In the next few years your optometrist may be fitting contact lenses for more than just your eyesight!

Contact lenses are more than just a way to restore vision without glasses, they are a highly advanced medical device that scientists are still learning how to utilize!  Contact lenses can be used as clear bandages to heal large abrasions.  Biomedical companies are developing ways to use them for delivering doses of antibiotics or other medications to the surface of the eye over a long period of time.  New research is now being reported that we may be able to use contact lenses in people with diabetes to monitor their blood sugar without painful finger stick tests.

At the University of Akron, professor Jun Hu has applied a chemical coating to contact lenses that react to glucose levels in tear film.  The coating is comprised of a molecule that binds to sugar in the tear film, and at a certain concentration, will cause a color change reaction.  Imagine a pH test with its color  scale, and you get a similar picture.  When the level of glucose returns to normal in the tear film, the color of the contact lens would again normalize.

In his initial proposal, Hu suggests the patient will wear the lens in 1 eye, and then take a picture of their own eyes with a free smartphone app to monitor for changes. The app will compare the color difference between the normal eye and the eye with the contact lens to calculate the blood glucose levels.  The color change will be subtle, without affecting vision or comfort of the contact lens.

Microsoft is researching an electronic sensor implanted inside the contact lens

A timeline for the product reaching the market is still at least three years away.  At the same time, other companies are researching using electronic sensors inside contact lenses to detect glucose level in the tear film.

Sources:  High-tech contact lenses: Glucose Monitoring by Dr. Goodfellow and Dr. Maino published in AOA News

We've already addressed the best solutions for your soft contact lenses, but for those patients wearing  specialty contact lens options, finding good information about how to care for your lenses can be quite difficult.  Synergeyes contact lenses are a unique "hybrid" option; one part soft lens and one part hard (or rigid gas permeable) lens.  The hard lens center allows for improved vision in patients with high astigmatism or irregular corneas (like those found in keratoconus).  The soft lens skirt of the lens allows for superior comfort.  These lenses last for 6 months of wear, but can easily tear or build up deposits if not cared for properly.  You can always find more information on the best way to care for your lenses at the Synergeyes website, but here is a breakdown of what I recommend.

SYNERGEYES DUETTE

The Duette lens is the company's latest design which has superior optics for "regular" corneas and up to 4 or 5 diopters of astigmatism. A multifocal design is also an option.  The company has performed studies to see which solutions operate best to keep the lens moisturized but still clean.  Click here to see a more thorough post on their findings.

1) CLEANING

The best options to clean your lens are Biotrue multipurpose solution and Aquify multipurpose solution. These two solutions provide the moisturization that the soft contact lens portion of your lens needs to prevent dryness, especially as the lens ages.  Previously Clearcare was the top recommendation, but in a large percentage of patients, the Clearcare solution will cause white deposits on the soft portion of the lens, preventing proper moisturization.  Clearcare can be used for intense cleaning, but I no longer recommend it on a nightly basis unless my patients have severe depositing issues.

2) FILLING THE LENS

Before you insert the lens into your eye, you should fill the lens with the correct saline solution to provide better fit and comfort.  I usually recommend Unisol 4 sterile saline for this purpose.  You want the solution that you fill your contact lens with to be preservative free, since preservatives can be toxic to the cornea with prolonged contact.  Preservative free artificial tears are sometimes also recommended.



SYNERGEYES CLEARKONE, SYNERGEYES KC, SYNERGEYES A

1) CLEANING
For this lens, I solely recommend Clearcare.  Synergeyes Clearkone is made for correcting the vision of patients with keratoconus.  The company also offers products like Synergeyes A that are made to correct for higher astigmatism.  These products are made with a hydrogel soft lens skirt (versus Duette which is a higher oxygen permeable silicone hydrogel), and this material responds better to the intense cleansing ability of Clearcare.


2) FILLING THE LENS
Unisol 4 saline is still a great option for filling the bowl of the lens.  Again, you really want to avoid preservatives if you are using this solution against your cornea all day.  In some cases, a thick preservative free tear like Celluvisc has even been used to help with comfort in patients that are just learning to use the lenses.  Long term the  thicker Celluvisc is usually replaced with a thinner solution to improve visual quality.

Wouldn't it be incredible if you could see your own blood vessels inside your body?  What if you could see your own brain tissue?

Wait.  You can with retinal photography.  Every day I take photos of the back (and front) of my patient's eyes and it is amazing how much information can be gleaned.  Your eye doctor can detect high blood pressure, high cholesterol, and diabetes just from looking for changes in your eyes.  Sometimes detecting these changes can save a person's vision from permanent damage; sometimes they can even save them from the repercussions of serious systemic diseases.

I can't recommend having a comprehensive eye examination more, even if you have no vision issues.  We all should want to see the inner workings of our bodies, and the eye is the perfect window inside!

Here are some of the photographs I have taken of common ocular conditions and diseases just this year.  I apologize about the persistent artifacts from my camera -- they look like 2 white circular glare areas in every photo.

MYELINATED NERVE FIBER LAYER (looks bad, but this is actually a harmless finding ) Myelination typically only exists behind the eye, but sometimes passes into the eye without harming vision

SCATTERED DRUSEN Enlarge this photo and you will see tiny yellow areas that are known as drusen near the dark central vision spot (the macula) Drusen are harmless by themselves, but can put you at a heightened risk for Macular Degeneration

CENTRAL RETINAL VEIN OCCLUSION This prompts an immediate referral and investigation for systemic health issues

CENTRAL SEROUS RETINOPATHY The area of edema is visible as subtle color changes around the macula This condition causes central vision changes, and is often due to stress Usually no treatment is necessary, just time for the swelling to resolve

ADULT VITELLIFORM DYSTROPHY See the yellow area at the macula?  It shouldn't be there.  This condition can cause central vision disruption, and no real treatment exists

I've only been blogging for a little over a year, but the blogging community is a fascinating world.  Between Pinterest and fashion blogs, we are constantly being bombarded with the latest trends and styles.  Some of the most popular fashion bloggers out there are leading the way in the newest glasses trends as well.  Here's a breakdown of the best glasses across Blogland.

What I Wore

Jessica Quirk's website was my first fashion blog find, and she frequently incorporates sunglasses into her signature styles.

Kendi Everyday

Her "geek chic" frames are still all the rage in the ophthalmic industry.

9 to 5 Chic

This blog can do no wrong as far as I am concerned.  She knows how to look work appropriate yet entirely young, fresh, and unique.  And of course, designer glasses are repeatedly featured in her looks.

Our ability to discern depth is a key visual skill that we begin developing at just a few months of age.  Imagine driving a car, playing sports, or even tying your shoelaces without being able to see depth.  It's not just about being able to see 3D movies--depth perception (or stereopsis) is an essential visual skill that we use every single day!

When artificial tears fail to treat my patients with dry eye, there are a number of alternatives available (click on Patient Guides and Dry Eye to see them all!)  Omega 3 supplements (fish oil) are a great possibility for using a nutritional additive to increase tear film production.  Many of my patients being monitored for blood pressure issues are already taking fish oil supplements, but new information is casting doubts on the use of fish oil for heart health.  Fish oil still definitely has its place in the ocular medicine world.  Here is an overview of what we know now.

The meibomian glands can become clogged (they look like white or yellow caps in the above photo) and thus prevent tear film from passing through every time you blink.  Photo via westsideoptometrynow.com

Imagine not being able to see--not even when you put on glasses!  This is what people who are legally blind face every single day.  And according to the most recent report from the National Eye Institute, the rate of blindness in Americans over age 40 has increased by 23% just since 2000.  America is an aging population, and with age comes an increased prevalence for visually devastating diseases like glaucoma and macular degeneration.  All reports show that we are not doing a good enough job at preventing vision loss before it is too late.

Just got a new daily contact lens that will be launched on the market for purchase in the near future.  I love daily contact lenses due to the unbeatable comfort and convenience.  Not to mention they are the hands down healthiest option in soft contact lenses for your eyes!  Read more about dailies here.

Biotrue One Day packaging.  Terrible picture because I took it hahah

Bausch and Lomb is launching a new daily lens called Biotrue One Day (with a similar branding concept to their Biotrue Multipurpose contact lens solution).  The lens is made of a new material called "Hypergel"  that offers better oxygen to the eye than traditional hydrogel lenses, but without any silicone polymers.  Currently lenses on the market are either hydrogel (an older material that has poor oxygen transmission but great comfort) or silicone hydrogel (higher oxygen to the eye, but comfort may not be as good as the old material in some patients).  Biotrue One Day lenses are being promoted as offering the same water content as your own eye, which should help improve end of day hydration of the lens.  The biggest complaint of daily contact lenses (or all lenses for that matter) is end of day dryness and discomfort.  If Biotrue One Day truly offers better end of day comfort, this lens could be come a practitioner's go to for computer users that suffer from contact lens dryness.

Biotrue One Day Apologies for the poor quality but I took this myself!  The lens is so new I couldn't find any images on google!

I got my first box of dailies today and look forward to trying them out and posting my opinions on this lens.


Disclosure: I am in no way affiliated with Bausch and Lomb and other than a free strip of 5 contact lenses, I am receiving no incentive for this or future posts.

Everyone wants to see better without glasses, and with today's refractive surgeries, that is an attainable wish for many prescriptions!  I talk to patients about LASIK several times a week, and we always discuss the potential side effects.  For most, the biggest complication after LASIK surgery is dryness.  Many people find they are using supplement artificial tear drops around the clock right after LASIK surgery, and this dryness can last anywhere from 6 months to years after the surgery date.

After blepharoplasty, the excess eyelid skin is removed and peripheral vision may improve. photo via davisglasses.wordpress.com

Me:  "So my technician tells me that you are interested in color contact lenses?"

COLOR LENS FAIL!  Photo via solutions-lens.com

via Fanta Eye Care

Keratoconus: an irregular, protruding cornea.  Photo via clspectrum.com

In my last post about keratoconus, I mentioned a promising new treatment called corneal cross-linking.       This procedure is still undergoing FDA approval, but more and more ophthalmologists across the states are starting to offer this treatment. Because this procedure is so new in the States, there is still much to learn.  Here is a breakdown of the information I have about corneal cross-linking:

What is corneal cross-linking?

The cornea is made up a collagen fibers that are woven together to make a tight and strong (and clear!) tissue.  In keratoconus, these collagen fibers are somehow weakened, causing the cornea to become misshapen, irregular, and scar over.  This results in devastating vision loss.  Corneal cross-linking is a process where the collagen fiber connections are strengthened again, so that the cornea can maintain its shape and clarity.   Cross-linking actually happens naturally as we age (the collagen fibers tend to strengthen their attachments around age 40) which is why keratoconus tends to be a degeneration of the young eye, and stabilizes later in life.

The Treatment Procedure


I won't begin to go into exact details (this blog is for everyone, not technical scientists!), but the general process is easy to explain.  Your ophthalmologist will apply riboflavin to the eye (after they prepare your cornea to improve penetration of the liquid riboflavin into the deeper layers of the eye).  Then your eye is exposed to UV light for around 30 minutes, which causes the chemical "strengthening" reaction between collagen fibers.  Studies have shown that this procedure increases the corneal "rigidity" by 328%!  You will be conscious the entire time of the procedure and should experience no pain.

Cross-linking procedure.  Riboflavin has been applied, and now UV light is being shone on the eye. Photo via clspectrum.com

Benefits
Of all studies so far completed (about 691 eyes worldwide have been done), an impressive 92% of patients saw NO progression of their keratoconus 1 year after the procedure.  55% (up to 81% in some studies!) of people saw their vision improve by 1 line or more.  In summary: with this procedure, your eyes should stabilize, and may even improve a little.

Vision is usually worse right after the procedure, and for as long as 6 weeks afterward.  Improvement in vision will begin to be evident by 3-6 months after the surgery date.

Potential Risks
In rare cases (8% from the recent research), the cornea can develop a permanent haze.  To avoid this risk, the cornea needs to be over 400 microns thick (this is a measurement that the surgeon will take prior to performing the procedure).

Who is a candidate?
Corneal cross-linking is ideal for patients with keratoconus who are under 35.  It can also be considered in older patients if their keratoconus is progressing.  You will still need glasses or contact lenses after the procedure, and your prescription may change afterwards.

Cost?
Because it is not yet FDA approved, the procedure is not covered by medical insurance.  Costs across the nation are $3-6,000.

In North Carolina, Dr. Patrick Laber is now offering the procedure.  (Most information provided in this post is courtesy of his detailed explanations!)

Photo via J CREW

With back to school ads littering the airways, it's time to start thinking about another change in seasons.  New trends for Fall 2012 seem to be focusing on a neutral color palate, letting the style lines of your glasses speak instead of the colors.  Thicker frames are still on point, so expect the "geek chic" trend to continue.  Gray, bone, tans -- all are making a major comeback from the days Michelle Pfeiffer was sporting them poolside in Scarface (below).

1983 is new again; Michelle Pfeiffer's classic look would be right on trend for fall 2012

   





Depending on your skin tone, a bone or light gray colored frame can be difficult to wear, so it is always best to try the frames on your face.  Darker browns seem to be more universally flattering.  As a general rule, darker skin tones can aim more towards the pale frame colors, while really pale skin tones will likely look too washed out in these lighter colors.

Readers from Anthropologie

Yves Saint Laurent priced at $295

Major 80's throwback via Cutler and Gross

Anne Hathaway at BBC Radio interview, wearing neutral plastic frames.  The darker  temples and dark brown tint help keep the lighter plastic from completely washing out her face.  This neutral color palate transitions as a perfect compliment to your fall wardrobe of darker colors, layered looks, and tweeds.

Everyday I see patients who are coming to the eye doctor for the first time in years because they noticed they just weren't seeing as well as they used to.  Well imagine what it feels like when the doctor looks at your screening tests and performs the refraction, and then tells you that you have a medical condition that will prevent you from seeing better, even with glasses!  Keratoconus is a condition that affects less than 1% of the American population, but it causes major visual issues that sometimes require intensive surgery like corneal transplants to treat.  It typically affects people between their late teens to late 30s, and usually progressively worsens as the eye continues to change with age up until our 40s, when the condition appears to stabilize.  In that period of 20 years where the cornea is susceptible to progression, people often end up needing surgery or at least speciatly contact lenses to achieve their best vision.

Have you ever been on a roller coaster where you experienced gradual dimming of your vision?  This phenomenon actually has a name:  the greyout.  While many people find this visual experience to cause nausea and severe discomfort, there are a large group of thrillseekers out there just looking for their next greyout experience.  Let's breakdown what the greyout really is:

King's Dominion Intimidator

Greyout Symptoms

• gradual dimming of vision
• color vision changes
• possible peripheral vision loss
• transient -- symptoms only last a few seconds and then return to normal

CENTRAL RETINAL ARTERY OCCLUSION

A new longitudinal study out of Bristol University continues to support other recent correlational data that time outdoors playing seems to be related to a decreased risk for poor distance vision.  Near-sightedness or myopia is a refractive condition where the person sees well up close, but very poorly in the distance.  Click here for more details.  In the past, data has supported that more time reading as a child is associated with myopia, but in this new study, time indoors (not specifically reading) also appears to have a link.

Colleague Dr. Joy Ellenberger and a young patient Photo Via Smith Eye Care

14,000 children were followed from age 8 to 9 until age 15 during Avon Longitudinal Study.  Children were grouped into 2 categories based on survey information provided by their parents:
High Time Outdoors = 3 or more hours in summer, 1 or more in winter
Low Time Outdoors = anything less
Those children spending "high time" outdoors were much more likely to have normal vision.

In the past, myopia development has been theoretically linked to near strain, like long hours reading.  New research however is showing that bright light may be essential in the developing eye.  Bright outdoor light stimulates the release of dopamine, a neurotransmitter, in the brain.  Research on baby chicks has shown that higher levels of dopamine in the brain and retinal cells is correlated with less risk of myopia.

Other research out of the University of Alabama at Birmingham (also home to an optometry school!) has shown that bright light exposure in tree shrews appears to minimize the risk for myopia.  Researchers with this study purport that their findings in future may supports increasing lighting intensity at schools to help prevents or slow myopia development

There is still much to understand in the relationship between sun exposure and vision development, and we can't forget about the risk of UV damage to the skin and eyes with prolonged times outdoors.  I do recommend bright lighting conditions for reading in all of my young patients, and encourage outdoor sport participation for those with a high genetic risk for myopia or children starting to show myopia at a young age.   And don't forget that sunglasses are still highly recommended to protect the eye from damaging UV rays!