In honor of New York Fashion week, it's time to role out the styles featured this past fall for the Spring 2013 season. Safety glasses seemed to be a big inspiration for several designers, which is a sentence I bet that most of us thought would never be formed. Oversize glasses are reaching new extremes in this case. I don't expect any of these looks to really take off, but the latest from the runways tend to sneak into daily wear in more subdued versions. Here's a look at this spring's futuristic safety-inspired eye wear:
For your patients that do need safety glasses, this trend may help that old box of safety glasses you keep in the back room look a little less dated and sad. The best part of oversized sunglasses? They offer full protection from the sun, protecting even the side of your face and all eyelid skin from harmful UV rays and greatly minimizing your risk for skin cancers in those areas!
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| http://cacharel.com/#!/amor-amor |
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| http://carven.com/ |
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| http://www.harpersbazaar.com/ |
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| http://www.michaelkors.com/ |
Diabetic retinal (internal eye) findings can be as mild as a small spot of blood, which may just require yearly examination. The three pictures below are actual patients where things have gotten a lot more advanced.
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| Non-Proliferative Diabetic Retinopathy with Diabetic Macular Edema. Please excuse the annoying camera flash |
This photo shows bleeding or hemorrhaging throughout the retina, but you also see exudate which is the yellow changes you see above the central vision spot (the macula). Exudate is evidence of swelling, which means that the blood vessels have been actively leaking in the area. This patient's central vision was reduced because the swelling was so close to her macula. She was seen by an ophthalmologist, who is monitoring closely for resolution.
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| Proliferative Diabetic Retinopathy |
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| Proliferative Diabetic Retinopathy |
The 2 photos above are from the same patient who has even more advanced damage. At the bottom of both photographs you can see small, "squiggly" spider-web like blood vessels. I know these pictures might not appear as severe as the first, but these new blood vessels (or neovascularization) are evidence of advanced changes. These lacy and thin blood vessels are created by the body when the ocular tissue is not getting enough oxygen. Instead of letting the tissue die, the body tries to get it more oxygen and nutrients by making new vessels. Unfortunately these vessels are delicate and prone to breaking, causing massive bleeding and sometimes even retinal detachments. This patient was immediately referred to an ophthalmologist for treatment!
I can't stress enough, even if you have great vision, it is essential to have regular eye exams. If you have been diagnosed with diabetes (type 1 or type 2) your eyes need to be checked at least yearly. With regular check ups and good blood sugar control, the risk of permanently losing your vision (and the function of other organs!) can be greatly minimized.
If you have a conjunctival cyst, the best thing you can do is avoid irritating it further -- that means no eye rubbing or poking at it try to get it to pop. As you blink, you may feel the cyst under your eyelid, creating an uncomfortable irritation. Over the counter artificial tears can help improve comfort, but until the cyst is gone, the irritation of it rubbing against your lid will persist.
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| This large cyst will probably require excision and drainage to fully heal. You can see the blood vessels in the conjunctival tissue clearly here--if one gets nicked during the excision you may have a little bleeding. This is why your surgeon is such a highly trained professional! |
You can try just using artificial tears and wait for the cyst to go away on its own, but sometimes a doctor's intervention can speed the process up quite a bit. Your eye care provider is going to check carefully to make sure nothing is trapped in the eye or eyelid that could be rubbing the area. A little speck of dirt or debris could be your culprit. I have found that steroids (drops or ointments) can help decrease the size of the cyst, but they don't work with every patient. For large, persistent cysts sometimes the only treatment is to get the cyst drained. The procedure is painless (a topical anesthetic is used), but you may get a little bleeding due to the surrounding blood vessels in the conjunctival tissue.
Did you know that since 2007, 40% of contact lens wearers in England and Japan wear daily disposable contact lenses, but in the United States dailies only comprise 14% of the market? See Contact Lens Spectrum for more information. We haven't embraced daily disposable contact lenses in the US to their full potential, but here's why I think these other countries are getting it right.
1) Daily Lenses offer maximum comfort
Contact lenses get dry; it is just a fact of life. Try putting a piece of plastic over your eye all day and why would we think they should be comfortable? But daily lenses are the thinnest options on the market, and since you are opening a fresh pair every day, they will have no build up or deposits that plague extended wear lenses even with the best cleaning solutions. Do you suffer from allergies? The last thing you need to put on your eye is a lens that has been exposed to your allergens for the past 2 weeks. A fresh lens will have collected no dust, pollen, or other allergen, so you will be getting maximum allergy relief.
I also love daily lenses for dry eye sufferers and 8+hour a day computer users. Sometimes getting just 8-12 hours a day of comfortable wearing time is a success, and with dailies my average patient is getting 12-14 hours routinely. With new materials like Acuvue's Trueye and Bausch and Lomb's new Biotrue 1-Day lenses, the amount of hydration and comfort with dailies continues to improve!
2) Daily Lenses have less complications
If you have ever had an eye infection, you know the pain, discomfort, and blurry vision that comes along with it. On top of all that, you are out of contact lenses and stuck in glasses for days to weeks. The best way to prevent your risk of infection is to limit the amount of bacteria exposed to your eye, which is why a daily lens is such a great option. With dailies, you have no cleaning to perform because you throw the lens away every night. You only touch the lens one time, when you are putting it in that morning, so the risk of dirty hands contaminating the lens is much lower than a lens you wear for 2 weeks or a month. Studies report that daily disposable wearers are about half as likely to have moderate to severe bacterial infections than other soft lens wearers (link).
3) Daily Lenses offer better oxygen to the eye
The amount of oxygen transmissibilty in a daily contact lens (DO/T) is typically lower than some monthly silicone hydrogel lenses when you look at the numbers, but don't be fooled. A monthly lens has to provide oxygen to your eyes for 30 days. A daily lens only has to allow oxygen for one day, and for 12-18 hours, your eye is going to be getting a lot more oxygen than it does through a conact lens that is a few wears old. I hardly ever see signs of oxygen deprivation like corneal neovascularization, infiltrative keratitis, and corneal scarring with daily lens wearers. What does that mean to you besides a happy optometrist? You will be seeing better, with less redness and irritation than with other lens modalities.
I know that daily disposable lenses can be a lot more expensive than older hydrogel lens options, but besides price tag, there are really no reasons to not be fitting dailies. And for patients who want comfort, safety, and convenience, dailies can be more than worth a price difference. Acuvue 1-Day Moist for Astigmatism has really increased the options for daily lenses in astigmatism patients, and for presbyopes I have had success with Cooper's Proclear 1-Day Multifocal lens. There is a reason that daily wear is gaining ground (finally) in America-- up to 17% of contact lens fits in 2012 versus only 11% in 2009 (Contact Lens Spectrum). Hopefully we can catch up with the rest of the world and embrace the best available contact lens technology at an even more increasing rate!
1) Daily Lenses offer maximum comfort
Contact lenses get dry; it is just a fact of life. Try putting a piece of plastic over your eye all day and why would we think they should be comfortable? But daily lenses are the thinnest options on the market, and since you are opening a fresh pair every day, they will have no build up or deposits that plague extended wear lenses even with the best cleaning solutions. Do you suffer from allergies? The last thing you need to put on your eye is a lens that has been exposed to your allergens for the past 2 weeks. A fresh lens will have collected no dust, pollen, or other allergen, so you will be getting maximum allergy relief.
I also love daily lenses for dry eye sufferers and 8+hour a day computer users. Sometimes getting just 8-12 hours a day of comfortable wearing time is a success, and with dailies my average patient is getting 12-14 hours routinely. With new materials like Acuvue's Trueye and Bausch and Lomb's new Biotrue 1-Day lenses, the amount of hydration and comfort with dailies continues to improve!
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| Daily lenses are individually packaged, so you always have a fresh lens and never need cleaning solution |
2) Daily Lenses have less complications
If you have ever had an eye infection, you know the pain, discomfort, and blurry vision that comes along with it. On top of all that, you are out of contact lenses and stuck in glasses for days to weeks. The best way to prevent your risk of infection is to limit the amount of bacteria exposed to your eye, which is why a daily lens is such a great option. With dailies, you have no cleaning to perform because you throw the lens away every night. You only touch the lens one time, when you are putting it in that morning, so the risk of dirty hands contaminating the lens is much lower than a lens you wear for 2 weeks or a month. Studies report that daily disposable wearers are about half as likely to have moderate to severe bacterial infections than other soft lens wearers (link).
3) Daily Lenses offer better oxygen to the eye
The amount of oxygen transmissibilty in a daily contact lens (DO/T) is typically lower than some monthly silicone hydrogel lenses when you look at the numbers, but don't be fooled. A monthly lens has to provide oxygen to your eyes for 30 days. A daily lens only has to allow oxygen for one day, and for 12-18 hours, your eye is going to be getting a lot more oxygen than it does through a conact lens that is a few wears old. I hardly ever see signs of oxygen deprivation like corneal neovascularization, infiltrative keratitis, and corneal scarring with daily lens wearers. What does that mean to you besides a happy optometrist? You will be seeing better, with less redness and irritation than with other lens modalities.
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| A lot of patients ask me about Acuvue's Trueye marketing campaign declaring you will have whiter eyes. There is no bleaching here -- daily lenses just offer maximum oxygen and moisturization, preventing blood vessel growth (neovascularization) and a chronic "red eye" appearance that plagues dry eye sufferers and patients who are overwearing their lenses. |
I know that daily disposable lenses can be a lot more expensive than older hydrogel lens options, but besides price tag, there are really no reasons to not be fitting dailies. And for patients who want comfort, safety, and convenience, dailies can be more than worth a price difference. Acuvue 1-Day Moist for Astigmatism has really increased the options for daily lenses in astigmatism patients, and for presbyopes I have had success with Cooper's Proclear 1-Day Multifocal lens. There is a reason that daily wear is gaining ground (finally) in America-- up to 17% of contact lens fits in 2012 versus only 11% in 2009 (Contact Lens Spectrum). Hopefully we can catch up with the rest of the world and embrace the best available contact lens technology at an even more increasing rate!
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| Corneal Arcus: that ring of blue is really cholesterol! photo via studyblue.com |
Have you ever noticed a faint white or bluish ring that appears to be around the iris (the pigmented part of the eye)? I have even had patients come in stating that they think their brown eyes are turning blue because they see this change in the mirror. Nope, your eyes are not getting bluer; they are getting more cholesterol-y. Arcus is a ring of cholesterol deposition in the cornea (the clear dome that lays over the iris). In the elderly, this is typically a normal change, and does not necessarily mean you have high cholesterol issues. If we see these changes in young patients (under 40), however, cholesterol levels should be checked!
2) Arteriosclerotic Changes
When your eyes are dilated or your retina is alternatively evaluated, your doctor is paying close attention to your retinal blood vessels. The arteries in the eye (really arterioles because they are too small to be arteries technically) will express the same health changes that arteries in the rest of your body are undergoing, making the eye a great place to assess vascular health. High cholesterol can cause hardening of the artery (causing a whitened artery appearance instead of the normal red). In more severe cases, there can even be plaques of cholesterol that block or limit blood flow. This can even cause vision loss in severe cases. If arteriole changes are noted, your doctor will suggest checking blood pressure, cholesterol, and other vascular issues and may even send a note with their findings to your primary care doctor. In many cases, these changes may not have any visual symptoms, making their detection completely dependent on you getting a health examination.
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| Lipemia Retinalis: severe whitening of the retinal vessels due to elevated cholesterol photo via doctorshangout.com |
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| A Hollenhorst plaque is a blockage of cholesterol that lodges within the retinal vasculature and obstructs flow via |
3) Xanthelasma
Cholesterol can also build up as plaques on the eyelids, typically on the nasal aspects of the lid. These areas look like elevated yellowish growths. They can be removed by a surgeon, but may return if cholesterol levels remain uncontrolled.
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| Xanthelasma plaques via dermis.net |
Interested in learning more about how high cholesterol affects your entire body's health? Check out this interactive resource from Healthline where you can learn more about cholesterol's toll on individual organs and body parts. You can also head here to see what 100% of your daily value of cholesterol looks like. Remember, your eye is a part of your body, and even if you don't have vision problems a yearly eye exam can help detect serious systemic health issues like elevated cholesterol, high blood pressure, and diabetes that could mean the difference in a happy, healthy life.
Optometrists or students that are blog readers, this post is for you! I just found out about an interesting new ophthalmic medication that is undergoing clinical research. Jetrea is a new intravitreal injection designed for patients with symptomatic vitreomacular traction. The medication is a specific enzyme lysing agent, designed to breakdown the connection between the vitreous and the retina underneath. This injection could be utilized in patients with vitreal traction resulting in an epiretinal membrane or an impending macular hole. At this point, research is early, and is just starting to be used in research surgery centers.
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| Photo via retinadoctor.com.au This OCT image shows the vitreous (thin superior line) attaching erroneously to the macula and distorting upward. There is a risk for a macular hole to develop if the traction continues. |
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| Prior to Jetrea, removing a symptomatic epiretinal membrane could only be done with delicate surgery, involving small forceps lifting and peeling the membrane off. Makes me glad I'm an optometrist and not an ophthalmologist. Photo via spirehealthcare.com |
Like all injections, there is always a risk for complications. These can range from new vitreal floaters or hemorrhages, to a retinal tear or detachment. Due to the complicated nature of treating vitreomacular traction, most surgeons will chose to monitor patients unless vision is greatly compromised. Prior to Jetrea, a membrane peel or other treatment for traction typically offered minimal if any improvement in vision. We will be learning more soon if this injection can help return visual acuity to greater levels!
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