For many patients, when I am performing their refraction they tell me it is a very stressful experience.  I try to make things easier by showing patients choices slowly and several times, and reassuring them when they select the same answers.  The refraction process can be stressful, but your doctor is making sure on the other side of that machine that you are getting glasses that you will be able to see clearly through.  You aren't going to end up with super thick glasses that you can't see through, no matter how many "wrong" answers you give. After all that, you finally get your prescription, and now you have the arduous task of selecting and purchasing glasses.

First; you have to select frames.  Styles, shapes, colors; that's a lot of choices!  Sometimes my patients come back several days in a row with friends and family and significant others, just to make sure they are picking the right frame.  The frames have to be comfortable and able to perform with your prescription, and of course, you have to feel like you look great in them.

But wait, you still aren't finished!  When you finally select your frames, your optician is going to review your prescription and start offering even more choices.  Thinner lenses?  Anti-reflective coating?  Scratch coating?  Transitions?  Even for people who are normally quickly decisive, the process can be overloading.  Let's clear one thing up though:  it doesn't have to be.  Here's a quick breakdown for what you need for your glasses to perform to their fullest:

1) Lens Material
Glasses are made out of several different materials, and depending on your prescription or medical conditions, your doctor is going to have a strong opinion on what will perform best.
-CR 39:  Great option for lower prescriptions; your "standard" material

-Polycarbonate:  a MUST for children or people with one eye due to previous injury or amblyopia.  Polycarbonate or a material called Trivex are required for safety glasses and preventing shattering

-High Index:  For higher prescriptions (over 4.00D typically) to keep lenses from being so heavy and thick

Photo via

-Glass: Yes, they still make this.  But select at your own risk; most doctors require you to sign a waiver if you insist on glass due to the major safety and shatter risks

2) Coatings
All glasses from a reputable optical should come with some UV coating and a baseline scratch coating with a warranty (typically 1 year).  I consider UV and some scratch warranty a minimum. Glasses are expensive, and they scratch very easily--completely decimating your vision when a scratch occurs.

Without AR coating on the left you can see major glare photo via

-Anti-Refective coatings:  Do you wear your glasses at the computer?  Do you drive in your glasses in the rain or at night?  If you answer yes to any of these, you need anti-reflective coating to prevent glare  from disrupting your vision while wearing glasses.  If you need high index lenses, then anti-reflective coating isn't even optional.  Your glasses simply won't perform without it.

-Scratch Coatings: More expensive scratch coatings are essential when you have more expensive anti-reflective coatings.  Anti-reflective coatings improve glare, but make your glasses more at risk for scratching.  Protect your investment with a better scratch guard to make your glasses perform longer.

-Transitions or photogrey:  If you spend a lot of time in and out of doors having UV protection can prevent sun damage in and around the eyes as well as reduce light sensitivity.   And they are 100% UV blocking which means they function as well as full sunglasses at protecting ocular health.

Cataract via

Cataract surgery is the most commonly preformed procedure in the US, and with new healthcare changes being actively debated, the "popularity" of cataract surgery has drawn a lot of attention.  A cataract is a thickening of the lens inside the eye, resulting in blurry, distorted vision that no glasses can improve.  For more information see this post.  Everyone gets a cataract eventually; it's part of being human.  But removing a cataract can mean more than just having clearer vision.  Studies are finding major health benefits that span beyond reading a few lines on a chart.

1) Cataract Removal Is Associated with Less Falls
Falling is a huge risk factor in the elderly population, and it means more than just injury and possible surgery.  Elderly patients that fall spend more time in hospitals, more time in nursing homes for recovery, and number of falls suffered are highly correlated with eventual death.  As many as 40% of all patients that enter the hospital over age 65 are hospitalized due to falls!  New studies show that removal of cataracts reduce the amount of falls a patient will suffer -- with better vision, patients can see and navigate their world more accurately.  

2) Cataract Removal Improves Ability for Independent Living
Similar to results seen above, studies have shown a linkage between cataract removal and better ability to live independently.  Elderly patients with cataracts removed not only fall less, they have better mobility around their own houses, and better ability to see to perform daily tasks like using the stove, and taking their own medications.

3) Cataract Removal May Improve Cognitive Ability and slow onset of Alzheimer's Disease
Imagine being stuck in a cloudy world where your daily life is limited by how poorly you see?  It is no wonder that elderly patients with cataracts have higher rates of depression and dementia.  A new study out of Paris showed that patients had improved mood and improved cognitive scores on a standardized tests following cataract surgery.  It is being theorized that this "improvement" in cognitive ability will correlate with delayed onset of Alzheimer's.  A patient with cataracts removed has better ability to see and interact with their world, keeping the mind active and engaged.

If you or a family member has been diagnosed with visually significant cataracts, it is always your choice to get them removed.  New data shows that removal means more than just clearer vision on a chart; it can make a huge difference in quality of life.  As healthcare cuts are being considered, I encourage all law-makers and all patients to keep this in mind; longer wait times might not seem such a sacrifice for cataract removal, but it could mean more falls in elderly patients, which bring with it a huge financial burden to the healthcare industry in addition to the obvious health hazard to each and every patient.  We are lucky to live in a country where a cataract can be diagnosed, and then removed in a very timely manner.  Most of my patients requiring surgery are able to have it performed on both eyes within a few months time.  I would hate to see any patient having to wait longer for a procedure that has now become so relatively low in risk with such huge rewards!

On February 15th, the Argus II retinal prosthesis was given the final clearance by the FDA as an ocular device to restore some amount of sight to patients with advanced Retinitis Pigmentosa (or RP).  This devastating disease is usually genetically inherited, and can cause severe vision loss as the photoreceptors in the retina are progressively destroyed.  While only about 100,000 Americans are diagnosed with the disease, this is the first medical device that has been proven to restore some of their lost vision.  In these patients, even a little help can make a difference in their daily life.

Argus II consists of a camera mounted on a pair of glasses image via

Argus II is really a small camera mounted to a pair of glasses that collects light information that is then transmitted to electrodes implanted in the patient's own retina.  Early research shows that the device can help patients regain the ability to detect differences in shades of light--allowing them to discern whites, grays, and blacks as different.  These differences sound small, but they can help patients regain the ability to see curbs along streets, stay on sidewalks when walking, or find and differentiate household items based on shade or color.  Some patients even reported being able to see large words or letters.  Stem cell research is also being investigated to restore the integrity of damaged photoreceptors in patients with RP, but research is still early in its progress.

The camera device transmits info to an implanted electrode, seen here image via

It's that time of year once more: my sample drawer is stocked with allergy eye drops to relieve the most common spring time complaint that brings my patients into the office--itching from seasonal allergies.   Do you suffer from seasonal allergies?  Are you a contact lens wearer?   Well fighting your itching, redness, and swelling just got a lot harder.  Contact lenses trap all of your allergen triggers right onto your eye like a little magnet.  Then every time you blink, you spread that allergy soup on your  contact lens all over your eye.  Graphic enough description for you?  Here's how we can help:

1) Don't sleep in your contact lenses
Get that allergy sponge out of your eye and give your eyes the night off.  Allergy sufferers are some of the worst patients for overnight wear because your lens buildup is never getting removed.  Not to mention, if you are using an allergy eye drop (even over the counter drops), you need to instill them when your contact lenses are out.  For more information on the best drops please see:
Over the Counter
Prescription

So take your lenses off, put in your medicine, and get a good night's rest.

2) Rub your Lenses!
When I ask people what contact lens solution they use, they often tell me "the no rub kind."  Well, let me debunk that myth.  Multi-purpose contact lens solutions like Opti-Free, Renu, and the generics work best when you rub your lens gently with solution in the palm of your hand. If you have purchased "no rub" solution, turn the box around and read the fine print.  "No Rub" solutions require that you hold the lens under a stream of contact lens solution for 30 seconds.  30 seconds!! Are you doing this?  If you are using these solutions properly, you will go through an entire bottle within 2 weeks!!

No Rub--but you need to hold the lenses under a stream of solution for 30 seconds! Just read the back of the box for all the fine print about these statements!

3) Change to Clearcare or Hydrogen Peroxide Solutions
NOTHING cleans your lenses better than Clearcare.  I love this solution for allergies, dry eye, and just people who wear monthly lenses but feel like they are getting "dirty" by the last 2 weeks.  Hydrogen peroxide solutions require that you let the lenses sit overnight for a minimum of 6 hours, but in the morning, your lens is going to feel much cleaner and fresher than any multi-purpose solution can achieve.  And this is one solution that really is "no rub"!



3) Switch to Daily Disposable Contact Lenses

If you have severe seasonal allergies (or especially year round allergy issues), there is nothing that will improve your suffering more than changing to daily disposable contact lenses (well, other than wearing glasses instead of contact lenses).  Daily lenses are such a great option because your eye gets to start with a fresh new lens every single day.  All of the pollen, dust, cat hair -- whatever your allergen trigger is that collects on the surface of your contact lens all day long just gets thrown in the trash at the end of the day.  Ahh, immediate relief.

Growing up, I always just thought that my vision was what it was.  I'm sure most of you felt the same way:  I needed glasses so I had "bad" eyes.  But with glasses (or eventually contact lenses) I could see 20/20 again, so I was "artificially" perfect again.  Everything seemed that simple.  You read the 20/20 line, you pass the test.

Photo via wikipedia.  Without glasses, vision for people with one, two, or three units of near sightedness get's markedly blurry.  With glasses, even people with near sightedness (or myopia) will see the clarity of the chart on the far left.  Even with the best prescription, most people will not be able to see any lines under the red line, which denotes perfect vision.  20/20 is considered "perfect" vision, but some people can see things even smaller than this!

But imagine if you could see even better than "perfect".  Fellow optometrist, Dr. Mike Peters, explores just that in his new article with Men's Health detailing the relationship between visual performance and athletic performance. Some humans actually have the ability to see far beyond perfect 20/20-- in fact the best recorded human visual acuity is 20/8.  Imagine how much faster you would read the exit sign on the highway, or see a ball coming your direction from across the field.  Not surprisingly, the best professional athletes tend to have superb visual acuity, not to mention phenomenal depth perception and  reaction times.

So the best athletes tend to have excellent vision, but were they just born with these supernatural gifts?  Even just a few years ago, many clinicians would have answered yes, at least in part, to this question.  In the past few decades, great advances have been made in the field of vision therapy, and we are finding that your vision and visual abilities can be trained and developed just like any other skill set.  As a child, every day you are learning to use your eyes and gaining better control.  We don't start out seeing 20/20 (typically it is more like 20/80 by 1 year of age); our brain, our eyes, everything must grow to work together.  You don't just see because you have eyes; you have to learn vision just like your learn how to walk.  We used to think development of vision occurred only in childhood, but we are learning that this process doesn't just stop in elementary school.  We can continue to help train the brain and eyes to improve visual function and performance.  You won't train yourself out of needing glasses, but you can train your eyes to focus faster, have better depth perception, and process the images that you see much more quickly.  This is vision therapy.

Sound interesting?  Talk with your eye care provider to see if they offer vision therapy or sports vision services.  More and more optometrists are specializing in this field, so even if your doctor doesn't offer vision therapy, they will be able to refer you to someone who does.   Visit covd.org for more information!

Better late than never I suppose.  I've been meaning to post last weekend's NBA All-Star recap all week, and believe me, this year still delivered plenty of source material.  It seems the popularity of glasses has not waned for our nation's foremost basketball stars.

Here's the best:

Kevin Durant's outfit may be suspect, but he always gets the most flattering fit on his glasses

LeBron James' polarized sunglasses also have a gradient tint, which is quite popular this season (changing from darker at top to lighter at the bottom).  Lot's of glasses being sported by his groupies in the background too,

I actually don't think Russell Westbrook's glasses are that bad here! He's getting better at using more appropriate ly sized frames

James Harden takes home the prize for best glasses style in my book -- great fit, well-proportioned shape. His beard makes a very rectangular face shape, so the more rounded frames balance things out nicely.  However picked these frames for him: job well done.

Teammates, and masters of the NBA glasses trend.  Russell has really come a long way; he even pulls off the very hard to wear clear plastic frames here!

Everyone's glasses styles were so much improved this year, I found hardly anyone that misfired on the size and fit of their glasses.  Even Carmello's difficult to wear round frames are an appropriate fit to the size of his face -- just a very hard shape for anyone to look great in.

Carmello Anthony's round sunglasses are a difficult shape for anyone to pull off.

I'm often getting recommendations for new topics (thanks everyone-- please keep it up!!) and this is one that FOX and ABC News picked up a few weeks ago on their medical segment.  So many Americans take a daily aspirin, and any chance of a linkage with the word "blindness" is quite a scary concept to hear about on the news.  But it's not time to shelve your aspirin yet if you regularly take it at the advice of your primary care doctor -- let's get down to the real facts about this new report.

Aspirin use MAY be linked to worsening Macular Degeneration

Dry Macular Degeneration

Firstly, do you have macular degeneration? If the answer is no (your eye care provider checks for this at every comprehensive examination), then this new possible linkage between aspirin and possible vision loss does not apply in your case.  Macular degeneration is a condition that destroys central vision,  typically affecting us as we age.  Risk factors for this disease include genetics, sun exposure, aging, and smoking.  There are two forms of macular degeneration: dry (the least visually devastating form) and wet (where there is active bleeding inside the eye, typically resulting in permanent reduction of vision).  Macular degeneration even its most advanced form will never cause complete blindness, but it can distort central vision so badly that it is hard to read, recognize faces, or do any of the fine detail tasks that we perform in every day life.

The new study in question followed around 2,000 participants in Sydney, Australia.  Results appear to show a correlation between daily aspirin use and the incidence of "wet" macular degeneration. Only 0.8 percent of non-aspirin users developed wet macular degeneration over the 15 year study period, while 1.9 percent of aspirin users developed the aggressive form of the disease.  Scientists say that the numbers are too small to point to definitive information that aspirin may worsen macular degeneration, so expect to see new studies launched in the near future to explore this research further.  For now, if you are taking aspirin recommended by your primary care physician, it is advisable to continue.  For those patients who do have macular degeneration, there may be more of dialogue regarding regular aspirin use between your eye care provider and your primary care provider to see if there are other alternatives.