There was a ton of great eyewear on stage Sunday night at the 2014 Academy Awards, and here's a recap of some of the night's best looks.  Meryl Streep was really the only female holding strong wearing her glasses with her red carpet look, but for the men, glasses were a very common accessory!  Black frames were the overwhelming favorite, likely since more colorful glasses might have looked too casual for black tie affair.

Giving an eye exam to a screaming 2 year old with zero attention span may be the least exciting part of your optometric day.  But I am here to offer you my quick and easy guide to making the most of the 5-10 minutes of information retrieving you may be at the luxury of obtaining.  Here's my quick and easy guide to making the most of your toddler or challenging pediatric exams.

Yes, if you Google a diagram of corneal layers this image is the first to come up.  No, it is no longer correct.  Not even Google can keep up!  via

Remember when we all thought the cornea was just five layers thick?  These were simpler times, when diagrams were neatly organized and mnemonic devices were memorized -- the ancient history of pre-June 2013.  That was when Professor Harminder Dua of the University of Nottingham first published his discovery of a layer just 15 microns thick between the corneal stroma and Descemet's Membrane which he named Dua's layer.  The thin corneal layer is surprisingly tough, able to withstand up to 2 bars of pressure.  Due to it's properties, it has been used as a guidepost for surgeons in corneal transplants, banking on the toughness of Dua's layer to determine the depth of their incisions.

Chicks have long been used to help investigate refractive error development since their ocular model closely resembles the development of our own  via

So little is really understood about the progression of myopia (near-sightedness).  Many of my patient's parents are quick to blame computer games and the large amounts of homework required by schools as to why their children's vision is getting worse from year to year, but these culprits are too simplistic.  Genetics, environmental influence--it seems to all be connected.  But new research points to a surprising new potential culprit -- light.

Around 2011 several reports came out linking myopia to reduced sunlight exposure in studies performed with baby chicks.  Sunlight, it appears, increases the rate of release of retinal dopamine, which inhibits growth rate of the eye.  Myopia is a result of light falling in front of the retinal photoreceptors, most often due to a longer than normal eyeball.   The more the eye grows, the more near sighted a person will be.  Researchers suggest 10-14 hours per week of outdoor light exposure may help slow myopia progression, but more studies need to be performed for this effect to be truly demonstrated.

A new study published in December takes our understanding of light's effects on myopia to a new level.  In their experiment, Foulds et al separated baby chicks into red light and blue light exposure groups with a 12 hour on/off cycle for a period of 2-6 weeks.  The results were amazing -- the red light group showed marked progressive myopia and the blue light group showed progressive hyperopia (far sightedness).  And then they did something even more impressive -- by putting the red-light raised chicks with now high-induced levels of myopia in blue light for 3 weeks, they reversed the myopia.  The same held true for reversing the hyperopia.

So what does this mean for us?  We are a long way from putting your child under blue light for 12 hours a day, but we are beginning to understand what is happening on the neurologic level of the eye when refractive error is created.  So many of our methods of reducing myopia have shown limited response, but maybe the future looks brighter.  If you are worried about your child developing high levels of near sightedness, my best recommendation to you is get them involved in outdoor sports.  Wear proper sun protection of course, but the more time spent outdoors with ambient light levels, the better your child's chances look for a lower prescription!  

For today's edition of "What's That in My Retinal Photo?" I decided to delve a little deeper--not just what, but why?  Many times finding the issue is just the first step; what caused the issue is where the real problem solving starts.

At first glance, maybe this photo looks very normal. But if you look more carefully at the superior edge of the optic nerve, you will see a circular red area that is a retinal hemorrhage.  A hemorrhage is blood inside of the eye, in this case trapped in a layer of the retina underneath the overlying retinal arterioles and venules (you can see the vessel clearly passing over top of it).  Blood in the retina is never good (especially not near the nerve where it could be a harbinger of serious ocular conditions like glaucoma), and when I see blood there is a lengthy discussion to be had.  The good news: this type of small hemorrhage in and of itself does not cause vision damage, and will be reabsorbed by the ocular tissue and gone in around 3 months, like nothing was ever there.  Bleeding inside the eye isn't painful, and unless your doctor finds it during your exam, likely you would never even know it was there.  So why do we worry so much about blood in the eye?  Because it means a number of things could be going wrong in your body (not just your eye!).  Here's a differential overview of what I need to investigate when I see blood inside a patient's eye:

• Hypetension, Diabetes, or other systemic vascular condition

Have you ever had a floater appear all of a sudden, like a fly or black speck in your vision that just won't go away.  Floaters really are inside the eye, a clump of the vitreous jelly that fills the eye that has pulled together and broken loose.  Sometimes when a large area of the vitreous pulls away from the retinal tissue, the tractional force of the floater breaking off can cause a blood vessel to bust open.  This is common in conditions like Posterior Vitreal Detachment which is a normal aging change that occurs when the vitreous separates from the back of the eye permanently.  Of course, a new sudden floater and blood in the eye can also be a sign of a retinal tear, so please see your doctor immediately if you see a new floater or flashing lights in your vision.

• High Risk Medications

This is not an exhaustive list, but look at all the potential culprits for a spot of blood in the eye!  Your eye doctor is not only trained to find these broken blood vessels, but also to determine the cause of your bleed before any permanent harm from systemic or ocular diseases can cause actual vision loss or major health issues.  Many people have had high blood pressure and diabetes diagnosed due to problems being caught at their routine eye exam!  The eye is truly the window into the body, and your eye doctor will work closely with your primary care doctor, cardiologist, endocrinologist, neurologist, or any other specialist that is treating you medically to help use the information found on your eye exam to keep your eyes and your entire body healthy for years to come.

NYFW runways delivered yet again on great eyewear fashions for the coming season.  Here are the best looks from top designers:

Phillip Lim took a new spin on traditional shapes and colors for sunglasses by adding a metal ring around the inside edge of the frame.

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A similar look was featured at the Carolina Herrera show, where a simple metal sunglass frame was enhanced with colorful zyl additions.  This combo of metal and plastic is likely to be a big feature in the season's frames

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Kate Spade is a perennial favorite, and her oversized plastic frames with a subtle cat eye lift in pastels and glitter are excessively wearable for every woman.

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For ophthalmics, orange got a lot of love at Rodarte, with a familiar oversized frame shape that has completely taken over the market in the last few years.

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And for the truly out-there, the concentric rings around Prabal Gurung's sunglasses were definitely futuristic.  Probably not for the faint of heart to pull off.

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Many of my optometrist/optometry school readers have likely already heard about the AOA backed Think About Your Eyes media campaign, and I am hoping that other readers have to -- either by seeing their ads on TV, magazines, or over the radio.  With healthcare changes just beginning to take effect, more Americans than ever will have vision coverage, but vision isn't even the best reason to get an eye exam!  The health of the eyes is so complex, and your eye doctor can find potentially blinding conditions years before they have time to cause permanent damage, as well as systemic health conditions like hypertension, cholesterol issues, and diabetes (just to name a few!).  Unfortunately due to years of difficulties fighting for recognition with insurances and others even in the medical profession, optometrists have been rather hidden from patient access due to insurance panel black-balling (which is now illegal with great legislature like the Harkin Act) and the important health aspects of an eye exam have been widely unpublished.

No more is this the case, and it is time for us to get behind the AOA's latest campaign to help bring the real benefit of optometry to the masses!

In the exam room, I get asked so many questions that surprise me -- the average American really knows very little about their eyes!  Here's an overview of some of my most frequently asked questions, and how optometrists can help:

What Age Should My Child Have Their First Eye Exam?

Infant's eyes are developing so quickly from birth -- going from seeing just blurry shapes to increasing clarity, depth perception, and the ability of the eye muscles to track and move together.  That is a lot of skills developing at once, and no surprise that many issues can result if this development is slowed or stalled.  As such I recommend taking advantage of a wonderful program called InfantSEE that provides a FREE eye exam for anyone under 1 year of age.  I recommend having that first eye exam at around 6 months to ensure the eyes are developing equally, and check for blinding congenital conditions like tumors and childhood cataracts and glaucoma.

Maybe your child is already older and has gone without an eye exam to this point. At worst, I recommend an exam before entering kindergarten to ensure your child is using their eyes equally.  If your child only sees clearly out of one eye, they are immediately at an unfair disadvantage to their fellow classmates in learning how to read, write, and do math. Eye screenings at your primary care doctor are incapable of finding inequality between the eyes at the rates to which they exist because children hate getting things wrong and will typically memorize letters or take a sneak look with their better eye to "pass a test". Make sure that you are helping your child perform their absolute best by making sure they can use both eyes with a real eye exam!

Should I have an eye exam if I have perfect vision?

Yes!  The vision component of your exam is just a small part, and the ability to see clearly is unfortunately no way to ensure that your eyes are healthy.  Most health conditions of the eye, like glaucoma, macular degeneration, ocular tumors, and destruction of tissue due to hypertension or diabetes does not cause vision loss until the condition is advanced enough to be irreversible in most cases.  If you wait to go to your doctor until you have vision loss, you will never be able to see clearly again!  Yes, let that sink in because for many people that is a shocking fact.

Your doctor is assessing your ocular health at every visit to find these issues years or decades before they can damage your ability to see, and that is why a yearly exam is essential to every single person. Remember, the retinal cells inside the eye are not fully visible without dilation or retinal photography, and these cells that allow us to see have no pain receptors so you want be able to feel any discomfort if you have a retinal disease!  You won't have a red eye; you won't have watering.  Ocular diseases cause painless, permanent vision loss!  These ocular conditions are treatable, and there is no excuse in today's age of medicine that so many people go blind due to ocular disease. With regular check-ups early risk factors or diseases will be found and treated before hopefully any vision loss can occur.

My eyes are red/itchy/watery/infected/have something stuck in them.  Should I go to the ER (or urgent care clinic for that matter)?

Well you most certainly can, but it is more expensive, more time consuming, and likely you won't be seen by anyone with specific eye training.  If you have a problem with your eyes, please don't waste your time and money going to someone that is not an eye specialist unless it is truly an emergency (like you got stabbed in the eye with a knife for example).  Your eye doctor has the proper training, equipment, and likely in-office samples to treat your condition quickly and accurately, without any long waits or excessive price to you out of pocket.

Allergies? Pink eye? Dry eye? Foreign body sensation?  Yes, I can help.  And I can accept your medical insurance as well!

Oh yes, and I can get you seeing as clearly as your eyes are capable of seeing too.

Please America, optometrists love this career and love helping people, so let us help you.