Eyedolaty celebrates its 5th birthday next month, and it's been amazing how much has changed in the world of optometry in the short time since I began blogging.  We've grown from the days of a free blogspot domain posting pictures of conjunctival cysts and bad NBA glasses fashion, to a trusted optometric resource where thousands of readers around the world turn to find new technology and solutions to their unique visual challenges. There are more resources than ever for young ODs to find their way online -- from the educational articles at Review of Optometry, to the quick and fun guides at New Grad Optometry, and the inspirational success stories at Women in Optometry.  

Way back  in the archives to first year and the White Coat Ceremony at SCO

If you've ever looked in the mirror and seen this:

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Thankfully subconjunctival hemorrhages look at lot worse than they truly are in most cases.  Blood is trapped on the surface of the eye due to a broken blood vessel in the conjunctiva (the vascular tissue that overlies the white of the eye). Because the conjunctival tissue is a vascular membrane, blood that leaks gets trapped underneath and can take 1-2 weeks to fully reabsorb.

What Caused This? 
The most common causes for subconjunctival hemorrhage are:

• coughing, sneezing, straining, heavy lifting, or vomiting These activities acutely raise blood pressure in the veins, causing a small rupture in the capillary bed where arteries and veins connect; it's called a valsalva maneuver.  
• injury 
• rubbing the eye
• trauma
• ocular surgery or ocular injections
• contact lens related injuries (inadvertantly pinching the conjunctiva for example when removing your contact lens -- about 5% of subconjunctival hemorrhages are related to contact lens wear) 
• uncontrolled vascular disorders like diabetes and high blood pressure, anemia, or blood clotting disorders
• blood thinning medications

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• Aspirin
• Warfarin  
• Coumadin
• Heparin
• Plavix
• nutritional supplements (these also have blood thinning or anti-coagulation properties which can increase the risk of subconjunctival hemorrhage, especially when the patient is already taking other blood thinners, or when they have uncontrolled high blood pressure)
• Tienchi (Panax notoginseng)
• Garlic Supplement (Allium sativum)
• Ginkgo biloba
• Fish Oil/Omega 3 
• Bilberry (Vaccinium myrtillus)
• Less common but possible:
• abrupt changes in acceleration like sudden braking during a car accident
• abrupt changes in barometric pressure like scuba diving
• viral conjunctivitis (acute hemorrhagic conjunctivitis)
• vascular tumors (cavernous hemangioma, lymphangioma)

What Can I Do To Look Normal Again?
Unfortunately subcojunctival hemorrhages will reabsorb in their own good time.  There is no eye drop or medication that can make them heal faster.  Typically resolution occurs within 1-2 weeks, depending on the size of the hemorrhage.  If the hemorrhage happened at the top of the eye, it may actually look worse before it gets better as gravity brings the trapped blood downwards toward the lower eyelid area.

To potentially speed things up you should:

• Avoid blood thinners like aspirin or the supplements listed above if possible (it's best to consult with your primary care doctor before changing medication)
• Avoid intense weight-lifting workouts (heavy lifting can cause another break)
• Some people report success alternating a cool and warm compress (just held over the closed eye --no rubbing).  Heat can improve circulation to the area and potentially help breakdown clotted blood so it absorbs faster.  Cool compresses can reduce the swelling often associated with an acute hemorrhage by constricting the conjunctiva.

Need a painkiller but have a subconjunctival hemorrhage?  Tylenol and Ibuprofen have reduced risk of blood thinning as a side effect than aspirin.  via

An estimated 11 million Americans have macular degeneration, and with an aging population the number of new diagnoses are expected to sky rocket by as much as 50% by 2050.  As the leading cause of blindness in Americans age 60 and older, we are still without any cures for this blinding eye disease.  The mainstay of treatment in the early (dry) stages of macular degeneration is all about preventive care -- sun protection, stopping smoking, and nutritional supplements have all been shown to reduce the risk of progression.  A 2014 study published in the Journal of Neuoscience suggests eye doctors should be adding at least one more recommendation to that list -- regular exercise.

Macular Degeneration causes permanent disruption to the retinal tissue and central vision loss, and unfortunately in many people it continues to worsen despite the best treatment options available today.

The premise behind the study is one that eye doctors hold very near and dear in concept -- the eye is a part of the neurological system, made of the same tissue that comprises our brain and central nervous system.  Aerobic exercise has already been proven to be both protective and rehabilitative in neurological diseases, improving memory in those with Alzheimer's and nonmotor function in Parkinson's.  Could exercise also be neuroprotective or rehabilitative in eye disease?

The Set-Up
48 mice were divided into different treatment groups and macular degeneration was simulated by using Light Induced Retinal Degeneration.  24 mice were placed in the "exercise" treatment group: they used a treadmill 5 days a week for 60 minutes each day at a set speed.  These mice were "pretreated" with a 2 week regimen of exercise, then were exposed either to toxic bright light (10,000 lux)  for 4 hours to cause Light Induced Retinal Degeneration or dim light (25 lux).  Another 1-2 weeks of exercise followed. The other 24 mice were placed on a non-moving treadmill for the same 60 minutes a day, so no active exercise occurred. They were then exposed to to either the toxic or dim light stimulus and maintained without exercise for 1-2 more weeks.  Retinal function was measured using ERG responses at the end of the four week period.

The Results
As predicted, toxic bright light exposure (10,000 lux) resulted in significantly worsened retinal function. But even in those mice undergoing toxic light exposure, the mice who had received pre and post-exposure exercise had much better retinal function than the stationary mice.  Interestingly, the mice that were exposed to dim (non-toxic) light had better retinal function if they were exercised than if they were not.  Could exercise also improve retinal function in normal eyes? Possibly, according to this data.

A) Toxic Light Exposure mice had greatly reduced ERG amplitudes compared to those exposed to dim light, but in both groups, the exercise mice had better retinal performance than their non-exercised cohorts. C) In the toxic light exposure group, treadmill mice had much greater retinal function than stationary mice.  The a-wave amplitude measures cone and rod function in an ERG via

Structural changes to the photoreceptors were also found.  In the mice exposed to dim light, there was no difference in the number of photoreceptor cell nuclei in the the exercise or non-exercised groups. But in mice exposed to toxic bright light, the exercised group had preserved photoreceptor nuclei, while the stationary mice lost approximately two rows of photoreceptor nuclei and suffered tissue disorganization.

Compare the number of photoreceptor nuclei in C (non-exercised mice before toxic light exposure) to D (non-exercised mice after toxic light exposure).  Both exercised and non-exercised mice suffered photoreceptor changes after toxic light exposure, but these changes were significantly more severe in the stationary mice group. via

Conclusion
The data very clearly implies that aerobic exercise can help our retina better withstand degenerative events.  Researchers theorized that brain derived neurotrophic factor (BDNF) was the essential protein activated with exercise that had neuroprotective benefits. Could BDNF be isolated outside of exercise to help in the treatment of conditions like macular degeneration?  Previous studies have shown unwanted side effects with the injection of neurotrophic factors, so at this time exercise is the best and safest way to activate the protein. We don't yet know how much or how long a person should exercise in order to produce enough BDNF to be effective. The results are convincing enough that I now add exercise to my list of recommendations for how patients can help prevent macular degeneration progression, along with wearing sunglasses, not smoking, and nutrition/AREDS 2 vitamins.  It's also a great recommendation for people with genetic risk factors for macular degeneration -- this study implies exercise can protect against retinal damage, so starting regular exercise while the eyes are healthy could be essential to protecting life long vision.

CooperVision continues to streamline their portfolio of available contact lens products by dropping older low oxygen permeable hydrogel lenses in favor of newer technology.  Beginning in April, here are the changes in product availability:

Discontinued Trials, Boxes still Available
No trials means that doctors cannot start new fits for this lens, and they cannot order replacements for lost or torn lenses.  Usually discontinuing trials is a precursor to discontinuing the lens itself as a way to pull it off the market less abruptly.

• Biomedics XC (also called UltraFlex XC)  

• Frequency 55 Toric 

Note the slightly whitish hue of the drop inside?  That's because this product isn't water or saline but an oil-based emulsion that's made to act like a restorative version of your own tear film.

We're launching a new feature on the blog today, bringing you advice on the top trends and technology in eyewear straight from the people who know it best, your optometrists!  If you are active on Instagram you'll definitely recognize our first featured OD; with over 2,000 followers, Dr. Fartash posts daily as @glamoptometrist about her favorite eyewear and eye-themed fashion.  She is a 2nd generation optometrist, born and raised in Orange County, California.  A graduate of SCCO (Southern California College of Optometry), she practices in both optical and private practice settings, as well as doing bedside exams at nursing facilities.  "What drove me to start a blog and Instagram was my passion for fashion.  Luckily, in optometry we are able to have both worlds collide."



Current Eyewear: As I am writing this I am wearing my Dolce & Gabbana horned rimmed ophthalmic glasses.  I have recently been more daring in the frames I wear and choose to live in color! So most of the newer frames I wear have lots of personality, like my pink Cartier [above] and red SEE glasses [below]. 

Dolce & Gabbana frames (left) and SEE frames (right)

Tom Ford Sunglasses

Cipro is commonly prescribed for bacterial infections of the sinus and GI tract via

Last month oral fluoroquinolones, which include the popular antibiotics Levaquin (levofloxacin) and Cipro (ciprofloxacin), made news in Canada as new legislation passed requiring a warning label about the increased risk for retinal detachment with these medications. Health Canada (the country's version of our FDA) cited a 2012 study by Dr. Mayhar Etminan that reviewed 4,383 cases of retinal detachments in British Columbia from 2000 to 2007.  The study found a 4.5 x greater risk of retinal detachment for patients taking oral fluoroquinolones.  The mean number of days before starting a prescription for a fluorquinolone to retinal detachment occurrence was 4.8 days.  The study author could only theorize how these antibiotics could be related to retinal detachment risk; previous investigation has shown oral fluoroquinolones disrupt collagen synthesis and can cause tendon weakness.  Theories arose that a similar effect on the eye's collagen tissue could potentially cause a risk for retinal detachment.

But Canada's ruling to put warning labels on these antibiotics is not without controversy.  The FDA and the American Medical Association have not come to the same conclusion that oral fluoroquinolones pose an increased risk. Several review studies have reported no correlation between the two; a 2013 study and most recently a 2016 meta-analysis showed no statistically significant association between fluoroquinolone usage and retinal detachment occurrence. 

Retinal Detachment via

What does increase the risk?
Retinal detachments are a serious medical condition, requiring prompt treatment.  Even with quick repair, vision loss can be permanent, so recognizing the signs and symptoms of a detachment is essential to saving sight.  Retinal detachments are painless, but they do cause sudden changes to vision like flashing lights, new floaters, or blacking out or shadowing of vision.  Check this article for more.

You are at an increased risk for retinal detachment, whether you are taking oral fluoroquinolones are not, if you are:

• highly myopic (near-sighted)
• had recent ocular surgery or injection of ocular medication
• had recent trauma
• are diagnosed with glaucoma, diabetes, AIDS, or malignant hypertension
• are diagnosed with a collagen tissue disorder like Marfan's Syndrome or Ehlers-Danlos
• have a family history of retinal detachment