Time for another fashion update, and coming off recent attendance at an eyewear expo, I can deliver news straight from the optical world's leaders!  According to designers, this seasons biggest trends are:

Kensie Frames

Lafant frames -- not a color combo for me, but the trend is for surprising and unexpected designs and color pairings

D+G in Red Crystal Lace

Jill Stuart: just one of the designers drawing on vintage for inspiration

Me: "Have you ever been diagnosed with any eye diseases like glaucoma or macular degeneration?"
Patient: "Yes-- I had a doctor tell me that I have that 'stig....stigmatism"
Or
Patient: "So what is wrong with my vision?"
Me: "Well today we have found some changes due to cataracts, but we can improve your vision by increasing your astigmatism correction in your glasses." 
Patient: "Oh no!  I have astigmatism!!?"

Multiple points of light fall onto the retina in Astigmatism.

The inner circle of the phoropter is used to refine the axis

Keratoconus causes large amounts of astigmatism and usually requires specialty contact lenses or even a corneal transplant

With school in full swing and popular television shows like "Glee" back from summer hiatus, the current "geek chic" trend in fashion and eyewear is popping up everywhere.  Let me spin a little tale for you (true of course!):
Mom and teenage daughter come in, eye exam goes great, and daughter needs an update in her glasses prescription.  I walk mom and daughter to optical, and then help as they debate glasses choices.  Mom finds an attractive purple plastic frame.  Daughter refuses to try it on.  She only wants to look in the men's section.  She only wants to see the BIGGEST glasses we have.  Then she finds the jackpot:  the glasses I like to refer to as "glasses for the elderly male that gets the same glasses every year" or "old reliable" for short.  The eye size is so large that the glasses literally devour her face; she loves them.  Mom doesn't.  They leave without buying anything.

Old Reliable comes in 2 standard colors: silver or gold.  Sometimes even having those two choices is more than some men want.

What did we just witness? Well, for one this is classic mom and teenage daughter in optical interaction.  But in this case, we are specifically witnessing "geek chic" fashion!  Glasses are so indy and alternative!  The uglier and geekier you look the better!  All joking aside, geek chic is a trend that I fully embrace as an eye care provider simply because people are actually wanting to wear their glasses.  The days of being made fun of or ostracized for being a glasses wearer are hopefully fading more and more into the past.  If you can feel stylish and proud of your glasses, well I am all for it!

Anne Hathaway rocking the geek chic style

But wait, in geek chic, glasses are NOT just for your face.  Glasses are popping up everywhere from jewelry to clothing!

Glasses necklace from Forever 21 (I have to admit, I own this)

"Kurt" from Glee wearing Urban Outfitters

And don't forget eye chart wall hangings for your home!

Hyperopia, or "far sightedness" can be a more difficult concept to grasp than myopia. Myopes need their glasses to see clearly, but it is not that straightforward for hyperopes.  When you think about someone that wears glasses, the classic image is a "Mr. Magoo" type that is bumbling around blind without their glasses. The thing is, hyperopes (in most cases) can see pretty well most of the time.  People with only mild amounts of hyperopia generally never even know they have refractive error until their focusing system begins to decline in a condition called presbyopia (more on that later) that occurs around age 40.

Mr. Magoo: a man sorely in need of contact lenses

In simple terms, hyperopes see better in the distance than they do up close (the opposite of myopes if you recall from this post). Opposite from myopes, light entering the eye falls behind the retina in hyperopia.  The focusing system (accommodation) must be used to bring the image back to lie clearly on the retinal cells.   Basically, hyperopes have to use their focusing system all the time, distance and near.  Known as accommodation, the focusing system must overcome the patient's prescription at distance to see clearly, as well as the prescription AND the near demand of a target when something is held up close.  This is why vision is more blurry at near to the patient; their focusing system is just too overwhelmed by the demand.

Why does light fall behind the retina?  Well, a patient with hyperopia has either:

• flatter cornea that doesn't bend light as much as an average cornea
• or a shorter eyeball

Pinhole glasses for sale at pinhole-glasses.com.  Your vision will be clear, but obviously limited.

Myopia, or "near-sightedness" is a very common ocular condition typically first found in school-age children.  These individuals have good near vision, but blurry distance vision.  They will typically need glasses for full time wear, especially for activities like driving.  Let's do a little break down of what causes myopes to have this blurry distance vision and how glasses work to correct the issue:

--Myopia is a result of one (or more) structural variations of the shape of the eye.  Each element of the eye has a certain size and shape to be "within normal limits," but when these measurements fall  slightly outside of normal, a refractive condition results.  Items that specifically affect the power of the eye are:

• The Cornea (a thicker than normal cornea will result in myopia)  Note: this is why surgeries like PRK and LASIK work to correct a myope's vision; these techniques reduce corneal thickness!
• The Lens (typically the lens thickness has minimal impact, but as it changes in conditions like cataracts, myopia may result)
• The Axial Length (this is the length of the eye; if the eye is too long, myopia will result)

Courtesy the National Eye Institute

How do glasses help myopia?  Optometrists use lenses in front of the eye to change how much light is bent (or refracted) as it travels through the eye so that a clear and distinct image falls on the retinal cells.  For myopia, "minus" lenses are used, which are thicker on the outer edges of the lens and thinner in the center.  With today's lens cutting technology, this difference in thickness if usually very subtle, so you may not notice it if you are a myope and just took off your glasses to test me out, haha.  Lenses have varying thickness and are measured in "Diopters (D)."  The dioptric value of the lens you need is the exact match to the amout of myopia you have (or the amount the image needs to be adjusted in order to fall clearly on the retina).  For example, I wear a -2.00 D lens, which corrects my 2.00 diopters of myopia.

Now what does this measurement of myopia mean?  To continue my example, a 2.00D myope means that I can't see clearly at any distance past 50 cm in front of my face.  Hold on -- how did I figure that out?  It is luckily a very simple equation.  If you divide 100 cm (1 meter) by 2.00D, you get 50 cm as the far point at which I can still see clearly.  This works for any amount of prescription.  If you are a 4.00D myope, then you can't see clearly past 25 cm in front of your face.  If you are a 20.00 D myope, well you get the picture, you have a hard time seeing much of anything.

Minus glasses not only clear the image to their wearers, they can cause a minification effect (especially in the higher powers).  This is why when you see someone wearing glasses for myopia it may look like their eyes are very small within their glasses (see picture below).

Note how the side of Buddy Holly's face seems smaller inside of his glasses.   Today, we can use high index material lenses to reduce the thickness of the lens and this minification effect.

The Phoropter, an amazing machine I spend a large portion of my day with

Soft contact lenses offer wonderful comfort and vision for the large majority of patients needing vision correction, but some patients (due to corneal shape or refractive error) just can't achieve satisfactory vision with a standard soft contact lenses.  Rigid gas permeable (or hard) contact lenses are still available largely because of this fact.  Lately I have had the privilege of working with a new lens design that combines the optical quality of a rigid contact lens with the comfort of a silicone hydrogel (or highly oxygen permeable) soft lens: the Synergeyes Duette.

Picture courtesy www.synergeyes.com

An ideal Synergeyes fit (courtesy Contact Lens Spectrum): Fluorescein staining should show even central clearance under the RGP (rigid) central portion of the lens

Schools across the country are heading back to the classroom in the next week or two, and as a parent there is more than enough to purchase and prepare to ensure your child is ready.  I know your schedules are busy, but I cannot recommend enough the importance of a full eye exam for children, especially as they return to the classroom with its multitude of visual demands!

Not everyone is ready for surgery when their cataracts are ready to be removed and that is ok!   Many patients schedule surgeries around their hobbies, families, or vacations.

Posterior Subcapsular Cataract with classic "swiss cheese" appearance is known for fast progression and poor central vision, especially noted with reading.

Snellen Charts (above) check visual acuity.  Don't expect 20/20 vision on day one, but that doesn't mean you won't get there.

This is a Seidel test where flourescein dye is used to ensure there is no leakage of internal fluid (aqueous humor) from the wound.  In the picture above, there is obvious leakage and this patient would possibly need suturing.

What goes around comes around, right?  Fashion has been recycling inspirations since the dawn of the fashion industry, and the same hold trues for eyewear trends.  Here's a look at new and old sunwear in one of this summer's hottest trends: Summer Stripes.

A small (typically around 2.5 mm) incision is made in the cornea  to allow entry.  Because the cornea is avascular, the wound will not bleed.  Due to the small size of the entry used in current procedures, no suturing is needed to close the wound.

Peeling the anterior capsule away to get to the cataract.  The surgeon must be careful to not make a hole too large in the capsule because it is needed intact to hold the intraocular lens implant!

Phacoemulsification allows the surgeon to "vacuum" out the cloudy lens.   All of the yellowed (or browned) cataract pieces are removed, leaving a clear and empty capsular bag in place.

An initraocular lens implant with  "arm-like" haptics that the surgeon uses to manipulate the implant into the capsular bag.

A successful cataract surgery where the intraocular lens implant rests inside the capsular bag that once held your cataractous lens.

At this year's Alzheimer's Association International Conference, researchers reported that a dilated fundus examination can aid in the detection of Alzheimer's.  The study found a high correlation between patients diagnosed with Alzheimer's or "pre-Alzheimer's" and changes in the blood vessels when viewed with retinal photography or via live fundus examination.  Thinning of retinal vessels (arterioles and venules) was noted, as well as a narrowed arteriole lumen.  Vessel changes were shown to correlate with PET scan findings of amyloid plaques (a typical brain scan finding associated with Alzheimer's).  Retinal findings will precede the onset of Alzheimer's dementia, and scientists are purporting that changes may be evident as early as 20 years earlier than the onset of symptoms.  

A normal retinal fundus photograph, depicting optic nerve (white circular area), retinal vessels, and macula (dark central area)

This is not the first time that researchers have reported the link between eye exams and earlier detection of Alzheimer's disease.  Previous studies (linked article from 2002) have shown an association between visual field defects and neuro-degenerative damage of Alzheimer's disease.

Sample Visual Field test, depicting right eye field loss

MRI depicting degenerative changes of Alzheimer's disease courtesy BBC News

Take away point: A complete eye exam with retinal photography and dilation can help detect a number of systemic conditions and is highly recommended!  Hypertension, diabetes, and numerous other diseases can be monitored and detected via retinal exams. Even if your vision is great and you have noticed no changes, a yearly eye exam can be an important part of monitoring your overall health.