+as+we+age.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="832" data-original-width="1353" height="392" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUTVdg8rlbvVSOQcV3TBomspy5xQXV5xDZKdmZ1yzTBo4oGxwrW4y92SsbgKnTFC7WCd64edpv3pWz-f5fZUaguZFtvYn5Jn4fKmBj9DiKHyLdXqOx_Uj3TwJw1rKM008SuaTXM9MJ-LD4/s640/Lens+thickness+increases+as+we+age.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Lens thickness increases as we age (thickness in micrometers on the Y axis). <a href="https://iovs.arvojournals.org/article.aspx?articleid=2125306">via</a></span></td></tr>
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But there's one major flaw to the system: as we accumulate birthdays from year to year, the lens is one of the only body parts that never stops growing. It lays down layers one on top of the other like the rings of a tree trunk. That's why sometime in our 40s, we notice our eye muscles are having more trouble moving the lens in and out of focus and adjusting our vision to see clearly up close. The lens has gotten so stiff, the muscles have to strain and work overtime to try to move it. Eventually in a few more years there's no amount of squinting or muscle straining that will budge the lens at all. Things just stay blurry.<br />
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And that's when we pick up those over the counter reading glasses.<br />
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Everyday patients experience this discouraging visual change and wonder, what could I do to make this better? Unfortunately <a href="https://www.aao.org/eye-health/tips-prevention/vision-training-not-proven-to-make-vision-sharper">no study has shown that eye muscle exercises can halt or reverse the effects of presbyopia</a>. Because the eye muscles are just as strong as they have ever been, and it's the thickening of the lens that's the problem, eye exercises aren't a possible solution since they don't treat the actual problem.<br />
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With modern technology, we have no way to thin the lens or restore it's flexibility, but a lot of research is looking at ways we could potentially delay onset of presbyopia until later in life. <b>The best way to slow down the eye's aging process? Sunglasses!</b><br />
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Sunlight exposes the skin and eyes to ultraviolet radiation, causing cellular damage over time that cause what we consider "normal" aging changes. Studies estimate that <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">90 percent of skin aging (wrinkles, discoloration, and thinning) is caused by exposure to the sun</a>. In the eye, we know that ultraviolet light also causes discoloration and thickening of the lens, <a href="https://www.ncbi.nlm.nih.gov/pubmed/10709349">resulting in cataracts as we age</a>. <br />
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Ultraviolet radiation in its' early stages of lens damage however may also have a connection to presbyopia. <a href="http://file.scirp.org/Html/15-8202088_31952.htm">Studies show people living closer to the equator have earlier onset of presbyopia signs and symptoms</a>. In India (10-30 degrees latitude) the average age of presbyopia onset is 37. Compare that with England (51-54 degrees latitude) where the average age of presbyopia onset is 43. The human lens absorbs both UV radiation and heat (infrared radiation), so scientists theorize that both the UV light exposure and the ambient temperature difference between these two countries is a cause.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigFjE55kg1KF0ay_7QXlBXflwXUTpRS-lO3sU_w-ZWgiA4UBWi7Enq0iKJ0JZfTjxuOweK9NrPJZjGoMFrel0NPcLxYlvYXbViSxAGln4hhd9kpXjQpR6BKvDQ9caTqX9vxzn6ySIEJIDa/s1600/Presbyopia+Global+Age+of+Onset.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="825" data-original-width="1139" height="462" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigFjE55kg1KF0ay_7QXlBXflwXUTpRS-lO3sU_w-ZWgiA4UBWi7Enq0iKJ0JZfTjxuOweK9NrPJZjGoMFrel0NPcLxYlvYXbViSxAGln4hhd9kpXjQpR6BKvDQ9caTqX9vxzn6ySIEJIDa/s640/Presbyopia+Global+Age+of+Onset.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Studies show about a 5 year difference in average age of onset of presbyopia between developed countries like North America, Japan, and Europe and less-developed countries like Latin America, Africa and Southeast Asia. Closeness to the equator and UV radiation exposure are leading theories as to why. <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/420914">via</a></span></td></tr>
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While several companies are investigating ground-breaking treatment options to delay or even cure presbyopia, from <a href="https://www.reviewofoptometry.com/article/ro0617-can-an-eye-drop-eliminate-presbyopia">eye drops</a> to <a href="https://www.researchgate.net/publication/319599881_Ciliary_Muscle_Electrostimulation_to_Restore_Accommodation_in_Patients_With_Early_Presbyopia_Preliminary_Results">electric shock therapy</a>, we are many years away from having treatable solutions. In the meantime, if you want to delay having to pick up those reading glasses at the store, invest in a high quality pair of sunglasses now and encourage your children to wear them full time starting from a young age. It's a lifetime of chronic exposure that causes these aging issues of the eye, and like most conditions, prevention is the best protection!Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com2tag:blogger.com,1999:blog-5227100415460909947.post-77334051778813159322018-09-16T13:03:00.000-04:002018-09-16T13:03:11.492-04:00Cloudy with a Chance of Fog: Today's Best Options for Fighting Contact Lens Fogging<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKcOeM9e3PqLdQY-tRyj2FiBCjNniodA9WEaLQ9ugD1xBMvWGf8uaM-CQzjFHb4UJHwbltYbOWUOnsRhsT9D_IFFog5ErY_HlQ7m7k9wmT6I1K-DKG43TexcWgx3l2EytLRiHBDIyhjWOz/s1600/Cloudy+Lens.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="317" data-original-width="423" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKcOeM9e3PqLdQY-tRyj2FiBCjNniodA9WEaLQ9ugD1xBMvWGf8uaM-CQzjFHb4UJHwbltYbOWUOnsRhsT9D_IFFog5ErY_HlQ7m7k9wmT6I1K-DKG43TexcWgx3l2EytLRiHBDIyhjWOz/s1600/Cloudy+Lens.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A non-wetting scleral contact lens <a href="https://www.clspectrum.com/newsletters/scleral-lens-monthly/may-2017">via</a></td></tr>
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If you've ever tried driving through a foggy windshield, you know the vision quality is far from ideal (or safe!). For many contact lens wearers, lens fogging is a daily struggle. Typically this fog is created by debris from the surface of your own eyes - tear film lipids, proteins, and mucins sticking and smearing on the surface of the contact lens and creating an oily coating. Blinking just spreads the film around, and typically only removing the lenses and cleaning the surface will improve your vision. In soft contact lens wearers, the solution to fogging issues is most often changing to daily disposable contact lens materials which maintain clarity due to a fresh, clean surface every day and being made from thinner and more debris repellent materials. For hard or rigid gas permeable lens wearers, hybrid contact lens wearers, or scleral contact lens wearers, no such solution exists. Luckily there are several options for improving clarity and busting fog with these lens options too!<br />
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<b><span style="color: #990000;">Enhancing Rigid Gas Permeable Lenses</span></b><br />
When I first started fitting scleral contact lenses, the image above was all too frequent in my exam chair. Patients would be putting on their first lenses directly from the lab, only to immediately find their vision foggy and distorted. Non-wetting lenses cause immediate fog issues from the moment of dispense; they look completely normal off the eye, but once on the eye the patient's tear film beads up into non-spreading droplets of tear film on the lens' surface. There is no way to clean or polish off this nonwetting issue. The best bet is to reorder the lens with a few pro tips:<br />
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<b><span style="color: #990000;">1. Call the lens manufacturer to report the issue. </span></b><br />
During the manufacturing process, rigid gas permeable contact lenses are cut on a lathe. For scleral contact lenses especially, this lathing process can expose the lens to excessive heat. Higher temperatures during manufacturing can prevent the lens from being able to properly wet on the eye. The lens manufacturer will make a note when remaking the lens to reduce lathing time in this case.<br />
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<b><span style="color: #990000;">2. Ask for Plasma Treatment and Wet Shipment.</span></b><br />
Plasma treatment is not a coating, but rather a hyper-cleaning technique that removes microscopic debris on the surface of the contact lens after the manufacturing process. Rigid gas permeable (RGP) contact lens plasma treatment involves the blasting of ionized oxygen particles against the surface of the lens in a vacuum chamber. The oxygen interacts with organic debris on the surface of the contact lens, especially effective against organic lipids and oils. Right after plasma treatment the lens is as clean as it will ever be! It is immediately placed in a liquid storage solution (most labs use Boston Simplus) because if the lens is stored dry at this stage, the surface will immediately start collecting debris again. <a href="https://www.clspectrum.com/issues/2017/april-2017/highlights-from-the-2017-gsls">Studies show</a> plasma treatment improves lens wettability and initial patient comfort, and reduces the risk of lens fogging.<br />
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<u>How to Care for Plasma-Treated Contact Lenses</u><br />
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If you have plasma treated contact lenses, the best way to maintain this level of surface clarity at home is to use the right RGP lens cleaner. <a href="http://www.bausch.com/our-products/contact-lens-care/gas-permeable-contact-lens-solutions/boston-simplus-multi-action-solution">Boston Simplus</a>, <a href="http://www.meniconamerica.com/consumer/lens-care/gp/unique-ph/">Optimum pH,</a> and peroxide based cleaners like <a href="https://www.clearcaresolution.com/?utm_source=google&utm_medium=cpc">CLEAR CARE</a> are all compatible. <b>Do not use abrasive lens surface cleaners</b> like Boston Advance.<br />
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<b><span style="color: #990000;">3. Talk Materials</span></b><br />
Silicone-based materials are very popular in today's contact lens marketplace due to their better breathability, but silicone can make contact lenses more hydrophobic - meaning they collect more debris. Changing to a lens material without silicone or with lower amounts of silicone can help reduce surface build-up issues.<br />
<span style="color: #990000;"><br /><b><span style="color: #990000;">Fluoroperm 60 or 30</span></b></span><br />
For healthy eyes without any evidence of prior scar tissue or oxygen loss (hypoxia) traditional, Fluoroperm is an incredibly debris repellent material! Fluoroperm 30 is considered an old-school work horse for heave depositing patients, but watch carefully for oxygen issues to the cornea like neovascularization or pannus. For patients in such low oxygen permeable lenses, changing lenses regularly is important to maintaining corneal health. For most RGP wearers, recommended disposal is 1-2 years to prevent infection or corneal scarring or warpage.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFMdR3yMls6f92AWid1gUxwhNRaeOmsPslprkrzd4h4xlera5k0qhxkcPORB1dImfbuzk7hpcFpsiiGR0bFRThZZN92iMZpkmtd2bOAD505-SF7JTLcomqxCwJRSSl4MltSRY5jJLoB_g_/s1600/Salzmann_2.9934524_std.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="531" data-original-width="800" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFMdR3yMls6f92AWid1gUxwhNRaeOmsPslprkrzd4h4xlera5k0qhxkcPORB1dImfbuzk7hpcFpsiiGR0bFRThZZN92iMZpkmtd2bOAD505-SF7JTLcomqxCwJRSSl4MltSRY5jJLoB_g_/s640/Salzmann_2.9934524_std.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The above patient has pannus (white areas seen temporal and nasal on the cornea) associated with Salzmann's nodular dystrophy. A low oxygen transmissible lens wouldn't be a good option in this patient because it could exacerbate corneal scarring. <a href="http://netherlens.com/april_2015"> via</a></td></tr>
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<span style="color: #990000;"><b>Tyro 97</b></span><br />
For scleral contact lenses that cover more of the eye, Fluoroperm does not offer enough oxygen transmission to be safe. In this case, Tyro 97 is an excellent option for debris repellent lens material that still provides enough breathability to be safely used in a scleral contact lens fit.<br />
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For years this was a go-to lens material, but many patients still experienced surface fogging and debris despite doing all of the above. Enter the newest lens material of choice for scleral lenses in my clinic: <b><span style="color: #990000;">Optimum Extra with Hydra-Peg</span></b><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcd3ALcgYaV6YF_ceqQvencrQAxkumHCoHBcw0HZ_l4sg9ZMDNEzJFFn9HJnHJ4LP5lgwtgGj4UU7PvuSmj-JtBo20vb-1sYXI0DyS_2SVxVNX5Ro6f15shk2oc2gHRgu_rwKpK3Ysb_nz/s1600/Tangible+Hydra-PEG.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="785" data-original-width="909" height="552" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcd3ALcgYaV6YF_ceqQvencrQAxkumHCoHBcw0HZ_l4sg9ZMDNEzJFFn9HJnHJ4LP5lgwtgGj4UU7PvuSmj-JtBo20vb-1sYXI0DyS_2SVxVNX5Ro6f15shk2oc2gHRgu_rwKpK3Ysb_nz/s640/Tangible+Hydra-PEG.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">via</a></td></tr>
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<b><br /><span style="color: #990000;">What You Need to Know About Tangible Hydra-PEG</span></b><br />
<a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">Tangible Hydra-PEG (Tangible Science) </a>is an exciting new coating available across multiple lens materials. Synergeyes hybrid lens materials and RGP Optimum lens materials are compatible currently, and <a href="http://www.bausch.com/our-company/recent-news/id/2426/6252018-monday">by the end of 2018 </a>it's expected that Boston materials will be available too. The PEG in Hydra-PEG stands for polyethylene glycol, a lubricant that's been used in artificial tears for decades. The Hydra-PEG coating is permanently bonded to the surface of the contact lens material, encapsulating the core lens material to improve wettability and help prevent surface lens debris. <a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">Multiple studies</a> have shown that the addition of Tangible Hydra-PEG to the lens surface improves both wettability of the lens and lubricity (reduced friction across the surface of the contact lens as you blink).<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvMlC-sXjxCGU5QxkImItrmzNol90s25Y_m_eQMc69n0SSzIABihR8ToXI4U8RjA9eLa5gS0o4vlkXJwWUeWT9cS_Sc1TrhQBXVr3MruXbg0gIZp6El_5WB6aNL648gR9USUJelasuB0W/s1600/Tangible+Hydra-PEG+2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="597" data-original-width="456" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvMlC-sXjxCGU5QxkImItrmzNol90s25Y_m_eQMc69n0SSzIABihR8ToXI4U8RjA9eLa5gS0o4vlkXJwWUeWT9cS_Sc1TrhQBXVr3MruXbg0gIZp6El_5WB6aNL648gR9USUJelasuB0W/s1600/Tangible+Hydra-PEG+2.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The addition of Hydra-PEG coating improved wettability and comfort across all lens types, gas permeable, soft silicone hydrogel based lenses, and hybrid contact lenses. <a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">via</a></td></tr>
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<a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">On-eye studies </a>performed at the University of Iowa also had compelling results. Existing RGP contact lens wearing patients were refit into lenses with Hydra-PEG coating. There was no change in visual acuity, but the patients classified before the study as moderate or heavy depositors in their habitual lenses reported clearer vision, better overall comfort, and less haze in their new Hyrda-PEG coated lenses.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HeMy8APIE8P7TzQZOsaT66CxnLyO1PvXa-heEJLfh4TG8ADl3MTMPaTR0x_QpNYSPA5rEDAY7BxXV7Gtvcpy5UxjLdeXQJYdnWRLmjkKbY8SoI-kS0yqIXQcQmuQV9CWLLJt7oN4Ir-O/s1600/Tangible+Hydra-PEG+3.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="325" data-original-width="980" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HeMy8APIE8P7TzQZOsaT66CxnLyO1PvXa-heEJLfh4TG8ADl3MTMPaTR0x_QpNYSPA5rEDAY7BxXV7Gtvcpy5UxjLdeXQJYdnWRLmjkKbY8SoI-kS0yqIXQcQmuQV9CWLLJt7oN4Ir-O/s640/Tangible+Hydra-PEG+3.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.artoptical.com/storage/docs/THP_White_Paper.pdf">via</a></td></tr>
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<b><span style="color: #990000;">Removing Lenses with Tangible Hydra-PEG</span></b><br />
The addition of Tangible Hydra-PEG can cause changes to the handling of the contact lens as well. Because of the increased lubricity (decreased friction) on the lens' surface, the contact lens becomes more "slippery" after the addition of Tangible Hydra-PEG. For gas permeable lens wearers, this is not typically an issue because the lenses are removed most often with plungers. But for soft or hybrid contact lens wearers, it might be more difficult to grip the lens between your fingers to remove.<br />
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If you are having difficulty removing your <a href="https://synergeyes.com/consumer/duette/videos/">Synergeyes hybrid contact lenses with Tangible Hydra-PEG coating</a>, the company recommends using a tissue over your fingers to help get a better grip.<br />
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<iframe width="320" height="266" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/E6etIoM2uHM/0.jpg" src="https://www.youtube.com/embed/E6etIoM2uHM?feature=player_embedded" frameborder="0" allowfullscreen></iframe></div>
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<b>Cleaning Lenses with Tangible Hydra-PEG</b><br />
Approved lens cleaners for use with Hydra-PEG include <a href="http://www.bausch.com/ecp/our-products/contact-lens-care/gas-permeable-lens-care/boston-simplus-solution">Boston Simplus</a>, <a href="http://www.meniconamerica.com/consumer/lens-care/gp/unique-ph/">Unique pH</a>, and <a href="https://www.clearcaresolution.com/?utm_source=google&utm_medium=cpc">CLEAR CARE</a> cleaning and disinfection solution. Do not use alcohol based cleaners as they could damage and strip the coating with time. Alcohol based cleaners like <a href="http://miraflow.com/">MiraFlow</a> are commonly recommended for patients with heavy depositing issues, but if you switch to a Tangible Hydra-PEG coated contact lens, this solution should be discontinued.<br />
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<b><span style="color: #990000;">Treating the Root of the Problem</span></b><br />
The most common reasons for fogging, debris, and lens wetting issues are because your own tear film's lipids and proteins are smearing up and collecting on the surface of the lens. Many doctors approach fogging as a two-prong attack: changing the lens surface to make it more resistant, and changing your tear film to make it more balanced. Patients with dry eye and <a href="http://www.eyedolatryblog.com/2017/06/diagnosing-meibomian-gland-disease.html">meibomian gland dysfunction </a>(MGD) are at increased risk of lens fogging because their tear film components of mucin and lipids are out of balance. Restoring the tear film to homeostasis can help decrease the amount of protein, lipid, and debris floating around in your tear film and thus decrease the risk of it causing fogging and debris on the lens surface.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguIXIgw09etUolMoVZEYyVRKIkOiY3WHb5B96kTMVn2zVmKWihoyQI5eQ3_tr8xUG-TMiM-rrTamD1CLD8uEzQCaCDJXism1zjNz2df_NSxQFQ3KZC-gqsnq_0sXYCa4od4t4Pnj9e7gIn/s1600/MGD.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1058" data-original-width="1418" height="477" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguIXIgw09etUolMoVZEYyVRKIkOiY3WHb5B96kTMVn2zVmKWihoyQI5eQ3_tr8xUG-TMiM-rrTamD1CLD8uEzQCaCDJXism1zjNz2df_NSxQFQ3KZC-gqsnq_0sXYCa4od4t4Pnj9e7gIn/s640/MGD.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Meibomian gland dysfunction is extremely prevalent! Over 80% of the estimated 20-30 million Americans with dry eye syndrome have meibomian gland disease. The meibomian glands express the lipid or oily layer of the tear film. </td></tr>
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To minimize lens surface issues in patients with MGD, doctors will often advise using a nightly warm massage or <a href="https://www.bruder.com/moist-heat-eye-compress/">Bruder mask</a> to improve gland expression, and cleaning the eyelid margins thoroughly each morning before inserting lenses. <a href="https://avenova.com/">Avenova </a>eyelid cleansing spray or <a href="http://www.ocusoft.com/9-months-ocusoft-lid-scrub-original-pre-moistened-pads-30ct">OCuSOFT</a> lid wipes are commonly prescribed options for daily lid hygiene. <br />
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<b>Lotions and Makeup</b><br />
The products you use around the eyes and face could also contribute to lens fogging! Before inserting your lenses, make sure you thoroughly wash off any lotions or creams from your hands and finger tips and dry your hands completely on a clean cloth. Makeup and lotions are heavy on oils, which can immediately fog your contact lens if they come in contact. Insert your lenses before applying any makeup or skin cream to avoid exposure of these oils to the lens surface. And when you do apply eye makeup, make sure you avoid the waterline area! This is where the delicate meibomian gland openings are located, and any makeup products applied here will be smeared across the surface of your eye and contact lens all day long.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLmeOW7ZtrXGlK3M1pEJcetTK_aYtm0EKLKfwJDp0zNfOse_4dKu2jMOmo6L1GED6imnuSlHGvsWva4FxHvlT3I2KBpR1SxAjsizdz10LoCp1tgPaooMjDYrQqoifepgXuBkrQpCj3Y2xi/s1600/makeup+on+waterline.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="214" data-original-width="300" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLmeOW7ZtrXGlK3M1pEJcetTK_aYtm0EKLKfwJDp0zNfOse_4dKu2jMOmo6L1GED6imnuSlHGvsWva4FxHvlT3I2KBpR1SxAjsizdz10LoCp1tgPaooMjDYrQqoifepgXuBkrQpCj3Y2xi/s400/makeup+on+waterline.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Makeup applied on the waterline (as above) is a major contributor to contact lens discomfort and fogging! <a href="https://www.reviewofoptometry.com/article/realworld-factors-that-affect-contact-lens-success">via</a></td></tr>
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<b>What's Next</b><br />
If you've been frustrated by foggy, cloudy contact lenses, there is plenty of hope in sight! Tangible Hydra-PEG coating is continuing to expand to multiple lens materials, and we may even see it commercially applied to standard soft contact lenses in the near future. Fighting off fog is a constant battle for patients with underlying risk factors like chronic dry eye, so working closely with your doctor to explore all causes and solutions for your particular underlying issues is essential to maintaining clear vision. The addition of coatings like Tangible Hydra-PEG is truly just the beginning! A recent <a href="https://www.reviewofoptometry.com/article/polish-up-your-practice-todays-contact-lens-surfaces">Review of Optometry</a> article previewed a future where contact lenses are coated with anti-microbial films to reduce the risk of contact lens related infections, of where contact lenses were treated with surface coatings that allow for electro-conduction, turning your contact lens into wearable lens technology that could monitor your health status directly from the surface of your eye.<br />
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<br />Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com2tag:blogger.com,1999:blog-5227100415460909947.post-4731825771836734442018-08-12T13:36:00.001-04:002018-08-12T13:56:49.437-04:00What You Really Need to Know About Over The Counter Artificial Tears<span style="font-family: inherit;">For many Americans, grabbing a bottle of eye drops at the store is just something you do without much thought. Whether your eyes are red, itchy, watery, or just feel like something is irritating them, grabbing a drop is the go-to solution. <b> But what are you really picking up when you grab an eye drop off the shelf? </b> And does what you select really matter? We're breaking down the biggest myths and misconceptions about the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124072/">$540 million a year over the counter eye drop industry</a>!</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfbvfVuzNGxXlNeIsJwtE3CgQ0uqHjJD1PdKRNGLK4bjQzSo0MkasPdev6k2lKDpBnU2WbEITtgmXgEUR4CcxSyGMxEqnOcSucLfT94kRpvBLlSlayrxC3aSWun4tMLIi5H4VmeUsod70o/s1600/Systane+Complete+Eyedolatry.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img alt="best artificial tear" border="0" data-original-height="1199" data-original-width="1600" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfbvfVuzNGxXlNeIsJwtE3CgQ0uqHjJD1PdKRNGLK4bjQzSo0MkasPdev6k2lKDpBnU2WbEITtgmXgEUR4CcxSyGMxEqnOcSucLfT94kRpvBLlSlayrxC3aSWun4tMLIi5H4VmeUsod70o/s640/Systane+Complete+Eyedolatry.jpg" title="Systane Complete" width="640" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: small;">As a dry eye sufferer myself (especially when flying or travelling), I like to keep artificial tears in my purse or carry-on bag at all times. You never know when your eyes are going to feel uncomfortable! If you are flying, I highly recommend putting in a drop before the flight takes off, and then if it's a long flight, reinserting each time you are fed a meal. This can help prevent major red eye and sandy/gritty discomfort when you land!</span></td></tr>
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<b><span style="font-family: inherit;"><br />Myth: You Should Only Use Rewetting Drops When Your Eyes are Uncomfortable</span></b></div>
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<b><span style="font-family: inherit;"><br /></span></b></div>
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<span style="font-family: inherit;">When treating dry eye and ocular discomfort, most of us wait until our eyes feel uncomfortable to reach for a drop. In fact, a common "old wives tale" that is often referenced is that using drops too frequently may be "addictive" or cause your eyes to become "dependent" on the drop. <a href="https://www.ncbi.nlm.nih.gov/pubmed/29715369">A 2018 study</a> uniformly disproves this notion! The study looked at 97 patients with clinically significant dry eye (diagnosed via ocular surface staining and a standardized dry eye questionnaire) separated into two treatment groups over a period of 6 weeks. One group was told to use Systane Ultra four times a day (<a href="https://www.statista.com/statistics/296148/top-ten-us-over-the-counter-brands-for-eye-ear-care/">the most popular over the counter rewetting drop by market share</a> in the US), and the other group was told to use Systane Ultra only as needed. On average the patients that were told to use drops "as needed" used them 1-2 times a day, if at all. At the end of the treatment period, both groups had mild improvements in their ocular surface staining and dry eye questionnaire results, with no statistically significant differences found between the two.</span></div>
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<span style="font-family: inherit;"><u>One trend that did show up in this study:</u> patients using 4 x a day dosing of Systane Ultra reported <b><span style="color: #990000;">statistically significantly higher symptom relief</span></b> on subjective measurements of comfort versus those using the drop as needed.</span><br />
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<b>The Case for Using Drops Regularly </b></span><br />
<span style="font-family: inherit;">Dry eye is a chronic condition, and researchers theorize that regularly treating the condition with planned drop administration, whether the eye was uncomfortable or not, improves the underlying state of the ocular surface, thus improving the patient's symptoms with time. Just like the benefits of consistently applying lotion to prevent dry skin, or consistently using an anti-wrinkle cream to prevent worsening of wrinkles, using rewetting drops regularly helps restore and repair the eye's surface, and prevents the exacerbations and flare ups of dry eye that cause discomfort. </span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<b><span style="font-family: inherit;">Myth: Generic Eye Drops Are The Same As The Name Brand</span></b></div>
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<span style="font-family: inherit;">When shopping at pharmacies or box stores, it's common to see a name brand drop sitting side by side with the store-brand generic with signage indicating you should compare the two, as if they were the same. This "compare to" packaging is the biggest myth in over the counter products. It takes place however due to a FDA ruling that allows over the counter eye drops to come to market without undergoing costly and lengthy new medication approval processes if their main active ingredients are listed on an "approved" list of ingredients for eye drops. The only active ingredients manufacturers are allowed to list on their over the counter drops are those on the "approved list," otherwise, they'd have to apply for new drug status and would become a prescription medication instead of over the counter. You can check out the FDA's most up to date approved eye drop ingredient list <a href="https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=349&showFR=1">here</a>. The list of active ingredients for rewetting drops (ophthalmic demulcents) was compiled in 1988.</span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<span style="font-family: inherit;">Because makers of over the counter eye drops are limited to only listing active ingredients in their drops as approved for over the counter use by the FDA, the ingredients listed on the packaging for most drops on the market will look the same. <span style="color: #990000;"><b>It's the inactive ingredients that make a drop different</b></span> - but these inactive ingredients won't be outlined in the generic packages "compare to" lists!</span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<span style="font-family: inherit;">Take for example the newly launched over the counter drop for <a href="https://www.systane.com/products/eye-relief/systane-complete-lubricant-eye-drops/"><b>Systane Complete</b></a>: </span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<b><span style="font-family: inherit;"><span style="color: #990000;">Active Ingredient:</span> Propylene Glycol </span></b></div>
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<span style="font-family: inherit;"><br /></span></div>
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<span style="font-family: inherit;">If you look at the active ingredient alone, this drop would "compare to" everything from ClearEyes to generics by Walgreens and GoodSense. What's new about Systane Complete has nothing to do with Propylene Glycol however, it's the inactive ingredients that are innovative and different and lead to the drop's increased performance.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8qbmdmDj3JVehcsKDXInU62urkGGiOkattlpJCNSQl2dGtrtpdtdk6lCRJQC9C5A7gPxzdX_uwfCm-wdlKn8YYIPSD-4cgvit9SPod8Y1P3Z74vnw6krURN1jNYjX_UOEsDjVhcwzM1_5/s1600/Systane+Complete+label.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img alt="" border="0" data-original-height="1600" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8qbmdmDj3JVehcsKDXInU62urkGGiOkattlpJCNSQl2dGtrtpdtdk6lCRJQC9C5A7gPxzdX_uwfCm-wdlKn8YYIPSD-4cgvit9SPod8Y1P3Z74vnw6krURN1jNYjX_UOEsDjVhcwzM1_5/s640/Systane+Complete+label.jpg" title="Systane Complete Label" width="480" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: small;">Active ingredients in all over the counter rewetting drops have to be on a list of FDA approved ingredients that originates from the 1980s. That's why so many generic drop makers can claim "compare to..." on their packaging and the active ingredients will look the same. It's the inactive ingredients that you should focus on when comparing drops!</span></td></tr>
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<span style="color: #990000; font-family: inherit;"><b>Inactive Ingredients:</b></span></div>
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<b><span style="font-family: inherit;"><br /></span></b></div>
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<span style="font-family: inherit;"><b><span style="background-color: white; font-size: 15.9991px;">Polyquaternium-1 (POLYQUAD)</span>:</b> This is the preservative that keeps a bottled drop free of bacteria and microbes and safe for repeated use. If a drop is preservative free, it either comes in single use vials or with a specially made dropper bottle that prevents contamination. <span style="color: #990000;">Unlike common artificial tear preservative benzalkonium chloride (BAK) </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958436/">which has been shown to be toxic to the cornea</a>, polyquaternium-1 is <a href="https://www.ncbi.nlm.nih.gov/pubmed/1301792/">has </a><span style="background-color: white; font-size: 15.9991px;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/1301792/">been shown to have no effects</a> on the movement, morphology, or activity of human corneal cells after a 24-hour exposure period at the 0.001% concentration used in Systane drops. If you have dry eye, the last thing you need is a BAK preservative exacerbating ocular surface cell damage. Look closely for this ingredient on your over the counter drop of choice, and reconsider the rewetting drop you are using if you find any known ocular irritant on the packaging.</span></span></div>
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<span style="font-family: inherit;"><b>Hydroxypropyl Guar (HP Guar): </b>When you put a wetting agent or lubricant like propylene glycol onto the eye, it will blink right off with time. For lasting comfort, you need to bind the propylene glycol wetting agent into the eye's own tear film matrix. This is the power of HP Guar. Think of it as the "glue" that binds Systane Complete to the eye for lasting comfort.</span></div>
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<span style="background-color: white; font-family: inherit; font-size: 15.9991px;"><b>Dimyristoylphosphatidylglycerol (DMPG):</b> Our tear film is a LOT more than just water! That's why water makes such a poor rewetting drop. The human tear film is actually a complicated matrix of mucin, water, and a top layer of lipid or oil. It's that top lipid layer that's responsible for holding the tear film onto the eye and preventing the eyes from watering. For people suffering from dry eye, the recent <a href="https://www.theocularsurfacejournal.com/article/S1542-0124(17)30134-9/fulltext">TFOS DEWS II</a> report revealed that the majority of patients (86%!) have a lipid deficiency to their tears called <a href="http://www.eyedolatryblog.com/2017/06/diagnosing-meibomian-gland-disease.html">meibomian gland dysfunction</a> or evaporative dry eye. DMPG is the vital component of Systane Complete to replace that missing lipid layer. </span></div>
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<span style="font-family: inherit;"><iframe allowfullscreen="" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/RDZmet5bPnA/0.jpg" frameborder="0" height="266" src="https://www.youtube.com/embed/RDZmet5bPnA?feature=player_embedded" width="320"></iframe></span></div>
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<span style="font-family: inherit;">The method of action of Systane Complete, explaining how the lubricant and lipid nanoparticles bind to the eye's existing tear film! <a href="https://www.systane.com/products/eye-relief/systane-complete-lubricant-eye-drops/">via</a></span></div>
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<span style="background-color: white; font-family: inherit; font-size: 15.9991px;"><b>In addition to the powerful inactive ingredients, the size of the molecular components of the drop's ingredients can have a major impact on drop performance. </b> Take for example the all important lipid component DMPG above. Lipid molecules can make a drop cloudy and white when they are larger in molecular size, causing blurry vision when you instill each drop. So why doesn't Systane Complete cause patients to complain of blurry vision? This drop if formulated with nanoparticles of DMPG (classified as 1-100 nanometers in size). By shrinking the lipid molecules to such a small size, we achieve a drop that is designed to go onto the eye clear, while packing much more lubrication into a single drop. The smaller the particles of lipids, the more lipid you can pack in each drop for maximum surface area coverage. Think about a beach ball versus a grain of sand. If you fill up a classroom with beach balls, you'll only be able to fit so many. But if you fill up a classroom with grains of sand, you'll get millions or billions of times more grains of sand packed in. This is the power of nanoparticle eye drops! <i>This excellent comparison is something I learned from Dr. Whitney Hauser in her courses on dry eye. Definitely head to her website <a href="https://dryeyecoach.com/">Dry Eye Coach</a> for more through and practical explanations.</i></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKj6OOvI8U89HuimIWZutfeyZu9KDV75D9hASaPp-vtvhJe9rMZZwRw8DHNFGytsp0DME7Z2ULTuWixBjRl3HY7Z8EijBkNmRZ9TWqW0ysr1HzXa2xC-UkChBblJXyP4ctv_zdeS9FffpT/s1600/nanoparticle.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" data-original-height="509" data-original-width="609" height="333" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKj6OOvI8U89HuimIWZutfeyZu9KDV75D9hASaPp-vtvhJe9rMZZwRw8DHNFGytsp0DME7Z2ULTuWixBjRl3HY7Z8EijBkNmRZ9TWqW0ysr1HzXa2xC-UkChBblJXyP4ctv_zdeS9FffpT/s400/nanoparticle.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: small;">How small is a nanoparticle?? REALLY SMALL <a href="http://ustachewicz.blogspot.com/2010/09/what-is-nano.html">via</a></span></td></tr>
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<span style="background-color: white; font-family: inherit;">Take Home</span></div>
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<span style="font-family: "times new roman" , "stixgeneral" , serif;"><span style="background-color: white; font-family: inherit;">Despite the labels, not all drops are created equal, and with 109 million Americans purchasing OTC drops each year, its time to invest in some actual relief. Using your drops regularly, every single day, not only won't hurt your eyes but <u>will</u> relieve your symptoms much better long term than just using a drop when your eyes bother you. And disregard that urge to save $2-3 on a generic -- when you compare those drops to the newest technology, you'll see there is no comparison at all.</span></span></div>
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<span style="font-family: "times new roman" , "stixgeneral" , serif;"><span style="background-color: white; font-family: inherit;"><i>I was not compensated for this post, and all opinions are my own. My office does receive free samples of Systane Complete, which I used for creating the images for this post.</i></span></span></div>
Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-88778972538843948302018-08-01T20:16:00.000-04:002018-08-01T20:16:58.350-04:00Discontinued Contact Lens Update<div>
Every year companies continue to streamline their contact lens portfolio options as new, more breathable materials become available! If you see your contact lenses on this list, be prepared to work with your doctor to find an alternative option this year. Here are the latest updates:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNgkhL6DFHRcANq8LGG_dLmMjvmZxGFjtbjgHoqbw4QN1D-zFsKRig9h5rq6ho0xRFCOYy_9UagKfxE2tMyYKK6QnN-FJ5EAQLSAYqS0vGlYTrlm_Q3NSOjn0RsPqqLotHc87ahmoMk0a5/s1600/CooperVision.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="400" data-original-width="400" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNgkhL6DFHRcANq8LGG_dLmMjvmZxGFjtbjgHoqbw4QN1D-zFsKRig9h5rq6ho0xRFCOYy_9UagKfxE2tMyYKK6QnN-FJ5EAQLSAYqS0vGlYTrlm_Q3NSOjn0RsPqqLotHc87ahmoMk0a5/s320/CooperVision.jpg" title="CooperVision" width="320" /></a></div>
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<b>Discontinued as of 11/1/2018:</b></div>
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<u>Monthly Lenses</u></div>
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Frequency 55 Toric</div>
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Frequency 55 Toric XR</div>
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Suggested Replacement: Biofinity Toric or Biofinity Toric XR</div>
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<u>Quarterly Replacement/Custom Order</u></div>
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Preference Sphere</div>
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Preference Standard</div>
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Preference Toric</div>
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Preference Toric XR</div>
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Suggested Replacement: Hydrasoft Sphere/Toric</div>
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<u>Daily Disposable</u></div>
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Clearsight 1-Day 30 pack</div>
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Proclear 1-Day 30 pack</div>
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Proclear 1-Day Multifocal 30 pack</div>
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90 pack lenses are still available</div>
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<b>Discontinued as of 11/1/2019:</b></div>
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<u>Monthly Lenses</u></div>
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Frequency 55 Aspheric<br />Expressions Colors</div>
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<u>Biweekly Lenses</u></div>
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Vertex Toric</div>
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<i>Note: 2019 marks the full discontinuation of all Frequency 55 and all Vertex products. Expressions were CooperVision's only color contact lens, so as of 2019 there will be no CooperVision color contact lenses either. </i></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN0I4wO8ZZkRa1-iw1OL-4UBxeXFnqF6mhtdSH1r3HLzAPczjv-ReaZ5i7cmPcxNkjwbkG-1889R9VS_3bR_RJHIj-str6lTNBZY-Kul3LFJQZfx7z2_WykKTnL37IaNbzvxDPQ5b4TPpw/s1600/Johnson-Johnson-Vision-Logo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="179" data-original-width="898" height="126" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN0I4wO8ZZkRa1-iw1OL-4UBxeXFnqF6mhtdSH1r3HLzAPczjv-ReaZ5i7cmPcxNkjwbkG-1889R9VS_3bR_RJHIj-str6lTNBZY-Kul3LFJQZfx7z2_WykKTnL37IaNbzvxDPQ5b4TPpw/s640/Johnson-Johnson-Vision-Logo.jpg" title="Johnson and Johnson Vision" width="640" /></a></div>
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<b>Acuvue 1-Day Moist for Astigmatism </b>Discontinuations Effective Immediately</div>
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<li>90 Pack in Plus Powers <i>30 packs are still available</i></li>
<li>Astigmatism in x 060 and x120</li>
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Suggested replacement: Acuvue Oasys 1 Day for Astigmatism is available around the clock</div>
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Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com2tag:blogger.com,1999:blog-5227100415460909947.post-34980003181932809652018-07-22T15:12:00.000-04:002018-08-01T19:57:51.970-04:00Now for Something Completely Different: New Transitions Colors, Mirrors, and Contact LensesPicture this: a sunny summer evening at a rooftop party in New York City atop the design studio of CFDA award winning designer, <a href="https://people.com/style/christian-siriano-transitions-collection/">Christian Siriano.</a> Everything is decked out in white marble, gold, and a variety of pinks. Models hustle up and down the stairs for quick changes, showcasing Siriano's resort wear looks to a posh young crowd of fashion insiders and social media influencers.<br />
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Shockingly enough, this is the eyecare industry. If drab and dark doctor's offices at a strip mall, or elderly people wearing rimless frames come to mind when you think <a href="https://www.transitions.com/en-us/?gclid=CjwKCAjw1tDaBRAMEiwA0rYbSOUGiA5d2YI1tcUS-XlLAKKnqxBUnwikSVeMq1bj6Js4qR0v6QsDkhoCuN0QAvD_BwE">Transtions</a>, prepare for your mind to be blown. This year Transitions has been extremely busy, with the launch of not one but two new lens products, and the announcement of a <a href="https://www.acuvue.com/acuvue-oasys-transition-contact-lenses">first ever contact lens option with partners Johnson and Johnson Vision</a>.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgENnM1pKPXCIO5PKmgdcnnVFKiKa74ZqrCT_G_nLOaSZSGFfh3d9a0HFsSleB_fgIsV6XE5C5RTIME2xNWIjmF-J1JZ3FDKzpJRnOlkfMiNn3udhkozGuNtWvjcgBU6lJv6cCjBQnmbxmf/s1600/IMG_6149.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1208" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgENnM1pKPXCIO5PKmgdcnnVFKiKa74ZqrCT_G_nLOaSZSGFfh3d9a0HFsSleB_fgIsV6XE5C5RTIME2xNWIjmF-J1JZ3FDKzpJRnOlkfMiNn3udhkozGuNtWvjcgBU6lJv6cCjBQnmbxmf/s640/IMG_6149.jpg" width="482" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">On the rooftop of Siriano's store and design space, The Curated NYC</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioykebH3_Ic0C4PQrtTweBo_8B20Lgnri3Dtvi4EZGlR8-x6DlOBKVegm6f4qG242IXPlW1VxrWXe_3x1Xop6YeWjA47Yb-chHflPBa213D8DupIVyxCjanrRgoL1rPoq7sLGyj4mWGVgf/s1600/IMG_6479.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioykebH3_Ic0C4PQrtTweBo_8B20Lgnri3Dtvi4EZGlR8-x6DlOBKVegm6f4qG242IXPlW1VxrWXe_3x1Xop6YeWjA47Yb-chHflPBa213D8DupIVyxCjanrRgoL1rPoq7sLGyj4mWGVgf/s640/IMG_6479.jpeg" width="480" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.vogue.com/fashion-shows/resort-2019/christian-siriano/slideshow/collection">Models in Siriano's 2019 Resort Collection</a></td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FyQdHZGrcvO4pVrco15NlMcE2hU-DKouvVrb4hdMH77YkXhfAwrxLiiEBydp0_Qe9u5GZkquzn-ogZdGmM-0Msz8fYCTrubxHf8dBF_MItbWsLXoxrk3DD8hmOKti7Nu1cHich_RLCiv/s1600/IMG_6490.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FyQdHZGrcvO4pVrco15NlMcE2hU-DKouvVrb4hdMH77YkXhfAwrxLiiEBydp0_Qe9u5GZkquzn-ogZdGmM-0Msz8fYCTrubxHf8dBF_MItbWsLXoxrk3DD8hmOKti7Nu1cHich_RLCiv/s640/IMG_6490.JPG" width="480" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The influence for Siriano's collection? Very Barbie.</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiShbjj5jED9S390ltyXB6t1bVBWmnuUHxme1OmqdFhDAraqXaB90Ecg0v9J45U2Z0ktpN_VgwyYuhU9UMEx_0wlk03RU2m95HVyIfZENLZRb_c8edjkt4SUrvxorozARJJf7NQMFJo1TUy/s1600/IMG_6483.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1600" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiShbjj5jED9S390ltyXB6t1bVBWmnuUHxme1OmqdFhDAraqXaB90Ecg0v9J45U2Z0ktpN_VgwyYuhU9UMEx_0wlk03RU2m95HVyIfZENLZRb_c8edjkt4SUrvxorozARJJf7NQMFJo1TUy/s640/IMG_6483.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Eyewear's biggest names were in attendance, including Coco of <a href="https://cocoandbreezy.com/">Coco and Breezy Eyewear</a> (center). </td></tr>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwS6fdHDbmXDusQiUrZDqkJueCCnX9OUkf2-WpZucPytL0yDR9VNunvzDdx57ntmWx31Up9Uay9e5i1FQNwwLsnVHU1AqvPeWRs_S_2ZZNH9INQFuqQO2f-AX92744l0oPhGMpKVx7WXk4/s1600/IMG_6487.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwS6fdHDbmXDusQiUrZDqkJueCCnX9OUkf2-WpZucPytL0yDR9VNunvzDdx57ntmWx31Up9Uay9e5i1FQNwwLsnVHU1AqvPeWRs_S_2ZZNH9INQFuqQO2f-AX92744l0oPhGMpKVx7WXk4/s640/IMG_6487.JPG" width="480" /></a></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn2OZBd8q4XzlB0qsmID4aDSHMo90a-EhlzN2ZqJW7AUZob1FOQRkk0XxhwGR_O5JNiSoA6vVcQ6C3JWnNE-vB79cuGGbwvrjjD8z1P_hRHPL3CWiw1bUvWPqfaKI2v1yCev6R0pO78fuY/s1600/IMG_6475.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1280" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn2OZBd8q4XzlB0qsmID4aDSHMo90a-EhlzN2ZqJW7AUZob1FOQRkk0XxhwGR_O5JNiSoA6vVcQ6C3JWnNE-vB79cuGGbwvrjjD8z1P_hRHPL3CWiw1bUvWPqfaKI2v1yCev6R0pO78fuY/s640/IMG_6475.jpeg" width="512" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Just hanging out in Christian Siriano's flagship store at The Curated NYC, pretending to be posh. </td></tr>
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<b>What's new? </b> Transitions lenses have added COLOR to their light adaptive options, allowing you to personalize your look to a degree never before possible. <b>Transitions Style Colors </b>come in 4 new options: Amber, Amethyst, Sapphire, and Emerald. These lenses are completely clear indoors, and transitions to a vibrant hue when activated by UV light.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9NUhHBK4sXhBQR9UsHJIwC5Z9wgKar71CsmNEPnFm4jDmNu4lBpaqNpadtmSaaSKTXBdZcneZs0K9JXMtTphKUSl9VwUmAQL36MKCPuxBSda-iRRDL39VxmJGUdEXA-CaR3oRoU8vIws4/s1600/4-new-colours.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="596" data-original-width="713" height="534" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9NUhHBK4sXhBQR9UsHJIwC5Z9wgKar71CsmNEPnFm4jDmNu4lBpaqNpadtmSaaSKTXBdZcneZs0K9JXMtTphKUSl9VwUmAQL36MKCPuxBSda-iRRDL39VxmJGUdEXA-CaR3oRoU8vIws4/s640/4-new-colours.jpg" width="640" /></a></div>
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In sunwear, flash mirror coatings have been hugely popular for decades. With the introduction of <b>Transitions XTRActive Style Mirrors</b>, you can now have clear eyewear indoors that transitions to a flash mirror sunglasses coating when activated by UV light outside. The mirrors are extremely fashion forward, with 6 color options that become more saturated as the intensity of light increases. They are available in pink, red, blue, green, gold, and silver shadow.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi43CHs42eJAuCYt2JDBU5QDtq9tQ5t9PexyE2IlyeguX36pzccsPddyvUkmkfuwLkISI-9ujNny5BdPW1bOb-jd4ylL52x32CikYOpIQFOBbEWpQFIwXtXOPMk6_QFX_pdHCtrkg01-NdC/s1600/JenniferLyerly_113.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1068" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi43CHs42eJAuCYt2JDBU5QDtq9tQ5t9PexyE2IlyeguX36pzccsPddyvUkmkfuwLkISI-9ujNny5BdPW1bOb-jd4ylL52x32CikYOpIQFOBbEWpQFIwXtXOPMk6_QFX_pdHCtrkg01-NdC/s640/JenniferLyerly_113.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Me wearing the Transitions XTRActive Style Mirrors in Blue</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf4N_cV34oDsHU2zsLiMDNN33gfEkGzpvGOKzDuUetLU0hOo3LFw6FI0UA8wDTVh12OKt-QljVHQgcIgBZOS69sk-jFIWnnRAcKlc6FLBNnXNnWeN2QyzdPJMxfbFXCJ_WGH9siUVOs-uf/s1600/IMG_6162.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1080" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf4N_cV34oDsHU2zsLiMDNN33gfEkGzpvGOKzDuUetLU0hOo3LFw6FI0UA8wDTVh12OKt-QljVHQgcIgBZOS69sk-jFIWnnRAcKlc6FLBNnXNnWeN2QyzdPJMxfbFXCJ_WGH9siUVOs-uf/s640/IMG_6162.JPG" width="432" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Student OD Kristin Lantz wearing the Transitions XTRActive Style Mirrors in Gold indoors at Optometry's Meeting</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Student OD <a href="https://www.instagram.com/eyeseitz/">Emilie Seitz </a>wearing the Transitions XTRActive Style Mirrors in Blue at June's Optometry's Meeting</td></tr>
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Check out the lenses in action below as the <a href="https://www.essilorusa.com/">Essilor</a> team showcases their personal eyewear style! To help out on this video, I got a chance to fly down to Essilor's headquarters in Dallas, Texas to prescribe lenses in action. As an aside, how awesome is it that Essilor chose a young female OD to be the "doctor" in their videos. I applaud the company for bucking stereotypes and putting forward a young woman as the image of a doctor and bucking the traditional older male figure that other eyecare industry companies abide by in their casting. Thank you for being so inclusive and reflecting the changing face of healthcare in America!</div>
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These mirrored lenses garnered the biggest buzz at the Transitions Launch Party event. Among the attendees were a number of social media influencers in their early to late 20's, and they were amazed by the technology that allowed lenses to change. That's right, a whole generation of eyewear aficionados will be experiencing Transitions lens technology for the very first time. The new colorful and vibrant products gives Millennials and Generation Z the chance to personalize their eyewear to a degree never before possible, with plenty of fashion to experiment with. In your offices, I encourage you to have hands on demonstrations available to let these younger generations of glasses wearers experience the technology interactively.</div>
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Backside anti-reflective coating comes standard on the lenses to help reduce glare, and just like mirrored sunglasses, Transitions XTRActive Style Mirrors offer excellent protection against uncomfortable glare without the annoying disruption to vision on digital devices caused by polarized sunglasses. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpbdD__nq9RybISf5z6hSZYM8ua8Mu-cmtHApr0P1wtBhPaYcS7Lzxq-yo9XhJ-oGYRoDTFNaubvxa8vIUySnYTeXCEE1GaJR-cPXZieA4muPwubZhTyF_T6FeTQe5cw7564KwZHGi9-32/s1600/IMG_6493.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="977" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpbdD__nq9RybISf5z6hSZYM8ua8Mu-cmtHApr0P1wtBhPaYcS7Lzxq-yo9XhJ-oGYRoDTFNaubvxa8vIUySnYTeXCEE1GaJR-cPXZieA4muPwubZhTyF_T6FeTQe5cw7564KwZHGi9-32/s640/IMG_6493.JPG" width="390" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrz7L81oolJxGF4YUfJ-ueJv1qu5HrnInvXPB2_lDVySn6_2f0ahMKO4wDNq3YCknkV2ozDppV0lr1W5gXgj9H-ZP7zAca3dgfcvuf1-TZPyKPYGo9gDyzIKuXBoz6NqeDiiBGprqCY14b/s1600/IMG_6507.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" data-original-height="885" data-original-width="888" height="636" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrz7L81oolJxGF4YUfJ-ueJv1qu5HrnInvXPB2_lDVySn6_2f0ahMKO4wDNq3YCknkV2ozDppV0lr1W5gXgj9H-ZP7zAca3dgfcvuf1-TZPyKPYGo9gDyzIKuXBoz6NqeDiiBGprqCY14b/s640/IMG_6507.JPG" title="Christian Siriano Transitions " width="640" /></a></div>
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<b>Are you excited to try the new lenses out for yourself? </b>Nothing beats getting to try out new technology <i style="font-weight: bold;">FOR FREE. </i>Essilor is including the new Transitions Style Colors for single vision (non-progressive) wearers as part of <a href="https://www.essilorusa.com/products/ultimate-lens#/">Essilor Ultimate Lens Package</a> at participating eyecare offices. With this promotional discount, when you buy 1 complete pair of prescription glasses, you can get a second pair of lenses free with the purchase of a frame. The free lens package has all the bells and whistles -- the EyeZen anti-fatigue lens to help reduce end of day eye strain, Crizal anti-reflective coating, and of course Transitions in whatever color your heart desires.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-R93ruNBQJjGc_WOMNvsP7FGBJ3Z_aFdfbezb2i_EvJn2QTV-yZcK7Z70G5_39KPZf9LBDtLHYr8KOcHJ5v2GEyrCbGrAqkExiWnb9rzqmogVyAXiKB9ogX1894DlrLqFiZUNZPGupVJ2/s1600/ultimate+lens+package.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="essilorusa.com/get-lenses/special-offers" border="0" data-original-height="330" data-original-width="1031" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-R93ruNBQJjGc_WOMNvsP7FGBJ3Z_aFdfbezb2i_EvJn2QTV-yZcK7Z70G5_39KPZf9LBDtLHYr8KOcHJ5v2GEyrCbGrAqkExiWnb9rzqmogVyAXiKB9ogX1894DlrLqFiZUNZPGupVJ2/s640/ultimate+lens+package.png" title="Essilor Ultimate Lens Package" width="640" /></a></div>
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<b>And if that's not enough to get you really excited about eyecare....</b><br />
Launching sometime in 2019, the recently announced <a href="https://www.acuvue.com/acuvue-oasys-transition-contact-lenses">Acuvue Oasys with Transitions</a> will be the first ever contact lens to darken with exposure to UV light. These contact lenses were designed with the demands of our digital world in mind; <a href="http://www.eyedolatryblog.com/2016/02/digital-glare-combating-light.html">millions of Americans suffer from light sensitivity, eye strain, and discomfort due to prolonged device use. </a> These new contact lenses are designed to combat both UV and high energy blue light entering the eye, and darken in bright light to reduce discomforting glare. Look for more info about the lens technology as we get closer to a launch date!</div>
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<i><span style="font-size: x-small;">Disclosure: I serve as a Transitions and Essilor Brand Ambassador, but all opinions are my own. This post was not sponsored, but I did participate in the Transitions Launch Party Event on behalf of Transitions Lenses.</span></i></div>
Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-66262139149611964502018-06-24T21:56:00.000-04:002018-06-24T21:56:21.469-04:00The Ongoing Debate About Omega-3 Supplements for Dry Eye If you've been diagnosed with dry eye in the last decade, you've likely been recommended fish oil/omega-3 supplements by your doctor. <a href="https://www.reviewofoptometry.com/article/from-alpha-to-omega-how-fatty-acids-fight-dry-eye">Multiple studies</a> since the early 2000's had indicated that dietary omega-3 intake was both anti-inflammatory and could improve signs and symptoms of dry eye over the course of a few months. The <a href="https://www.nih.gov/news-events/news-releases/omega-3s-fish-oil-supplements-no-better-placebo-dry-eye">newly published DREAM study</a> (Dry Eye Assessment and Management Study) funded by the National Institute of Health however is making waves by calling into question prior studies showing omega supplementation's effectiveness. <span style="color: #990000;">In fact, the DREAM study showed patients with dry eye taking omega-3 supplements achieved no better outcomes than placebo.</span> The results are raising more questions than answers as doctors try to make sense of the study that was designed to be the largest investigation of omega supplements and dry eye to date.<div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY5KtY0UgyEX0T94zPNx5MkfahheMvBmY23dBGCTPjGtqHmP5fXo0GdhRajpO1cGzKAN0i8jWYw5ZwWxyTIq7D-QFbfF5MTcW5B7qgC-JNAH_Fr-zx4FS0QWw6J5dazL7fpXtuehWcM0jr/s1600/dry+eye+omega.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="523" data-original-width="1000" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY5KtY0UgyEX0T94zPNx5MkfahheMvBmY23dBGCTPjGtqHmP5fXo0GdhRajpO1cGzKAN0i8jWYw5ZwWxyTIq7D-QFbfF5MTcW5B7qgC-JNAH_Fr-zx4FS0QWw6J5dazL7fpXtuehWcM0jr/s640/dry+eye+omega.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Recommending omega-3 supplements has been standard of care for dry eye treatment for over a decade, but new research is calling the practice into question. <a href="https://www.stonewire.ca/eye-care-tip-of-the-week/4-taking-an-omega-3-fish-oil-supplement-can-help-reduce-dry-eye-symptoms">via</a></span></td></tr>
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<b><span style="color: #990000;"><br />About the DREAM Study </span></b></div>
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The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1709691">DREAM study</a> followed over 500 patients diagnosed with moderate to severe dry eye disease for over 1 year. Patients were randomly assigned to either treatment or control groups in a double blind study design. Treatment group patients were started on 3000 mg of fish-derived omega 3 supplements daily (n-3 eicosapentaeonic and docosahexaeonic acids, better known as EPA and DHA). The placebo group received 5 mg of olive oil supplements daily in identical capsules as the treatment group. Patients were evaluated for improvements in <a href="https://static1.squarespace.com/static/51ba5346e4b09459e2a8c0aa/t/55e5e844e4b0b7789bdf80f2/1441130564021/osdi.pdf">OSDI score</a> (a standardized questionnaire to assess dry eye symptoms) over <span style="font-family: inherit;">baseline at both 6 and 12 months of treatment. Improvements in conjunctival staining, corneal staining, tear break up time, and Schirmer's test were also assessed. </span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Staining of the cornea (seen here) and conjunctiva, or white of the eye, is a sign of significant dry eye disease. In these patients, the eye is so dry that cell walls are broken on the eye's surface!</span> <a href="https://www.instagram.com/kmkoptometrypro/">via</a></td></tr>
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<span style="font-family: inherit;"><span style="background-color: white; font-variant-ligatures: common-ligatures;"><br />At the end of 12 months, both groups showed improvements in dry eye signs and symptoms. There were no significant differences between the omega-3 supplement group and the placebo olive oil group in average changes from baseline in the OSDI symptom score, conjunctival staining score, corneal staining score, tear break-up time, or</span><span style="background-color: white; font-variant-ligatures: common-ligatures;"> Schirmer’s test.</span></span></div>
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<span style="color: #990000; font-family: inherit;"><span style="background-color: white; font-variant-ligatures: common-ligatures;"><b>The Repercussions and Debate</b></span></span></div>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;">When results were published in April, 2018 the eyecare world was rocked by the reveal that omega-3 supplementation performed no better than placebo on any dry eye measurement assessed. However, the interpretation of the results has been mixed and is leading to more questions than answers.<span style="color: #990000;"> </span>Dr. Penny Asbell, a study chair of the trial and an ophthalmologist at Mount Sinai Hospital <a href="https://www.nih.gov/news-events/news-releases/omega-3s-fish-oil-supplements-no-better-placebo-dry-eye">was quoted as saying definitively</a>, <span style="font-family: inherit; font-weight: bold;">"</span></span><span style="background-color: white;"><span style="font-family: inherit;"><b>The results of the DREAM study do not support use of omega-3 supplements for patients with moderate to severe dry eye disease."</b><span style="color: #444444;"> </span>Others, however do not support such a bold assertion. </span></span></div>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;">One of the major knocks of the study was that all enrolled <b>patients were allowed to continue taking any previously prescribed dry eye treatment</b> (including over the counter artificial tears and prescriptions like <a href="http://www.eyedolatryblog.com/2016/07/meet-xiidra-newest-dry-eye-therapy.html">Xiidra</a> or <a href="http://www.eyedolatryblog.com/2012/02/patients-guide-to-restasis.html">Restasis</a>). These treatments have clinical studies showing they improve dry eye signs and symptoms on their own over the course of several months, and would have influenced the improvement seen in patients in both treatment groups. </span></div>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;">In statements reported in <a href="http://www.optometrytimes.com/dry-eye/omega-3s-no-better-placebo-dry-eye">Optometry Times</a>, however, Dr. Asbell contends the fact that patients were permitted to continue using their previously prescribed dry eye therapies is actually one of the DREAM study's strengths. "We took patients who were symptomatic despite whatever treatments they might be doing, and they were allowed to continue those treatments. It was typical of the kinds of patients I see and other clinicians see in the office every day." </span></div>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;"><b>Another issue with study design under contention is the selection of olive oil as the placebo</b>. Dr. Scott Hauswirth, OD served as a clinician at a DREAM study site. While some view the equal improvement in dry eye signs and symptoms observed in patients both taking omega-3 supplements and the olive oil placebo as evidence that omega-3 supplements were ineffective, he sees the results as evidence that olive oil may actually have been treating the patients' dry eye as well. "Oil oil turned out to be a surprise performer," he told <a href="http://www.optometrytimes.com/dry-eye/omega-3s-no-better-placebo-dry-eye">Optometry Times</a>. "Because both oils improved dry eye signs and symptoms over the course of the trial, DREAM ended up essentially comparing two treatments."</span></div>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;">"Olive oil is not considered [to have] a significant effect on dry eye disease," counters Dr. Asbell concerning the selection of the placebo. Olive oil has served as the placebo in clinical trials investigating the effects of omega-3 supplements for cardiovascular health and rheumatoid arthritis because it has no measurable increase in fatty acid uptake in the body. Over the course of the 1 year study, blood samples proved there was no significant impact seen in the content of oleic acid (which comprises roughly 68% of olive oil) in the fatty acids of red blood cells. Patients on omega-3 supplements did have blood sample testing proving 5 fold increases in EPA in red blood cells over placebo.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">ScienceBasedHealth, makers of HydroEye which contains both Omega-3 and Omega-6 GLA wrote a detailed response to the DREAM study on their website citing concerns over the design and conclusion. <a href="https://www.sciencebasedhealth.com/Webpage.aspx?WebpageId=702">via</a></span></td></tr>
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<span style="background-color: white; font-variant-ligatures: common-ligatures;"><br /><b>Others contend that looking at omega 3 supplementation alone leaves out the <a href="http://www.eyedolatryblog.com/2017/07/omegas-and-dry-eye-science-behind.html">vital role that anti-inflammatory omega 6 supplements (such as gamma-linolenic acid) can have in treating dry eye</a>. </b>A<a href="https://www.ncbi.nlm.nih.gov/pubmed/18313350"> 2008 study</a> comparing GLA omega 6 supplements versus an olive oil placebo did show statistically signficant improvement in dry eye symptom scores and assessment of contact lens comfort.</span></div>
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<b><span style="color: #990000;">What will be the lasting impact of the DREAM Study? </span> </b>Doctors are now faced with deciding if recommending omega-3 supplementation is the proper suggestion for their patients suffering with dry eye. What's promising is that all patients, on placebo or treatment, did have improvement in both their signs and symptoms of dry eye while being treated. Whether that improvement came from their continued use of artificial tears or previously prescribed dry eye medications, or was in any way impacted by the supplementation of omega-3s or olive oil is hard to tease out from the DREAM study alone. Until more information is gleaned, doctors will continue to have to make personal judgement calls on whether they think the chance that omega-3 supplements might help is evidence enough to recommend their use. </div>
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Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-89672331437214001222018-05-28T17:19:00.000-04:002018-05-28T17:19:40.513-04:00Designer Spotlight: Wesley Knight Bespoke EyewearFor those of us in the eyewear industry, it's often hard to see past the "way things are done" and find true innovation. Many of us grew up wearing glasses, grew up shopping for glasses, and in our careers have talked and touched and troubleshooted glasses thousands upon thousands of times. What familiarity and experience can't give us though, is a new way of looking at things.<br />
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Enter <a href="http://www.wesley-knight.com/">Wesley Knight</a>, the unlikely young artist who's making a name in eyecare by doing everything differently. Knight didn't up wearing glasses or with any family association or experience within the industry. Growing up in a creative household, he found a passion for sewing and garment construction, constantly challenging himself with new materials and ideas. He was experimenting with design using an old cow horn when the idea of horn rimmed glasses first came to mind. Only problem was, he had no idea how to make glasses. <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_aDwMM5MMuAxwevs1W0Dvi3FYBVt6r2v3WawvgkmeEYcr9nQGGFln0aVNf93AqLWssfMdfUo43rleXxs3NRCjWGwFjqp7H49850icHfo7aNhWB4S1oUMTpQGtjt_m6OWB58vRF_M_sjsX/s1600/Wesley+Knight+NY+Post.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="610" data-original-width="915" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_aDwMM5MMuAxwevs1W0Dvi3FYBVt6r2v3WawvgkmeEYcr9nQGGFln0aVNf93AqLWssfMdfUo43rleXxs3NRCjWGwFjqp7H49850icHfo7aNhWB4S1oUMTpQGtjt_m6OWB58vRF_M_sjsX/s640/Wesley+Knight+NY+Post.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://nypost.com/2018/04/27/trendsetters-are-paying-thousands-for-these-bespoke-glasses/">via</a></td></tr>
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There are no books or classes or local tradesmen that you can learn from to find a pattern for making glasses from horn. His design process centered around the material first, and he worked backwards from there to construct his own patterns to make the glasses themselves. What started as a project fueled by curiosity led to a passion that would become his career. In 2013 he launched his own bespoke eyewear business in Nashville, TN and success came quickly. That year he was a runner-up for <a href="http://gardenandgun.com/feature/2013-made-south-awards-style-design/">Garden & Gun Magazine's prestigious Made in the South Awards,</a> and the success from that feature eventually led to his moving from Nashville to a studio in New York City in 2017. Just this April he was featured in the <a href="https://nypost.com/2018/04/27/trendsetters-are-paying-thousands-for-these-bespoke-glasses/">New York Post</a>, merely a month after attending his first ever <a href="http://lofteyewearshow.com/">Loft Eyewear Show</a> during Vision Expo East.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcoIKImCdT1nEXg9uA__MzhN3b1sK3c-3131Y1zz1_0y608KQdYJ_WLnlMKuOBlyuoD2U6DbKIkqzL7g7hlmU5xFulexeq7KFgtkWwpWMgC_WRtl7H7XJzBe33OiPhYv3nxQe-WUCH5DJ7/s1600/Wesley+Knight+Bespoke.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="684" data-original-width="709" height="616" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcoIKImCdT1nEXg9uA__MzhN3b1sK3c-3131Y1zz1_0y608KQdYJ_WLnlMKuOBlyuoD2U6DbKIkqzL7g7hlmU5xFulexeq7KFgtkWwpWMgC_WRtl7H7XJzBe33OiPhYv3nxQe-WUCH5DJ7/s640/Wesley+Knight+Bespoke.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A frame takes shape, <a href="https://www.instagram.com/wesleyknight/">via Instagram </a></td></tr>
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<b>Why Bespoke?</b><br />
In 2018 the idea of bespoke is trending big, but in eyewear its concept is often over applied. For Knight, bespoke has a meaning that is a true calling: <a href="https://www.articlesofstyle.com/articles/post/the-art-of-bespoke-eyewear-feat-wesley-knight">"<span style="background-color: white; color: #3f474d; font-family: proxima-nova, serif; font-size: 16px;">The word </span><em style="background-color: white; box-sizing: border-box; color: #3f474d; font-family: proxima-nova, serif; font-size: 16px; margin: 0px;">bespoke</em><span style="background-color: white; color: #3f474d; font-family: proxima-nova, serif; font-size: 16px;"> represents a relationship between man and maker. </span><span style="background-color: white; color: #3f474d; font-family: proxima-nova, serif; font-size: 16px;">When I build bespoke I always tell my clients we build it together. Bespoke is an intimate process of creating functional art that you wear 12-14 hours a day. It has to be perfect.</span></a>"<br />
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Because of this passion for his craft, Knight's process is a lot different from the traditional optical experience. From the humble beginnings of old cow horn, he's now using sustainably sourced water buffalo horn from India, lighter than plastic and with the added benefit of being absorbent of the oils on our skin and face. Instead of an optical where clients come to shop his designs, Knight typically travels to his client's home or office and gets to know their personal style and aesthetic. Each frame is custom designed for his clients, usually over the course of several meetings. The process is interactive between maker and client; Knight will create multiple designs and prototypes until the final design is approved and crafting the horn begins. The result is a pair of glasses uniquely created for the wearer; designed to perfectly fit the width of a bridge and the bend of an ear, as well as to highlight the person's face shape and proportion.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXw83vLfIfpxPE55EjoKuRlarYAxzWydEwZbkc_8Zj1ffXFlPVB3fc12GlTG-OktVjkgzFYeHyOSjzijA4OR6tzP8hqCI4hhf4lMOV2SJpob3CT_F5_2kd23lOnVE0w0-DhT-6LNCL4GWH/s1600/Wesley+Knight+Loft+Eyewear.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="660" data-original-width="713" height="592" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXw83vLfIfpxPE55EjoKuRlarYAxzWydEwZbkc_8Zj1ffXFlPVB3fc12GlTG-OktVjkgzFYeHyOSjzijA4OR6tzP8hqCI4hhf4lMOV2SJpob3CT_F5_2kd23lOnVE0w0-DhT-6LNCL4GWH/s640/Wesley+Knight+Loft+Eyewear.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://lofteyewearshow.com/image/171701051789">via</a></td></tr>
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At the Loft Eyewear Show, Knight admits eyewear buyers didn't know what to make of his business model or his product. That hasn't stopped some of the biggest names in optical from partnering with him on his product. He's producing a limited collection of ready to wear designs this year for luxury eyewear A-listers <a href="http://selimaoptique.com/">Selima Optique</a>, <a href="https://blackoptical.com/">Black Optical</a>, <a href="https://www.1010optics.com/">10/10 Optics</a>, and <a href="http://rappoptical.ca/">Rapp Optical</a>. While these ready to wear pieces won't be custom made, he has used his most classic design patterns curated from his many clients since 2013 to create an everyday luxury product for the larger population of eyewear aficionados.<br />
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Keep checking <a href="https://www.instagram.com/wesleyknight/">Knight's Instagram </a> for more details!<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidUyBVygYZoyAtaMdkvhNcyg54Bl-IfQwga7CC0qUmBpNwaBGheZPqFNh9hlH_fWds3gwJ2qtrH59iGjx-9DoGxcgQ1f1Up6eXTvC9gGjhCYGxCl4W7lwkqhSw_lzLQEKM4zxYVdb-5hfp/s1600/Wesley+Knight+Bespoke+2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="707" data-original-width="694" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidUyBVygYZoyAtaMdkvhNcyg54Bl-IfQwga7CC0qUmBpNwaBGheZPqFNh9hlH_fWds3gwJ2qtrH59iGjx-9DoGxcgQ1f1Up6eXTvC9gGjhCYGxCl4W7lwkqhSw_lzLQEKM4zxYVdb-5hfp/s640/Wesley+Knight+Bespoke+2.png" width="628" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Check out his entire collection of bespoke eyewear on Knight's<a href="http://www.wesley-knight.com/bespokeportfolio-1"> online portfolio</a></td></tr>
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<br />Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com0tag:blogger.com,1999:blog-5227100415460909947.post-70251557243737615642018-05-13T17:41:00.000-04:002018-09-16T13:14:34.703-04:00Let There Be White: LUMIFY is the Red Eye Drop Your Eye Doctor Always Wanted for YouIf you suffer from chronic bloodshot or red eyes, you're used to hearing a lot of unsolicited comments and questions. "You look tired." "Are you sick?" "Do you have pink eye?" You may have even been incorrectly judged at work or by friends and family as being drunk or smoking marijuana. But for most people with chronic redness, it's a symptom of their personal ocular chemistry and daily environment. Hours of computer use, inflammatory skin conditions like rosacea or eczema, dry environments like sitting under a vent or fan, working around dyes or chemicals, frequent flying, or driving for long hours with the vents in your car blasting air right at your eyes -- all of these common conditions can lead to recurrent red eyes! For many jobs these work environments are ubiquitous and unavoidable, so to combat the appearance of bloodshot eyes, sufferers turn to the pharmacy eye drop aisle. Visine and ClearEyes are household names, but how they work to accomplish red eye relief has left plenty to be desired. Luckily, a new option is no available over the counter that is poised to revolutionize red eye relief for the millions of Americans suffering from the stigma and stereotyping associated with having chronically red eyes!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbRCXzPHxwwCgrR-uCiEU3hWhkJ_xNjR8bR09sx4CM7gcVujKNkDphjKhoux7JCOECfIgIr-Uh0WmS7JEAC5Sqa8qkVFSQa9yIYy3Q4GEfcoUrXAIQ8L5_aOHs5clZ79wxrevOQnoauXHJ/s1600/Lumify+dinner.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1560" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbRCXzPHxwwCgrR-uCiEU3hWhkJ_xNjR8bR09sx4CM7gcVujKNkDphjKhoux7JCOECfIgIr-Uh0WmS7JEAC5Sqa8qkVFSQa9yIYy3Q4GEfcoUrXAIQ8L5_aOHs5clZ79wxrevOQnoauXHJ/s640/Lumify+dinner.jpg" width="622" /></a></div>
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<span style="font-family: inherit;"><a href="http://www.bausch.com/our-products/allergy-redness-relief/lumify-eye-drops">LUMIFY</a> (<span style="background-color: white;">brimonidine tartrate ophthalmic solution 0.025%) was FDA approved on December 22, 2017 for the treatment of ocular redness. <b>The drop is a novel approach to treating red eye with less risk for significant rebound redness.</b> If you have historically used red eye drops like Visine or ClearEyes, you may have noticed your eyes look more red a few hours after use. That's because traditional red eye relief drops work by constricting arterioles, decreasing both blood flow and oxygen getting to the ocular tissue. Once the drop's constriction effects begin wearing off, the arterioles rebound in size and get to work fast to deliver the oxygen and inflammatory mediators that were being slowed down by the drop. The result is enlarged artery walls pumping more blood to make up for lost time, which makes your eyes look redder than they did prior to inserting the drop. <span style="color: #990000;">Unlike previous red eye drops, LUMIFY acts by constricting the venules on the ocular surface, not the arterioles.</span> By working specifically on the venules, oxygen flow from the arterioles is maintained to the ocular surface, preventing the risk of rebound redness!</span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.lumifydrops.com/The-Lumify-Story">via</a></td></tr>
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<span style="background-color: white;"><b>If you have historically used red eye drops, have you noticed that their effectiveness seems to wear off with time?</b> Where you might have needed 1 drop a day when you first started using the drop, now you might be up to 4 or 5 times a day, and still feeling like your eyes look red. This is a real and serious side effect of traditional red eye drops! <span style="color: #990000;">Another great benefit of LUMIFY over older red eye drops on the market is that it has less risk of tachyphlaxis, or the drop losing effectiveness with time. </span> <a href="https://www.reviewofophthalmology.com/article/vasoconstrictors-myths-and-realities">Studies have repeatedly shown</a> that as your body is exposed over and over again to nonselective adrenergic vasoconstrictors like those found in Visine, Clear Eyes, and generic red eye relief drops, the body actually downregulates the number of receptor cells for the medication so that the medication's active molecules can't bind! Your body wants to maintain a steady state, called homeostasis, and if it feels it's getting too much of the vasoconstricting signal, it won't let your arteriole walls respond anymore by actually removing the receptor molecules the eye drop would bind to. The result? You keep putting in drops, but don't get any additional relief. </span><br />
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<span style="background-color: white;"><b><a href="http://www.bausch.com/ecp/our-products/otc-ophthalmics/lumify-drops">In 6 clinical trials of LUMIFY and over 600 patients, there was no occurrence of tachyphlaxis or rebound hyperemia. </a></b></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.bausch.com/ecp/our-products/otc-ophthalmics/lumify-drops">via</a></td></tr>
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<span style="background-color: white;"><b>Be Aware of the Risks of Exposure to Preservatives </b></span><br />
<span style="background-color: white;">Because red eye drops also have preservatives in the bottle, there is an additional side effect of toxic reactions on the surface of the eye from using too much of both traditional red eye drops and LUMIFY.</span><br />
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<span style="background-color: white;">The preservative in LUMIFY is benzalkonium chloride, which <a href="https://iovs.arvojournals.org/article.aspx?articleid=2367891">studies show</a> can be toxic to the human cornea at even low doses. Benzalkonium chloride concentrations as low as 0.0001% exposed on the eye for as little as 5 minutes will cause some degree of cell damage to the human cornea and conjunctiva cell tissue. </span><br />
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<span style="background-color: white;"><b>Directions</b></span><br />
<span style="background-color: white;">LUMIFY is FDA approved for use to relieve redness in adults and children aged 5 years and older. Instill 1 drop in the affected eye every 6-8 hours, and do not use more than 4 times a day. <i>Because of the Benzalkonium chloride preservative used, I personally recommend to my patients to use no more than 1 x a day to help reduce the risk of corneal toxicity. </i></span><br />
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<span style="background-color: white;">LUMIFY works quickly and lasts! <a href="https://www.ncbi.nlm.nih.gov/pubmed/29461408">95% of patients saw improvement in red eye appearance in just 1 minute and 79% of patients maintained red eye relief after 8 hours.</a></span><br />
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<span style="background-color: white;"><u>Do not use this drop if:</u></span><br />
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<li>you are pregnant or nursing (consult your doctor first)</li>
<li>over contact lenses</li>
<li>if redness or eye irritation persists for more than 3 days</li>
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In my own office, LUMIFY has been wowing my staff and patients alike:<br />
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Me Before:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIs87Dm6ClNq5c6-g0VspUTj6SUBCtoXkwF2ufsppzNG2KKUY-CWIwL4WGm0l6utEPWDpEZo69PzCqaOnI_JkH8uonmXlsDeDJD6rgGOPQMRqHV9Gnk3ErvJwT1NCqaH3EgsaOWcgFl7Kh/s1600/Lumify+Before.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1343" data-original-width="1600" height="335" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIs87Dm6ClNq5c6-g0VspUTj6SUBCtoXkwF2ufsppzNG2KKUY-CWIwL4WGm0l6utEPWDpEZo69PzCqaOnI_JkH8uonmXlsDeDJD6rgGOPQMRqHV9Gnk3ErvJwT1NCqaH3EgsaOWcgFl7Kh/s400/Lumify+Before.jpg" width="400" /></a></div>
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Me 1 minute after instilling LUMIFY:<br />
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<b>Take Home</b> As an optometrist, I'm thrilled to have a red eye drop that I can recommend to patients that offers relief without the side effects that traditional red eye drops have caused. However, those of you suffering from chronic red eyes still may be dealing with an underlying culprit that a red eye reliever alone can't solve. <a href="http://www.eyedolatryblog.com/2011/12/patients-guide-to-dry-eye-syndrome.html">Dry eye syndrome</a> is one of the most common causes of chronic redness, and treating the underlying dry eye issue is the best path towards true relief. Always consult with a doctor if you have recurrent red eye issues, because it could be the signs of a more serious underlying problem!<br />
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<i>This post was not sponsored by Bausch & Lomb, and all opinions are my own.</i></div>
Dr. Lhttp://www.blogger.com/profile/04010339494622274605noreply@blogger.com12