We've talked about selecting frame choices for your face shape (see these posts), but your frame selection has more importance than just style.  If you wear your glasses most of the day, they need to be specialized to perform for your daily activities.  The shape and sizes of frames can have a big impact on how happy you are with your glasses on a daily basis!  Here's a breakdown of the best choices for frame design depending on your occupation/lifestyle.

1) Computer Use

Computer users spend often long hours at the screen.  In addition to anti-reflective coatings and tints, your frame size can really improve comfort at the computer.  Your best choice depends on your personal work set-up and prescription:

• Single Vision Lenses; 1 computer screen:  In this case, smaller sized glasses can be better.  You want your glasses to be light weight, and smaller frames will limit the amount of bulk on your face.  When there is only one prescription in your lenses, you can always look through the center of your glasses and be in the right "spot" for your best vision.  Most of my patients prefer frames with nosepads at the computer so they can be adjusted to sit in the right place and with minimal pressure.  Frames without nosepads are comfortable too, but tend to slide around easily depending on the shape of the bridge of the nose.

If you prefer plastic frames, try smaller eyesize brands like Kate Spade; light weight and comfortable all day long

• 2 computer screens:  My patients often do better with slightly larger frames in this case.  The smaller your lenses are, the less area you have to be able to cut your eyes from side to side, meaning more head and neck turning.  With 2 large screens, a slightly larger lens size means less turning of your head back and forth to stay in the central area of the glasses.

Deeper segment, larger lens size, adjustable nosepads, and semi-rimless to reduce weight on your nose.  These Ray Bans would be perfect for work if you need a larger lens size

• Progressive or bifocals:  If you are wearing bifocals or full progressives (no-line bifocals) at the computer, you know that turning your neck up all day to be in the right spot is brutal on your spine.  I often recommend larger frame sizes for progressives to distribute the power better through the lens, but if it is too large, you are going to have to tilt your head back quite a bit to enter the computer area.  One solution is having separate computer glasses.  Smaller lens sizes will put the computer zone closer to the optical center of your glasses, but don't go too small!  If you computer zone is only 1-2 centimeters of the lens, it's going to be a lot more tedious to find than if you had larger glasses where the computer zone was 4-5 centimeters. This is why your optician is so vital to helping with frame selection when you wear multifocal glasses!

Put Transition lenses in these Linda Farrow frames and they could easily look just like normal sunglasses when in sunlight.  Larger frame size means you are less likely to see over the edge of the frame in your peripheral vision

Have you ever found yourself wondering why you have to pay extra to have a prescription for contact lenses?   My patients often tell me the same things:  their prescription hasn't changed in years, they like the comfort of their lenses, they just want their same prescription again.  At my office, I never renew a prescription without evaluating the contact lens on the eye, testing vision, and checking the eye carefully for any signs of damage from contact lens wear.  These actions are the contact lens evaluation, an additional piece of the exam that glasses wearers would not need.  Typically your vision insurance has a separate copay for a contact lens evaluation because they also understand that it is a separate part of the exam.  What are the components of a thorough contact lens evaluation?

Neovascularization via

We all know that 20/20 is perfect vision, but there is a very small, central area of the eye that makes those fine details of 20/20 possible.  This central vision area is called the macula.  In this ocular structure, you have the highest density of photoreceptor cells in the entire eye.  As a result, in retinal photographs this high density area looks like a dark spot in an otherwise light pink or purple retina.  Most of my patients ask me if that dark area is a problem, but as long as the color is uniform, your macula should be nice and dark.  Color variations in that area are indicative of possibly permanent, devastating visual conditions.  Here are some that I have seen in my practice to date:

Normal, healthy retina with a dark central macula.  This is your comparison photo for mine below! photo via

Diabetic Retinopathy with exudates and macular edema

Geographic Atrophy from Macular Degeneration

Macular Scarring withWet Macular Degeneration

Toxoplasmosis

Plaquenil Retinopathy

Runny nose, itching, sneezing?  In the past, you might have just reached for OTC anti-histamines like Claritin.  But when you bring these complaints to your primary care doctor, sometimes you and your doctor will opt for a prescription strength treatment.  Over the past few years, Flonase (fluticasone) has become an overwhelmingly popular choice as a prescription medication for chronic seasonal (and perennial!) allergy sufferers.  Flonase is a steroid nasal spray, meaning that its key method of action is to fight the inflammation causing all of those allergy symptoms.  Many people are aware of the long term side effects of prolonged steroid use, and there are some potential ocular effects that your doctor should discuss with you:

Via

Herpes Simplex looks similar to other more common eye infections; it takes a trained ocular specialist to determine the difference.  Photo via

Harper's Bazaar

Weather is still refusing to relinquish winter here, but there are plenty of great sunglasses out there to brighten your spirits even when you don't see the sun!

Kate Spade

Celine

Cutler and Gross

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!