There is definitely no denying that daily disposable or single use contact lenses are taking the marketplace by storm.  If you are a regular blog reader, you know that I am passionate about the unparalleled comfort and health benefits of wearing single use contact lenses.  And for many people that are part-time contact lens wearers, dailies have the added benefit of being markedly less expensive; you only use the lenses that you need, and you never have to buy solutions.  With the unparalleled explosion of single use lenses on the market, this year has seen a lot of growth in the multifocal daily contact lens realm.  Multifocal contact lenses are designed to help the wearer focus in a range of  visual needs, from far distance, to computer, to cell phone reading.  Many people that need multifocal lenses spend significant amounts of their day battling dryness -- either due to extended computer use or due to hormonal and body chemistry changes occurring as we enter our forties and fifties.  Daily wear lenses can maximize lens comfort by offering the least risk of dryness with contact lens wear, and also now provide that vision flexibility that we need as our eyes enter presbyopia (or what many people will just call "tired eyes" and trouble focusing up close).  If that sounds like you, here are some great new lens options to explore with your doctor:

Proclear 1-Day Multifocal

The near center progressive design can give wearers variable vision depending on their pupil size, so what power each person needs to achieve their visual needs is dependent to a large degree on their anatomy via

This was the first readily available daily disposable multifocal on the market, and the Proclear 1-Day line of lenses tends to be very comfortable for most wearers.  The design is a bit challenging since finding the right power of the lens is not intuitive.  Luckily CooperVision has provided a detailed fitting guide to get you off to the right start.

8.7 BC
Power Range = +6.00 to -10.00
The lens is not add power designated which makes the fitting process less intuitive.  I always discuss with patients that I do not expect the contact lens prescription for this lens to match in any way what their glasses or previous contact lens prescriptions have been because of this disconnect in the way the lens is fit.





Dailies Aqua Comfort Plus Multifocal

A schematic of the design: near center, with rings of intermediate and then distance fanning out. via

When this lens launched earlier this year it was a great alternative option because it offered a design that doctors are already comfortable and familiar with fitting.  This lens uses the exact same multifocal design set-up to Air Optix Multifocal, and it is easy to transition patients that have worn the Air Optix lens into this daily version if they need the added comfort benefit without expecting to lose any vision.  You can follow the Air Optix Multifocal Fitting Guide to get started.



Biotrue ONEday for Presbyopia
This lens is just hitting the market in a limited initial roll out, and I am very excited to have it in my arsenal.  Using the same "3-Zone Progressive" design that is found in the Purevision2 Multifocal lens, I am especially happy to have this design as a daily option because I have found that this lens has been very effective for many of my patients.  Again, if you have patients happily wearing the Purevision2 lens, changing to Biotrue ONEday will be a seamless transition in vision if they need the added comfort of a daily lens.

8.6 BC
Power Range = +6.00 to -9.00
Add power = Low only at this time, with additional roll-out of High add power next year

1-Day Acuvue Moist Multifocal
This lens is slated to hit the market in late 2015, but we don't know much about what it will bring to the dailies multifocal market.  The 1-Day Acuvue Moist material is one of my favorites for all day comfort, so this fact alone is worth being hopeful.  Previous Acuvue multifocal designs (Oasys for Presbyopia, anyone?) have been left behind as newer options with better optics emerged, but Johnson and Johnson is introducing a brand new multifocal design for this lens.  Not much is known about the characteristics of this design at this time, but I will continue to keep you updated as we learn more!

This week I am excited to attend Vistakon's Women in Optometry Focus Group, and it is excellent timing that so much is going on within the company this year.  On October 6th, Johnson and Johnson launched broadened parameters in its popular 2 week lens brand, Acuvue Oasys for Astigmatism. For those of you with higher amounts of astigmatism this lens could help you attain better vision without the need for more expensive custom lenses.

via

What's New:
The Oasys for Astigmatism lens is now available in 10 degree axis options around the clock in all cylinder ranges up to -2.75.  In the past, only the older generation Soflens 66 Toric offered -2.75 cyl options without being custom order, and this brand's -2.75 range is now limited to minus spherical powers.   Acuvue Oasys Astigmatism now offers up to -2.75 cyl in powers from +6.00 to -9.00 to cover a broad spectrum of lens wearers.

Eyewear has had one thing hold true the last few years: big and bold. Whether it was oversized geek chic frames or bright blasts of color, glasses were all about making a statement.  So this season's trend took me a bit by surprise: neutrals are back in a big way.  Whether you prefer your frame to be metal or plastic, soft browns and pale peaches are the color of choice.  Here's a look at what's trending:

Lasers are such a buzzword in eyecare, and ever since the femtosecond laser entered the realm of cataract surgeries -- one of the most common surgical procedure done in the United States!-- the industry has been making the shift towards performing more accurate and better healing cataract extractions with laser precision.  Laser-assisted cataract surgery is not, however, covered by standard medical insurances, so when you discuss the option of upgrading to laser surgical options you need to know what improvement in outcomes you can expect for your extra money.   Today's post breaks down what femtosecond laser cataract surgery can offer as a potential improvement over traditional procedures, and what top ophthalmologists in my area are saying about their experience.
As technology improves, what the laser can accomplish may continue to evolve, so keep checking back here for more information as we learn more.

The Traditional Manual Surgery

A great schematic of the standard, manual cataract surgery.  The surgeon makes a incision into the eye, opens the capsular bag that holds the cataract inside, breaks up the cataract and removes it, then places a clear implant inside the capsular bag to correct your vision after surgery.  via

What Does the Laser Do Differently?
Cataract surgery involves your ophthalmologist cutting into the eye (either the cornea or the sclera which is the white of the eye) and then removing the cloudy lens (cataract) inside and replacing it with a clear implant to provide visual correction.  Despite being a quick procedure, with most surgeries lasting no more than 15 minutes, there is a lot going on and a lot of subtle techniques your surgeon is using to insure good vision for you, quick healing time, and to help prevent post-operative infections like endophthalmitis.  The femtosecond laser can take the place of procedures that surgeons were traditionally doing manually, like making the incisions into the eye, and opening up the capsule where the cataract sits (this is called capsulorhexis).

This is what your surgeon sees behind the monitor of the laser.  Your surgeon uses fine detail calculations to program the incision site for your surgery to insure the very best visual outcome.  via

What Are the Benefits?
When the precision of a laser is used to make incisions in the ocular tissue, the expectation is better visual outcomes.  If you have astigmatism, the laser can help make incisions to more precisely correct astigmatism post-operatively, meaning a less likely chance that you will need glasses after surgery.  If you are upgrading to toric (astigmatism) or multifocal (for distance and near vision) implants anyway, many surgeons will automatically also upgrade you to laser assisted surgery to insure a better outcome.  Yes, these upgrades are a greater out of pocket cost to you, but the result is the chance that you won't need glasses to see after cataract surgery, so you are getting major benefits if you have demanding visual needs.

The capsularhexis on the left was manually made, and shows a close-to-perfect circular opening, but obviouly some distortion.  On the right, the laser does it with the utmost perfection. via

In addition to the initial incisions, the laser is also used to help open up the capsule that holds the cataractous lens inside. Traditionally surgeons have to manually open this bag, making a tiny circular incision with delicate hand movements, being very careful not to tear the opening too large. While many surgeons are so good at what they do, they can make a perfect circular incision with a smooth edge by themselves, the laser can help attain that level of perfection every time.  What does a perfect capsulorhexis mean to you?  A tear in the capsule can be devastating to vision if the implant falls into the back of the eye, but luckily this is a very rare side effect of cataract surgery.  The more common issue with an imperfect capsule opening is the risk that as the implant "settles" inside the capsular bag, an imperfect opening will cause pulling or shifting of the implant out of place, and thus a shift in the clarity of your vision.  This is a problem that is not fixable after cataract surgery because there are too many risks involved with trying to remove the capsule or re-position the implant unless it is absolutely necessary.  A pefect capsularhexis means less chance of unequal pulling or shifting of your implant, which means your best chance for perfect vision after surgery!

Finally, the laser is also used to help break down the cataract.  The cataract inside the capsule bag can be very thick and dense (especially if you waited awhile before having surgery).  With the laser's help, the surgeon will need less time breaking up the cataract and less time removing it from your eye.  The faster this part of the procedure goes, the lower the chance is for serious infection and inflammation after the surgery.  This is especially useful in patients that have medical conditions or that are on medications that make traditional cataract surgery more difficult.  Flomax is a great example of a medication that can cause difficulty in the operating room (it makes dilation difficult, making a very, very small window through which your surgeon must work).  If you have corneal degeneration issues like Fuch's dystrophy or endothelial guttata, then the high heat used during traditional cataract surgery can increase the risk of permanent damage to your corneal endothelial cells. Laser assisted surgery helps limit the risks involved in these cases.

Are there any Cons?
The use of the femtosecond laser has a few pitfalls, especially for surgeons used to traditional methods.  Dr. Alan Carlson is an acclaimed cataract surgeon in my area, and recently spoke about his experiences at a local meeting.  He reports that laser assisted surgery does add additional time to his surgical time, meaning a longer time under operation for the patient, and typically a lower number of surgeries that the ophthalmologist will be performing that day.  Dr. Carlson also reports a definite learning curve on using the laser to its utmost abilities.  As you get more comfortable using the laser to make your incisions, the outcomes and techniques get better and better, just like any other highly skilled method.  If you are considering laser assisted cataract surgery, make sure that your ophthalmologist is performing this type of surgery routinely; it is still a new procedure, so no one will have years of experience with it, but if they are using the laser on most patients you will know that they have established their own technique for success with it.  Another great option is to talk with someone who had laser-assisted surgery.  What was their experience?  What did they feel like they gained?  Talking with others that had surgery with your doctor can always help put you at ease, no matter what type of specialist you are seeing.

There is no doubt that laser-assisted ocular surgeries are the trend for the future, and as our world becomes more digital and thus visually demanding, we all have high expectations for vision after major eye surgeries.  Laser-assisted procedures are a step towards achieving the next level of visual perfection, and for many that extra quality of sight is worth any additional price tag.

A friend recently contacted me with this sad story: an elite young gymnast, Deanne Soza, is at risk of permanent and severe vision loss due to an aggressive contact-lens associated infection.  Reading the posts from her family it appears she had contracted a possible Acanthamoeba infection in both eyes from wearing contact lenses in a hot tub.  Acanthamoeba is a protozoan parasite that is commonly found in water - swimming pools, lakes, and yes, hot tubs.  As doctors work to treat the infection and save Deanne's eyesight, it highlights a new and disturbing trend in the eye care world.  Corneal infections from contact lens wear are actually on the rise, and it is time for both contact lens wearers and eye doctors to rethink what we can do to prevent even just one more person from going blind or suffering vision loss from wearing contact lenses.

I don't show a lot of graphic pictures on the blog, but this is what an advanced Acanthamoeba infection looks like. When it gets to this point, vision is likely permanently damaged and your doctor is battling to save your eye at all.  via

What Can You Do?

If you wear contact lenses, it is so easy to treat them with relative indifference.  Every single day I have patients tell me that they sleep in lenses that aren't approved for it, wear lenses 2 or 3 times longer than the FDA and their doctor have prescribed, and disinfect their lenses with cleaning supplies that are not safe to use with contact lenses.   Tap water, sterile saline, your saliva, or any home-made solutions are not safe for cleaning your lenses!  If you follow these safety protocols, then contact lens wear should be safe for you:

1) Follow the Prescription
Do you have monthly lenses? Biweekly lenses?  Lenses approved for overnight wear?  Your doctor has prescribed lenses with specific wearing schedules, and make sure you know what you lens is made for.  If you wear a 2 week lens for over a month, you are putting yourself at a really high risk of complications.  Why risk blindness when just changing out your lens will keep your eyes safe?  Make sure you tell your doctor how you want to wear your lenses, and they can help you find a lens material approved for that wear time.

2) If your eye is red or irritated, take your contact lenses out
When you are a contact lens wearer, it is often like telling someone they have to go to prom in a potato sack to get them to wear their glasses for a few days.  But if your eye looks red or feels a little uncomfortable (yes, even just a little!), you should throw away your contact lens and wear glasses.  If your eye isn't 100% back to normal later that day, call your doctor to be seen immediately!  Do not wait until you have vision loss or discharge or severe pain.  You need to stop contact lens wear the second your eyes don't feel right to prevent severe infections.

Does your eye look or feel just a little irritated.  If you notice even mild redness like above, take your contact lenses out and wear your glasses that day!  If your eye is irritated, it needs a chance to fully recover without exposure to bacteria or other microbial pathogens that your contact lens may have on it!  via

3) If your eye is exposed to water, take your contact lenses out
Any water-related activities are extremely dangerous when combined with contact lenses. Rare but severely aggressive pathogens like Acanthomoeba live in water and soil.  Swimming in lakes or pools or hot tubs and getting that water in your eyes just coats your contact lens with loads of pathogens.  If your eye gets even a small scratch or dry spot under your contact lens, then the infection can break through the corneal epithelium and penetrate deep into your eye.  That's why removing lenses to clean them right after exposure is so important, and removing lenses if your eye feels even just a little uncomfortable is crucial.  You need to have a 100% normal corneal surface to safely wear contact lenses -- no scratched areas, and no dry areas.

What Can Your Doctor Do?

I am a huge proponent of talking about daily disposable contact lenses with my patients.  I know dailies aren't as popular in the US because they are seen as price prohibitive, but they are far and away the safest way to wear contact lenses.  When you throw away your lens every day, there is no chance to seal bacteria or any infectious entity against your eye.  As contact lens risks come under increasing scrutiny from the FDA , I expect that we will see growing numbers of patients switching to dailies for all the perks of both safety, comfort, and incredibly clear vision since there is no build up or lens deterioration to combat.   I ask all of my fellow eye care specialists to advocate for daily disposable lens wear, and even if your patient isn't interested in dailies this year, if we continue to talk about the benefits and safety, we can help prevent the number of infections and the number of people being blinded by their contact lenses forever!

Have you ever pulled down your eyelid and looked closely at the tissue underneath?  For most of us, the only reason to look under your eyelid is if it feels like there is something stuck underneath.  But not everything that you see within your conjunctival tissue (the vascular layer that makes up the underside of your eyelid) is a foreign body or stye.  Imagine if you pulled your eyelid down and saw this:

Inferior tarsal conjunctival concretions via

Have you ever looked through a pinhole and noticed that you can see really well? Even without glasses?  The reason that pinholes work is that they shrink the amount of stray light information entering the eye, creating less distraction and minimizing the amount of distortion than can get processed and create a "blurry" image when the information reaches the brain.  The same effect is commonly used in cameras to create a clear image.  The big drawback of pinholes?  Your world is limited to a small speck of vision (albeit a clear, small speck).  Wouldn't it be great if your eye had an internal pinhole so that vision isn't as limited peripherally but you could get the same amount of crystal clarity without the need for glasses?  That is the concept behind the proposed eye drop from Presbyopia Therapies, LLC being investigated for treating blurry vision after age 40.

Small pupils create a pinhole effect, sharpening vision by limiting distortion to a small area.  Presbyopia Therapies, LLC is working on an eye drop that can cause this constriction temporarily to improve vision for the day without side effects! via

Dr. Terry Kim is an ophthalmologist and leading researcher for the eye drop, and he recently spoke on Eyetube.net about his research if you are interested in watching the interview.  The drop is a new product that somehow separates miosis (pupil constriction) from accommodation (muscle action of focusing), allowing the pupil to become a pinhole without creating terrible headaches and brow pain that similar pupil constriction drops like pilocarpine are associated with.  In current research trials, the drop is being dosed daily and achieving vision effects for 8-10 hours.  Both distance and near vision is improved in his experience (just like we would expect with a normal pinhole effect).  The possibilities are theoretically endless; in addition to correcting prescriptions temporarily, these miotic drops could limit glare or halo issues after LASIK surgery or corneal injuries which are often worsened with night vision due to our larger pupil size in dim lighting.  A small pupil will keep vision away from these distorted corneal areas, preventing light from hitting these imperfections and creating glare, shadows, or halos.

We are still a few years away at least from having a drop of this nature on the market, but Dr. Kim reports that they will enter Phase 2 clinical trials next year, which means that we will be getting more concrete study results soon as to how the drop is tolerated and the amount of vision the average user is achieving.  If you are interested in learning more right now, this article was the most comprehensive I could find currently. Stay tuned because as I learn more, I will continue to update on the blog!