Who doesn't want longer, fuller eyelashes?  Latisse is a prescription medication that can give you just that when applied daily to your lash line over the course of three to four months.  The amount of lash growth that you achieve may vary, and these pictures from the Latisse website give you a great overview of the kind of success you may achieve:

BEFORE:


BEFORE:
As you can see, results are going to vary based on your individual eyelash make-up.  But with daily use for the given time period, you should be seeing longer and fuller lashes from your baseline.

How Does it Work?
Latisse is the trade name for 0.03% bimatoprost, chemically a prostaglandin analogue. Prostaglandins are naturally found in our body as part of the inflammatory cascade, and bimatoprost increases the action of these mediators.  Originally bimatoprost was used as a topical eye drop for glaucoma, but a surprising side effect occurred -- users of the drop were experiencing an abundance of eyelash growth. Bimatropost had a secondary effect of stimulating anagen phase eyelash growth, resulting in users experiencing this eyelash explosion. After this secondary effect was tested and confirmed for safety, the original glaucoma eye drop was reformulated for the specific purpose of eyelash growth and that was the birth of Latisse.

What Are the Side Effects?

Latisse comes with applicators to help minimize exposure to skin and ocular tissue and target your eyelashes themselves! via

Because of its chemical make-up, Latisse can cause inflammation around the eyelid skin (remember, it increases the action of prostaglandins, which are part of our body's inflammatory pathway).  Because of this, I always recommend using the applicator carefully -- try to apply just on the eyelashes and avoid putting too much on the eyelid area.  Some people may be allergic to Latisse, and you would experience red and swollen eyelids within a few applications.  If the product comes into contact with the white of your eye itself, you may also notice redness and irritation on the white of the eye due to this inflammatory function of the drop.  If you apply the drop at night, it is common to wake up with red and irritated eyes in the morning if Latisse got in contact with your eyes.

Other side effects include increased pigmentation around the eyelid and even iris.  Latisse can cause an increased expression of our body's melanin (pigment).  This means a darker color to your skin along the lid line, but many times you will hear this marketed as a natural "eyeliner" effect.  More significant in issue is the chance that your iris will be darkened by Latisse use.  If you have light brown, hazel, or green eyes, Latisse can cause more melanin to be expressed, and thus darken your iris color.  Blue eyes are generally not affected since they have an absence of melanin to begin with.  If you have light brown or hazel eyes you should take this potential darkening effect into consideration, because it may not be reversible even if you stop using Latisse.

Take Home
Latisse is a very effective prescription for eyelash growth with minimal side effect risks.  I recommend trying to avoid too much contact with your eyelid when applying with the wand, and avoid exposing the drop to the surface of your eye if you are concerned with the risk of red and irritated eyes or darkened iris pigmentation.  If you stop using the drop, your eyelashes will eventually return to their normal state, so you would have to continue with the drop long term if you want long term effects.  Also, there is no generic version of Latisse, so depending on your medical insurance there may be a large price involved (in the same range as high end wrinkle cream products).  On average a single prescription of Latisse costs $120 without insurance coverage.

Have you used Latisse and want to share your before and after photos, or your experience?  Please comment or post your link below!

Wondering what the top trend for eyewear is this fall?  Look no further than Raf Simmon's sunglasses for Dior for a trend that the most fashion forward celebrities are embracing.  Dior's So Real sunglasses are an architectural rethinking of the clubmaster, a look that is incredibly futuristic in appearance despite its retro inspiration.  Celebrities like Olivia Palermo and Rihanna have embraced the look for recent fashion week appearances around the globe.

Rihanna via

Olivia Palermo via

The color options are just as inspiring as the unique frame shape.  Just check out this black version with the bright blue nosepads.  This is a trend I can really see taking off.  Neon nosepads with a more basic frame in a solid black or brown could be great.
Not convinced yet?  Supermodel Karina Kurkova sported a great pair of Dior So Real sunglasses for a recent spread in Vogue Spain.

via

 And you know that they are seriously trending in the eyeworld if Dr. Glover at Eye See Euphoria is posting about it.

Dior So Real Sunglasses via Eye See Euphoria

Not sure your pocket book can support this trend?  Look for similar options at your local high end optical by embracing the mix of plastic and metal.  Architectural details like browbars or oversized metal bracketing can elicit this same retro turned futuristic feel.  And if you can find frames with colored nosepads, then take a risk.  This touch of detailing can elevate your frame selection into what is styling into 2015!

Shop the Style (images are clickable!)

When checking someone's dilation, there can be a number of findings in the outer periphery of the eye that have no affect on the person's vision.  That's why dilation or fundus photography like Optos are so important to the ocular examination -- changes in the eye don't necessarily cause changes in vision.  Today we explore a relatively common ocular finding, congenital hypertrophy of the retinal pigment epithelium (or CHRPE for short).

An impressive Optos image of CHRPE just outside of the posterior pole via

CHRPE as viewed by off-axis fundus photography.  This picture was taken by me which explains why it is not that great. All of the white spots are artifact.

If you are going to buy one pair of glasses, please buy tortoise shell, black, or a a blendable neutral. But if you are going to buy two (or more) pair of glasses, then this post is for you.  I wear glasses at least 5 days a week, so having a few fun pair in my rotation is essential.  I honestly don't think you can make a better choice on your second pair of glasses than to go bold on color -- and red glasses are my statement of choice for fall and winter 2014.

Prodesign 1705 via

Red eye? Time to see your eye doctor via

It's that time of year again -- red eye time of year.  For every red eye patient that comes through the door I have a differential list going of 3 most likely suspects.

1) Do they wear multiple wear contact lenses?  Corneal ulcer is my first thought until I see otherwise

2) Do they itch?  Allergies and itching are almost always hand in hand

3) Is there crusting?  Viral conjunctivitis or pink eye as it is commonly called is so prevalent this time of year because of the number of viral colds going around.  Plus with back to school time, being around children is a really common infection source.  That means parents and teachers are at higher risk of coming to my office with a viral infection.

The reason that it is so important to see an eye doctor for a red eye is that your primary care doctor does not have the equipment to differentiate any of the above.  And the treatments for each of the above issues are vastly different!  You need a high powered ocular microscope to find a corneal ulcer (unless it is visible just looking at the person, in which case we are in a very emergent situation where there will almost certainly be permanent vision loss).  But the most important thing that is necessary when determining is this virus, allergies, or bacteria is a close microscopic evaluation of the under eyelid (tarsal) conjunctiva. Viruses typically have a follicular reaction in the conjunctiva, and bacteria and allergies classically have papillary reactions. Without a microscope, seeing this subtle difference is impossible.

Differentiating Papillae from Follicles

Papillary Reaction

A great example of papillae via

Giant Papillary Conjunctivitis -- Due the the chronic nature of inflammation, the papillary reaction is larger as the areas of irritation expand into each other.

Bacterial infections are very rare by comparison, so the most likely culprit when I see papillae under the eyelid is allergies.  Papillae are signs of chronic irritation, where the conjunctival tissue has become elevated and swollen due to repeated exposure to an irritant.  There are two important distinctions that are hallmark signs of papillae:

1. Red Center =  Papillae are elevations of the vascular conjuncitval tissue so there will be a red central vascular core to the lesions
2. Distinct Elvations = The conjucntival tissue has fibrous connections that limit the size and expanse of swelling.  This means distinct, well separated bumps in the papillary reaction.  The only time this logic doesn't fully apply is when the inflammation has been around for so long that the bumps begin to coalesce, creating the large cobblestone appearance we associate with giant papillary conjunctivitis.

Follicular Reactions

Follicular reaction via

While papillae are consistent with a local irritation, follicles are a sign of an immune reaction in the area.  This finding is almost always an indication of a viral infection of the eye.  Follicles have a larger appearance than papillae, and have a white central core since they are really accumulations of cellular level inflammatory agents -- lymphocytes, lymphoblasts, and macrophages if you remember your microbiology.   The big tell-tale sign of follicles are:

1. White Center = look for that inflammatory matter filling the center of the bump

Take Home

Having a hard time seeing the difference?  That's understandable because it takes doctors that are trained in this numerous patient encounters to develop a quick sense of which is which, and there are still some reactions that have questionable appearances with characteristics of both.  My real take home for any non-OD readers of this post is that a red eye takes a specialist to properly diagnose. The tell-tale anatomy is so nuanced, it is impossible to see without the proper equipment.  So please, see your eye care provider for any eye care needs so that you get the proper treatment without delay.

There is definitely no denying that daily disposable or single use contact lenses are taking the marketplace by storm.  If you are a regular blog reader, you know that I am passionate about the unparalleled comfort and health benefits of wearing single use contact lenses.  And for many people that are part-time contact lens wearers, dailies have the added benefit of being markedly less expensive; you only use the lenses that you need, and you never have to buy solutions.  With the unparalleled explosion of single use lenses on the market, this year has seen a lot of growth in the multifocal daily contact lens realm.  Multifocal contact lenses are designed to help the wearer focus in a range of  visual needs, from far distance, to computer, to cell phone reading.  Many people that need multifocal lenses spend significant amounts of their day battling dryness -- either due to extended computer use or due to hormonal and body chemistry changes occurring as we enter our forties and fifties.  Daily wear lenses can maximize lens comfort by offering the least risk of dryness with contact lens wear, and also now provide that vision flexibility that we need as our eyes enter presbyopia (or what many people will just call "tired eyes" and trouble focusing up close).  If that sounds like you, here are some great new lens options to explore with your doctor:

Proclear 1-Day Multifocal

The near center progressive design can give wearers variable vision depending on their pupil size, so what power each person needs to achieve their visual needs is dependent to a large degree on their anatomy via

This was the first readily available daily disposable multifocal on the market, and the Proclear 1-Day line of lenses tends to be very comfortable for most wearers.  The design is a bit challenging since finding the right power of the lens is not intuitive.  Luckily CooperVision has provided a detailed fitting guide to get you off to the right start.

8.7 BC
Power Range = +6.00 to -10.00
The lens is not add power designated which makes the fitting process less intuitive.  I always discuss with patients that I do not expect the contact lens prescription for this lens to match in any way what their glasses or previous contact lens prescriptions have been because of this disconnect in the way the lens is fit.





Dailies Aqua Comfort Plus Multifocal

A schematic of the design: near center, with rings of intermediate and then distance fanning out. via

When this lens launched earlier this year it was a great alternative option because it offered a design that doctors are already comfortable and familiar with fitting.  This lens uses the exact same multifocal design set-up to Air Optix Multifocal, and it is easy to transition patients that have worn the Air Optix lens into this daily version if they need the added comfort benefit without expecting to lose any vision.  You can follow the Air Optix Multifocal Fitting Guide to get started.



Biotrue ONEday for Presbyopia
This lens is just hitting the market in a limited initial roll out, and I am very excited to have it in my arsenal.  Using the same "3-Zone Progressive" design that is found in the Purevision2 Multifocal lens, I am especially happy to have this design as a daily option because I have found that this lens has been very effective for many of my patients.  Again, if you have patients happily wearing the Purevision2 lens, changing to Biotrue ONEday will be a seamless transition in vision if they need the added comfort of a daily lens.

8.6 BC
Power Range = +6.00 to -9.00
Add power = Low only at this time, with additional roll-out of High add power next year

1-Day Acuvue Moist Multifocal
This lens is slated to hit the market in late 2015, but we don't know much about what it will bring to the dailies multifocal market.  The 1-Day Acuvue Moist material is one of my favorites for all day comfort, so this fact alone is worth being hopeful.  Previous Acuvue multifocal designs (Oasys for Presbyopia, anyone?) have been left behind as newer options with better optics emerged, but Johnson and Johnson is introducing a brand new multifocal design for this lens.  Not much is known about the characteristics of this design at this time, but I will continue to keep you updated as we learn more!

This week I am excited to attend Vistakon's Women in Optometry Focus Group, and it is excellent timing that so much is going on within the company this year.  On October 6th, Johnson and Johnson launched broadened parameters in its popular 2 week lens brand, Acuvue Oasys for Astigmatism. For those of you with higher amounts of astigmatism this lens could help you attain better vision without the need for more expensive custom lenses.

via

What's New:
The Oasys for Astigmatism lens is now available in 10 degree axis options around the clock in all cylinder ranges up to -2.75.  In the past, only the older generation Soflens 66 Toric offered -2.75 cyl options without being custom order, and this brand's -2.75 range is now limited to minus spherical powers.   Acuvue Oasys Astigmatism now offers up to -2.75 cyl in powers from +6.00 to -9.00 to cover a broad spectrum of lens wearers.

Eyewear has had one thing hold true the last few years: big and bold. Whether it was oversized geek chic frames or bright blasts of color, glasses were all about making a statement.  So this season's trend took me a bit by surprise: neutrals are back in a big way.  Whether you prefer your frame to be metal or plastic, soft browns and pale peaches are the color of choice.  Here's a look at what's trending:

Lasers are such a buzzword in eyecare, and ever since the femtosecond laser entered the realm of cataract surgeries -- one of the most common surgical procedure done in the United States!-- the industry has been making the shift towards performing more accurate and better healing cataract extractions with laser precision.  Laser-assisted cataract surgery is not, however, covered by standard medical insurances, so when you discuss the option of upgrading to laser surgical options you need to know what improvement in outcomes you can expect for your extra money.   Today's post breaks down what femtosecond laser cataract surgery can offer as a potential improvement over traditional procedures, and what top ophthalmologists in my area are saying about their experience.
As technology improves, what the laser can accomplish may continue to evolve, so keep checking back here for more information as we learn more.

The Traditional Manual Surgery

A great schematic of the standard, manual cataract surgery.  The surgeon makes a incision into the eye, opens the capsular bag that holds the cataract inside, breaks up the cataract and removes it, then places a clear implant inside the capsular bag to correct your vision after surgery.  via

What Does the Laser Do Differently?
Cataract surgery involves your ophthalmologist cutting into the eye (either the cornea or the sclera which is the white of the eye) and then removing the cloudy lens (cataract) inside and replacing it with a clear implant to provide visual correction.  Despite being a quick procedure, with most surgeries lasting no more than 15 minutes, there is a lot going on and a lot of subtle techniques your surgeon is using to insure good vision for you, quick healing time, and to help prevent post-operative infections like endophthalmitis.  The femtosecond laser can take the place of procedures that surgeons were traditionally doing manually, like making the incisions into the eye, and opening up the capsule where the cataract sits (this is called capsulorhexis).

This is what your surgeon sees behind the monitor of the laser.  Your surgeon uses fine detail calculations to program the incision site for your surgery to insure the very best visual outcome.  via

What Are the Benefits?
When the precision of a laser is used to make incisions in the ocular tissue, the expectation is better visual outcomes.  If you have astigmatism, the laser can help make incisions to more precisely correct astigmatism post-operatively, meaning a less likely chance that you will need glasses after surgery.  If you are upgrading to toric (astigmatism) or multifocal (for distance and near vision) implants anyway, many surgeons will automatically also upgrade you to laser assisted surgery to insure a better outcome.  Yes, these upgrades are a greater out of pocket cost to you, but the result is the chance that you won't need glasses to see after cataract surgery, so you are getting major benefits if you have demanding visual needs.

The capsularhexis on the left was manually made, and shows a close-to-perfect circular opening, but obviouly some distortion.  On the right, the laser does it with the utmost perfection. via

In addition to the initial incisions, the laser is also used to help open up the capsule that holds the cataractous lens inside. Traditionally surgeons have to manually open this bag, making a tiny circular incision with delicate hand movements, being very careful not to tear the opening too large. While many surgeons are so good at what they do, they can make a perfect circular incision with a smooth edge by themselves, the laser can help attain that level of perfection every time.  What does a perfect capsulorhexis mean to you?  A tear in the capsule can be devastating to vision if the implant falls into the back of the eye, but luckily this is a very rare side effect of cataract surgery.  The more common issue with an imperfect capsule opening is the risk that as the implant "settles" inside the capsular bag, an imperfect opening will cause pulling or shifting of the implant out of place, and thus a shift in the clarity of your vision.  This is a problem that is not fixable after cataract surgery because there are too many risks involved with trying to remove the capsule or re-position the implant unless it is absolutely necessary.  A pefect capsularhexis means less chance of unequal pulling or shifting of your implant, which means your best chance for perfect vision after surgery!

Finally, the laser is also used to help break down the cataract.  The cataract inside the capsule bag can be very thick and dense (especially if you waited awhile before having surgery).  With the laser's help, the surgeon will need less time breaking up the cataract and less time removing it from your eye.  The faster this part of the procedure goes, the lower the chance is for serious infection and inflammation after the surgery.  This is especially useful in patients that have medical conditions or that are on medications that make traditional cataract surgery more difficult.  Flomax is a great example of a medication that can cause difficulty in the operating room (it makes dilation difficult, making a very, very small window through which your surgeon must work).  If you have corneal degeneration issues like Fuch's dystrophy or endothelial guttata, then the high heat used during traditional cataract surgery can increase the risk of permanent damage to your corneal endothelial cells. Laser assisted surgery helps limit the risks involved in these cases.

Are there any Cons?
The use of the femtosecond laser has a few pitfalls, especially for surgeons used to traditional methods.  Dr. Alan Carlson is an acclaimed cataract surgeon in my area, and recently spoke about his experiences at a local meeting.  He reports that laser assisted surgery does add additional time to his surgical time, meaning a longer time under operation for the patient, and typically a lower number of surgeries that the ophthalmologist will be performing that day.  Dr. Carlson also reports a definite learning curve on using the laser to its utmost abilities.  As you get more comfortable using the laser to make your incisions, the outcomes and techniques get better and better, just like any other highly skilled method.  If you are considering laser assisted cataract surgery, make sure that your ophthalmologist is performing this type of surgery routinely; it is still a new procedure, so no one will have years of experience with it, but if they are using the laser on most patients you will know that they have established their own technique for success with it.  Another great option is to talk with someone who had laser-assisted surgery.  What was their experience?  What did they feel like they gained?  Talking with others that had surgery with your doctor can always help put you at ease, no matter what type of specialist you are seeing.

There is no doubt that laser-assisted ocular surgeries are the trend for the future, and as our world becomes more digital and thus visually demanding, we all have high expectations for vision after major eye surgeries.  Laser-assisted procedures are a step towards achieving the next level of visual perfection, and for many that extra quality of sight is worth any additional price tag.

A friend recently contacted me with this sad story: an elite young gymnast, Deanne Soza, is at risk of permanent and severe vision loss due to an aggressive contact-lens associated infection.  Reading the posts from her family it appears she had contracted a possible Acanthamoeba infection in both eyes from wearing contact lenses in a hot tub.  Acanthamoeba is a protozoan parasite that is commonly found in water - swimming pools, lakes, and yes, hot tubs.  As doctors work to treat the infection and save Deanne's eyesight, it highlights a new and disturbing trend in the eye care world.  Corneal infections from contact lens wear are actually on the rise, and it is time for both contact lens wearers and eye doctors to rethink what we can do to prevent even just one more person from going blind or suffering vision loss from wearing contact lenses.

I don't show a lot of graphic pictures on the blog, but this is what an advanced Acanthamoeba infection looks like. When it gets to this point, vision is likely permanently damaged and your doctor is battling to save your eye at all.  via

What Can You Do?

If you wear contact lenses, it is so easy to treat them with relative indifference.  Every single day I have patients tell me that they sleep in lenses that aren't approved for it, wear lenses 2 or 3 times longer than the FDA and their doctor have prescribed, and disinfect their lenses with cleaning supplies that are not safe to use with contact lenses.   Tap water, sterile saline, your saliva, or any home-made solutions are not safe for cleaning your lenses!  If you follow these safety protocols, then contact lens wear should be safe for you:

1) Follow the Prescription
Do you have monthly lenses? Biweekly lenses?  Lenses approved for overnight wear?  Your doctor has prescribed lenses with specific wearing schedules, and make sure you know what you lens is made for.  If you wear a 2 week lens for over a month, you are putting yourself at a really high risk of complications.  Why risk blindness when just changing out your lens will keep your eyes safe?  Make sure you tell your doctor how you want to wear your lenses, and they can help you find a lens material approved for that wear time.

2) If your eye is red or irritated, take your contact lenses out
When you are a contact lens wearer, it is often like telling someone they have to go to prom in a potato sack to get them to wear their glasses for a few days.  But if your eye looks red or feels a little uncomfortable (yes, even just a little!), you should throw away your contact lens and wear glasses.  If your eye isn't 100% back to normal later that day, call your doctor to be seen immediately!  Do not wait until you have vision loss or discharge or severe pain.  You need to stop contact lens wear the second your eyes don't feel right to prevent severe infections.

Does your eye look or feel just a little irritated.  If you notice even mild redness like above, take your contact lenses out and wear your glasses that day!  If your eye is irritated, it needs a chance to fully recover without exposure to bacteria or other microbial pathogens that your contact lens may have on it!  via

3) If your eye is exposed to water, take your contact lenses out
Any water-related activities are extremely dangerous when combined with contact lenses. Rare but severely aggressive pathogens like Acanthomoeba live in water and soil.  Swimming in lakes or pools or hot tubs and getting that water in your eyes just coats your contact lens with loads of pathogens.  If your eye gets even a small scratch or dry spot under your contact lens, then the infection can break through the corneal epithelium and penetrate deep into your eye.  That's why removing lenses to clean them right after exposure is so important, and removing lenses if your eye feels even just a little uncomfortable is crucial.  You need to have a 100% normal corneal surface to safely wear contact lenses -- no scratched areas, and no dry areas.

What Can Your Doctor Do?

I am a huge proponent of talking about daily disposable contact lenses with my patients.  I know dailies aren't as popular in the US because they are seen as price prohibitive, but they are far and away the safest way to wear contact lenses.  When you throw away your lens every day, there is no chance to seal bacteria or any infectious entity against your eye.  As contact lens risks come under increasing scrutiny from the FDA , I expect that we will see growing numbers of patients switching to dailies for all the perks of both safety, comfort, and incredibly clear vision since there is no build up or lens deterioration to combat.   I ask all of my fellow eye care specialists to advocate for daily disposable lens wear, and even if your patient isn't interested in dailies this year, if we continue to talk about the benefits and safety, we can help prevent the number of infections and the number of people being blinded by their contact lenses forever!

Have you ever pulled down your eyelid and looked closely at the tissue underneath?  For most of us, the only reason to look under your eyelid is if it feels like there is something stuck underneath.  But not everything that you see within your conjunctival tissue (the vascular layer that makes up the underside of your eyelid) is a foreign body or stye.  Imagine if you pulled your eyelid down and saw this:

Inferior tarsal conjunctival concretions via

Have you ever looked through a pinhole and noticed that you can see really well? Even without glasses?  The reason that pinholes work is that they shrink the amount of stray light information entering the eye, creating less distraction and minimizing the amount of distortion than can get processed and create a "blurry" image when the information reaches the brain.  The same effect is commonly used in cameras to create a clear image.  The big drawback of pinholes?  Your world is limited to a small speck of vision (albeit a clear, small speck).  Wouldn't it be great if your eye had an internal pinhole so that vision isn't as limited peripherally but you could get the same amount of crystal clarity without the need for glasses?  That is the concept behind the proposed eye drop from Presbyopia Therapies, LLC being investigated for treating blurry vision after age 40.

Small pupils create a pinhole effect, sharpening vision by limiting distortion to a small area.  Presbyopia Therapies, LLC is working on an eye drop that can cause this constriction temporarily to improve vision for the day without side effects! via

Dr. Terry Kim is an ophthalmologist and leading researcher for the eye drop, and he recently spoke on Eyetube.net about his research if you are interested in watching the interview.  The drop is a new product that somehow separates miosis (pupil constriction) from accommodation (muscle action of focusing), allowing the pupil to become a pinhole without creating terrible headaches and brow pain that similar pupil constriction drops like pilocarpine are associated with.  In current research trials, the drop is being dosed daily and achieving vision effects for 8-10 hours.  Both distance and near vision is improved in his experience (just like we would expect with a normal pinhole effect).  The possibilities are theoretically endless; in addition to correcting prescriptions temporarily, these miotic drops could limit glare or halo issues after LASIK surgery or corneal injuries which are often worsened with night vision due to our larger pupil size in dim lighting.  A small pupil will keep vision away from these distorted corneal areas, preventing light from hitting these imperfections and creating glare, shadows, or halos.

We are still a few years away at least from having a drop of this nature on the market, but Dr. Kim reports that they will enter Phase 2 clinical trials next year, which means that we will be getting more concrete study results soon as to how the drop is tolerated and the amount of vision the average user is achieving.  If you are interested in learning more right now, this article was the most comprehensive I could find currently. Stay tuned because as I learn more, I will continue to update on the blog!

The dust is just settling on New York Fashion Week's Spring/Summer 2015 shows, and as always the street style was as much on display as the designer's runway looks.  Sunglasses were on prominent display again this year, but one trend was a resounding winner: Mirrored Sunglasses.  Whether you paired them with classic aviators or bold plastic frames, wore them in the new-again round shapes or more traditional lens cuts, or sported the mirrors in color hues from blue to red, these sunglasses were everywhere.

Amber tinted mirrored sunglasses give an edge to a more feminine bow-tie blouse and a-line skirt via

Similar effect here -- a soft, feminine dress when paired with mirrored wayfarers and a color block clutch can look quite edgy via

Jessica Minkoff, Marie Claire's Senior Marketing Editor wears blue mirrored sunglasses outside of the Rodarte show via

Mirrored shades get the architectural treatment via

Blue mirrored shades and sneakers give a nice contrast to this board-room ready blouse and skirt via

Model Behati Prinsloo pairs mirrored aviators to bring her 90's inspired grunge street style into 2014 relevancy via

Blue mirrored shades were popular with men too as seen via

The take away?  Mirrored sunglasses are very versatile -- you can pair them with almost any look and add an element of futuristic edge.  While the look is definitely strong, if you talk to people in the optical industry, you might hear some negative feedback.  Mirrored lenses can have some associated glare (the front surface is nothing but reflection when you add mirrors), so if you are glare sensitive or want sunglasses with the best vision of your life, don't get mirrored lenses.  But if you are wanting to embrace a really fashion-forward trend that is here to stay (for the next season at least), mirrored lenses are definitely a style to embrace!

Are you feeling the trend?  Please post any links to mirrored sunglass styles that you are liking and I will be happy to feature them in a coming post!

Do you sometimes feel a sharp pain in your eye, and then experience watering and light sensitivity? Do you frequently wake up with a sore, tender eye and blurry vision?  Do your eyes frequently water or even matter when you wake up in the morning?  If these are symptoms that brought your to this blog, I highly recommend that you schedule a visit with your optometrist because you may have a chronic and recurrent condition called corneal erosion.

Understanding the Basics of Recurrent Corneal Erosion

The easiest way to see a corneal abrasion or recurrent erosion is to use NaFl dye.  In this picture the person has a large abrasion right in the center of the cornea which would have a huge impact on vision.  An abrasion this size could take several days to a week to fully heal; and if you get recurrent breaks in this area it could cause a huge toll on your life -- constantly battling a week of pain, light sensitivity, and blur.  This is why Recurrent Corneal Erosion is such a difficult problem to have to deal with.  via

Recurrent corneal erosion is a relatively common issue for people with dry eyes or those with a history of previous corneal abrasion.  Finger nail scratches or paper cuts to the cornea are common initial injuries -- the abrasion you suffer from such a small and thin corneal scratch may have difficulty healing properly.  As the cornea heals itself from that injury, the junctions that hold your epithelial cells together may never fuse with the same strength, leading to areas that are susceptible to re-breaking.  From that moment of your initial injury onward, if your eye gets too dry or irritated, the tissue may break open again causing the same terrible symptoms of pain, watering, light sensitivity, and blurry vision that you experienced when you first had the abrasion.  Overnight dryness is the most common culprit for these recurrences -- your eyes will get too dry overnight, causing the surface epithelial tissue to stick to your eyelid.  When you open your eyes in the morning, those sticky areas will break right open where the junctions are permanently weakened from your prior abrasion.  The result is severe pain, and a fresh new abrasion to battle.

Treatment Options

GenTeal Gel is a go-to product for me in cases of overnight dryness via

Typically the best way to prevent recurrent erosions is to prevent your eye from getting too dried out, especially overnight when our eyes are more prone to getting dry anyway.  That means using moisturizing drops, gels, or ointments on a routine basis.  For many of my patients, just using a rewetting gel drop or ointment at bedtime is enough to prevent a morning recurrence.  Drops like Refresh Liquigel, Systane gel, or GenTeal gel or ointment are excellent products.  It is also best (if possible) to avoid any direct airflow to your eyes overnight.  That means no ceiling fans or vents blowing at your face.  If you use a CPAP machine it can also cause direct "wind" blowing on your face, so a good quality eye ointment is essential to prevent excessive overnight corneal dryness in this case.

If you are still getting a few corneal erosions a year, over the counter drops may not be enough to solve your problem.  There are several surgical treatments that have been effective for treating and preventing future recurrent erosions, and your doctor will work with you to find a plan right for your eye.  Options include lesser invasive procedures like using a bandage contact lens or doing a month long pulse of steroid drops and doxycycline, to more advanced surgical options. Anterior stromal puncture is a common method that surgeons will use to prevent future erosions where they purposefully cause multiple pinpoint breaks in a circular ring around the cornea to try to stimulate a full healing attack from your body to reset all of those problematic weak epithelial junctions.

ProKera amniotic membrane lens is a large disc placed on your eye to help heal the epithelial junctions permanently. The lens itself is not comfortable, and will cause blurry vision while you wear it, but for many this is worth the results.  via

A new treatment on the market that has been showing great success is the use of ProKera, The concept is simple: a contact lens that is made out of amniotic tissue is applied to the eye that bathes your cornea in natural anti-inflammatories and healing mediators.  The hope is that this membrane can help fully regenerate your cornea with its full epithelial junctions intact, meaning a strong new cornea of your own that is resistant to future breaks. Optometrists and ophthalmologists can both use this membrane contact lens to help your eye heal, but since this is amniotic membrane tissue, the expense can be high if your medical insurance does not have full coverage. Another thing to note is that the ProKera lens is definitely not for everyone -- it is bulky and uncomfortable while it is on your eye, and you will have blurry vision for the entire time you are wearing the lens (typically a week or more).  For most wearers, it is worth a week of discomfort if you could possibly have a lifetime without another corneal break.  Again, your doctor can help you decide which approach to your recurrent erosions is right for you, and hopefully prevent another painful recurrence.