Oregon cheerleaders sported custom school-themed contact lenses for their game on Saturday via

Did anyone watch the Oregon/Washington football game last weekend and notice something a little odd with the cheerleaders?  In addition to the usually inspiring uniforms sported by the football team (I for one am a HUGE fan of the feathered shoulders that change colors from different angles), Oregon's cheerleaders went outside of the box to show school spirit by incorporating custom contact lenses into their game day attire.  The result?  A gimmick look that as an eye doctor I can only hope doesn't catch on.

Why do eye doctors hate color and halloween-theme contact lenses so much?  We aren't against having fun, but contact lenses are actually a really dangerous device in the wrong (or poorly trained) hands.  When you break down what a contact lens really is, you can see why-- a contact lens is a piece of plastic that lays over your cornea (which by the way only gets its oxygen straight from the atmosphere since if has no blood vessels of its own).  No surprise, that little plastic piece obstructs oxygen from getting to the eye, and can result in infection or severe scarring (and permanent vision loss) if the cornea suffocates too long.  But when you have decorative contact lenses, it is easy to think of them as a fashion accessory instead of medical device, and not take the care required to safely wear lenses seriously.  Let's be frank, Oregon athletics seems to have no shortage of money, so the cost of custom contact lenses, the doctor's fee to have them prescribed (you can't buy any contact lenses legally without a prescription from a doctor even if they have no correction and are just zero-powered!), and the training for the cheerleaders to properly care for them was probably an easy expense.   I am sure that Oregon took all the necessary precautions, and that there were no harmed eyes in the entire incident.  All in good fun.  What "scares" me is the example this sets. For most people, buying custom contact lenses is excessively expensive, and the temptation is to keep the lenses much longer than they are safe to wear.  Most color contact lenses on the market have a shelf-life of 2 weeks (Acuvue and Freshlook), and never more than 1 month (Focus Monthly Softcolor).  That means total lifespan, not number of wears.  I do worry that high schools may want to copy this trend, but without the financial backing, would be tempted to put students at unwarranted risks.  And even if other schools don't want to take on the legal ramifications and responsibility of fitting students with contact lenses, it does encourage Americans as a whole to treat contact lenses with a lowered level of concern.

I'll go ahead and spare anyone wanting to comment about me taking things too seriously-- no need to "call the contact lens police", just wishing that we would all treat our eyes carefully.  When I stop having to treat patients for bacterial ulcers and corneal abrasions from their contact lens wear, and I don't have to worry about that middle of the night phone call from someone at risk from blinding themselves permanently because they didn't treat their contact lenses seriously, then maybe cheerleaders wearing crazy contact lenses for "fun" will seem like a better idea.  Until then, let's all be careful. With Halloween around the corner, the temptation to wear contact lenses unsafely is at its highest, so let's review some simple rules of advice.

Don't eat unwrapped candy.  Don't poke something into your eye unless you know everything about it.

See, easy enough.

This one isn't exactly a "bump" but I thought it would be good to include in my series (see these posts on eye and eyelid bumps).  Every once in a while,  I will have a concerned child or parent ask me about a small purple-ish circular appearance on the white of the eye.  Typically these areas are seen under the eyelids, but can appear anywhere on the white of the eye.  In many cases, they do appear to have a slight elevation over the area that is purple-hued (commonly 1-2 mm in size).  The good news-- if your eye looks like this, it is all very normal:

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A zoomed-in look via

A nerve loop of Axenfeld is a normal, often pigmented loop found in the sclera (white ocular tissue) where the posterior ciliary nerve comes very close to the scleral surface before it loops back through the sclera and then into the ciliary body.  In many cases there is a slight elevation to the area as the nerve loops back into the scleral tissue.  The pigmentation of the area may increase with time, and is commonly faint, giving a "purple" appearance instead of brown or black.  These areas can never result in melanoma, or any other cancerous or infective condition, and do not need treatment.

Unfortunately, many of my patients fear that these areas are signs of damage from pencils being poked at the eye by a classmate (usually a colored pencil of course).  Apparently pencil poking is still quite common in today's younger generation.  And apparently my office is not the only eye care specialist that gets these questionable pencil foreign body questions.  There are multiple reported cases of these normal nerve loops being mistaken for entrapped graphite pencil tips.  

Sigh of relief, if you have this, you are just a normal person after all.   But if you get poked by a classmate's pencil, probably best to still get it checked out by your eye doctor!

Most of you have probably seen the Novant Health commercial promising a doctor's visit via the web from the ease of your desk chair (or lake house deck as the commercial depicts), but have you ever wondered what the real feasibility of telemedicine is?  How likely is it that your medical condition can be accurately treated via a web chat?  How can telemedicine be practically applied?

If a patient's photograph looked like this in their retinal screening, it would prompt a call for a live office visit for the doctor to assess the patient's diabetic retinopathy in person!

The truth is, I do think there is some room for telemedicine in our future, and I am not the only eyecare provider that sees its merits.  Wills Eye Hospital (the optometrist medical bible is named for it, by the way) has a retinal photography telemedicine department, and they aren't the only one.  Similar strategies were being used in the VA Hospital system when I was rotating through several years ago.  What's so great about retinal telemedicine?  Photographs of the retina can be used to track changes for various conditions, like diabetic retinopathy and macular degeneration.  While you can't replace a one on one visit with the doctor altogether, when monitoring a condition for changes, telemedicine can be a great resource.  The patient would be able to come to the clinic with more flexibility since they wouldn't have to be scheduled into the doctor's patient care hours, a technician would be trained to take the photograph, and then the doctor would have a dedicated period of time to review the collected data and images, and then inform patients of their results.  The photography is utilized as screening tool (typically some manner of vision check and compliant questioning would also be recorded by the technician to help detect any other issues). If changes are seen in the photograph (or the patient has specific complaints to be addressed), then a live visit with the doctor would be necessitated.  If the retinal image and vision are stable, the doctor may decide to push back a live follow-up visit.  This method of treatment has proven to be effective in recent studies: at the European Retina Congress, there was a 90% agreement between treatment plans of in-office ophthalmologist visits and telemedicine reviews for a group of patients being followed with macular degeneration.  A photograph can tell the doctor so much about the ocular condition, and a trained doctor can catch the signs of even the smallest of changes.

There is a large gap between photo-monitoring retinal conditions, and ridding the need for any in person office visits with your eye care provider, so I am not purporting that a photograph will replace all patient care.  The retinal evaluation is just one small aspect of the comprehensive ocular exam, and you can't evaluate the entire retina without dilation and a live, in-office view of the retina by the doctor.  But conditions like macular degeneration and diabetic retinopathy do result in the need for more frequent monitoring than just yearly examinations, and telemedicine may help reduce the burden on the healthcare industry by offering patients convenient times without double or even triple-booking doctors.  I don't expect the type of clinical care that the commercials depict where a doctor seems to be on duty full-time with web access is the way of the future--the type of care that can be provided without direct evaluation is very limited.  But the industry around us will continue to change, and telemedicine in eyecare  may become more and more utilized as our population ages and more people are diagnosed with macular degeneration and diabetes.  The health care industy is an exciting landscape, and it is fascinating to see how new technology can entirely change the face of our standard of care!

The Leader C2 frame comes in 6 colors and multiple accent colors for the temple.  Via

Glasses fashion has always been about individuality, but Hilco is taking sports goggles to a whole new level.  Their new Leader C2 frames are Rx-able sports goggles that meet federal ASTM standards for safety eyewear.  But what makes this frame so unique is the customization potential!  You can select from a wide variety of colors to match your team uniform, and even have your personal jersey number displayed on the temple.  For kids, these customization options could make wearing their protective eyewear more appealing, as it is now a part of their team uniform.  And anything that makes wearing ocular protection fun and exciting for kids, I stand firmly behind!

I can't imagine the crickets that Huffington Post writer Amanda Chan must have faced when she pitched her recent article idea concerning contact lens safety to her editors.  Contact lens wearers are a notoriously tough crowd -- most people have a hard time listening to their doctor for advice on their contact lens wear, much less an article in a newspaper.  That's why I applaud the efforts of her article, What Every Contact Lens Wearer Needs to Know (But is Afraid to Ask), for asking contact lens wearers to question the safety of their daily practices.

Large Corneal Scar from contact lens complications.  This person will never see clearly again! Via

If you are a blog regular, you know that I can get on a major soap box about contact lens compliance.  But that is only because as an optometrist, I am constantly seeing the side effects that contact lens wear can cause.  Contact lens wear can cause permanent scar tissue, and in some cases permanent blindness!  Yet, most of us admit to treating contact lenses carelessly.

How many times in this past year have you stretched the wear time of your contact lens by a few days or weeks (if you say months, really be still my heart!).

How many times did you put the contact lens in your mouth to rehydrate it or run it under tap water?

How many times did you sleep in your lens when you know that you don't wear a lens approved for overnight wear?

And how many times did you toss your lenses into a case of multi-purpose contact lens solution without emptying the case from the night before, or even put them in fresh solution but without rubbing the lens or cleaning it in any way before tossing it in?

And we wonder why there is a 12.5 x greater risk of infection when you wear multiple-wear contact lenses when compared to the industry safety leader, daily disposable options?

I love daily disposable contact lenses because all of those major risk activities we just mentioned are negated when you wear the super-hydrated daily wear options.  No nightly wear needed--you just toss the lens in the trash (or on your nightstand for the next morning's trash) and pop in a fresh pair in the morning.  No cleaning; no risk of overwear.  It is just so easy.  But dailies only make up about 17 percent of American contact lens sales (compared to nearly 40% globally).  So if you don't wear daily lenses, make sure you are taking the steps necessary to keep your eyes healthy for years to come.  One infection can mean you can never wear contact lenses, or have quality vision!, ever again if the infection occurs in the wrong place on your cornea.  Is it really worth the risk of blindness?

Key take homes from my experience (and perfectly outlined by aforementioned article):

• Know your contact lenses.  Know how often you need to throw them away and if they are approved for overnight wear; and then follow the guidelines.  The FDA tests these lenses to get these guidelines; your doctor doesn't make them up!  But in some cases, your doctor may tell you that with your particular eyes, a certain lens is not safe for you and you may have even stricter contact lens wear guidelines.
• Know your solutions.  If you are using a "no-rub" solution, it doesn't mean that you just toss your lens in a case.  You have to read the fine-print!  A no-rub solution means you have to "power wash" your contact lens with a stream of fresh solution for 30 seconds before putting in the case with fresh solution.  If you properly are using a no-rub solution, you should use up an entire bottle within 2-3 weeks.  Best just to rub, right?
• Know how old your case is.  My oh my, have I seen some terrible looking cases.  Cases are petri dishes of bacteria-broth, and if you can actually see dirt on your case, don't put your contact lens in there.  It's a no-brainer.  I strongly recommend the every 3 month disposal of your case rule that Dr. Thau and Dr. Taylor describe in the article.

I'm a little late with my fashion week post, but better late than never.  Here's a glimpse of the eyewear top designers sent down the runway:

Just Cavalli goes futuristic in Milan.  Mirrored sunglasses continued to be a popular trend for designers.

Louis Vuitton frames with widened bridge evoke a sports goggle aesthetic.  It's hard to imagine these being popular mainstream, but definitely breaks the norm!

Burberry Prorsum in London.  While this frame shape can be challenging to wear, the graphic juxtaposition of white frame and dark lens is a definite bold statement.

Charlotte Ronson rehashes the geek chic look - oversize frames re-envisioned in clear plastics.  To me, this takes the trend way over the top, but that's what fashion week is all about.

Marc Jacobs sunglasses in dark plum, giving a harder to edge to the familiar round shape from last season that was seen more frequently in pastels.  I can imagine these darker jewel tones faring well on the market after we were bombarded with pastels and neons for the past few seasons.

Via

The medical landscape is constantly changing, and eye care providers have a new medication in their arsenal to fight glaucoma with the introduction of Simbrinza (Alcon).  Want a refresher on glaucoma? Simbrinza is a combination drop containing the carbonic anhydrase inhibitor brinzolamide with the alpha 2 adrenergic agonist brimonidine.  These medications individually have been used in glaucoma treatment for years, and with a combination of the two, the hope is that a patient will get the combined method-of-action effects of these two drugs with a lower frequency of daily dosing.

What You Need to Know:

Early FDA studies show Simbrinza to have a high efficacy in the lowering of IOP (intraocular pressure) with a reported 21-35% reduction.  The recommended dosage is 3 x a day for maximum effect.  Not surprisingly, side effects and contraindications are indicative of what we would find with each individual drug:

Most common side effects: blurred vision, eye irritation, unpleasant taste, dry mouth, and eye allergy

Price:  Around $100/ bottle for cash pay patients; coupon cards available through Alcon
      -- At this time I do not know the average copay with medical insurance to expect, but I will try to update this when I receive the information!

When Not to Use:

Like all CAIs, Simbrinza is not recommended for patients with known sulfa allergies, significant corneal endothelial loss (it can result in corneal edema in patients with conditions like Fuch's Dystrophy), or in conjunction with oral CAIs.

Like all alpha 2 adrenergic agonists, there is a risk of hypotension when combined with anti-hypertensives, an increased risk of side-effects when taken concurrently with MAO Inhibitors, and lethargy in children under 6 years of age (in as high as 50-83% of pediatric glaucoma patients! -- most specialists highly advise against pediatric dosing of this drug as a result).

The drug is Pregnancy Class C, meaning it is not advisable unless the benefits outweigh the potential risks.

Why This is Exciting News for our Industry

Any time we get new glaucoma medication, it is a step in the right direction.  Even though this particular drug only combines two existing therapies, combination drugs already on the market are so effective because they require less dosage for patients.  Imagine you were taking brimonidine and a CAI individually.  You have 2 different bottles to buy every month and as many as 6 drops to instill a day (up to 3 x a day each).  Then imagine getting just 1 bottle to keep track of for the month, and dosing half as often.  It may not seem like much of a difference, but studies routinely show that poor drop compliance is a huge reason glaucoma patients suffer progressive damage.  Glaucoma is a painless and symptomless disease, and remembering to put 6 drops in a day is probably not going to happen unless you are the most vigilant of patients.  By making your patient's drops easier to remember to take, and less of a drain on their day, you can make it easier for them to keep their pressure controlled every day of the year!