Let's just say spring is looking really good for eyewear.  Here's a little sneak peak at what we can expect to see for the new year:

Dolce and Gabbana  via

Dolce and Gabbana via

Bottega Veneta via

Bottega Veneta via

Giambattista Valli via

Giambattista Valli via

Marni via

Marni via

When prostaglandin analogue eye drops for glaucoma became available mainstream in the 1990s, they revolutionized glaucoma management and became the first line treatment for most patients. Now Valeant/Bausch and Lomb has submitted a new classification of glaucoma drop treatment to the FDA for fast-track approval: Vesneo, a combination drop of the proven prostaglandin analogue class with the first ever utilization of topical nitric oxide for additional pressure lowering effect.

How aqueous humor travels through the anterior chamber via

1. The most obvious ocular health concern that you'll spot is at the macula.  See those yellow color distortions right in the center?  Those are drusen consistent with dry age related macular degeneration.  This patient came in for her annual exam with a known history of AMD that was being followed, so this macular appearance was expected.  But can you see the new issue?

2. Follow the artery (the lighter colored blood vessel) up from the optic nerve and you'll come to a whitish round circle smack in the middle of the artery wall.  This is a cholesterol plaque lodged in the arteriole, called a Hollenhorst plaque.  Luckily you can see blood passing through the artery to the other side.  If the blood vessel is white on the other side of the artery we know we have full obstruction and this would be an artery occlusion instead of just a plaque (occluded arteries are much more serious!).  A cholesterol plaque, even when there is blood passing around it, is still a potentially serious threat to vision and systemic health; if there's a blockage in your eye there is likely a risk for cholesterol blockages elsewhere too.

What You Need to Know
Cholesterol blockages or Hollenhorst plaques are often found without causing any vision symptoms, so this is just one more reason why routine ocular health checks with dilation or imaging is a vital part of everyone's preventative health care.  The patient above had absolutely no vision complaints, and unless blood flow is being blocked, likely there will be no affect on vision. If there is a plaque limiting blood flow to the retinal tissue, the patient will likely experience blacking out of vision (called amaurosis fugax or transient ischemic attacks) that can last for minutes at a time. Any sudden vision loss is always worth a call to your eye doctor, even when it is painless!

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There is no active treatment for Hollenhorst plaques in the exam chair, but finding the cause of the blockage is the first line of action. Studies suggest between 45-55% of patients with Hollenhorst plaques have significant carotid stenosis (blockage) of the internal carotid artery on the same side as the affected artery.  Your doctor will order a carotid doppler or ultrasound to detect the presence of stenosis.  If you have been diagnosed with conditions like high cholesterol, high blood pressure, diabetes, or are a smoker you are at a much higher risk of getting these cholesterol blockages due to chronic damage to your artery walls. The carotid artery is particularly at risk for cholesterol plaque blockage because it splits into multiple branches right as it enter the base of the skull.  The split into smaller passageways creates an area for cholesterol plaques to get lodged, constricting blood flow through the area.  The carotid artery is very dangerous to occlude though -- it's delivering blood not just to your eye but to your brain so a blockage here could put you at risk for serious health issues and even a stroke.

If your doctor finds carotid stenosis on your ultrasound, it will likely be treated with oral medications like anti-platelet/blood thinners (baby aspirin is a common one) and cholesterol lowering medication like the statin category of meds.  Surgical treatment is sometimes required to remove the obstruction -- typically when the carotid is > 60% stenosed surgery is the preferred treatmetn method. 

Optos retinal imaging showing a Hollenhorst plaque via

By The Numbers
While you might not notice any problems or changes in your vision, if a Hollenhorst plaque is found during your eye exam it's not to be taken lightly.  The Beaver Dam Eye Study found that those with Hollenhorst plaques or any retinal emboli were at a 3 x higher risk of fatal stroke over the next 8 years.  This is a finding not to be ignored, and just another reason that when you go to your eye doctor, you need to have retinal imaging and or dilation done every single year, even if you don't notice any problems with your vision.  An eye exam is a snapshot of your entire systemic health, and using the retina like a window into your body's inner workings can save your life.

Nonprescription reading glasses can get a bad rap -- you've seen the turnstiles at the drug store featuring bland "unisex" frames in uninspiring silver metal or black.  But wearing over the counter reading glasses doesn't have to be a fashion sentence of doom.  Today we're interviewing Angie Stocklin, Co-Founder and COO of Readers.com. Several years ago I started following Angie on Pinterest and found her to be a constant source of eyewear fashion! I was repining nearly everything she posted.  Here's her take on the best ways to let over the counter reading glasses become a stylish part of your wardrobe.

Bookworm

Brit

Allergy season is almost upon us, and itchy eyes, nose, skin, and throat is par for the course for many. But there are plenty of people out there that experience itchy, irritated eyelid skin all year round and no amount of Zyrtec or Benadryl is going to help.  In fact, they will probably make it worse. That's because allergies can cause itching, but so can dryness and inflammation, both of which are chronic and can cause you to experience red, itchy eyeild symptoms year round.

Why do the eyelids get itchy or irritated?  The skin of your eyelid is incredibly thin and delicate, and the blood vessels are quite close to the surface.  As a result, any internal inflammation causing the veins to dilate and fluid to pool under the eyelid skin is going to make a bigger impact. The thin eyelid skin swells quickly, giving you that red puffy appearance. Check out this post for more

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Another culprit to eyelid irritation is the eyelashes themselves.  Think of your lashes like little feather dusters, catching debris and keeping it away from the eye itself.  The eyelash follicle is a collection area for tons of microscopic allergens like pollen, dust, dry skin, makeup and even an inviting little home for mites like Demodex that survive off of eating your dry skin particles. Read more here. All of this is going on at a microscopic level that you aren't visibly going to see when you wash your face, and as a result, when was the last time you really cleaned carefully right into your eyelash roots? Scary, right.

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Right on the inside of the eyelash follicle in the delicate waterline area are your meibomian glands, oil glands responsible for secreting the top layer of your tear film with every blink.  These glands are easily clogged by dry skin and debris, or by anything that can harden oils like cold air, wind, inflamed eyelid skin (inflammation makes the lid margin swell and can block the gland opening), and not blinking frequently enough (like when we use computers, cell phones, or even read for long periods of time).  If your oil glands are malfunctioning, your body can even start making soaps along your eyelid margin which foam up and of course cause stinging and burning.  Keeping those oil glands open, free of debris, and properly secreting is essential to comfortable eyelids and the eye itself -- if you don't have a good tear film, your body can't blink away debris properly and you'll have worsened ocular allergies!  It's all a terrible feedback circle.

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Now that we've got the picture for why our eyelids need help, how do we clean them properly to get rid of debris and reduce irritation?  Soap and water is often much too harsh for your delicate eyelid skin, and if we are cleaning right into the lash roots, of course it could get into your eye and burn like crazy.  That's why baby shampoo was so popular for a while, but if you've ever used baby shampoo regularly for eyelid cleansing, you know it is incredibly harsh and drying for routine use.  Instead, we need a product that will clean, but won't strip all the oils from your skin and leave it parched,dry, and irritated all over again.

My Favorite Products:

Blephadex:
If you don't read anything else, just buy this.  Hands down this is the best eyelid cleansing product I have ever used.  It is coconut oil and tea tree oil based -- great for sensitive skin types and incredibly soothing.  The coconut oil will hydrate your skin while it's cleaning, and the tea tree oil is excellent for reducing Demodex colonies and inflammation.  It is an excellent eye makeup remover; you can rub it right into your lash follicles and not worry about burning or stinging.  For most people, using this product every other night will be enough on a routine basis, but if you have a lot of irritation going on you might want to use it nightly for a week to get things under control.

Pads or Foam Version via Amazon

Ocusoft: 
Before I found Blephadex I had been using Ocusoft pads for years and they work wonderfully. Excellent for nightly makeup removal, non-drying, and easy to find over the counter at your local pharmacy, Target, or even grocery store.  Ocusoft also makes an excellent pump bottle foam, a spray version for those who do better with a less aggressive approach, and even cooling gel for night time use.

Ocusoft pads have been solving eye irritation successfully for years and are easy to find over the counter at your local pharmacy or on Amazon

The HypoChlor spray or gel is a new product, great for eyes that don't need the intensity of the foaming pad and need a more gentle approach without sacrificing effective bacteria and inflammation control.  Applying HypoChlor gel at night is a great soothing way to kill bacteria and reduce eyelid swelling while you sleep. via

Avenova:

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This hypochloric acid spray is all natural and easy to use -- just spritz a few times on a cotton pad, then rub along your eyelids.  It's incredibly gentle but cuts debris and dry skin quickly without you needing to rub much at all.  This product is gentle enough for use every single day, but it kills the most common strains of skin bacteria (and even MRSA!) in under 1 minute.  If you are prone to chronic styes, this is the product for you.  I've had several patients using daily Ocusoft still get styes (a bacterial infection of the meibomian gland), and according to their data, Ocusoft can take more than 30 minutes to kill these same bacterial strains.  So if you've tried Ocusoft and are still getting styes, this prescription lid cleanser would be a great alternative.  Right now Avenova is the only product listed here that is only available with prescription, typically running about $30 at your local pharmacy.

When I'm examining the front surface of the eye in the slit lamp microscope, I'm carefully evaluating your eyelids, lashes, conjunctiva, and cornea.  The cornea is the clear tissue that acts as the window for light entering your eye -- because it is clear light penetrates unobstructed through your pupil and onto the retina for visual processing.  But when the cornea is not clear, this can greatly impact vision and ocular health long term.  Scars, corneal degenerative conditions, inflammatory events, or oxygen deprivation can all permanently cloud the cornea.  These areas of cloudiness generally aren't reversible, but  if it has happened already to you, it's your doctor's job to make sure that you know everything you need to do to prevent further corneal opacification (cloudiness).  A real common finding I see in the exam chair looks like this:

The above picture shows pannus caused by contact lens overwear/abuse.

Do you see that whitened spot at the bottom of the cornea?  There are little blood vessels inside which you can faintly see within the whitened portion.  This is a mild case of corneal pannus, about 1 mm in size which is what I will often see in my patients.  Pannus is growth of vascularized tissue within the otherwise avascular cornea -- to make that simpler, you have blood vessels growing into your cornea which causes a cloudy/whitened area within a tissue that is ideally perfectly clear for maximum light penetration.

What Causes Pannus?

1. Oxygen Deprivation From Contact Lens Wear: When you wear contact lenses, the material each lens is made from has a certain number of oxygen particles that can pass through the material in a given time.  This breathability score is called Dk/t and a quick google search can tell you what the oxygen transmission is for your current contact lens brand.  Most of today's most popular multiple wear lenses have really high Dk/t scores -- many over 100 units which is very highly breathable.   But if you don't throw your lenses away at the appropriate time, or you sleep in your contact lenses when you don't have the proper lens to do so, you are risking starving your cornea of that vital oxygen it needs. If the body let's your cornea starve for oxygen underneath your lenses, your cornea will die -- that means blindness!  Instead, it tries to save you by shooting blood vessels from the conjunctiva or the white of the eye into the cornea to help get by, but the result is pannus -- a permanent cloudy place that you will never be able to see through again.   When your doctor sees pannus they know that your contact lens habits aren't working for you -- that means changing to a higher oxygen lens material, changing your wear schedule, or if severe enough you may have to permanently change to glasses wear only.

   Much more severe pannus in a patient with limbal stem cell deficiency via

2. Chronic Inflammation: Not all of my patients with pannus are contact lens abusers.  Many of them suffer from chronic inflammatory conditions like dry eye, previous severe viral infections of the cornea, or injuries like burns.  Pannus is like scar tissue, showing areas that have been damaged by acute events or chronic irritation.  What's going on in dry eye that could cause this kind of damage?  Your tear film is the cornea's only protection from the harsh outer world -- ceiling fans, vents, bright sun, staring at the computer or your cell phone for hours at a time.  It's a hard world out there.  When you don't have an adequate tear film, your cornea is exposed to these harsh environments, and additionally the tissue begins to become inflamed.  Dry eyes are red and irritated because of the inflammation they are associated with -- the lower tear volume on your eye's surface means an excessive amount of inflammatory mediators hanging out on the eye.  Their job is to trigger your eyes to start watering to put moisture onto the eye when it is needed, but with that watering comes more inflammatory mediators and you enter a feedback circle of continuous eye irritation.  When I see pannus in a patient with ocular rosacea or dry eye, it means that we need to significantly increase lubrication with eye drops or gels, and it's probably a great time to consider a topical anti-inflammatory like Restasis or pulses with steroids like Lotemax or Alrex.

You've probably heard of Latisse, the eyelash growing serum that was discovered when glaucoma patients taking prostaglandin analogue eye drops had the desirable side effect of longer, thicker eyelashes.  But there's new research showing that not only can prostaglandins make your eyelashes fuller, they can also penetrate the skin and reduce under eye puffiness too.  XAF5 is a topical ocular ointment made by Topokine Theraeutics derived from prostaglandins that specifically targets under eye bags. XAF5 breaks down subcuntaneous (under the skin) eyelid fat that causes those pesky puffy under eye bags, or steatoblepharon in the dermatological world.  The ointment works by penetrating through the skin and binding to fat cells, shrinking them in size and also preventing new fat cell formation.