Eyedolatry

CooperVision Product Discontinuations for 2018

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Meet Vyzulta, The Revolutionary New Glaucoma Therapy

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How to Spot and Avoid Dangerous Stem Cell Scams for the Eye

Stem cell treatments have promised regenerative cures for many untreatable conditions since the first successful stem cell transplant back in 1956. In the world of eyecare, where damaged retinal tissue results in permanent and uncorrectable vision loss, the prospect of recovering vision with a stem cell therapy is an understandably exciting one. Much excitement surrounded the successful Phase I/II clinical study of injecting stem cells into the eye to treat conditions like Stargardt macular dystrophy and macular degeneration in February 2015. Of the 18 patients treated with stem cell injections in that study, there were no significant adverse events and 47% of eyes showed either improvement or no worsening in vision over a 2 year period. But unfortunately these early successes in the field of ocular stem cell injections have led some to take risky approaches to gain financially from the excitement around stem cell treatments and the desperation of patients that are faced with living with permanent vision loss.

Pluripotent stem cells from the California Institute for Regenerative Medicine which is currently doing FDA approved stem cell research for retinitis pigmentosa.

In September 2017, a report was published in OSLI Retina of a 77 year old woman blinded after receiving stem cell injections in both her eyes to treat macular degeneration. Despite years of treatment for wet macular degeneration, this patient's vision was limited to 20/400 in the right eye and 20/200 in the left eye due to the severity of her disease. She reached out to a clinic in Georgia that reported doing new stem cell treatments for macular degeneration, where she thought she was enrolling in a clinical study. She paid $8,900 for the treatment, money she raised on a crowd funding website. On the day of treatment she was injected with stem cells in both eyes. A little over a month later she presented back to her usual doctors at the Florida Retina Institute with retinal detachment in the left eye, and then another 2 months later the right eye also detached. Despite multiple surgeries to try to repair the tissue, she suffered devastating vision loss. Her sight is now reduced to hand motion in the right eye and no light perception (unable to see anything at all - just total darkness) in the left eye, and she is no longer able to walk on her own.

The patient's eyes after retinal detachment repair via

What's even worse? This has happened before. In March, major news networks picked up the report of 3 women blinded after similar stem cell injections in Florida published in the New England Journal of Medicine. Like the Georgia case, these women had macular degeneration, had paid $5000 to be treated, were injected in both eyes on the same day, and thought they were participating in a clinical trial. In this instance, the study center in question was actually listed on ClinicalTrials.gov, but the National Health Institute released a statement after this report that the Clinical Trials website is open to anyone in the medical community to post a study, and the listing of a study center is not an endorsement that the FDA is supervising or involved in the study. Since that time the rules for posting a study have been updated.

With over 570 clinics advertising stem cell treatments directly to patients online, the lack of oversight by the FDA and the confusion that exists as to the safety of these treatments poses a major risk. How can you spot a potentially dangerous treatment?

Are you being asked to pay out of pocket? Federally funded clinical trials will not require you to pay to participate! Paying thousands of dollars out of pocket is a red flag that you are not in fact participating in a clinical trial.
Are you receiving treatment at an accredited ocular treatment center? The safest place to have any experimental treatment is at a center known for participating in clinical trials. Especially for ocular treatments where the risk is so great, make sure that you are being seen by an eye doctor specifically. If something were to go wrong, like retinal detachment, you'll need to be in a facility that is equipped to take you immediately into ocular surgery. Ask if there is an ocular surgeon on site to treat complications like retinal detachment if you are at a private facility and aren't sure. If the answer is no, it is a big red flag.
Are you being treated in both eyes at the same time? Never, never, never should an experimental procedure be conducted on both eyes at once. Only the worst seeing eye should be treated in a clinical study of a high risk treatment, and that eye should be observed for improvements or complications for a period of months before treating the other eye would be considered.
Is the treatment specifically approved by the FDA or under a clinical investigation that has been approved by the FDA? Stem cell therapy is regulated by the FDA, so require that you see paperwork confirming you are in a FDA regulated and approved clinical trial. You can learn more about how to spot a scam on the FDA's website.

In March 2017, a study out of Japan reported a man received the first of its kind stem cell transplant treatment for macular degeneration. One year after treatment his vision is stable with no improvement or worsening from baseline. via

The possibilities of stem cell therapy in eyecare are very exciting, but these cases show that we have much to learn about how to utilize stem cells safely in ocular tissue. If you or a loved one are considering stem cell treatment, look carefully for these red flags before taking on the risk of permanent blindness.

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Study Shows Blue Blocking Glasses Improve Visual Performance

blue blocker coatings 1:36 PM

Are you unsure of the importance of prescribing and wearing protection against high energy blue light exposure? With a number of studies published in the past decade about the potential dangers of prolonged exposure to high energy blue light from computer and screen time, blue blocking technology has been a buzz word in the optical industry. While we know excess exposure to blue light can cause fatigue, light sensitivity, and even difficulty sleeping, some studies additionally report that high levels of exposure could potentially cause toxicity within our retinal cells - increasing the risk of blinding eye diseases like macular degeneration. The debate is ongoing since only animal studies have been done to date linking this potential for retinal toxicity, so as an optometrist both my colleagues and I must decide if we prescribe blue blocking lens technology for visual performance reasons in addition to the possible health risks. Can blue blocking eyewear make a marked difference in visual performance for patients with a history of prior vision loss from eye disease? A March 2017 study published in BioMed Central Ophthalmology showed exciting results about the power of blue blocking technology!

This study caught my eye because I personally wear Transtions XTRActive in brown and Crizal Prevencia in my glasses. You can see the purplish reflections here off my Prevencia blue blocker coating when I'm working on Eyedolatry!

The Set Up

The study looked at 60 patients with a known history of vision loss. Half of the patients had central vision loss (called central scotoma - meaning they had a missing area of vision within 5 degrees of the fovea), and the other half had peripheral scotoma (vision loss outside of 5 degrees from the fovea). These patients had conditions ranging from age related macular degeneration, Stargardt macular dystrophy, diabetic retinopathy, glaucoma, Retinitis Pigmentosa, ocular albinisim, and degenerative myopia. Patients' vision was assessed both on high contrast black lettering on a white background (a traditional Snellen chart), low contrast (using the MARS contrast sensitivity chart) and with Glare Testing (where a light was shone at the patient while checking acuity to mimic the affect of oncoming glare on vision). Patients' vision was checked with their normal best corrected vision, and then the patients were fit with photochromic Transitions XTRActive lenses with Crizal Prevencia blue blocker anti-reflective coatings. Transitions XTRActive lenses block 88-95% of blue light at the high energy blue wavelength of up to 430 nm when activated. Crizal Prevencia filters 20% of high energy blue wavelength light indoor and out.

Glare Testing simulates the affect of oncoming glare on visual ability via

The Results

Wearing the Transitions XTRActive and Crizal Prevencia blue blocking glasses improved visual performance on all three types of vision test for patients in both categories of vision loss.

For patients with central scotoma the average best corrected visual acuity increased from 0.30 ± 0.20 to 0.36 ± 0.21 decimals for black on white letters. For patients with peripheral scotoma the average best corrected vision increased from 0.44 ± 0.22 to 0.51 ± 0.23 decimals for black on white letters.
Significant increases were also detected in contrast sensitivy test: the letter count for the Mars test increased from 26.7 ± 7.9 to 30.06 ± 7.8 in patients with central scotoma and from 31.5 ± 7.6 to 33.72 ± 7.3 in patients with peripheral scotoma.
Glare was also significantly reduced, as shown by the results of the glare testing: the letter count increased from 20.93 ± 5.42 to 22.82 ± 4.93 in patients with central scotoma and from 24.15 ± 5.5 to 25.97 ± 4.7 in patients with peripheral scotoma.

The study took things one step further to see if yellow filter lenses (which would block 100% of blue light) would give better visual performance versus the combination of Transitions XTRActive and Crizal Prevencia. The blue blocker lenses provided patients with statistically significant better visual performance on all three vision tests when compared to yellow filter lenses. Interestingly, there was no statistically significant difference in performance of patients wearing yellow tinted lenses compared to wearing normal, clear eyewear. Study designers theorize that due to the gross color change caused by the yellow filters, less benefit was seen by these patients with vision loss who are already more sensitive to the impact of low light levels reaching the retina. No patients tested complained about color vision distortion using the blue blocker glasses, as opposed to yellow filters which did cause vision complaints from most (yellow filters innately make everything in the field of vision yellow in appearance).

Yellow tinted lenses have an overt color skew to everything you see, which was less effective in improving visual performance for patients with vision loss in this study. via

We still are just beginning to understand if our increased exposure to indoor levels of high energy blue light could increase our risks of blinding eye disease like macular degeneration, or if wearing blue blocking lenses could in anyway be protective against disease progression. What this study does show definitively is that blue blocking lens technology can functionally improve vision in patients with eye disease, even if we don't yet have the science to fully conclude if it can help protect them from further vision loss. If we can provide our patients with better visual performance, with better ability to see even in low contrast situations like driving at night or in the face of glare like oncoming headlights, the power of this technology truly speaks for itself.

Of important note: this study was not funded by Essilor (the makers of both Transitions XTRActive and Crizal Prevencia). You can access the full findings here.

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The Not-So Hidden Dangers of Lash Lift

dry eye lash lift 2:39 PM

Few cosmetic enhancements seem as desirable as longer lashes in today's beauty marketplace; from prescription serums to fiber mascaras, and false lashes to lash perming, the cosmetic industry is overrun with options for achieving gravity defying eyelashes. Unfortunately one of the leading reasons why so many products exist for getting longer lashes is that all of the available enhancement options come with a certain risk for ocular surface discomfort and dry eye signs and symptoms. Serums like Latisse can cause redness, irritation, and chronic meibomian gland dysfunction. The preservatives and chemicals in most mascaras are known ocular irritants. And the glue used to apply false eyelashes can cause severe allergic reactions, and increase the risk for styes.

via

Newer to the market is lash perming, a procedure that focuses on enhancing the look of your own lashes. Dubbed Lash Lift, these procedures promise to be a more natural approach to bolder looking lashes for people who want to lay off daily eyelash curling and heavy mascara or false lashes. The process uses no long term glue holding in fake lashes, and can enhance lash appearance without the need for irritating lengthening serums or mascara. The person's own eyelashes instead are permed so that they curl dramatically upwards; one treatment can last 6-8 weeks. The beauty world has been abuzz with dramatic before and after images, with features on daytime TV, magazines, and a huge push from beauty bloggers sharing their results.

But is Lash Lift really safer than other options for lash enhancements on the market? Like most cosmetic products and procedures, there are significant possible dangerous side effects to the delicate surface of the eye. The process of an eyelash perm itself has several potential hazards, and would need a very careful and well trained aesthetician performing the procedure to prevent the risk of chemical injury to the eye.

via

First, protective pads are glued to the top and bottom surface of the eyelid in an effort to shield the eyelid skin from unneccessary exposure to the perming chemicals. If the glue were to come in contact with the waterline or surface of the eye, it could cause major irritation. Some skin types may also be at risk of having an allergic reaction to the glue, so the skin should be tested before the procedure on the arm to rule this out.

A silicone curler is then glued to the top eyelid, and the eyelashes are then curled up over the curler pad and glued to stay in place. Then a chemical perming solution is combed through the eyelashes to break down the keratin shaft and encourage the hair to bend to the shape of the curler. Different companies will use different perming solutions, but the main ingredient is ammonium. Because the beauty industry is not regulated in the same way as the medical industry, companies do not have to share what ingredients and what percentages of these ingredients are used in the procedure. We do know from multiple studies of preservative BAK (benzalkonium chloride) that even low amounts of ammonium is toxic to the cornea and conjunctiva (white of the eye).

The waterline is where the delicate meibomian glands are located, right below the root of the eyelash follicles. As you can see from this photo, the glands are exposed to the treatment solutions, even though your eye is closed. Glues or perming solution contacting the glands could result in toxicity, which you would experience as redness, puffiness, and lingering dry eye symptoms like irritation, watering, and itchiness or discomfort. via

To avoid the potential risks, Lash Lift providers have extensive FAQs warning about the dangers of the process to the surface of the eye. You must remove contact lenses before the procedure, and those that have had ocular surgeries, including blepharoplasty (eyelid lifts) and LASIK must wait at minimum 6-12 months before having the procedure done. Aestheticians warn that Lash Lift should NOT be performed if a person has a history of eye allergies, eye infections, styes, sensitive eyes, watery eyes, or chronic dry eye.

Are these warnings enough, however when only 8 million of the estimated 25-30 million Americans with chronic dry eye have actually been clinically diagnosed with the disease? How many women or men pursuing this procedure would have consulted with an eye doctor first to have the opportunity to even be diagnosed with dry eye syndrome? Because the cosmetic industry is not regulated under the FDA with the same guidelines as the medical industry, this is where the system really breaks down.

Like all options available on the market for lash enhancement, lash perms come with inherent risks for the ocular surface. Some people might have severe reactions from lash growth serums but do great with lash perms like beauty blogger Kate of The Small Things Blog. Others might have recalcitrant dry eye side effects from Lash Lift procedures like Kelly from No Thanks to Cake. There is no completely safe way to manipulate the ocular surface with chemicals, whether they be from serums, perms, or glues. Knowing the risks and the dangers before the procedure, and getting routine eyecare to ensure that you aren't at risk before pursuing these cosmetic enhancements is the key!

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An Optometrist's Guide to Influencer Marketing with Zyloware

brand influencer marketing 9:00 AM

When I started Eyedolatry back in 2011, the idea that optometrists would be doing most of their marketing online was still a relatively new concept. In the years that followed, just having a functional website has become a bare minimum; an active Facebook page and an inventive Instagram account are considered must have marketing tools in 2017. But as the marketing demands on practitioners have increased, many practice owners feel left behind on how to stay relevant in the fast paced social media marketplace. Everyone from optical brands to pharmaceutical companies are reaching out to ECPs to help them navigate the new world order, and one of the most successful digital marketing partnerships has come from optical frame company, Zyloware. Founded in 1923 by Joseph Shyer, this independently owned optical frame company is the oldest family-owned optical line in the United States. How have they stayed relevant? By embracing new ways to reach both doctors and patients.

Social Media Tip: Tell a story with your social media accounts. Find a way to use the optical frames you want to feature as a larger brand story that says something about the person or lifestyle you want to market to. A picture of a frame on your optical board won't drive much engagement. I love featuring eyewear with other jewelry on my eyedolatry_blog insta account because it tells the story of who I am as a doc: my eyewear is a style statement that I select with as much care as any piece of jewelry I put on each morning.

Getting Started with Influencer Marketing

In addition to marketing their frame lines using social media and brand influencers, Zyloware's marketing website, We Are Zyloware features tips for doctors to make their own social media message successful. They post sample Instagram and Facebook images that doctors can use directly, or as inspiration to create their own. And they discuss in detail how to partner with local influencers in your community to create a bigger footprint for brand awareness. "The best part about working with brand ambassador is reaching people that we would never be able to reach on our own," states Gabrielle O'Brien, the marketing coordinator at Zyloware Eyewear. "Influencers become a reliable, reputable source for their loyal followers, so when their followers see them wearing our frames, they are more likely to follow us or like us on social media." Check out this great article featuring one of my personal eyewear style star crushes, @faceprint.eyewearlove .

For your own small business optical, this is easily translatable into a marketing strategy for you. Find local bloggers or local Instagram influencers by searching for people that are hashtagging your city, or that might be part of a larger local blogger network or ring. The key is finding social media influencers that are in your local community, and have followers in your local community. That way when they post about a great frame their received from your office, or the fantastic eye exam they had with you, it can immediately impact your appointment scheduling and new patient eyewear sales.

Take photos in familiar locations that other social media users will recognize as part of their local community!

How Do You Know What to Post?

"My advice would be to first look at your analytics [on your social media or Facebook account]," counsels O'Brien. "Find out what content and posting times get the most engagement (likes and comments), then figure out what kind of content your audience enjoys the most. Do they enjoy seeing your frames, a quote, eyewear displays, or pictures of you?"

Photos of you and your staff are huge sources for increased engagement, and as a founder of a social media marketing service, Defocus Media, it's an easy strategy that is too often overlooked. Beautiful faces of models don't make an effective local marketing campaign, even though that's what many ECPs default to on their accounts because its the marketing we see so often in our own lives. Instead, focus on recognizable places and people to make sure your posts look less like an ad, and more like a post by a friend of family member. We are much more likely to stop, look, and engage if the content connects with us personally.

Hey, I'm no model, but real people with real imperfections are a beautiful way to make your social media account feel organic and authentic. The best ads and marketing campaigns don't feel like ads, and as a small business in your local community, creating that local personal touch is essential to standing out from larger corporate chains.

"Don't be afraid to post content that isn't related to your field; not everything has to be focused on eyes or optics. The majority of your content is going to be optics/eyes, so it's refreshing to your audience when it's something different," advises O'Brien. Creating a brand is about curating a lifestyle, so it's great to post food, places, or images that connect with what your overall message as a small business is about. Unique, funky frames? Posting local art or architecture can help build your local community following and also says a lot about your business as being part of the art scene. Sports vision practice? Posting sports images even when there is no direct link to eyes or vision involved helps connect your optometric office with the sports world. The real crux is to have a complete understanding of what your brand is, then tell that story in everything your do.

Running Social Media Contests

O'Brien also has excellent advice for running social media contests to grow engagement. "When structuring a contest, we make sure that the content is fun and eye-catching, but also simple to enter. Establish that to enter the contest you have to follow our account @zyloware and the account of the brand influencer hosting the contest, like the photo, and then tag a friend in the comments. We've had a lot of success from contests like this."

"For example, one contest that we did with our good friend @TheDapperJuan, he gave away two of our Randy Jackson Sunglasses. It was open for three days and you were allowed to have multiple entries, as long as it wasn't celebrities or athletes. At the beginning of that contest, we had 9,948 followers, and by the end of it we gained 604 new followers! We had increased brand exposure from a trusted source, increased our followers, and started to build strong relationships with a new target market."

Try It Out Yourself!

You know you want to win these Via Spiga frames for your own eyewear wardrobe!

Love my Via Spiga frames? You can enter to win your own and a chance to work with Zyloware as a future brand ambassador feature by heading to my instagram @eyedolatry_blog all week!

If you are looking for ways to grow your social media expertise or get involved with the mission and eyewear of Zyloware, you can email the marketing department at marketing@zyloware.com

Disclosure: The Via Spiga frames used in this post were care of Zyloware

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Can I Have Your Number? The Unexpected Daily Challenges of A Young Female OD

Bright Eyed Blog 10:45 PM

If it's not obvious by the fact my "down-time" is spent here, blogging about my profession, I really love being an optometrist. I would make that decision again even if I time-traveled back to my undergrad days (and please, don't let that recurring nightmare of facing tests and papers all over again ever become reality). But there are plenty of times in this career where I've had experiences I'd rather forget. Uncomfortable encounters with male and female patients, angry belligerence, threats, casual and blatant sexism. All in a day's work when your profession is part of the customer service industry known as healthcare.

The face I make when I think about this issue - captured perfectly by artist Karen Goins

Recently I was asked to reflect upon some of the difficult situations I've been placed in as a young female optometrist by fellow OD from across the globe in Australia, Jane of BrightEyed Blog. She interviewed both me and my friend Dr. Jaclyn Garlich of 20/20 Glance fame about some uncomfortable scenarios we've been faced with, and how we best recommend other new grads tackle the challenge if they are ever put in the same situation.

When she asked me about dealing with patients that ask for my number or ask to meet up for food or drinks, several scenarios came to mind. There’s no perfect way to handle when a patient asks for your number or to meet later out of the office, but here’s my go to:

“Thank you, are you inviting my (husband/boyfriend) too?” and then laugh good-naturedly and reassuringly that it’s not that awkward that just happened, even though it is.

Ok maybe you don’t have a boyfriend or husband, but I think this answer is less awkward than other possible answers, and your patient doesn’t need to know that you are single. I’ve tried out “It’s company policy we can’t date patients” but that’s really strange to say, and makes the patient think maybe you’d be interested if you could get around company policy. You don’t want to encourage them in any way.

Sometimes you have to use more than just humor though. I can think of one situation where I had to tell a patient they were being inappropriate and just let things get awkward. I was doing direct ophthalmoscopy (by the way this was the last time I did that on an adult now that I think about it!) and of course you have to get really close to your patient to see anything. The patient started laughing, so when I was done I asked what was funny. My mistake!! He replied, “I was just thinking when you were so close, what would you do if I just turned around and kissed you.”

I think my eyebrows shot into my hairline. I don’t really remember thinking but I just said, “Well I’m glad you didn’t. I would have probably hit you with this piece of equipment and it’s pretty heavy.”

We finished the exam pretty quickly from there. I don’t encourage threatening to hit your patients with ophthalmic devices, but it did straighten him up pretty fast.

Direct Ophthalmoscope, ocular assessment tool and an OD's Maglite in case of emergency.

My best advice for you when you encounter patients that make you feel uncomfortable is to try to deflect first with humor when possible if the situation is not an overt threat, then with expediency if anything persists. If a line is crossed, the exam needs to be over. Leave the room, and ask the patient to leave. Don't let a scenario go on too long because the risk increases if the person feels they are being reciprocated. You should never be in the office by yourself for safety reasons, and because you are there with others so close by, know that you have staff members and maybe even other doctors there with you that will support you if a patient needs to be asked to leave.

You make think this story is a rare event, but many of you have experienced something similar in practice already, maybe even during clinic hours at your optometry school. I've heard everything from one-off comments about my size, to emails appearing in my work account asking to meet for dinner or drinks, to that one time I was told an enlightening story about why my patient was so upset when I came in the room because he loved when his doctor wore a white coat so he could imagine them with nothing on underneath (yikes- I was glad I wasn't wearing one that day!). I realize that my experiences are so common, and honestly so much less threatening than many of my industry friend's horror tales, that it's a shame we don't get taught explicitly how to deal with this type of sexual harassment as part of our medical schooling. In 2017, these experiences are still normal. Patients hitting on you or inappropriately making advances on you is going to happen! It’s happened to every female optometrist I know, and quite a few of the men. When it happens, you’re going to feel gross and uncomfortable, but it is not your fault. Be prepared and plan ahead with strategies for how you will deal with this situation, and that way you'll know immediately what to do when it happens to you!

Want to read more awkward new grad scenarios and real world advice? Check out all the topics Jane, Jackie, and I discussed about dealing with the daily challenges of being a young female OD in her blog posts here and here.

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