If you have been diagnosed with dry eye, which 48% of Americans experience according to this study, your doctor has probably tried to describe the underlying cause of your dryness.  You knew your eyes were feeling badly:  itching, watering, redness, burning, pain, dryness, or blurriness between blinks are all common symptoms of dry eye syndrome.  Now it is your doctor's job to find a way to make your eyes feel better and perform more optimally.  In order to do that, they have to know what is causing your dryness.  Current literature often breaks down dry eye syndrome as one of 2 categories:

• Aqueous Deficient Dry Eye:  Basically this means you aren't making enough tear film.  In many cases this is associated with conditions like Sjogrens Syndrome where inflammatory mediators are reducing both tear and saliva production
• Evaporative Dry Eye:  Basically the tears that you make just dry right up off the ocular surface.  This type of dry eye means you are producing tear film, but the tear film is missing the proper components to stay long enough on the eye. 

Inspissated Meibomian Gland

Posterior Blepharitis

Chronic Infammation -- classic for Ocular Rosacea

Long-standing Dry Eye

In just 10 days I have the pleasure of speaking as a panelist for Allergan's VIEW (Visionary Insights for Eye Care Women) luncheon at my state's optometric society meeting.  It was such a great honor to be chosen as a speaker, representing the changing face of the new generation of optometrists--a profession dominated by females. More students than ever are graduating with their doctorate in optometry (when I first enrolled there were 16 schools in the USA, now there are 21 with more scheduled to open in the coming years).  And more students than ever are females (there is a reported 60-65% female enrollment in optometry schools across there country).

Why are so many women pursuing optometry, especially when faced with the negativity of many optometrists in today's healthcare marketplace?  There are many reasons that would appeal to stereotypic gender norms:

•  optometry is a flexible career, with part-time work available for family-minded doctors
•  shorter lenght of time in school (a 4 year program instead of 4 plus 4 or more years of residency in an MD program)
•  no surgeries, so no blood / lower stress, no life or death discussions

But we all know that for many women, these perceived "female-friendly" points may not have had any influence on their career decision at all.  My personal opinion is that optometry is appealing as a career in general, not just to women.  More than ever, women are driven to pursue higher education, and as such they are finding careers in medicine, law, and other professional degrees.  But where optometry really separates itself from other professions is the ability to focus on one topic, and become an expert at that.  Optometry is a career that appeals to the detail-oriented (maybe there are more of females with this talent/curse than males??).  You spend the entire day looking at one body part, talking about one body part, measuring and calculating minuscule changes in that body parts length and curvature.  You talk about eyes all day long.   To me, as a woman, I love having that focus, the ability to pour my entire body of knowledge and study into the smallest of details about the human eye.  Thinking of being an expert on the entire body sounds just ludicrous to me -- I don't know how primary care doctors can manage so much at once.  As an optometrist, I am the doctor you see for all eye-related questions and concerns-- the eye specialist.  You can't get much more rewarding than that for someone that loves details.

With that being said, I am not immune to the pinch of negativity in my industry. I feel my eyes are more open than ever to the uncertainties of healthcare in today's world.  I have seen the profession of optometry struggle under the weight of reduced insurance reimbursements and general perception of the value of an eye exam.  Eye exams reimburse very little through most vision insurances (between $40-50 for a comprehensive exam on average).  In the past, doctors have offset those terrible margins by relying on product sales, but glasses and contact lens marketplaces have expanded (like all products) into the realm of the internet, and doctors are feeling the heat to see more and more patients every day.  In many cases this means compromised ability to focus on the details that made our profession so unique and rewarding -- the time to discuss all of the health benefits of the exam, to investigate dry eye, ocular allergies, and UV exposure changes that affect the eye and vision.  The eye is the only part of the body to assess the blood vessels with a live view, and most of my patients are surprised to learn that I am screening them for hypertension, cholesterol issues, and diabetes during their eye exam.

So why do so few people in the general population not know that your eye exam is an important health screening?  Most people are under the misconception that if you can see, your eyes are healthy.  If you read this website routinely, you know how many times I have debunked this myth.  In most cases, if your vision is affected by an ocular disease, it is too late to improve vision, even with glasses or contact lenses.  

My charge to all optometrists, new and old, female and male, is to embrace this profession for the specialist career that it is.  We need to educate at every chance we get what we are seeing when we look at our patient's eyes.  We need to take medical responsibility for the eye -- we are the primary EYE care provider after all.  We are who you need to see for a red eye, dry eye, burning eye, blurry eye, watery eye.  You name it; we are eyes.  Embrace the medical training we have and promote it!  This is the way to bring optometry into 2014, and the new wave of female optometrists are going to be the industry leaders to usher this change in patient perception.

If you are a female optometrist or optometry student, please comment and let me know what struggles you have faced or concerns that you have about our career and our role as female doctors in shaping its future.  I want to hear from you, so that I can bring these topics to my VIEW panel discussion, and the greater audience of online readers and industry leaders!

I may have been the only person on Friday to open my work email and do a little dance of excitement when I saw the good news -- Biofinity XR is launching on November 4th!  To most of us, wearing contact lenses seems like a normal part of our day.  We don't ever worry about what would happen if there were no contact lenses being made in our prescription.  But for some people, having a soft, disposable contact lens that is available in their power at their doctor's office is a luxury they have never experienced.  With Cooper's new launch, we will finally have a contact lens that offers the thin material and high oxygen benefits that lower prescription wearers have been enjoying for a decade!

via

A typical RGP (gas permeable lens above, compared to the larger scleral lens below via

The first time most people see a scleral contact lens, the immediate response, is "wow, that's big."  The size of a scleral contact lens can be intimidating, but there are so many reasons for patients (and their doctors) to learn to love these larger contact lenses.  They offer unparalleled vision and comfort for many patients with irregular corneas, dry eye, or high astigmatism.  If your doctor has recommended scleral contact lenses for you, here's what you need to know:

A scleral contact lens fully covers the cornea and sits on the white of the eye (the sclera) via

• Scleral Contact Lenses typically range from 14 to over 18 mm in diameter, fitting completely over the cornea so that no part of the edge of the lens touches the cornea.  As such, the lens is much more initially comfortable than a smaller rigid gas permeable lens that moves around on the cornea with blink.   A scleral lens basically creates a shell covering the cornea, masking any corneal irregularities like keratoconus, scarring from refractive surgeries like RK and LASIK that have resulted in vision issues, and high amounts of astigmatism.
• Scleral lenses create a little pool of moisture under the lens that stays between the contact lens and the cornea all day.  Due to this property, scleral lenses have even been used for dry eye treatment.  Before you put your lenses in, you must fill the contact lens with the proper saline (or bath water if you will) to keep your cornea from getting irritated under the contact lens.  Most commonly recommended filling solutions are:

• Preservative Free Saline (like Unisol)
• Preservative Free Artificial Tears
• 0.9% NaCl inhalation vials (off label use but these are preservative and buffer free, making them ideal for the sensitive cornea)

• These lenses are difficult for some to learn how to insert and remove.  Since you are filling your contact lens up with a pool of solution, you have to put the lens in without dumping all of your solution out.  Your doctor will train you on the proper technique, but the Scleral Lens Education Society has a great instruction video if you need more help at home: 


• Why do I fit scleral contact lenses?  They definitely aren't a quick-fit type of contact lens, but once you have the proper lens, your patient should see better and with better comfort than they have in years.  With that being said, I typically plan for between 3-5 visits for first time scleral wearers to get the proper lens fit.  If you are a patient in the process of the fit and are feeling frustrated, keep in mind that these lenses are all made to order, and the parameters to change are very involved.  Most companies have a remake period of 2-3 months since it takes 1-2 weeks to make a new lens, and then more time to ship out and schedule a time that works for the patient's schedule.
• Wouldn't it be nice if scleral contact lenses are the end all-be all lens that works for everyone?  Unfortunately, that is not the case.  I have found that people with small diameter corneas and small eyes/tight eyelids are very difficult to fit with this lens.  I use Essilor Jupiter lenses, and their company representative discouraged fitting lenses on people with smaller than 12 mm corneas (especially with limbus to limbus astigmatism) due to the problematic issues they have encountered.  These lenses are gaining more and more popularity, but doctors are still debating the best fitting techniques and trouble shooting skills, so we may not be able to get the perfect lens for every patient yet.  With more doctors fitting sclerals, and more companies offering better parameter options, the industry may grow to accommodate more and more patient types. If you are an optometrist or student, I plan on posting tips on scleral lens fitting in a future post, so stay tuned for what I have learned so far!

I was blown away when I stumbled across these sunglasses by Midas and Moros!  If you are looking for glasses to make a bold statement, look no further.  These sunglasses take accessorizing to a whole new level.  Let's take a look, shall we:

Duchess and Heidi

Gatsby

Autumn

Crete

Their glasses are non-prescription, 100% UV Blocking and Polycarbonate (shatter-proof material), which means that you are not sporting a strong fashion statement, but protecting your eyes when you wear these sunglasses too.  All photos via

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:

Via

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!