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!

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.  

I am a huge fan of both Alrex and Lotemax, and there are some major changes going on at Bausch and Lomb that could make Lotemax an even more useful tool in your arsenal  The suspension version of Lotemax as we know it is no more.  Instead, Lotemax is being relaunched as a gel formulation.  I was confused at first too--- this is different than the recently launched Lotemax ointment.  The new gel formulation shouldn't cause visual blur, doesn't come in a tube like an ointment, and has all the same applications of the suspension drop with a few major upgrades:

photo via lotemaxgel.com

-No more shaking!  Your patient will get the same, full concentration when just squeezed straight out of the bottle
-70% less toxic preservative BAK than original Lotemax.  This is a major plus when treating your inflammatory dry eye and SPK
-the pH is now 6.5, closer to the pH of the natural eye, making the drop more comfortable upon installation
-the formulation also includes glycerin and propylene glycol which are common ingredients in artificial tears

FDA studies have approved the new gel for post-surgical inflammation, but just like Lotemax suspension off-label uses can vary case by case for inflammation, dry eye, and allergies.  I've yet to write my first Rx for Lotemax gel (awaiting some patient rebates to arrive at my office) but all of the data indicate that this is going to make Lotemax even more potent and useful for treating lingering inflammatory issues.

Disclaimer: I am not affiliated with Bausch and Lomb in any way.

In honor of New York Fashion week, it's time to role out the styles featured this past fall for the Spring 2013 season.  Safety glasses seemed to be a big inspiration for several designers, which is a sentence I bet that most of us thought would never be formed. Oversize glasses are reaching new extremes in this case.  I don't expect any of these looks to really take off, but the latest from the runways tend to sneak into daily wear in more subdued versions.  Here's a look at this spring's futuristic safety-inspired eye wear:

http://cacharel.com/#!/amor-amor

http://carven.com/

http://www.harpersbazaar.com/

http://www.michaelkors.com/

For your patients that do need safety glasses, this trend may help that old box of safety glasses you keep in the back room look a little less dated and sad.   The best part of oversized sunglasses?  They offer full protection from the sun, protecting even the side of your face and all eyelid skin from harmful UV rays and greatly minimizing your risk for skin cancers in those areas!

Unfortunately, Americans are being diagnosed with diabetes at record rates, which means that eye examinations mean a lot more than just screening for glasses.  I am often asked what diabetic changes in the eye look like, so below are a few pictures of some of my most advanced diabetic changes.  An eye exam is a crucial part of your diabetic care because the eye is the only part of the body where blood vessels can be seen.  If you have bleeding from damaged blood vessels in your eye, there are likely changes going on throughout your body.  I always send a letter to my patient's primary care doctors when they have been diagnosed with diabetes, reporting any ocular findings.  If we all work together (patients, and all doctors!) we can help prevent severe damage from occurring!

Non-Proliferative Diabetic Retinopathy with Diabetic Macular Edema.  Please excuse the annoying camera flash

Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Have you ever rubbed your eye and then noticed, a small clear bump on the white of the eye?  Usually rubbing will just cause redness, but sometimes excessive rubbing of the clear vascular tissue (the conjunctiva) that lays on top of the white of the eye (these sclera) can cause a cyst to form.  Think of it like a blister, like the ones you get on your feet when your shoes rub an area over and over again.  The good news:  these cysts are harmless.  The bad news:  they aren't very comfortable, and can be really hard to get rid of.

If you have a conjunctival cyst, the best thing you can do is avoid irritating it further -- that means no eye rubbing or poking at it try to get it to pop.  As you blink, you may feel the cyst under your eyelid, creating an uncomfortable irritation.  Over the counter artificial tears can help improve comfort, but until the cyst is gone, the irritation of it rubbing against your lid will persist.

This large cyst will probably require excision and drainage to fully heal.  You can see the blood vessels in the conjunctival tissue clearly here--if one gets nicked during the excision you may have a little bleeding.  This is why your surgeon is such a highly  trained professional!

How to Treat

You can try just using artificial tears and wait for the cyst to go away on its own, but sometimes a doctor's intervention can speed the process up quite a bit. Your eye care provider is going to check carefully to make sure nothing is trapped in the eye or eyelid that could be rubbing the area.  A little speck of dirt or debris could be your culprit. I have found that steroids (drops or ointments) can help decrease the size of the cyst, but they don't work with every patient.  For large, persistent cysts sometimes the only treatment is to get the cyst drained.  The procedure is painless (a topical anesthetic is used), but you may get a little bleeding due to the surrounding blood vessels in the conjunctival tissue.

Did you know that since 2007, 40% of contact lens wearers in England and Japan wear daily disposable contact lenses, but in the United States dailies only comprise 14% of the market?  See Contact Lens Spectrum for more information.  We haven't embraced daily disposable contact lenses in the US to their full potential, but here's why I think these other countries are getting it right.

1) Daily Lenses offer maximum comfort
Contact lenses get dry; it is just a fact of life.  Try putting a piece of plastic over your eye all day and why would we think they should be comfortable?  But daily lenses are the thinnest options on the market, and since you are opening a fresh pair every day, they will have no build up or deposits that plague extended wear lenses even with the best cleaning solutions.  Do you suffer from allergies?  The last thing you need to put on your eye is a lens that has been exposed to your allergens for the past 2 weeks.  A fresh lens will have collected no dust, pollen, or other allergen, so you will be getting maximum allergy relief.
I also love daily lenses for dry eye sufferers and 8+hour a day computer users.  Sometimes getting just 8-12 hours a day of comfortable wearing time is a success, and with dailies my average patient is getting 12-14 hours routinely.  With new materials like Acuvue's Trueye and Bausch and Lomb's new Biotrue 1-Day lenses, the amount of hydration and comfort with dailies continues to improve!

Daily lenses are individually packaged, so you always have a fresh lens and never need cleaning solution

2) Daily Lenses have less complications
If you have ever had an eye infection, you know the pain, discomfort, and blurry vision that comes along with it.  On top of all that, you are out of contact lenses and stuck in glasses for days to weeks.  The best way to prevent your risk of infection is to limit the amount of bacteria exposed to your eye, which is why a daily lens is such a great option.  With dailies, you have no cleaning to perform because you throw the lens away every night.  You only touch the lens one time, when you are putting it in that morning, so the risk of dirty hands contaminating the lens is much lower than a lens you wear for 2 weeks or a month. Studies report that daily disposable wearers are about half as likely to have moderate to severe bacterial infections than other soft lens wearers (link).

3) Daily Lenses offer better oxygen to the eye
The amount of oxygen transmissibilty in a daily contact lens (DO/T) is typically lower than some monthly silicone hydrogel lenses when you look at the numbers, but don't be fooled.  A monthly lens has to provide oxygen to your eyes for 30 days.  A daily lens only has to allow oxygen for one day, and  for 12-18 hours, your eye is going to be getting a lot more oxygen than it does through a conact lens that is a few wears old.  I hardly ever see signs of oxygen deprivation like corneal neovascularization, infiltrative keratitis, and corneal scarring with daily lens wearers.  What does that mean to you besides a happy optometrist?  You will be seeing better, with less redness and irritation than with other lens modalities.

A lot of patients ask me about Acuvue's Trueye marketing campaign declaring you will have whiter eyes. There is no bleaching here -- daily lenses just offer maximum oxygen and moisturization, preventing blood vessel growth (neovascularization) and a chronic "red eye" appearance that plagues dry eye sufferers and patients who are overwearing their lenses.

I know that daily disposable lenses can be a lot more expensive than older hydrogel lens options, but besides price tag, there are really no reasons to not be fitting dailies.  And for patients who want comfort, safety, and convenience, dailies can be more than worth a price difference.  Acuvue 1-Day Moist for Astigmatism has really increased the options for daily lenses in astigmatism patients, and for presbyopes I have had success with Cooper's Proclear 1-Day Multifocal lens.  There is a reason that daily wear is gaining ground (finally) in America-- up to 17% of contact lens fits in 2012 versus only 11% in 2009 (Contact Lens Spectrum).  Hopefully we can catch up with the rest of the world and embrace the best available contact lens technology at an even more increasing rate!

Have you had your systemic health checked lately?  For many people, the answer is no.  Luckily if you are getting routine eye exams, your eye doctor can detect early signs of systemic health issues like high cholesterol!  How can I see potential cholesterol issues in your eye?

Corneal Arcus: that ring of blue is really cholesterol! photo via studyblue.com

1) Corneal Arcus

Have you ever noticed a faint white or bluish ring that appears to be around the iris (the pigmented part of the eye)?  I have even had patients come in stating that they think their brown eyes are turning blue because they see this change in the mirror.  Nope, your eyes are not getting bluer; they are getting more cholesterol-y. Arcus is a ring of cholesterol deposition in the cornea (the clear dome that lays over the iris).  In the elderly, this is typically a normal change, and does not necessarily mean you have high cholesterol issues.  If we see these changes in young patients (under 40), however, cholesterol levels should be checked!

2) Arteriosclerotic Changes

When your eyes are dilated or your retina is alternatively evaluated, your doctor is paying close attention to your retinal blood vessels.  The arteries in the eye (really arterioles because they are too small to be arteries technically) will express the same health changes that arteries in the rest of your body are undergoing, making the eye a great place to assess vascular health.  High cholesterol can cause hardening of the artery (causing a whitened artery appearance instead of the normal red). In more severe cases, there can even be plaques of cholesterol that block or limit blood flow.  This can even cause vision loss in severe cases.  If arteriole changes are noted, your doctor will suggest checking blood pressure, cholesterol, and other vascular issues and may even send a note with their findings to your primary care doctor.  In many cases, these changes may not have any visual symptoms, making their detection completely dependent on you getting a health examination.

Lipemia Retinalis:  severe whitening of the retinal vessels due to elevated cholesterol photo via doctorshangout.com

A Hollenhorst plaque is a blockage of cholesterol that lodges within the retinal vasculature and obstructs flow via

3) Xanthelasma

Cholesterol can also build up as plaques on the eyelids, typically on the nasal aspects of the lid.  These areas look like elevated yellowish growths.  They can be removed by a surgeon, but may return if cholesterol levels remain uncontrolled.

Xanthelasma plaques via dermis.net

Interested in learning more about how high cholesterol affects your entire body's health?  Check out this interactive resource from Healthline where you can learn more about cholesterol's toll on individual organs and body parts.  You can also head here to see what 100% of your daily value of cholesterol looks like.  Remember, your eye is a part of your body, and even if you don't have vision problems a yearly eye exam can help detect serious systemic health issues like elevated cholesterol, high blood pressure, and diabetes that could mean the difference in a happy, healthy life.

Optometrists or students that are blog readers, this post is for you!  I just found out about an interesting new ophthalmic medication that is undergoing clinical research.  Jetrea is a new intravitreal injection designed for patients with symptomatic vitreomacular traction.  The medication is a specific enzyme lysing agent, designed to breakdown the connection between the vitreous and the retina underneath.  This injection could be utilized in patients with vitreal traction resulting in an epiretinal membrane or an impending macular hole.  At this point, research is early, and is just starting to be used in research surgery centers.

Photo via retinadoctor.com.au This OCT image shows the vitreous (thin superior line) attaching erroneously to the macula and distorting upward. There is a risk for a macular hole to develop if the traction continues.

Prior to Jetrea, removing a symptomatic epiretinal membrane could only be done with delicate surgery, involving small forceps lifting and peeling the membrane off.  Makes me glad I'm an optometrist and not an ophthalmologist. Photo via spirehealthcare.com

I know that not everyone loves glasses as much as optometrists do, but frames have really found their way into quirky and fun clothing as well.  Independent retailers like Modcloth have really popularized this "dork chic" or "geek chic" look.  Interested in trying it out?

Eye Wear Shall We Go sweater via Modcloth

Frames and Fortune Dress via Modcloth

via Red Pepper Quilts

Via Hawthorne Fabrics

Are your eyelids rimmed in red, itchy, or irritated?  Do you wake up with crusting along your eyelid margin?  Is your vision blurry sometimes between blinks?

Debris built up on the lashes causes a lot of inflammation! Get in there with a gentle massage to remove it.  photo via medlibes.com

OCUSOFT:  my very best friend for managing blepharitis

This eyelid has a ton of surface debris, and all of that inflammation is clogging up the meibomian (tear) glands that run just under the eyelashes.  This will make you eye very dry and uncomfortable as a side effect! Photo via optometricmanagement.com