July is being dedicated to sunglasses here at Eyedolatry, so prepare yourself for a lot of fashion-inspired posts this month.  From now until late August, millions of Americans will be trekking to the coast or the community pool to enjoy the fantastic weather.  A must-have for your summer adventures? Sunglasses.  Even if you are just walking around at the Farmer's Market, or bustling around town in and out of doors, sunglasses are protecting your eyes not just from annoying glare, but the harmful UV light that leads to conditions like Macular Degneration and advanced or early onset cataracts (see this post).  I am going to be featuring local Carolina fashion and lifestyle bloggers this month on what they look for in sunglasses, and their favorite way to style their glasses for Summer 2013.

Up first is Caitlin, a blogger out of Charlotte, North Carolina.  Her blog Southern Curls and Pearls is an homage to her personal style and Carolina roots. Her featured glasses for the summer are a classic tortoise shell look that are 100% UV blocking that she was able to snag on sale at her local Anthropologie.





What does she look for in sunglasses?

"I want sunglasses that protect my eyes but are chic at the same time, and these are definitely it. The tortoise look is really "in" at the moment, so I knew I couldn't pass these up. They are also similar to a Karen Walker pair I've had my eyes on, but without the expensive price tag! "

Karen Walker Super Duper Strength Suns

Via

The Karen Walkers she refers to have been sported by celebrities like Gwen Stefani, but come with a $348 price tag.  Looking for designer shades but a chance to try them on and get great local service?  Remember, you can also find designer sunglasses at your local high end optical providers that are 100% UVA and UVB blocking with the quality of frames that will last for years and years, and often this time of year they will be running sunglass promotions to help you save by protecting your eyes.  And if you have vision insurance or a flexible spending account, you can use your benefits towards prescription sunglasses too (even if you have a very small prescription) because sunglasses are really medical devices that are protecting your eyes and eyelid skin from cancer and degenerative conditions for years to come.

I truly believe my patients try to keep their eyes healthy.  We talk every year about the cornea getting enough oxygen under their contact lenses, and I know that my patients want to wear their contact lenses correctly so that their eyes stay healthy enough for another year of contact lens wear.  Imagine how hard it is for the patient (and for the doctor for that matter) when you have to have a conversation about not being able to wear contact lenses anymore -- for a few months, or perhaps even for a lifetime depending on the amount of damage.

This eye may look okay at first glance, but there is a huge scar in the central cornea!  This person will never be able to see clearly again!  Via

The biggest reason my patients tell me that they don't change their contact lenses on time is simply because they forget.  Their lenses are so comfortable, they just don't remember to change them after 14 or 30 days.  Some people even tell me that they will use comfort as a judge to know when to You cannot trust how a lens feels, because you cannot feel your cornea getting oxygen from the atmosphere.  If you fall into this category of lens wearers that has trouble remembering to change on time, here are some helpful aids to let you keep your eyes healthy enough for contact lens wear!
change the lenses.  If you wait until your lenses feel bad to change them, you have waited to the point that your eyes have suffered damage!  And all that lack of oxygen in an old contact lens smothers your corneal nerves, so next month, you will feel even less as your eye is starving more and more for oxygen.

1) Email Based
Acuvue as a brand makes some of the hardest lenses to remember to change on time (every 2 weeks!) so I appreciate their effort to help remind patients to keep healthy since they know they have a problem with their lenses being abused.  Their website Acuminder tool is free; can be used with any product (not just Acuvue lenses), and is very non-invasive.  You just sign up for a monthly or 2 week email (depending on your lens) that will remind you to throw your lenses away.  They also offer a text message based system.

2) SmartPhone Apps
There are number of apps out there that act as reminder alarms, but here is a breakdown of my opinion:

Contact Lenses Timer app: free and simple interface

• Lens Tracker LE: Free; Simple and clean.  It also tells you how many lenses you have left so you don't surprise yourself when you are on your last box.
• Contact Lens Tracker:  $0.99; To me the app has a little too much data -- it can track the number of times you wear a lens as well as how old the lens is, which is information that may confuse the issue.  If you have a monthly lens, you need to replace it monthly whether you wear it 28 times or 31 times.  The lens deteriorates every day it is opened from the package, not just every day you wear it.
• My Contact Lens:  $0.99; To me this one looks to be aimed for younger patients. It has linked data pages to tell you proper cleaning and care, removal strategies, etc.  
• Contact Lenses Timer: Free;  It also has a place for you to record you doctor's name and number, your brand and prescription, in case you ever need that information.  
• Contact Lenses: Free; Again, too complicated with the ability to "skip a day" of wear affecting the tracker.  And you have to record each eye separately.

There are certain ocular diseases that we all know can cause blindness, and we know that we should be checked for those at every eye examination.  But during my tenure as an optometrist, I have discovered that while most people have heard of conditions like glaucoma, cataracts, and macular degeneration, we haven't done a very good job of telling people what those ocular conditions actually are. Glaucoma is a disease of the eye where the optic nerve is destroyed, causing permanent visual loss.  For more details, please read this post.  What most people don't realize is that diagnosing glaucoma is a very complicated process.  Your doctor can't just look at your eyes and say "You have it!" (unless it is very advanced that is).  Here is a breakdown of all the information your doctor is collecting to screen your eyes for glaucoma at every eye examination:

1) Checking the pressure inside the eye

Goldmann's Tonometry is a more accurate pressure reading that is often used to verify NCT (or air puff) data

The dreaded air puff test has an important goal-- it tells your doctor the pressure inside of your eye.  A range of pressure between 10 and 21 mmHg is considered normal, but some people are going to have higher pressure and it still be normal for them.  The air puff (or non-contact tonometer) is a preliminary screening tool.  If your pressure is high, it does not mean you have glaucoma.  If your pressure is normal, it does not mean that you don't have glaucoma.  Your eye pressure is going to be different depending on the time of day, the medications you take, whether you are sitting or lying down... Lots of things can vary.  But over the course of several years of pressure data, your doctor is compiling a trend for your "normal" pressure, which can help them find suspicious changes with time.  For example let's say you have a pressure of 10 for several years, and the next year we check your pressure and it is 18 mmHg.  That is still a normal pressure reading according to our "average range", but it is not normal for you!

2) Inspecting the Anatomy of the Eye
I don't want to make this too complicated, but when the doctor looks at the surface of your eye in the microscope, they are checking for numerous medical conditions, including suspicious structural changes that could cause acute spikes in your eye pressure.  If the anatomy of your eye where the cornea meets the iris (colored part of the eye) is very narrow, you are in a higher risk category for having this acute spike.  This is something your doctor measures at every examination, and will record in your chart whether this structural meeting place is "wide open" or grade the amount of narrowing on a scale of 1 to 4.  If you are in the 1-2 range on this grading scale (very narrow), your doctor will be discussing the signs and symptoms of an acute angle closure attack.  If you have acute onset redness, pain, blurry vision, and halos around lights, you need to be seen immediately!

3) Inspecting the Anatomy of the Optic Nerve

Via

The optic nerve is a like a chord that hooks the back of the eye to the brain.  In the retinal photographs that many doctors take, it looks like a yellow circle.  Inside of this chord, blood vessels run through delivering oxygen and nutrients to the eye.  That means that there is a hole inside of the nerve to let the vessels pass through.  In doctor-speak, this hole is called "the cup".  To make things as simple as possible, the bigger your hole, the more at risk you are for glaucoma, because in glaucoma the nerve tissue is dying, which would cause the hole to get bigger and bigger, or more hollowed out if you will.  Here's the catch -- not everyone with a large hole or "cup" has glaucoma.  Some people just genetically will have a large hole.  And not everyone with a small cup does not have glaucoma.  I have seen several patients with a small cup that had diffuse visual field loss from glaucoma.  There are some trends that help your doctor determine if your nerve "cup" size is normal:

• Is the size of the cup the same in both eyes?  If you have one large hole and one small hole, there is a greater chance that the eye with the large hole has a disease process.  Usually in nature we are symmetric in anatomy, so we would expect the right and the left eye optic nerve to look the same if it was healthy and normal.
• Is the size of the cup the same as last year?  As 10 years ago?  This is where photodocumentation is pivotal.  In a normal eye, the size of the hole in the nerve will not be changing from year to year.  If you have photos of your eye over a lifetime, it can be very beneficial to have your doctor compare to check for gradual changes.  If you started out with a smaller hole and now have a larger hole a few years later, that is very suspicious for glaucoma.
• Is there bleeding around the nerve?  A hemorrhage near the nerve is often a sign of glaucoma (called a Drance hemorrhage).
• The bigger the nerve, the bigger the cup.  This is a just a rule of thumb -- not everyone has the same size optic nerve.  If you have a larger optic nerve, your doctor expects you to have a larger hole inside the nerve.  What is a normal size hole in one person with a large nerve, could be a major glaucomatous process in another person with a smaller nerve size.  It is all relative!

This picture is from the right and left eye of the same patient.  Look at the asymmetry of the cup or hole inside the optic nerve!  The large hole inside the nerve on the right side of the photos is a major giveaway that this person probably has advanced glaucoma.

Ever been at a friend's house and realized you didn't bring your contact lens case or solution?  Or flying and suffering from the displeasure of horrendously dry contact lenses, but being unable to take them out because your case and solution are in a checked bag?  For a contact lens wearer, life is not always conducive to the items you need to properly care for your lenses.  And every time you stretch those lenses a little longer than comfortable, or you don't store them properly in fresh solution, you are risking infection they may permanently mean the end of your contact lens wearing days (not to mention the chance of permanent blindness!).  Luckily, a group of entrepreneurs out of California have created a product that can solve these contact lens issues without compromising safety.

via

The Refresh Card was this year's winner of Duke's Start Up Challenge for good reason.  The idea is so remarkably simple and accessible, it will leave you wondering why it wasn't available sooner.  Contact lenses have been mainstream since the 1970s, but solutions and the contact lens cleaning process have been overwhelmingly the same for at least 20 years.  The Refresh Card is the size of a credit card so that you could even store one or a few in your wallet or purse, but has pop-out compartments that can be manipulated to to make a contact lens case and 2 packets of solution.  All those years playing with Transformers paid off for these entrepreneurs.




Just pop-out the contact lens wells (conveniently marked R and L), clean your lenses with the provided solution packet, and store.  The blue top portion of the card will slide back on to seal your lenses safely overnight. Currently the product is available for pre-order at the company's website, so not yet available for mainstream use.  I had reached out to the company to see what brand of contact lens solution they would be using, but got no answer, so I am surmising that is still in the works.  I will update this post as soon as I learn more details (like projected cost and solution brand to be used).

Package as photographed by me

Maybe it is my relative youth in the world of optometry, but trying out a new contact lens product still really excites me.  For the past few months, I have heard a constant buzz about Ciba's new daily lens material that is being used in the freshly launched in America DAILIES TOTAL 1.  The product is a water gradient delivery system, (for more information read here) that aims to prevent the contact lens from pulling water from your eye to stay hydrated, the culprit causing end of day dryness in so many contact lens wearers.

Whenever anyone tells me they have the newest, latest greatest anything, I am always suspicious.  When Ciba declared this lens "a game changer"  it sounded to my skeptical ears like a product destined to flop.  When I saw the packaging (it looks like a toothpaste box) and saw the obnoxious ALL CAPS in the nomenclature, it grated on my contact lens critic nerves.  But Ciba is on to something with this lens.  My rep for the company kept telling me that frequently when someone puts on the lens in front of him, they say they can't feel it.  So I decided to test drive it for myself.  I put the lens in.  I tried to feel it.  I really did.  But Ciba won round one:  I could not even really convince myself that the lens was on my eye without looking in the mirror.  It was that comfortable.

Come on, you know you are thinking toothpaste too

I also have to admit that I am a tough critic for more reasons than just my skeptical nature.  I have very dry eyes with contact lens wear, and I typically wear my glasses 5 days a week, as much for comfort as for style.  I have only a few products that I really swear by.  Avaira is the only multiple wear product I can stand on my eye for longer than a few hours.  Proclear 1-Day used to be my lens of choice for comfort, but about 12-14 hours in, I would have to manipulate the lens under my eyelid to try to relieve dryness, or use a re-wetting drop.  Then I discovered Acuvue 1-Day Moist.  This has been my favorite product for nearly 2 years.  I wear this lens comfortably late into the day and on airplanes.  But I still find I get issues with comfort and lens awareness around that 14 hour mark.  The DAILIES TOTAL 1 is the first contact lens that I have worn where I really didn't get lens awareness until close to 16 hours into the day.  I was able to wear them with acceptable comfort all the way to the 18 hour mark.   I really didn't even start feeling like I had a contact lens in my eye until 6-8 hours of wear had passed.  And did I mention that some days I was wearing this lens under exceedingly poor circumstances?  I have a lot of grass and pollen allergies that typically make my lenses feel like steel cages in my eyes after being outdoors for a few hours, but the Dailies TOTAL 1 still felt comfortable after spending 4 hours outside.  I am a contact lens cynic, and the type of patient that typically finds no true satisfaction with contact lens wear, and now I am a believer that we really do have a new product to offer patients that can truly help make their contact lens wearing life better.

Now is this lens perfect?  No, I still got a little dry and irritated towards the very end of my (very long) day.  But I was able to wear the lenses comfortably longer than with any other contact lens I have ever put in my eye.  I had good vision (I wouldn't say the clarity was a real remarkable point, but it was at least as good as any other daily lens I have been wearing over the past 3-4 years).  The major drawbacks are going to be availability and price. The lens is only available in minus spherical powers (no astigmatism, no multifocal, and no plus!) so only a certain population of patients will even be eligible to wear the lens.  Ciba does plan to utilize the science of their water gradient technology to expand into different lens types, so larger ranges of vision issues can benefit.  Price is going to be a huge factor, and like any premium product new to the market, it is priced accordingly.  You won't be able to find this lens for much less than $100 for a box of 90.  Compared with the price of even other dailies on the market, you will definitely be paying a premium to enjoy the extra benefits of this lens.

Take home points:

Try this lens if you feel like you have never really had a comfortable contact lens for one reason or another: dryness, lens awareness, redness, allergies.  This lens may be the closest thing available to solve your problems.
Try this lens if you want to see what the best contact lens technology for comfort on the market can provide.
Try this lens if you are a skeptic; maybe you might become a believer too!

Disclaimer:  I am in no way affiliated with Ciba and was not compensated for trying their product or writing this post.  

Here's a post for all the nerds out there:  Yesterday I got the news that what we thought we knew about the cornea (the clear layer of tissue located on the front of the eye) was actually all wrong.  Scientists have a discovered a new layer of corneal tissue, and since the cornea is where many ocular surgeries are performed, this new discovery could have a huge impact on the way we treat corneal diseases and procedures for corneal transplants.

Cornea with scarring from surgical procedures (via ) The new discovery of Dua's layer could help surgeons target this strong tissue and hopefully limit surgical complications.

Traditional thought had the cornea with 5 distinct layers: the epithelium, Bowman's layer, the stroma, Descemet's layer, and the endothelium.  Each layer is susceptible to particular corneal degenerative conditions, and these layers are routinely used as markers for the depth of incisions needed for surgeries.  The new layer, named Dua's layer after the scientist who discovered it, is located between the corneal stroma and Descemet's.  It
is remarkably thin -- only 15 microns in total!  But it is incredibly strong, able to withstand a large amount of pressure.  Due to its strength, surgical procedures may utilize this area in future as a location to guide laser incisions, preventing damage to weaker corneal layers. With a discovery this new, we have yet to realize the impact on applied science.  But we do know that a lot of textbooks will need to be rewritten!

Looking for something a bit different in sunglasses this summer?  Mirrored sunglasses have been a staple in sportswear for athletes in highly-reflective or bright conditions (like most snow sports), but have crept into the fashion scene this summer for street wear. Try this retro-look for something new this summer:

Trussardi

Wildfox Couture

RayBan

Via Marie Claire China