Need a little last-minute inspiration for your costume this weekend?  Your glasses don't have to be in the way for your costume; you can make them a vital part of your look!  Here are some of my favorite ideas for the season that are all about your eyewear.

Clark Kent/Superman can be cute at any age -- but he needs his glasses to complete his disguise via

Have some round frames on hand?  It's Harry Potter's signature style via

Cousin It: layer lots of Dollar Store hula skirts for the "hair" and top off with your favorite pair of sunglasses.  Just make sure you can see through those skirt straws.  via

You could also use a large alarm clock or a toy clock at your house to make this White Rabbit costume via

Instagram-famous Trotter the French Bulldog seems to have an endless collection of doggie costumes (glasses included of course). via

Hipster cat probably doesn't really love wearing glasses though, let's be honest. via

I love how these oversized sunglasses really add to your classic bumblebee costume.  via

Sure if you have safety glasses you could be a scientist.  But why not be a Jurassic Park scientist while you're at it with a quick trip to the toy section (or your kid's toy box). via

Ok, I'm not going to even pretend this is last minute.  But aviator sunglasses are essential if you are going as a pilot this year. via

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Less than 10% of contact lens wearers use RGP lenses, and this niche market hasn't seen much change in technology or price in many years in traditional lens options.  Next week prices are slated to take a sudden spike however as Valeant Pharmaceuticals institutes a price hike to their multiple RGP materials-- reports saying prices are increasing on various products from 28 to as much as 127%.  Valeant owns about 75% of the U.S. RGP market between their 2014 purchase of Bausch and Lomb (who owns the popular Boston material line) and their recent acquisition of Paragon Vision Sciences who manufacturers common lens materials Paragon HDS and Fluoroperm.  Price increases are set to take effect after October 30th. All this comes in the shadow of much larger legal issues brewing within Valeant's corporation.

For decades, parents of children born with congenital cataracts (a cloudiness of the lens that reduces vision from birth) were faced with a difficult choice.  If they did not have the cataract removed early on, the result was permanently reduced vision in the eye even if cataract surgery was performed at an older age because the eye was functionally occluded during it's prime years of visual development. However if they did remove the cataract, there was significant risk of complications with using intraocular lens implants (IOLs) at such a young age, and parents were often left with having to use high powered glasses in the affected eye until the child was older and could have a less risky IOL surgery implantation.  Both choices had major drawbacks -- a risky surgery or a child needing to wear bulky glasses with a high prescription in the affected eye that is left without a lens for several years.  Luckily research has provided us with new options, and the current recommendations from a 2014 study by the American Medical Association point towards contact lens use as being a great alternative in the pediatric aphakic patient until an IOL can be safely implanted.

Congenital cataract via

The research published in the Journal of American Medical Association Ophthalmology compared the visual outcome of infants with unilateral congenital cataracts treated with implantation of an intraocular lens immediately after removal of the cataract, or treatment with contact lenses until a child could more safely have an intraocular lens implanted.  The Infant Aphakia Treatment Study followed 114 infants with congenital cataracts in one eye removed surgically between age 1 and 6 months.  Study participants were enrolled randomly between 2 groups: 57 having immediate IOL implantation, and 57 using contact lenses for vision correction while aphakic (without a lens).

The Results:

At 12 months old, infants in both treatment groups had no statistically significant difference in visual acuity (measured with grating acuity).  The IOL group had more intra- and post-operative complications, higher cost of treatment (by 38%), and higher stress reported by parents or caregivers 3 months after surgery.

At 4.5-5 years old, children were again assessed.

Vision: The average visual acuity between both treatment groups had no statistically significant difference.  50% of children in both groups had "poor visual acuity" out of the treated eye (vision was equal to worse than 20/200 in that eye).  Twice as many children had "good visual acuity" (greater than or equal to 20/32) in the contact lens group compared to the IOL group; 23% of the contact lens group had good acuity versus only 11% of the IOL group.

Ocular Alignment: A high number of patients in both treatment groups had issues with strabismus (an eye turn) in the treated eye.  37% of children in the contact lens group and 43% in the IOL group had strabismus surgery by age 5.

Adverse Effects:  There was a significantly higher complication rate in the IOL group compared to the contact lens wearing group.  56% of contact lens wearing group had had at least 1 adverse event as compared to 81% of children in the IOL group with adverse events.  Glaucoma developed in statistically similar rates between each group.  Contact lens adverse events included corneal abrasion, ulceration, and infections, but none of these events resulted in corneal scars that were considered to impact visual acuity.  Three patients in the contact lens group had IOL implantation before age 5 due to issues with "the day to day contact lens changing and maintenance."

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Additional Surgeries:  At age 5 only 21% of the contact lens wearing group had to have additional intraocular surgery compared with 72% of the IOL group.  The most common surgical procedures were clearing the visual axis of opacity (lens reproliferation, hemorrhage), followed by glaucoma surgery.

Conclusions:
This study did not demonstrate any visual benefit of recommending IOL implantation at the time of infant cataract extraction as compared to leaving the child aphakic and correcting vision with a contact lens.  Due to the significantly higher risk involved with IOL implantation at such a young age, it should only be considered if there is a reason that parents or the child will have extreme difficulty with contact lens insertion, removal, or wear.

This quote from study author Dr. Scott R Lambert, MD sums it up nicely:
"We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL," Dr. Lambert said. "However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child's best interests."

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On a personal, today's post was inspired by a friend of the blog's recent battle with congenital cataracts in her newborn son.  Christina was featured back in 2013 as part of our local blogger sunglasses initiative, and her son, Thomas, has recently had successful bilateral congenital cataract removal.  Just like this study suggests, her doctor has recommended leaving Thomas aphakic and they are about to start with contact lens wear in the coming weeks.  If you want to follow along with Christina and Thomas, just check their blog for regular updates at Carolina Charm. We are wishing them the best in the next step of their journey!

The first hard (rigid gas permeable) contact lens was introduced mainstream in the 1970s.  If you or your parent recounts their lens wearing experience from this decade, it usually is not with fond memories.  The lenses weren't comfortable, you had to clean them with much greater care, and they were a lot more expensive.  So when disposable hydrogel (low oxygen permeable) soft lenses hit the market in 1987, and then later high oxygen permeable (silicone hydrogel) soft lenses became available in 2002, many thought RGP contact lenses would go the way of the dinosaur.  Who would want hard contact lenses they kept for a year or two at a time when they could have a new, fresh, inexpensive, comfortable lens exchanged out monthly (or even more often!)?

Debris (in this case microscopic balls of mucin) trapped underneath your contact lens can result in increased risk for inflammation and infection of your eye with contact lens wear.  It's much more common to get debris like mucin balls under soft contact lenses as compared to under RGP lenses. via

The truth however, defies that expectation.  RGPs continue to make up around 7-10% of the contact lens wearing market, and the number of wearers has not been steadily declining, but instead remaining stable over the last decade.  The two biggest reasons for the resilience of RGP lenses in the marketplace are visual quality and excellent ocular health benefits.  Soft contact lens wearers suffer from microbial infections at an average rate of 4/10.000 wears per year; RGP wearers only have infections at a rate of 1.2/10,000 wears per year.  So if we are throwing away soft lenses more regularly, why do we have more infections with these lenses than the older generation RGP materials?  The answer lies to a large extent with how your tear film moves underneath the contact lens.  Tear film movement is responsible for washing away debris, bacteria, and cycling nutrients in a regular flow out from underneath the contact lens with every blink of your eye.

Understanding Tear Film Exchange

Imagine the front surface of your eye.  Your cornea is continuously coated in tear film.  That tear film expresses with every blink, moving across your eye and then drained down your nasolacrimal duct through the puncta openings in your eyelid.  The tear film helps keep your eye hydrated; it's essential for comfort, oxygen transmission, and clear vision, and also is responsible for flushing away debris and contaminants that your eye gets exposed to regularly in the atmosphere.

There are multiple layers to your tear film, and when you place a contact lens on the eye, the tear film must split to both coat the lens surface and the space between your cornea and your contact lens. via

Now imagine putting your contact lens on your eye.  When the lens sits on the cornea, it splits your tear film in half; some of the tear film now goes over top of your contact lens, but some of it remains underneath the lens, sandwiched between your lens and the cornea.  In order to properly flush "dirty" tear film off the eye with your blink, you must move not just the tear film from over top of the contact lens, but also the tear film from the behind the lens. This is the limiting step with soft contact lenses.  Tear exchange is measured in units of tear turnover time; T95 represents the time in minutes for 95% of the tear volume to be eliminated from under the lens.  The lower the T95, the faster (healthier) the movement of tear film from under the lens. Studies show the average T95 for soft contact lenses is around 30 minutes; the  average T95 for RGP contact lenses is around 5 minutes.

Why do RGPs exchange tear fluid so efficiently?  

1. Smaller Diameter:  The average RGP is about 5 mm smaller than the average soft contact lens, and because it is smaller, it is easier for tear film to move freely underneath.

   RGP lenses are typically between 9-10 mm in size via

   A well-fit soft contact lens is around 14 mm in size and covers the entire cornea via

2. More Movement on the Eye:  RGPs are properly fit to have more up and down movement on the eye than soft lenses are traditionally fit.  The properly fit RGP lens will move 1-2 mm vertically with blink.  A soft contact lens typically moves around 0.5 mm.  The lesser movement of soft lenses is one of the reasons that they are considered to be significantly more comfortable on the eye than RGPs.  Mobile RGP lenses bump against your eyelids as you blink, creating lens awareness (let's face it-- that's a euphemism for discomfort) that's a hallmark of RGP wear. But the con of soft contact lenses eliminating this comfort problem caused by greater movement is a tighter fit that traps tear film and the debris caught inside it longer underneath the lens.  This is one of the reasons that doctors must carefully assess the fit of soft contact lenses every year for proper on-eye movement.  A decrease in lens movement with blink of just 0.2 mm can increase the wearer's risk for an inflammatory or infectious event 4.5 times higher.  Just a little too tight can mean the difference between you getting an infection this year!

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It's that time of year again -- allergy season.  My patients often tell me that they take a little break from contact lenses for a week or two during the spring or summer because their eyes bother them only when their contact lenses are in.  The reason?  Contact lenses trap irritants like dust or pollen against your eye, so when your personal irritant is "in season" you are getting a concentrated dose of it as it sticks and hangs out on your contact lens all day long.  Another reason is that when we have allergies, the inner lining of our eyelids (the palpebral conjunctiva) swells in response into layers of little bumps called papillae.  These bumps rub over the contact lens with every blink, creating much more friction and discomfort than you normally experience when your eyelids aren't having a reaction.

How can you fight back against irritation this time of year?  Here are a few simple ways to improve comfort and get your lenses back to their best performance:

Ask yourself: When was the last time you threw those lenses away?
If you can't remember, it's probably been too long.  An old contact lens is going to collect significantly more buildup because the surface becomes "stickier" as the coatings to repel debris are worn away during the lens' lifespan.  This wearing off of lens coating and hydration layers is the same reason that an old contact lens causes irritation even when it's not allergy season.  Without a good surface, the aged contact lens creates excess friction against your eyelids, increasing discomfort and also the chance for ripping or rolling under the eyelids to occur.  Not to mention that you'll be seeing worse because the lens material distorts with age, and you'll be putting yourself at risk for much more serious infections. If you are entering allergy season with a 2 week lens, and it's been 2 weeks, time to throw it away and start again with a fresh lens.  If you want lenses to perform to their best, you've got to give them a chance by disposing of them properly.

Don't go to bed without removing your lenses.
Do you usually sleep in your lenses?  It's going to make it a lot more comfortable over the next few weeks if you take your lenses out at night and clean them properly.  We need to remove all of those allergens your lens collected during the day, and give your eyes a chance to recover without a pollen-coated dirty contact lens nestled against it all night long.  Think of your contact lens like an air filter. All of the air getting to your cornea has to pass through that contact lens.  If your air filter is clogged with pollen or other microscopic debris, it's not going to let much oxygen through, and it's not going to feel so good having all that trash against your eye all the time.  You can put your lenses back in when you wake up.

Cleaning: You're Probably Not Doing it Right
Imagine your normal routine.  Do you just take your contact lenses out and throw them in your case? Well, you're doing it wrong.  Multipurpose contact lens solutions like Opti-Free, Renu, Biotrue, Revitalens, Aquify, Complete, and the generic store brands require rubbing your contact lenses with solution before  you store them in the case overnight.  Without the rub, you are leaving > 80% of the day's debris still on your contact lenses!  If you look, you'll notice the box of your solution doesn't even say no-rub anymore; that's because the published research has proven time and again that not rubbing just doesn't work.

What do you do if you are great about rubbing your lenses already, but your lenses still feel dirty and uncomfortable?  Time to invest in a stronger cleaning solution like Clear Care or Peroxiclear.  You need to read the instructions carefully because these solutions can burn your eyes if not used correctly, but for most people the extra few seconds of preparation is totally worth the way the lenses feel the next day.  Another great option is a extra strength soft contact lens cleaner that you use as an additional supplement to your normal multiple purpose solution.  These extra cleaners like Miraflow or the generic version which can be found at Walgreens are great for weekly use for an extra boost. Again, just make sure you read the instructions first because all of these deep cleaning products can't be put directly into the eye without causing serious injury.

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Do Some Prep-Work
Here's a pro-tip for year round comfort: before you put in your contact lens, put in a drop of a moisturizing artificial tear.  One drop of Systane Ultra or Refresh Optive every morning before insertion gives a nice buffer of hydration between your cornea and your contact lens, and can add as much as a few extra hours of comfortable lens wear to the end of your day.  If your eyes feel a little irritated or scratchy before you go to remove the lens, go ahead and put in another drop before you take your lens out.  A lens that has dried and stuck to your cornea will feel a little irritating and like it's not moving properly, but it won't usually hurt until after you take it off and peel a layer of cornea that was adhered to the lens with it.  A drop before removal can help lift the lens up and off your cornea and prevent those painful corneal abrasions that come from a dried out lens.

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Use a Good Allergy Drop
Are your eyes itching?  Chances are, you'll need an anti-histamine or even steroid based allergy drop to control your symptoms and keep contact lens wear comfortable.  Alaway and Zaditor are my two favorite over the counter anti-histamine drops (both need to be used 2 x a day to work effectively). There are a number of great once a day drops on the prescription market too (check this post for some of the most popular).  Remember, allergy eye drops will work best if used when you are NOT wearing contact lenses, so a great time to insert your drop is before you put your lens on in the morning, and after you take them out at night.  For eye symptoms specifically, try to avoid oral OTC allergy medications like Zyrtec, Claritin, and Benadryl.  All of these oral anti-histamines will dry your eyes out as a side effect, making your contact lenses a lot less comfortable!

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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