Ever been at a friend's house and realized you didn't bring your contact lens case or solution?  Or flying and suffering from the displeasure of horrendously dry contact lenses, but being unable to take them out because your case and solution are in a checked bag?  For a contact lens wearer, life is not always conducive to the items you need to properly care for your lenses.  And every time you stretch those lenses a little longer than comfortable, or you don't store them properly in fresh solution, you are risking infection they may permanently mean the end of your contact lens wearing days (not to mention the chance of permanent blindness!).  Luckily, a group of entrepreneurs out of California have created a product that can solve these contact lens issues without compromising safety.

via

The Refresh Card was this year's winner of Duke's Start Up Challenge for good reason.  The idea is so remarkably simple and accessible, it will leave you wondering why it wasn't available sooner.  Contact lenses have been mainstream since the 1970s, but solutions and the contact lens cleaning process have been overwhelmingly the same for at least 20 years.  The Refresh Card is the size of a credit card so that you could even store one or a few in your wallet or purse, but has pop-out compartments that can be manipulated to to make a contact lens case and 2 packets of solution.  All those years playing with Transformers paid off for these entrepreneurs.




Just pop-out the contact lens wells (conveniently marked R and L), clean your lenses with the provided solution packet, and store.  The blue top portion of the card will slide back on to seal your lenses safely overnight. Currently the product is available for pre-order at the company's website, so not yet available for mainstream use.  I had reached out to the company to see what brand of contact lens solution they would be using, but got no answer, so I am surmising that is still in the works.  I will update this post as soon as I learn more details (like projected cost and solution brand to be used).

Package as photographed by me

Maybe it is my relative youth in the world of optometry, but trying out a new contact lens product still really excites me.  For the past few months, I have heard a constant buzz about Ciba's new daily lens material that is being used in the freshly launched in America DAILIES TOTAL 1.  The product is a water gradient delivery system, (for more information read here) that aims to prevent the contact lens from pulling water from your eye to stay hydrated, the culprit causing end of day dryness in so many contact lens wearers.

Whenever anyone tells me they have the newest, latest greatest anything, I am always suspicious.  When Ciba declared this lens "a game changer"  it sounded to my skeptical ears like a product destined to flop.  When I saw the packaging (it looks like a toothpaste box) and saw the obnoxious ALL CAPS in the nomenclature, it grated on my contact lens critic nerves.  But Ciba is on to something with this lens.  My rep for the company kept telling me that frequently when someone puts on the lens in front of him, they say they can't feel it.  So I decided to test drive it for myself.  I put the lens in.  I tried to feel it.  I really did.  But Ciba won round one:  I could not even really convince myself that the lens was on my eye without looking in the mirror.  It was that comfortable.

Come on, you know you are thinking toothpaste too

I also have to admit that I am a tough critic for more reasons than just my skeptical nature.  I have very dry eyes with contact lens wear, and I typically wear my glasses 5 days a week, as much for comfort as for style.  I have only a few products that I really swear by.  Avaira is the only multiple wear product I can stand on my eye for longer than a few hours.  Proclear 1-Day used to be my lens of choice for comfort, but about 12-14 hours in, I would have to manipulate the lens under my eyelid to try to relieve dryness, or use a re-wetting drop.  Then I discovered Acuvue 1-Day Moist.  This has been my favorite product for nearly 2 years.  I wear this lens comfortably late into the day and on airplanes.  But I still find I get issues with comfort and lens awareness around that 14 hour mark.  The DAILIES TOTAL 1 is the first contact lens that I have worn where I really didn't get lens awareness until close to 16 hours into the day.  I was able to wear them with acceptable comfort all the way to the 18 hour mark.   I really didn't even start feeling like I had a contact lens in my eye until 6-8 hours of wear had passed.  And did I mention that some days I was wearing this lens under exceedingly poor circumstances?  I have a lot of grass and pollen allergies that typically make my lenses feel like steel cages in my eyes after being outdoors for a few hours, but the Dailies TOTAL 1 still felt comfortable after spending 4 hours outside.  I am a contact lens cynic, and the type of patient that typically finds no true satisfaction with contact lens wear, and now I am a believer that we really do have a new product to offer patients that can truly help make their contact lens wearing life better.

Now is this lens perfect?  No, I still got a little dry and irritated towards the very end of my (very long) day.  But I was able to wear the lenses comfortably longer than with any other contact lens I have ever put in my eye.  I had good vision (I wouldn't say the clarity was a real remarkable point, but it was at least as good as any other daily lens I have been wearing over the past 3-4 years).  The major drawbacks are going to be availability and price. The lens is only available in minus spherical powers (no astigmatism, no multifocal, and no plus!) so only a certain population of patients will even be eligible to wear the lens.  Ciba does plan to utilize the science of their water gradient technology to expand into different lens types, so larger ranges of vision issues can benefit.  Price is going to be a huge factor, and like any premium product new to the market, it is priced accordingly.  You won't be able to find this lens for much less than $100 for a box of 90.  Compared with the price of even other dailies on the market, you will definitely be paying a premium to enjoy the extra benefits of this lens.

Take home points:

Try this lens if you feel like you have never really had a comfortable contact lens for one reason or another: dryness, lens awareness, redness, allergies.  This lens may be the closest thing available to solve your problems.
Try this lens if you want to see what the best contact lens technology for comfort on the market can provide.
Try this lens if you are a skeptic; maybe you might become a believer too!

Disclaimer:  I am in no way affiliated with Ciba and was not compensated for trying their product or writing this post.  

Here's a post for all the nerds out there:  Yesterday I got the news that what we thought we knew about the cornea (the clear layer of tissue located on the front of the eye) was actually all wrong.  Scientists have a discovered a new layer of corneal tissue, and since the cornea is where many ocular surgeries are performed, this new discovery could have a huge impact on the way we treat corneal diseases and procedures for corneal transplants.

Cornea with scarring from surgical procedures (via ) The new discovery of Dua's layer could help surgeons target this strong tissue and hopefully limit surgical complications.

Traditional thought had the cornea with 5 distinct layers: the epithelium, Bowman's layer, the stroma, Descemet's layer, and the endothelium.  Each layer is susceptible to particular corneal degenerative conditions, and these layers are routinely used as markers for the depth of incisions needed for surgeries.  The new layer, named Dua's layer after the scientist who discovered it, is located between the corneal stroma and Descemet's.  It
is remarkably thin -- only 15 microns in total!  But it is incredibly strong, able to withstand a large amount of pressure.  Due to its strength, surgical procedures may utilize this area in future as a location to guide laser incisions, preventing damage to weaker corneal layers. With a discovery this new, we have yet to realize the impact on applied science.  But we do know that a lot of textbooks will need to be rewritten!

Looking for something a bit different in sunglasses this summer?  Mirrored sunglasses have been a staple in sportswear for athletes in highly-reflective or bright conditions (like most snow sports), but have crept into the fashion scene this summer for street wear. Try this retro-look for something new this summer:

Trussardi

Wildfox Couture

RayBan

Via Marie Claire China

If you can't tell by the subject matter of my last few posts, I have been really inspired by the wave of new technology on the horizon in the eyecare industry.  Whether it is the more universal intrigue of Google Glass or the promise of sophisticated performance goggles that could monitor pulse and heart rate while protecting you from UV damage, our eyes are at the forefront of tomorrow's innovations.  And living where I do, my patients are often telling me about new technologies at the companies they work for before I even hear about them in optometric journals!   Here's another example of a local Raleigh company bringing the ocular world the next wave in advancement:

Corinthian Ophthalmic is a small start up that has received funding to produce the first electronic ocular  dropper.  This device would help solve major issues for patients who take eye drops every day but have trouble either getting the drop in or remembering to do so.  Imagine trying the squeeze a small eye drop bottle when you have arthritis, and then trying to be certain that you actually got one drop out, and in to the eye instead of on your cheek.  Patients will even routinely scratch their corneas when struggling with instilling eye drops!  An electronic drop delivery device could eliminate all of these problems by:

Corinthian's early prototype via

• controlling the exact size of the drop that enters the eye; preventing wasting of drops which can greatly help with a patient's monthly bills
• electronic guiding system that would tell the patient when the device is centered to deliver medicine to the eye's surface
• reminder alarm to tell you when to put the drop in
• reporting system that your doctor could access to see if you have been using the drops as directed
• no squeeze necessary, so no difficulties with small bottle size or highly viscous drops getting stuck in the bottle
• potentially a shake setting that would shake the medication for the patient if needed (studies routinely show that patients do NOT shake their drops on a regular basis when educated to do so by their doctor and on the prescription label)

Do you get a lot of build-up on your contact lenses by the end of the day?  See if these symptoms sound familiar:

• your lenses feel very uncomfortable as you blink
• your vision gradually reduces as you go through your day
• when you take your lenses out at night you see debris or film on the surface of the lens

1) Check your disposal time
If you know you are prone to overwearing your lenses, build-up is a big red flag that your lenses are past their expiration date.  Check with your doctor or you can look things up online to reaffirm how often you should be throwing away your lenses.  Many of my patients that get depositing in Acuvue lenses find that their issues completely resolve once they begin throwing the lenses away every 2 weeks like the lenses are approved for.

Miraflow is hard to find, so I often recommend the Walgreens version below.  Both via

2) Change your Cleaning Process
There is a reason that so many contact lens solutions are available on the market -- different people need different options to get the best results from their contact lenses.  There are a number of great cleaning options out there, so here is how to best maximize your results.

• Add a specific daily cleanser to your regimen

• Products like Miraflow Extra Strength Daily Cleanser or even the generic Walgreens version are specific cleansers safe to use with soft contact lenses and Synergeyes hybrid contact lenses for removal of deposits.  They are alcohol based, so it is always best to rinse the lenses with a cleanser afterwards.  Just apply a drop to your contact lens in the palm of your hand, and gently rub in a circular motion for 15 or so seconds.   Then you can rinse off with your regular multi-purpose contact lens solution or sterile saline

Change to Clearcare for overnight cleaning

Anyone who reads this blog has picked up on the fact that I am enamored with Clearcare.  This solution solves so many of patients problems due to the strong overnight cleans you receive with a peroxide based solution.  Just remember to let the lenses sit overnight and never put the solution directly into your eye.  This solution works perfectly with soft contact lenses of all shapes and sizes, and if you are a known depositor I still use it with my Synergeyes patients (though for many patients in Synergeyes Duette the preferred solutions are Aquify or Biotrue).  All other types of Synergeyes lenses (Clearkone, etc) should use Clearcare for best results. 

3) If you are still having issues, it is time to see your doctor
 Sometimes there is a medical condition causing you to get more build-up on your lenses, and without treatment, you may not have complete resolution.  Allergies or the more aggressive GPC (giant papillary conjunctivitis) where your eye basically rejects contact lens wear can cause depositing as a side effect. Treating the eye with anti-histamines or stronger steroid eye drops can help decrease the inflammation to your eye and make lens wear possible again.

4) Change to Daily Disposables
While dailies aren't available in every prescription, sometimes it is easiest to just change to a lens that you throw away every day instead of trying several cleansing products nightly to combat lens build-up.  Check with your doctor to see if daily lenses are available for you.

Imagine biking down a winding mountain road, wind in your face--but not your eyes because they are protected by full coverage sports goggles.  And then oh no, your bike chain breaks.  And you don't know how to repair it.  But wait--those goggles that were shielding your eyes from sun and wind just a second ago can also access an electronic repair guide!

Bolle designs performance goggles for outdoor sports ranging from biking to snowboarding.  Via

Smart goggles like these are not so distant in our future according to entrepreneurs at Laut Design.  They are partnering with performance glasses enterprise Bolle to help design the next generation of sports goggles.  The concept sounds similar to Google Glass with electronic projection that can be accessed to view maps, odometers, heart rate monitors, and endless possible applications.  All while utilizing the highly performance based goggle design that Bolle has popularized with glare and UV protection, and specialized tints to enhance performance in a variety of light conditions.

There are no projected release dates on when a smart goggle design may first hit the market, but expect the next generation of performance glasses to perform at a whole new level!

The product has launched in Europe, but not yet in America.  Via

We are merely months away from the American launch of another new daily disposable product, this time courtesy Ciba Vision!  Daily disposable products are the major forces on company's pipelines these days, with Bausch and Lomb's new Biotrue daily launching earlier this year, and Cooper Vision's Proclear 1-Day Multifocal launching last fall.  For contact lens wearers suffering from dry eye, the new daily materials offer a reason to hope!

What makes the new DAILIES TOTAL 1 product different?  Ciba reports that this lens is the first "water gradient" technology on the market.  The daily is made from a new silicone hydrogel material called delefilcon A.  At the central core the lens has only a 33% water content, allowing for record high oxygen transmissibility (a stunning 156 Dk/t!).  But this relatively low water content would have meant questionable comfort as the lens drew water from the eye during the course of the day.  The solution?  The water content of the lens increases gradually towards the front and back surface of the daily lens.  At the surface of the lens, the water content reaches 80%, which matches the water content of the cornea.  The theory is that if the contact lens and the cornea have the same water content, there will be less drawing of water from the eye into the lens, meaning better end of day comfort.  Another plus?  The lens has an 8.5 base curve, whose closer fit to the eye can offer better initial comfort to the average myopic lens wearer with steeper corneal curvature.

We are hoping to see these lenses available in our office later this fall, and can't wait to see the results.  As with any product, this lens may or may not work for your particular needs, but it is great to see companies focusing so much on combating dryness and switching concentration to daily disposable products which offer the best in comfort and safety to all contact lens wearers!

Somewhere in the distance a bone chilling screech breaks the silence of the exam room.  "You mean, I can't wear my contact lenses at all?  For an entire week?"  If you are a contact lens wearer, nothing chills the heart more than hearing the dreaded words: "you have to wear your glasses."

For over 2 million people worldwide diagnosed with Multiple Sclerosis, finding a treatment that controls the disease can be both costly and time-consuming where time is of the essence.  With MS, trial and error with a drug could mean the difference in permanent debilitation.  Luckily, more and more promising drugs are hitting the market.  Newly launched Tecfidera is one of the most promising oral medications (and for those with MS, an oral treatment is a brave new world because traditional medications have required daily injections!), but comes with a hefty price tag around $54,000 for a year of treatment.  Like all medications, you won't know if it works for you with the same effectivity seen in trial data.  New research from Johns Hopkins suggests that your eye doctor may be able to work in conjunction with your primary care provider to track if your MS medication is working effectively for you!

OCT imaging showing the thickness of individual retinal layers via

Ocular tissue is neural tissue, just like the tissue that makes up the brain.  As such, changes seen in the retinal tissue appear to reflect changes going on in the brain tissue with people diagnosed with MS.  Over a period of 21 months, Johns Hopkins researchers monitored the OCT (Ocular Coherence Tomography) scans of 164 patients with MS.   An OCT is a advanced scanning device that measures the thickness of retinal and optic nerve tissue, and compares the eye to a normative data base.  To date, the technology is routinely used to track changes associated with glaucoma and macular degeneration.  Researchers found that retinal thinning greatly increased in patients with new T2 lesions and in patients who had worsening levels of disability over the course of the study.  The data looks promising for testing new neuroprotective agents -- after starting a new medication, doctors could potentially use OCT readings to determine if the medication was effective before debilitating progression of the disease caused functional changes in a patient's daily life.  More research is required before this use of technology is implemented in normal protocol, but in a few years, MS patients may be routinely referred for eye examinations to monitor how well their medication is working!  Just one more way to utilize the amazing window into the brain that our ocular tissue provides.

via

Have you or a loved one been diagnosed with MS?  I am partnering with Healthline to promote their video campaign: "You've Got This" where people living with MS can post inspirational video messages that can inspire and encourage others who are recently diagnosed.  Visit the link here to check out the videos or post your own!  Healthline is donating $10 for every video submitted so please take some time to post your story or words of hope for this great cause!

It is the year 2013, and Google is not about to let us forget it.  The world is abuzz with news releases from the company's latest tech venture: Google Glass.  This "wearable" computer is basically a smart phone -- sitting on your face.  And while Google Glass isn't going to help you see (protocols are in development for a future version that can be fit over prescription glasses), these glasses are letting us see into our possible future.

Almost everyone has a pair of basic brown or black sunglasses, but if you are ready for a real statement, try wearing bolder prints with your sunglasses.  The fashion world is all about mixing, matching, and layering competing prints these days, so there is no better time to add a fashion-forward printed sun to your spring wardrobe.

Dolce and Gabbana

Tory Burch

Kate Spade--I know I have posted these before but I really do love them

via

A Visual Field test is use to detect glaucoma damage and monitor for progression.  In many cases, early damage that shows up on this test is not noticeable to the patient in their daily life. Glaucoma damage would go entirely undetected if left untreated until the disease had resulted in permanent peripheral field loss via

Glaucoma is a really difficult disease (read here for more details on what glaucoma is!).  Imagine that you have to tell a person that they have a disease where they have to take an eye drop every single day for the rest of their life.  The drops aren't going to make you feel any better; the disease is painless, and if you have had vision loss already they won't give you the vision back.  You can see how there is little incentive to use those drops every day.  This is a conversation that eye care professionals have very frequently, and for many of us, we have to have it every time our patients return for their follow-up appointments because they are routinely missing their drops!

One thing we do know; even if your patient reports good compliance with their glaucoma medication, they probably aren't taking it as often as they tell you.  Studies estimate that as high as 25% of patients prescribed glaucoma medication actually take NONE of the drops prescribed.  Only 25 to 35% of patients in the same study had full compliance.  This means that most people have "partial compliance" - -getting the drop in irregularly.  Usually they remember when it gets closer to their next appointment (just like flossing your teeth before you see the dentist!).  When the patient has their pressure checked, it may read normally if they have used their drops more regularly over the past few days, but their peripheral vision or optic nerve scans may show increased damage.  What is the doctor left to think??  Well, if your doctor thinks you are getting your drops in regularly and you are still having progression of glaucoma, they are going to prescribe more drops!

We all know that the more drops you prescribe, the less likely a patient is going to be able to afford their glaucoma treatment and remember to get the drops in.  If a patient can have good control of glaucoma with just one drop, it is definitely ideal.  Before adding more drops to a patient's regimen, I always like to investigate to see if they are using the drops regularly by asking these questions:

• How often do you miss your drops?   If they say a few times, does that mean a few times a month?  Or a few times a week?  It makes a big difference to get these details!
• When did you last use your drop?  Did they get it in last night or this morning?  Or was it a few days ago?
• What is the name of your drop?  Not everyone is going to remember this, so it also works to have them bring their drops in to their appointment.  I love looking at the drops because you can see how much is left in there and when their last refill was.  If they have a full bottle and the refill date was a few months ago, you know they aren't using their drops.  Sometimes they are using a drop by mistake that isn't even the one for glaucoma.  They could have had an old antibiotic, or worse a steroid! that they have been using daily by mistake!
• What grade would you give yourself on using your drops?  Asking a person to take accountability for themselves can sometimes lead to more honest answers.  If they tell you they get their drop in regularly, and then give themselves a "B" you need to know why.
• Ask them to show you how they put their drop in.  I don't do this often, but if I am getting concerned that a patient might be having trouble, it is a really good idea.  Sometimes they will miss their eye altogether when they try to put the drop in.  I heard a story at the VA Hospital where I interned about a patient who put the drop on his tongue when the doctor asked him to demonstrate.  No wonder his pressure was so high that day!

We've talked about selecting frame choices for your face shape (see these posts), but your frame selection has more importance than just style.  If you wear your glasses most of the day, they need to be specialized to perform for your daily activities.  The shape and sizes of frames can have a big impact on how happy you are with your glasses on a daily basis!  Here's a breakdown of the best choices for frame design depending on your occupation/lifestyle.

1) Computer Use

Computer users spend often long hours at the screen.  In addition to anti-reflective coatings and tints, your frame size can really improve comfort at the computer.  Your best choice depends on your personal work set-up and prescription:

• Single Vision Lenses; 1 computer screen:  In this case, smaller sized glasses can be better.  You want your glasses to be light weight, and smaller frames will limit the amount of bulk on your face.  When there is only one prescription in your lenses, you can always look through the center of your glasses and be in the right "spot" for your best vision.  Most of my patients prefer frames with nosepads at the computer so they can be adjusted to sit in the right place and with minimal pressure.  Frames without nosepads are comfortable too, but tend to slide around easily depending on the shape of the bridge of the nose.

If you prefer plastic frames, try smaller eyesize brands like Kate Spade; light weight and comfortable all day long

• 2 computer screens:  My patients often do better with slightly larger frames in this case.  The smaller your lenses are, the less area you have to be able to cut your eyes from side to side, meaning more head and neck turning.  With 2 large screens, a slightly larger lens size means less turning of your head back and forth to stay in the central area of the glasses.

Deeper segment, larger lens size, adjustable nosepads, and semi-rimless to reduce weight on your nose.  These Ray Bans would be perfect for work if you need a larger lens size

• Progressive or bifocals:  If you are wearing bifocals or full progressives (no-line bifocals) at the computer, you know that turning your neck up all day to be in the right spot is brutal on your spine.  I often recommend larger frame sizes for progressives to distribute the power better through the lens, but if it is too large, you are going to have to tilt your head back quite a bit to enter the computer area.  One solution is having separate computer glasses.  Smaller lens sizes will put the computer zone closer to the optical center of your glasses, but don't go too small!  If you computer zone is only 1-2 centimeters of the lens, it's going to be a lot more tedious to find than if you had larger glasses where the computer zone was 4-5 centimeters. This is why your optician is so vital to helping with frame selection when you wear multifocal glasses!

Put Transition lenses in these Linda Farrow frames and they could easily look just like normal sunglasses when in sunlight.  Larger frame size means you are less likely to see over the edge of the frame in your peripheral vision

Have you ever found yourself wondering why you have to pay extra to have a prescription for contact lenses?   My patients often tell me the same things:  their prescription hasn't changed in years, they like the comfort of their lenses, they just want their same prescription again.  At my office, I never renew a prescription without evaluating the contact lens on the eye, testing vision, and checking the eye carefully for any signs of damage from contact lens wear.  These actions are the contact lens evaluation, an additional piece of the exam that glasses wearers would not need.  Typically your vision insurance has a separate copay for a contact lens evaluation because they also understand that it is a separate part of the exam.  What are the components of a thorough contact lens evaluation?

Neovascularization via

We all know that 20/20 is perfect vision, but there is a very small, central area of the eye that makes those fine details of 20/20 possible.  This central vision area is called the macula.  In this ocular structure, you have the highest density of photoreceptor cells in the entire eye.  As a result, in retinal photographs this high density area looks like a dark spot in an otherwise light pink or purple retina.  Most of my patients ask me if that dark area is a problem, but as long as the color is uniform, your macula should be nice and dark.  Color variations in that area are indicative of possibly permanent, devastating visual conditions.  Here are some that I have seen in my practice to date:

Normal, healthy retina with a dark central macula.  This is your comparison photo for mine below! photo via

Diabetic Retinopathy with exudates and macular edema

Geographic Atrophy from Macular Degeneration

Macular Scarring withWet Macular Degeneration

Toxoplasmosis

Plaquenil Retinopathy

Runny nose, itching, sneezing?  In the past, you might have just reached for OTC anti-histamines like Claritin.  But when you bring these complaints to your primary care doctor, sometimes you and your doctor will opt for a prescription strength treatment.  Over the past few years, Flonase (fluticasone) has become an overwhelmingly popular choice as a prescription medication for chronic seasonal (and perennial!) allergy sufferers.  Flonase is a steroid nasal spray, meaning that its key method of action is to fight the inflammation causing all of those allergy symptoms.  Many people are aware of the long term side effects of prolonged steroid use, and there are some potential ocular effects that your doctor should discuss with you:

Via

Herpes Simplex looks similar to other more common eye infections; it takes a trained ocular specialist to determine the difference.  Photo via

Harper's Bazaar

Weather is still refusing to relinquish winter here, but there are plenty of great sunglasses out there to brighten your spirits even when you don't see the sun!

Kate Spade

Celine

Cutler and Gross

For many patients, when I am performing their refraction they tell me it is a very stressful experience.  I try to make things easier by showing patients choices slowly and several times, and reassuring them when they select the same answers.  The refraction process can be stressful, but your doctor is making sure on the other side of that machine that you are getting glasses that you will be able to see clearly through.  You aren't going to end up with super thick glasses that you can't see through, no matter how many "wrong" answers you give. After all that, you finally get your prescription, and now you have the arduous task of selecting and purchasing glasses.

First; you have to select frames.  Styles, shapes, colors; that's a lot of choices!  Sometimes my patients come back several days in a row with friends and family and significant others, just to make sure they are picking the right frame.  The frames have to be comfortable and able to perform with your prescription, and of course, you have to feel like you look great in them.

But wait, you still aren't finished!  When you finally select your frames, your optician is going to review your prescription and start offering even more choices.  Thinner lenses?  Anti-reflective coating?  Scratch coating?  Transitions?  Even for people who are normally quickly decisive, the process can be overloading.  Let's clear one thing up though:  it doesn't have to be.  Here's a quick breakdown for what you need for your glasses to perform to their fullest:

1) Lens Material
Glasses are made out of several different materials, and depending on your prescription or medical conditions, your doctor is going to have a strong opinion on what will perform best.
-CR 39:  Great option for lower prescriptions; your "standard" material

-Polycarbonate:  a MUST for children or people with one eye due to previous injury or amblyopia.  Polycarbonate or a material called Trivex are required for safety glasses and preventing shattering

-High Index:  For higher prescriptions (over 4.00D typically) to keep lenses from being so heavy and thick

Photo via

-Glass: Yes, they still make this.  But select at your own risk; most doctors require you to sign a waiver if you insist on glass due to the major safety and shatter risks

2) Coatings
All glasses from a reputable optical should come with some UV coating and a baseline scratch coating with a warranty (typically 1 year).  I consider UV and some scratch warranty a minimum. Glasses are expensive, and they scratch very easily--completely decimating your vision when a scratch occurs.

Without AR coating on the left you can see major glare photo via

-Anti-Refective coatings:  Do you wear your glasses at the computer?  Do you drive in your glasses in the rain or at night?  If you answer yes to any of these, you need anti-reflective coating to prevent glare  from disrupting your vision while wearing glasses.  If you need high index lenses, then anti-reflective coating isn't even optional.  Your glasses simply won't perform without it.

-Scratch Coatings: More expensive scratch coatings are essential when you have more expensive anti-reflective coatings.  Anti-reflective coatings improve glare, but make your glasses more at risk for scratching.  Protect your investment with a better scratch guard to make your glasses perform longer.

-Transitions or photogrey:  If you spend a lot of time in and out of doors having UV protection can prevent sun damage in and around the eyes as well as reduce light sensitivity.   And they are 100% UV blocking which means they function as well as full sunglasses at protecting ocular health.