The typical way your eyelid appears when you have a stye. There is usually no white head because most styes are inside the eyelid!  via

If you have had a stye before, you know that you never, ever want to have one again.  The pain, discomfort, and just horrific appearance is enough to make anyone miserable.  If you have a red, sore to touch, and swollen eyelid, then stye is on the top of your list of culprits.

Australia's Fashion Week street style via

There's no doubt that one of the top trends for both men and women this spring is clear frames.  For sunglasses or ophthalmics, clear plastics are popping up everywhere.  Incorporating this new look into your spring wardrobe may be a little more difficult than previous looks that were more universally wearable from seasons past. Clear plastics can easily look bulky or like safety glasses if you don't pay attention to the details.   But when you take into account your face shape and skin coloring, you can elevate your wardrobe to the next level with this great fashion-forward look.

Pictured to the right is a great example of clear sunglasses gone right.  Sunglasses are going to be much easier to pull off because the darker lens color breaks up the clear plastic to prevent the look from going too washed out.

For ophthalmic frames, it takes a little more forethought to achieve a flattering look.  Here's a breakdown of the best frame choices to incorporate clear plastics into your everyday wear:

Michael Kors MK 832 Color: Sand  via

When looking for clear frames, think about your skin tone.  If you have really light skin, completely clear plastic can really wash out your features.  Ivory tones can be much more flattering for lighter complexions!

Michael Kors 659 Color: Crystal via

But for darker skin tones, you can really pull off anything.  The frame above has clear plastic eyepieces and crisp white temples, which makes for a really bright and fresh look.  I also really love that this frame is a smaller shape -- the oversized frames that are so popular right now can go too safety glasses in appearance when made with clear plastic.  A slightly smaller frame shape can make this look much more wearable, and less like lab-wear.

Jimmy Crystal New York, Style: Engagement  via

Another great way to pull off clear plastics is to incorporate a brighter statement on the temples.  Look for a bright pop of color, or more eye catching crystal work like the frame above.  That will keep the frame from entirely blending into your face if the color of the plastic is matching your skin tone too closely.

via

Or look for an extra pop of interest in the frame shape.  The dark color used on the temples really accentuates the cat eye shape here, adding more visual interest and dimension.  This is really one of my favorite ways to use the clear plastic trend -- pair it with cat eye for the ultimate Spring 2014 look.

I like to describe the way this lens works to the patient (briefly) because it can really set expectations to an appropriate place.  Multifocal lenses DON'T work like progressive or bifocal glasses.  Your eye is getting multiple images at the same time, and the brain interprets them.  If that sounds like it is incredibly complicated and difficult for the brain to do, it's because it is, so don't expect it to look perfect especially at first via

Time to revisit the fitting strategies of another lens that has performed very well for doctors and their patients since its introduction -- Biofinity Multifocal. This monthly contact lens offers one of the largest ranges of parameters on the market, and with so many choices a fitting guide can come in handy as new ODs develop their strategies for meeting the demands of contact lens wearers around age 40 or over (read more about the normal focusing change that occurs around 40 here).

Starting Place

1) Determine Dominance   I always like using the +1.50 blur out method -- the eye that is most bothered by the plus is the dominant eye.

2) Select Distance Power  Start both eyes with their vertexed, spherical equivalent distance power.

3) Select Add Power

Choose an add based on the following table:






Spectacle Add                                  Dominant Eye                Non-Dominant Eye
+1.00 to +1.25                                   D lens                              D lens
+1.50 to +1.75                                   D lens                              D lens
+2.00 to +2.25                                   D lens                              D lens
+2.50                                                 D lens                              N lens

Note this is different than the original fitting guide that suggested switching to the N lens as soon as you reach +2.00 add power.  Many doctors still have great success switching to N at that point, but for best distance vision and driving performance, CooperVision now suggests delaying that switch to N unless absolutely necessary.

Improving Distance
1) Over refract the dominant eye.  Try to push -0.25 up to -0.50 over the dominant eye to improve distance.
2) If that does not work, then drop back to the original vertexed power, and drop the add a step lower.
For example if you started with a -2.00 +2.00 D lens, and going as high as -2.50 over the dominant eye didn't solve the distance complaint, then try -2.00 +1.50 D as your next choice.

Improving Near
1) Over refract the non dominant eye.  Try to push +0.25 up to +0.50 over the non-dominant eye to improve near.
2) If that does not work, then drop back to the original vertexed power, and increase the add a step higher.
For example if you started with a -2.00 +2.00 D lens, and changing to -1.50 +2.00 D lens didn't solve the near complaint, then try -2.00 +2.50 D as your next choice.
3) If that does not work, then drop the add back down to the original starting place and try the N lens.
For example if you started with a -2.00 +2.00 D lens, and changing to -2.00 +2.50 D lens didn't solve the near complaint, then try -2.00 +2.00 N as your next choice.

Trouble Shooting
This goes without saying if you have read any of my other posts on multifocal contact lenses, but setting the patient's expectations is key to success.  Multifocal lenses require that both eyes are open for best vision, so comparing the two eyes is a recipe for disaster.  The patient is going to want to do this at first, and it is your job as the doctor to reassure them that it is not supposed to look the same out of each eye, especially as soon as you start making any changes to improve distance or near suggested above.  The second you switch to the N lens, distance vision is not expected to be better than 20/30+.  You have officially sacrificed the non-dominant eye's distance vision as soon as you change to an N lens, and you have to prepare the patient for that sacrifice and its pros and cons.

If your patient has higher than -0.75D cyl (astigmatism) they are likely not a great candidate -- especially if the astigmatism is on the dominant eye.  

If the patient needs a +2.25 or higher add, and has very small pupils (which is common as we age), then use 2 N lenses if they are demanding good near vision.  The D lens optical zone for distance is 2.3 mm in size, so if the patient has a pupil no larger than 2.3 mm in size, they will NEVER get into the intermediate or near zones.  As soon as you change to 2 N lenses, remember their distance at best is 20/30 so make sure they are prepared for this lowered distance expectation.

What I love about Biofinity

The comfort of Biofinity is one of the biggest perks -- very thin and highly breathable. Unless your patient has difficulty with insertion and removal and swears by the original Purevision lens because everything else is too thin, they are going to love Biofinity.  I don't think I have ever had anyone in 3 years of fitting this lens that said they didn't like comfort, unless they had handling issues or major dry eye issues (but that's why we have new daily multifocal products like Cooper's own Proclear Multifocal 1-Day).

Another potential perk for this lens is the ability to use the distance center design for off-label uses like slowing myopic progression. There are currently studies underway to investigate this usage and its effectiveness.  Recent articles in Contact Lens Spectrum have reported that using a distance center design multifocal contact lens to slow the progression of myopia may reduce the rate by 30%!  No official study results out yet with the use of Biofinity Multifocal for this purpose, but hopefully we will be getting more information soon and ODs around the country may have a new option for parents concerned with their child's visual development.

How terrible is that thick layer of yellow pollen coating everything in your home town right now?  In the City of Oaks, let me tell you, it is peak allergy season.  Sneezing, coughing, congestion; itchy, red, and watery eyes.  Luckily, there are so many great allergy eye drop products that your optometrist can prescribe, there is no reason to suffer.  Here's a break down of the best drops on the market, in alphabetic order (I am in no way affiliated with any of these companies):

With (hopefully) one last blast of winter leaving the Carolinas, it's been hard to go back to wearing sweaters for the last few days.  How can you make sweaters feel less tired?  By pairing them with a fashion forward pair of glasses of course.  Once again, cat-eye frames are a major staple of the Spring 2014 runway.  Here's a look at how resident glasses style expert, Dr. S, is styling her transition into spring.



Cat-Eyes can be worn by most any face shape, but the more subtle the up-turn of the frame at the temples, the more universally flattering the frame. Below, the BCBG frame featured cat-eye effect is very minimal, for a more subdued (and very wearable) look.


Dark frames transition easily from winter into spring, or any season for that matter.  You can mix and match with every possible outfit when your glasses are dark brown or black.  Everyone needs a darker color of frames for the sheer versatility.  You can dress them up or dress them down.  These are your staple pair of glasses, but that doesn't mean they have to be boring.  When you pick a dark, basic color, aim for a little bit of style in the frame shape, and that's where the cat-eye look can be a great option!





If you really want to transition your look into spring, though, pick a pop of color!  The cat-eye shape really stands out when a bright color is used along the temples.  A bright blue here gives this frame a much stronger pop, but any bright or bold color will treat you well this spring.  Violet, pink, and orange are very popular accent colors this season too.

Frame: Clearvision, BCBG  Style: Julietta   Color: Blue/Tan

All photos in this post are from the talented Melissa Delorme Photography

Macular Degeneration is the leading cause of blindness in the United States.  It can be found during routine eye exams, but don't wait to get your eye health checked until you have vision issues!  There is no cure of macular degeneration, and treatments that exist work best when started early in the disease process!

With Medicare announcing its 2012 payments last month, ophthalmology had a microscope upon them as questions about why $20 million was paid out to a single ophthalmologist in Florida that year.  While there is an investigation about whether these charges were fraudulent, the entire world of ophthalmology has been getting lambasted in the press over the expensive use of Lucentis to treat wet macular degeneration.



You see, Lucentis costs Medicare about $2000/injection.   But Avastin, a drug made by the same company (Genentech) that is biologically similar, cost only $50/injection.  

Lucentis is a "snip"  off the larger Avastin molecular, designed to be specifically used in the eye via

Why aren't ophthalmologists saving Medicare (and taxpayers) an estimated $1 billion by using Avastin? These recent news articles would lead you to believe they are the exact same drug, with the exact same efficacy.  And it is true that studies have shown Avastin and Lucentis do have a very similar efficacy when used to treat macular degeneration.  But Lucentis has been FDA tested and approved for intravitreal injection to treat macular degeneration, and Avastin has not.  Avastin usage in the eye is still considered "off-label" since Genentech has never sought FDA approval for this use of Avastin.

Doctor's use off-label applications of medications very frequently, and using Avastin for macular degeneration does have science to support the doctor's decision to do so.  But are we forgetting why so many doctors that were often using Avastin made the switch over to Lucentis in 2012 any way?

via

Unlike Lucentis that comes ready from the parent company Genentech for doctors to inject in their offices, Avastin has to be compounded into formulation for ocular injection.  This is the job of a compounding pharmacist, someone that the ophthalmologist or surgery center would contract with to ready their injections.  Unfortunately Florida, Tennessee, Texas, and a VA hospital in Los Angeles all had separate instances of contamination during this compounding procedure in 2011.  At least 21 people across those instances were infected by the Avastin injection, and in some cases the infection resulted in blindness.  One of the patients that lost vision sued for a reported $4 million, with litigation against the ophthalmologist, the pharmacy, and Genentech who manufactured Avastin.

Under this heavy fire, here was Genentech's statement to the New York Times:

“Avastin is not manufactured or approved and to date has not been proven safe for use in the eye,” a spokesman for the company said Tuesday.

So why would any ophthalmologist be willing to risk infection of a patient by using Avastin, if they would not have the support of the company who made that drug?  It would be a huge financial and ethical risk if doctors did not disclose to patients this risk of infection (no matter how small), and if both treatments are covered by the patient's insurance, why would the patient choose the off-label treatment with infection risk, versus the FDA-approved treatment?

It has been hard reading the news the last few days as the media has continued to spin against ophthalmology's practices.  But the truth is, ophthalmologists were using the FDA-approved treatment they had on the market to treat a condition that is the leading cause of blindness in the United States. Would you want your parent or grandparent to be blinded by macular degeneration, when there is a safe, FDA-approved treatment?  Absolutely not.  And until ophthalmologists get industry and FDA support for using Avastin safely, why would they make the switch?  Doctors have to think about their patients, and not about tax payer dollars, unfortunately.  And when you are the patient looking at 2 treatment options: one FDA approved, and one not, which would you pick?  You probably aren't thinking about taxpayer dollars at that moment either; just about your vision which is in imminent risk of permanent loss.

Optometrists, ophthalmologists, healthcare practitioners of all branches, and mostly the patients who are getting these treatments need to band together right now for what makes sense.  This is not the time for finger pointing, even though the financial burden on our health care system seems so overwhelming, blaming someone is the easiest option to "fix" things.  We want the best treatments for ourselves and our families, and doctors want to offer their patients the best standard of care.  When we want so much, sometimes it starts to get expensive.  And unfortunately, there is just no one that can be blamed for that simple fact.