Hopefully everyone has wonderful plans for the fourth -- be it relaxing at home or enjoying some time outdoors (hopefully if you are going to North Carolina beaches things will be clearing up later this holiday weekend from Hurricane Arthur).  No matter where your travels take you, the 4th of July is typically a time spent outside so be sure to protect your eyes with your favorite pair of sunglasses.  Here's some Independence Day inspired looks if you need some last minute suggestions to get you in the spirit:  Red  Alexander McQueen Sunglasses via
White Michael Kors Jemma Aviators via


Blue Mirrored Ray Bans via



And if you want it all---Sheriff & Cherry Americana Sunglasses via

Ocular vitamins have long been a mainstay for macular degeneration management, since the first AREDs study was reported back in 1999.  Subsequent investigations have adjusted what vitamins to include in our recommended formulas: removing beta carotene, adding lutein and zeaxanthin, not adding Omega 3s... It has been an active and ongoing investigation to determine which supplements truly seem to help.  But a recent article published by Dr. Awh in Ophthalmology has raised a new question: does your genetic make-up influence what supplements work for you?  The results were surprising, and have the ocular medical world taking a second look at just how important genetic testing with macular degeneration might be.

Published data from Dr. Awh's review showing different breakdown of genes performed better with different nutritional supplementation routines  via

Little known fact but today is a national holiday.......at least for your eyes.  June 27th has been deemed National Sunglasses Day, and if you didn't already do so every single time you step outdoors, it is time to rethink the importance of donning a pair.  Sunglasses truly do deserve a day of their own; they may be the ultimate medical  device ever created-- so fashionable and street smart we even forget that they are protecting us sometimes.

Why Should Everyone Wear Sunglasses?

We all know that sun-burnt skin carries an increased risk for skin cancers, and sun damage to the eye is no less dangerous.  The truly scary thing about ocular sun damage is that it can cause serious vision and health issues decades later.  In fact, studies report that as much as 80% of  our lifetime ocular sun damage occurs by age 18.  That means protecting ourselves at an early age is extremely important when we reach our 60s and 70s, when medical conditions like macular degeneration, cataracts, and cancers are more likely to begin developing.  You can learn more here about all of the ocular medical issues that sun damage can cause.  We should all protect ourselves right now to prevent problems later, and with sunglasses it is never too young to start.

Look closely in the mirror.  Do you notice a small elevation or a yellowish tint to the white of the eye around 3 or 9 o'clock?  That is likely a pinguecula, a growth on the eye from sun exposure.  It is not cancerous, but can cause the eye to look chronically red and irritated, can make contact lenses much less comfortable, and is often associated with worsened dry eye issues.  Sunglasses can prevent pinguecula formation, and if you already have them, they can also keep the pinguecula from getting bigger and turning into a pterygium (below) which can cause serious visual issues.

If I haven't convinced you yet of the medical need for sunglasses, don't you want to look younger?

image 1; image 2

Have you ever noticed that as we age our eyes tend to yellow and discolor, and of course wrinkles develop around the eyelid skin.  The aging process and the appearance we associate with it is really exacerbated by sun damage. In addition to UV exposure being a major health and eye disease risk, it also causes some very common changes to the ocular surface that can be cosmetically disturbing to patients.  I often have patients ask me in the exam room how they can make their eyes look brighter and whiter (and younger).  Sunglasses are essential to keeping the conjunctiva (a vascular tissue that lies over the white of the eye) clear and un-inflamed.  Sun damage quite commonly causes thickening and hardening of this vascular layer and the result is often pinguecula or even more aggressive ptergyia growths on the eye.  These conditions are irreversible, and once these growths develop they cannot be removed without surgery (and unfortunately they tend to grow back).   If you have chronic dryness issues, sun damage can be a major factor for why your eyes looks so chronically red and irritated.  Growths on the eye from excessive sun exposure are one of the first places that will dry out with computer use or in dry environments, making your eyes red, dry, and even watery.  Growths like pinguecula don't start forming just when we are older -- they are a result of sun damage that occurred when we were children or teenagers in most cases.  Protecting the eyes from childhood can prevent these growths and the dryness and irritation that can cause, but it is never too late to start wearing sunglasses now.  You can't reverse the damage you have already suffered, but you can keep it from getting even worse.

Want a new pair of sunglasses?  Luckily my good friend and fellow blogger Dr. Glover at Eye See Euphoria is raffling off 2 great pair of sunglasses today.  Enter now for a chance to win a free pair of 100% UV blocking protection, with a lot of style thrown in for good measure -- just what we want in our favorite pair of sunglasses.  Click the picture of the pair you prefer to link to his site and enter for the giveaway.

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If you haven't heard the news, NBA prospect Isaiah Austin (who was featured here in our post about
NCAA March Madness) was faced with the devastating diagnosis that he is no longer able to pursue his dream of becoming a professional basketball player.  On Sunday, the star who had already overcome blindness in one eye after a retinal detachment in high school was diagnosed with Marfan Syndrome.  It leaves many people wondering, how did it take so long for his potentially life threatening condition to be diagnosed?  Luckily an eye exam is a very common place for the initial suspicion for Marfan Syndrome to arise.  Here are some warning signs that every optometrist is looking for during a routine exam:

1) Displaced Lens

A displaced lens is easy to spot after dilation.  In acute cases it is typically symptomatic (like after an eye injury), but in Marfan Syndrome the patient is typically a child, and may have developed the displaced lens very young in life so they might not necessarily have visual complaints.  via

Far and away the most common ocular finding consistent with a diagnosis of Marfan Syndrome is ectopia lentis, or a displaced lens.  Nearly 60% of people with Marfan Syndrome will also have a displaced lens in either one or both eyes.  Lens dislocation is a result of anomalous lens zonules (the fibrous connections that hold the lens in place behind the iris), and in Marfan's is most likely dislocated superior temporal in direction.  Lens dislocation can be asymptomatic, but it can also cause double vision or distortion in 1 eye.  A dilated examination is the best way to observe lens dislocation.  A displaced lens can also increase the risk for glaucoma, making routine eye exams even more important. Another change that can commonly be seen in the lens is early cataract formation.  In most people, cataracts are a normal aging change that will begin developing around 60.  In those with Marfan's, cataracts may develop much younger in life.  

2) High Amounts of Myopia

Marfan Syndrome is a genetic anomaly of the connective tissue of the body, and the length of the eyeball is an area where this can often manifest.  People with Marfan's are typically quite tall, with long fingers and limbs.  Their eyes are also typically much longer in axial length than average, resulting in highly near sighted prescriptions.  These high prescription can be associated with other ocular issues like amblyopia (lazy eye) and strabismus (eye turn), as well as an increased risk for retinal tears and detachments due to the excessive stretching of the retinal tissue over the elongated globe.  The signs and symptoms of a retinal detachment are an ocular emergency, so a patient with Marfan's should be well aware of what to look for:

• flashing lights
• a veil or dark curtain falling over the vision
• a ton of new floaters or large floaters

Call your eye doctor immediately if you are having these sudden symptoms.  Retinal detachments are painless, so you are relying completely on sudden visual changes to alert you to the issue.  People with high prescriptions or other risk factors for retinal tears should wear protective glasses when in high injury risk environments (like playing sports).

3) Difficulty with Contact Lenses Due to Anatomy

In addition to the common associates above, several contact lens-related observations during a routine exam can be suspicious for Marfan Syndrome.  The patient will typically have a flat cornea but a high prescription (meaning a very long eye ball is the cause of their nearsightedness), and this flat cornea can make contact lens wear difficult.  They can also have larger than average corneal size and diameter, and can have sunken eyes (enophthalmos) with a small palpebral (or eyelid) opening.  These features: flat cornea, sunken eyes, and large corneas can make fitting the patient with contact lenses very challenging and can be a red flag to your eye doctor to consider ordering testing for the condition in the presence of other common hallmarks.

Why is Marfan Syndrome Important to Diagnose?

The inherent risk in patients with Marfan's is for cardiovascular malformations that could result in death. Heart conditions can make playing sports or activities with high demand too dangerous, and in the case of Isaiah Austin an EKG heart screening during his NBA workouts revealed the malformation in his heart that spurred the genetic screening test that confirmed diagnosis.  In any patient with a dislocated lens, Marfan Syndrome is on the top of potential associated causes, and is the finding that your eye doctor will be looking for even in young children.

I truly encourage all parents, especially if your child is an athlete, to take your child for a comprehensive ocular examination.  During the course of the exam, more than just vision is going to be assessed.  The health of the eye can be so telling for systemic and genetic overall health conditions, and a trip to the eye doctor might even help save a life!

Air Optix Colors as photographed by me

It is common knowledge that doctors hate color contact lenses.  Why, may you ask?   The oxygen levels passing through the lens are traditionally terrible --causing tons of infections and scar tissue in patients. The comfort was a disaster for most people, which means tons of complaints when you come in to see your doctor at an annual visit.  Not to mention the fact that color contact lenses are innately for "cosmetic" use, which just seemed to undermine the seriousness that a doctor needs you to approach contact lens wear and its responsibilities with to avoid complications.  Over the past few years, the market had been making a concentrated movement away from color contact lenses.  The old Durasoft lenses were discontinued, followed shortly by all of Acuvue's color contact lens products.  But there is actually, finally, a new color contact lens option that solves some of the issues that colors have been causing for years, and it just launched this month!

Air Optix Colors is available at many of your doctor's offices right now as an initial roll-out, but by August availability is expected nation wide.  The product uses the exact same Air Optix Aqua lens material and parameters, with color added into the silicone hydrogel polymer.  A breakdown of the key perks:

Dk/t = 138 in a -3.00 D lens (blowing the Freshlook Colorblends option out of the water which had a 19)
Power availablity:  plano to -6.00 right now, but will be +6.00 to -8.00 at the time of full roll-out
Wear Schedule:  Monthly disposal; nightly removal
Colors:  A wide initial range that will look familiar to Freshlook Colorblends wearers.  The only real notable absence is the amethyst option that is quite popular where I live and work.

Via

Ciba has also launched a website to "try on" colors, where you can upload a picture of yourself and then superimpose the color options over top.  The goal is to narrow the selection down at home before you try color samples on at the doctor's office.

Pure Hazel

 The color pairing here really gives the frame dimension, making for a more sophisticated look than your average colorful pair of plastic frames.



All photos are via Melissa DeLorme Photography

If you wear multiple-wear contact lenses (be they soft contact lenses with a monthly or 2 week disposal, hybrid lenses, or even RGPs), you have probably experienced the significant decrease in lens comfort common as a contact lens reaches the end of its life span.  The lens may feel grimy, filmy, and deposited.  It may feel dry and brittle along the edges.  It may move around more on your eyes, or stick more to your eyes at the end of the day.  Luckily, there is still hope for monthly, 2 week, and extended wear contact lenses to have better comfort -- you just need to look at your solution!

Cleaning your contact lenses is a lot more than just dropping them into a container with solution.  Over the course of your day, your contact lenses are exposed to airborne debris in your environment, lotions and makeup products like mascara that you use around the eye, eye drops that you are using for redness, dryness, or itching, and your own tear film.  That is a lot of exposure for a thin little piece of polymer draped over your eye every day.  To achieve maximum comfort and performance, you need to be able to remove all of this debris at the end of the day from your lenses and start fresh the next morning.  If you use a multi-purpose solution like Opti-Free or Renu, that is why rubbing your lenses is such an essential step.  But if you really want your lenses to feel brand new (or as close as possible without changing to daily disposable lenses), you need something even stronger in your solution regimen.

PeroxiClear package via

Hydrogen peroxide solutions have long been popular for contact lens wearers because they offer the best debris-removing option on the market, and they are 100% preservative free for people with more sensitive eyes.  Clear Care has been a mainstay for my office -- I am constantly running our of samples because I recommend it so often.  But Clear Care has some new competition in the launch of Bausch and Lomb's PeroxiClear which is now widely available this month on your local store shelves.  What are the differences between Clear Care and the newer PeroxiClear?  Here's a breakdown of PeroxiClear's main features and upgrades:

PeroxiClear is Faster
Neutralization time is only 4 hours whereas Clear Care has a 6 hour time window.  For most patients this shorter time may not be a huge advantage because their lenses are being cleaned overnight, but if you have a job where your schedule shifts from day shift to night shift, or an irregular sleeping schedule, a 4 hour process could have a major advantage.

PeroxiClear has an Extra Moisturizer
Bausch and Lomb included an extra wetting agent in their solution (Polymer 181) that binds moisture to the lens at a higher rate than older generation hydrogen peroxide solutions. Bausch and Lomb's own market study reports that their product strongly out performs Clear Care on the amount of surfactant (moisturizer) found on the lens surface at the end of the day, leading to better all-day lens comfort.

Color coded case = pure genius. Via

PeroxiClear's Lens Case is User Friendly
I love Clear Care, but long ago I found myself baffled by their right and left lens basket design.  Why make it so hard to see?  The little L in the corner that is beige on beige plastic?  That is a recipe for disaster in people that just took their contact lenses out!  A genius at Bausch and Lomb decided this was a problem that could be fixed, so they made the right side white so it is really easy to keep your lenses properly separated.  Especially in presbyopes or high hyperopes, this design can mean a lot.

Have you tried PeroxiClear yet?  Please leave me your thoughts and comments because I would love to hear if you find this product better than other hydrogen peroxide systems on the market!