Eyedolatry

Digital Glare: Combating Light Sensitivity From Your Devices

You know that feeling -- the ache behind your eyes, the heavy feeling of your eyelids, the redness and under eye circles you see looking in the mirror, and that intense sensitivity you get when you look at bright lights or step outside of your workplace and venture outdoors. This feeling of light sensitivity and tired eyes has a name -- digital eye strain. For 65% of Americans digital eye strain is wreaking serious havoc on work performance, and how your eyes feel when you're not logging those long hours at your computer and cell phone screen. The average American spends nearly 6 hours a day using mobile digital devices and almost 11 hours daily when you include time on desktop computers, laptops, and watching TV! Our eyes struggle adapting to light after logging long hours in a digital environment for two big reasons:

We don't blink as much. Blinking is essential to keeping the surface of our eye hydrated, but we blink about 50% less looking at a digital device than we do when in normal conversation. If the eye is too dry, you will experience redness, watering, vision fluctuations, stinging, burning, and light sensitivity. Think of your tear film as a protective coating, not dissimilar to enamel on a tooth. Without a good tear film coating, our corneal nerves are exposed to the elements, and they fire like crazy when they encounter things like natural sunlight or fluorescent lighting. A dry eye will water excessively when you encounter bright lights, and you will often get a burning or stinging sensation in bright lights too.

Look at your computer or cell phone in a dark room. What color light do you see coming off the screen? That's the high energy blue light that's getting so much press for causing sleep cycle, vision and light sensitivity issues! via

Digital devices emit high energy blue wavelength light. Ever noticed the bluish glow emitting from digital devices like your computer or even fluorescent overhead lighting? All digital devices emit high energy visible light (HEV) which in high amounts can disrupt pupillary constriction, sleep/wake cycles, and even increase the risk for ocular diseases like macular degenration. What does that mean to you? Our pupils constrict when exposed to brighter light to minimize the amount of light that enters your eye. Blue light disrupts pupil constriction, confusing the system so that it doesn't react as quickly or as greatly to other light sources, which in turn leaves you wincing in the glare. Delayed and irregular pupillary function can also make it much harder for you to focus between near and far, meaning that you will have a much harder time focusing clearly to drive home at night after a long day at work. And then when you try to go to sleep, the blue light you've been exposed to at higher than normal levels has been signaling your body all day to stay awake. That means you'll have a much harder time getting enough hours of restorative sleep and an unrelenting "tired eyes" feeling even when you wake up the next morning. Not to mention more pronounced under eye bags and red eyes when you get that first morning look in the mirror.

What can you do?

Luckily there are great products out there that are specifically geared to reducing your sensitivity both while looking at the screen and when you step away into normal indoor and outdoor light. My go-to choice for digital device users with light sensitivity is Transitions XTRActive. For years Transitions have been associated with sunglasses for outdoor wearers, but here's how they work even better in my opinion for indoor light sensitivity:

Transitions XTRActive in brown is nearly-clear indoors (can you see the tint above?), but has just enough tint to provide relief from the glare emanating from your screen that will keep your eyes blinking more normally, and reduce that light sensitivity you start feeling after a few hours. via

Light Tint Indoors I love the XTRActive brown for a barely-there indoor tint that protects your eyes from fluorescent lighting and the glare coming from your computer screen and cell phone. In the past we've used yellow tinted computer glasses like GUNNAR lenses for a similar effect, but the yellow tint totally colors your vision yellow, and of course looks yellow to everyone else too. The XTRActive tint is so subtle that no one is going to look at your glasses and think they are anything other than clear. And you'll see clearly out of them too.

Full Tint and UV Protection Outdoors You know the worst glare is when you get up from your computer, and then step outside for lunch. If you don't have sunglasses to immediately change into, you're relegated to suffering. XTRActive lenses fully darken outside, and are the best Transitions to date at darkening behind the car windshield. That means you're protected all day without needing multiple pairs of glasses. I especially love the XTRActive lens for that sensitive dawn and dusk commuting time where the sun is blasting you head on or through your rear view mirror, but it's too dark to see clearly through full sunglasses.

Industry Leading Blue Light Protection The best glasses for anyone with daily digital device use have to reduce the side effects of excessive HEV blue light exposure. All Transitions products are innately blue light protective. Transitions Signature VII blocks 20% of HEV blue light indoors, and XTRActive is an impressive 34% blue blocking indoors. You can couple this with great blue blocking anti-reflective coatings like Crizal Prevencia for the best indoor protection against blue light available on the market today.

Want to try the product out for free to see if it works for you? You can get a free trial decal for your glasses here.

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CooperVision Discontinues 2 Lenses; Biofinity Toric XR Set to Launch Spring/Summer

Biofinity Toric XR 7:00 AM

Lot's of announcements with the start of 2016 at CooperVision, including the impending nationwide launch of the lens we've been waiting (and waiting, and waiting) for -- Biofinity Toric XR. For patients with high amounts of astigmatism, CooperVision has been the only company providing soft contact lens options that aren't custom order for this community for years. But Frequency 55 Toric XR is limited by its' low oxygen permeability (Dk/t is 15.7 in this lens -- other monthly disposable lenses on the market typically have numbers over 100), and the more updated extended power range option Proclear Toric XR isn't much better at 30.9 Dk/t. Proclear Toric XR has also been notorious for easy ripping, a headache for patients and your doctors! Biofinity Toric XR will be the first lens that isn't custom order that is made in a highly breathable silicone hydrogel material (Dk/t for Biofinity is 116). This higher breathability is a needed improvement for patients that have suffered scarring or corneal health changes from the lower oxygen materials they've been stuck with due to their high prescriptions in the past. The lens has been launched on a very limited initial roll-out already (about 400 offices nationwide), but is slated to be released nationwide between April and June/July. Here are the details:

Biofinity Toric XR

Power Range:

Sphere +10.00 to -10.00 (0.50 steps above +/- 6.00)
Cylinder -2.75 to -5.75 (in 0.50 steps)
Axis 0 to 180 (in 5 degree steps)
in Rx ranges from +8.50 to +10.00 cylinder axis is only available -0.75 to -2.25 at this time

Discontinued Lenses

CooperVision discontinued two older hydrogel lenses with the start 2016 effective immediately:

Frequency 55 Sphere (1 month disposable)
Vertex Sphere (2 week disposable)

Please note that Frequency 55 Aspheric was not discontinued and has not been slated for such at this time. No toric lenses were discontinued, so Frequency 55 Toric and Vertex Toric are still currently available.

This lens is now discontinued, but Frequency 55 Toric and Frequency 55 Aspheric are both still available. via

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An Intro to Refractive Surgery Options

can keratoconus have LASIK? 7:02 PM

In today’s world, there isn’t just one way to achieve clearer vision. If you are ready to move on from glasses and contact lenses, current refractive surgery options are better than ever. So what is the right surgical option for you? Short answer: it depends. So many factors play into which surgery will be most successful for your individual eyes, and your doctor will help you make the right choice based on your own needs. Here’s a brief overview of the most popular surgery choices on the market today, and some of the key factors that make certain surgeries more ideal for certain patients.

LASIK (Laser Assisted Stromal In-Situ Keratomileusis)

A flap of the cornea is removed during LASIK
that is reapplied to act as a natural bandage via

When we think refractive surgery, most of us think of LASIK. Laser eye surgery has the benefit of being quick, relatively painless, and has a very quick recovery time. Today’s most accurate version of LASIK uses the laser for the entire procedure, both to cut a flap in the cornea that will act as a natural bandage as your eye heals and to perform the thinning of the cornea that “zeros out” your prescription. This is often called bladeless LASIK or LASEK, and with its advent we’ve seen significantly better vision correction for both high prescriptions and astigmatism. Studies suggest that LASIKcan routinely correct as high as -9.00D of nearsightedness (myopia), up to+2.50D of farsightedness (hyperopia) and up to 3.50D of astigmatism. Today's Intralase procedures can accomplish as much as 6.00D of astigmstism. This power range is based on an average corneal thickness; if you have thinner corneas there won’t be enough tissue to remove to correct for higher prescription ranges. Corneal thickness is a measurement that all doctors will take to make sure you are a good candidate for surgery, and depending on the results your doctor will be better able to advise you as to whether you would still need glasses after surgery, or if surgery would be safe for you at all.

Who can’t get LASIK? People with thin or irregular corneas (conditions like keratoconus for example) are unable to get LASIK surgery due to the risks of thinning their cornea to a point of prolapse. People with corneal dystrophies, corneal scarring or a history of keloid scarring are not good candidates – if the cornea scars, you won’t be able to see clearly through it. Inflammatory conditions are also a relative contraindication; people with rheumatoid arthritis, sarcoidosis, a history of herpes infections, Sjogren’s Syndrome, or significant dry eye will all heal poorly after surgery. Nearly everyone has dryness for the first 6 months after surgery, but many people that had dry eye complaints before surgery have severe dry eye problems after the surgery, sometimes requiring lifelong treatment. Many doctors will recommend treating even mild dry eye before doing a surgical treatment to maximize the possibility for success.

What kind of vision can I expect? Studies show that 94% ofpatients will achieve 20/40 or better (legal driving vision) after LASIK. As you can see from those numbers, not everyone achieves 20/20 vision after LASIK. You’ll be hard pressed to find a doctor that would guarantee such. Vision won’t necessarily be as good as it is right now with your glasses or contact lenses after surgery, and some people will still wear night driving glasses after surgery to achieve that crystal sharp 20/20 vision if they desire it. Even if your prescription isn’t corrected to zero, it will be very close. Studies of LASIK surgeries since 2000 show 88% of eyes are within 1.00D of zeroprescription (emmetropia) after surgery, and 92 percent of eyes are within2.00D of emmtropia. After age 40, everyone that has LASIK surgery to fully correct distance vision will still need reading glasses as they go through the normal aging condition called presbyopia where our eyes naturally lose the ability to focus up close. So LASIK doesn’t mean no glasses ever again, but it does mean for most people that you will be glasses free for at least the majority of your day.

PRK (Photorefractive Keratectomy)

PRK is an older surgical procedure to correct vision that does not utilize a laser or a corneal flap as a natural bandage after the procedure. As such it is significantly more painful – expect to miss around a week from work as you recover. But the pro of PRK is that without a flap, you are fully regrowing a new cornea as the tissue heals, meaning less risk of scar tissue for people with thinner corneas or mild corneal changes that would prohibit them from LASIK. PRK is typically around the same cost as LASIK, and studies show that visually patients that underwent LASIK or PRK achieve similar post-surgical results.

Phakic IOL

What if your prescription is too high for LASIK or PRK? Your better option is to opt for an intraocular implant (IOL) that fully corrects your prescription– almost like having a contact lens implanted internally. An IOL can correct very high prescriptions, as high as -20.00D and up to -6.00D of astigmatism. The IOL is placed either in front of your iris or behind your iris and in front of the lens (phakic means that they leave your lens in place). The true perk of phakic IOLs is that nearly any prescription is possible, and if for some reason there is an issue, it is also possible to have it removed, unlike LASIK or PRK where the cornea is permanently changed. The downside to phakic IOLs is that they require a much more invasive operation. The lens has to be inserted into the eye, and since it is being placed much more internally than a LASIK or PRK procedure that only treats the cornea, there is an increased risk of cataract formation, glaucoma, or even retinal breaks or detachments. The risks of these side effects is very low; studies show 1% of patients with phakic IOL develop acataract after the surgery.

A phakic IOL sits in front of the cornea acting like an internal contact lens via

Take Home:

With so many options, the best way to select the right surgery for you is to talk with a doctor you trust. Refractive surgeons are well-versed in the options available today, and based on your personal and family medical history, your prescription, and your eye’s anatomy, they’ll be able to recommend the best option for you. Just remember, any refractive surgery may not be able to achieve perfect, 20/20 vision in all lighting conditions. Today’s refractive surgery may not mean no glasses ever again for every patient, but it will definitely significantly reduce your dependence on corrective eyewear and the freedom to see clearly without the constant hassle of bulky frames or contact lenses. And what’s more, the technology just keeps getting better. Even people with high prescriptions can now enjoy refractive surgery, even if you’ve been told you weren’t a candidate for LASIK in the past. Better versions of LASIK and now the mainstream use of phakic IOLs means that there is a surgery option for nearly everyone.

This post also appears on the CIA Medical Insights Blog as free content donation by Dr. L to help promote discussion of ocular health on their website

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There's a Bump on My Eyelid: Molluscum Contagiosum

multiple white growths on eyelid 7:00 AM

A new white-colored, painless bump appears on your eyelid margin. You've rubbed at it, and now there are more. What could it be?

image via

Molluscum contagiousum is a viral infection that is most commonly seen in children or adults with weakened immune systems. Less than 5% of children in the US are infected each year. The virus spreads from direct contact, so it is possible for you to spread the virus to different parts of your skin and to others.

Classic appearance of a molluscum lesion photographed by Dr. Dovie at Blacksburg Eye

via

You can spot molluscum skin lesions by their appearance: they are round, dome shaped growths with a depressed center and are typically white in color. They are most commonly found right along the lid margin, but can be seen anywhere on the skin around the eyes.

Like most viruses, there is no treatment for this infection. For patients with a healthy immune system, the lesions will resolve by themselves given time. A typical course of infection is two to seven weeks. As long as the lesions are visible throughout the various molluscum contagiosum stages development you are still contagious, so careful hand washing and avoiding direct contact with others is advisable to prevent spreading the virus. In children and adults with a short course of presentation, typically just monitoring for improvement is the only needed treatment. For patients that aren't improving, or show signs of multiple lesions, it is best to order blood work to rule out a systemic health condition that would compromise the immune system. Inflammatory conditions like rheumatoid arthritis and sarcoidosis (and the medications that treat them!) can cause depressed immune systems, as can systemic infections like HIV or AIDs and sexually transmitted diseases. In some persistent cases where the patient has a depressed ability to fight off the molluscum virus, the contagious lesions can last up to a year. In these instances it is possible to perform curettage, where a doctor removes the lesion and treats the area with anti-septic. Controlling the health condition that is causing immune system depression is the best way to prevent further molluscum infectious lesions after performing curettage to remove them.

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Trending: Rose Quartz and Serenity Eyewear

blue tinted lenses 10:02 PM

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What You Need To Know Before Cataract Surgery in 2016

Dr. Isaac Porter 9:19 AM

There are a few things in life that are inevitable. As a colleague of mine likes to phrase it, "If you live long enough, you will get a cataract." But developing cataracts is not a diagnosis of doom and gloom. Today's cataract surgery is as much a refractive procedure to bring you back to clear vision (maybe even without glasses!) as it is a medical one. Some of my patients are actively hoping for that cataract diagnosis from year to year so we can correct their high nearsightedness or reduce their dependence on reading glasses. And cataract surgery itself has changed so much, even in the last decade. Now there are ways to reduce healing time, and achieve more precise vision refinement. There are implants that can correct even high amounts of astigmatism, and that can help you read again free from those OTC readers. If you are about to undergo cataract surgery, here are the two questions you need to ask yourself to prepare for the best procedure for your needs:

1) Should I Get Laser Assisted Cataract Surgery?

Laser assisted surgery can have many benefits, but it is not covered by medical insurances. It's an extra expense and you need to decide if it's worth the cost for you. The laser does not do the actual removal of your cataract; you will still have to undergo surgery in the operating room to remove the cloudy lens inside your eye. Using the laser has these advantages:

Makes a more precise incision (capsulorhexis) so that the optical implant (IOL) placed inside your eye to correct vision is more likely to center perfectly and stabilize there for best vision. Without a laser cutting the capsulorhexis, your doctor will use a traditional manual cut, which even with a skilled surgeon will not be perfectly symmetric. That imperfection increases the risk of shifting and decentering of your IOL, reducing the possibility that you will get perfectly corrected vision from your implant.

This is an excellent maunual capsulorhexis, but you can see even with a great technique there is imperfection being created. via

Notice the more precise circular incision of the laser assisted capsularhexis. A more precise incision will hold the IOL (seen here with a bluish outline) perfectly centered in the visual axis.via

Breaks up the cataract prior to being physically removed in the operating room. Using the laser to break down the cataract first reduces the time of your operation, which in turn makes for less exposure to high energy phacoemulsification techniques that can increase internal inflammation and increase the risk of operative side effects like cystoid macular edema, iritis, and corneal edema (swelling).
Places more precise limbal relaxing incisions to reduce low amounts of astigmatism. If you have astigmatism left over after your cataract is removed you may still be reliant on glasses for clear vision. The laser assisted surgery can help reduce your astigmatism by placing more precise laser markings in the cornea that counteract the astigmatism present in that tissue post-operatively.
Want to learn more? Check out this great podcasts from cataract surgeon Dr. Isaac Porter:

Who is not a candidate? Dr. Porter states that most patients are great candidates for laser assisted surgery, but he would likely be unable to use the laser procedure for patients with dense corneal scars. If it is hard to visualize the eye through the scars it would be hard to align the laser properly which reduces it's usefulness.

2) Should I Get a Specialty IOL?

Medical insurances like Medicare pay for "standard monofocal IOLs", which means that only 1 aspect of your vision will be corrected. Most people will chose to correct their distance vision, which means they will need reading glasses full time after the surgery. If you have high amounts of astigmatism (typically greater than 1.00D of astigmatism), then a standard IOL will not correct for this either, and you will need full time glasses to see clearly after the surgery. Depending on your refractive needs, you can choose to upgrade to one of two types of premium IOLs:

Toric IOL: For patients with more than 1.00D of astigmatism it is unlikely that simply removing the cataract and placing limbal relaxing incisions will fully correct this. A better option is to correct your astigmatism within the implant itself. Many surgeons will recommend that you have laser assisted surgery if you chose to upgrade to a toric IOL because they can better increase accuracy for the way the IOL positions (and thus the vision you will achieve) by creating a more perfect capsulorhexis.
Multifocal IOL: Another inevitability about eyes? Around 45 you are going to lose your ability to read and do up close activities (called presbyopia). Standard implants cannot correct both your distance and your reading vision; you have to pick one. If you want to be able to see clearly again to read without reading glasses, you would need to upgrade to a multifocal IOL. These implants have rings of distance and near vision within the implant so that your brain receives both images on the retina for processing. Most people that get multifocal IOL implants may still need reading glasses under certain conditions (dim lighting, really small print, reading for long periods of time), but the need will be significantly reduced. There is also the risk for glare off of the implant because the rings in the implant will create more reflections. Your doctor will discuss the pros and cons with you, but if you want to avoid having to use full time reading glasses after surgery, this is an upgrade worth considering. You can learn more from Dr. Porter here.

A multifocal IOL via

Not everyone is a candidate for multifocal IOLs due to the possibility that the rings will reduce vision if you have an ocular condition that reduces vision or could potentially hurt vision in future. Patients with diabetes, macular degeneration, glaucoma, and other eye disease are typically excluded from multifocal implants because these conditions could lead to future vision loss that would make the ring design of the implant a hindrance to clear vision.

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Unisol 4 Discontinued; Your Best Replacement Options

contact solution sensitive eyes 11:03 AM

In fall 2015 Alcon very quietly discontinued their preservative free saline solution for contact lens rinsing and filling, the well-regarded Unisol 4. Most local pharmacies and box stores are now out of the product, and patients that have used the product loyally for years are scrambling for a replacement. If you don't think the panic is real, just check out the price gauging on ebay -- $50 for a 3 pack that would have run you under $10 just a few months ago. I've spoken with a rep from Alcon, and there was no official statement released as to why the product was discontinued, and there is no plan for reinstating the product in future. If you are in need of preservative free saline, here are a few doctor recommended solutions that can take it's place.

To Rinse Your Lenses

via

Preservative free salines make a great rinse for both soft and hard (RGP) contact lenses. If traditional multipurpose solutions burn or sting, you can rinse off your contact lenses with a preservative free saline before inserting them in the morning. Just remember, these salines are not lens cleaners so you always have to use a cleaning solution with your lenses for disinfection/overnight storage. Your best options for a preservative free rinse are:

Arm & Hammer Simply Saline Sterile Saline Solution: This is an aerosol spray can that can be used to rinse off your lenses. The spray can design prevents contamination. If you fill your contact lenses with saline before putting them in your eyes, do NOT use this product because you will be left with tons of air bubbles! Update: this is also now discontinued!

Purilens Plus: This cleaning system uses a simple preservative free saline solution in combination with a special cleaning chamber that uses UV light to kill germs and bacteria. The saline solution component is very similar to Unisol 4 in chemical component and could be safely used to rinse or fill your lenses. You can buy Purilens Plus Ultra PF sterile saline separately from the rest of the cleaning system.

CLEAR CARE Rinse and Go: Alcon launched this "replacement" for Unisol in spring 2016, made specifically for rinsing contact lenses. It is a preserved saline so it is fine for rinsing, but not suitable for filling contact lenses.

To Fill Your Lenses

via

If you wear Synergeyes or scleral RGP contact lenses you have likely been instructed to fill your contact lens with preservative free saline before inserting it into your eye. Never fill your lenses with cleaning products -- that means no multipurpose solutions and no conditioning solutions like Boston. The preservatives in these cleaners are made to kill bacteria, but they are non-discriminating in their toxicity and will kill your corneal cells too! Your best options for preservative free fill solutions are:

Addipak Saline Solution for Inhalation: These vials of saline are preservative free and buffer free so they are ideal for extended contact with the cornea.

Modudose Saline Solution for Inhalation: Also preservative free and buffer free; I've been using this brand for years and it is super affordable and easy to order in bulk on Amazon.

In a bind you can also use preservative free artificial tears like Refresh Optive Preservative Free but these over the counter lubricants do contain pH buffers which can be irritating to sensitive corneas with prolonged exposure.

The Purilens Plus Ultra PF saline mentioned above is also preservative free, so it could be used to fill contact lenses as well as rinse them. I strongly prefer the preservative and buffer free vials mentioned above, but if for some reason those aren't working well for you, the Purilens Plus is the most similar thing to Unisol on the market today.

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