There Is Something In Your Eye – Now What?

It is never planned. You could be putting on makeup, gardening, or even just running errands on a windy day, but all of a sudden you have something in your eye and it hurts. What do you do?
something in your eye

Small Foreign Objects

First and foremost – DON’T RUB your eye!! This could scratch your cornea and make things much worse.

  • Wash your hands thoroughly with soap and water.
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  • In a well-lighted area, look in a mirror to try and find the object in your eye.
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  • If you wear contacts, remove them before trying to remove the object or flushing your eye.
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  • Try blinking and letting your natural tearing flush out the object.
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  • If the object is on the colored part of the eye or under the upper lid you can try to flush it out gently with clean cool or lukewarm water in one of three ways:
     

    1. Completely fill an eyecup or small juice glass with water and put your open eye into the container to flush out the object. Do this standing over a sink as the water will overflow.
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    3. Use a clean eyedropper and fill with water. Be careful to not touch the tip of the eyedropper to the eye.
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    5. Turn your head so your eye is down and to the side, then hold your open eye under a faucet.

     

  • If the object is in the corner or on the white part of the eye you can try flushing the eye using one of the methods listed above or a using wet cotton swab or twisted piece of tissue to lightly touch the foreign object. Make sure to not apply pressure to the eye.
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  • If it is under the lower lid you can use any of the methods above by gently pulling down on your lower lid to access the object, but be careful to not push the object further down.
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  • A scratchy feeling of slight discomfort may continue for a short time after removing a small object. I discomfort continues after 24-48 hours, your eye becomes red or your vision becomes blurred, immediately seek medical attention.
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  • Never use tweezers, toothpicks or other hard objects to remove an object as these could damage your eye.

Never try to remove a piece of metal, anything that has punctured your eye or an object that will not come out after flushing with water. Cover both eyes to help prevent eye movement and there is no pressure on the eyes. Have a friend drive you to eye doctor immediately.

Chemicals

Do not touch your eye, but IMMEDIATELY flush your eye with clean running water from a faucet.

  • Flush your eye for a minimum of 15 minutes holding your eye open and at an angle so the runoff water does not run into the other eye. If both eyes are affected or the chemicals are on other parts of the face or body, you need to do the flushing in a shower.
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  • If you wear contact lenses, leave them in and start flushing immediately. If they do not fall out from the flushing process you can try to remove them. Then repeat the entire flushing process.
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  • Seek medical attention immediately upon completing the flushing process, regardless of how your eyes feel.

Prevention

The best way to protect yourself from getting anything into your eyes is to protect them.

  • Never use chemicals without wearing goggles that completely surround and protect the eyes.
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  • Wear specially designed goggles when swimming.
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  • Wear goggles when participating in sports where you could get hit with any flying object like a ball or bat. Also in any sport where you could get an opponent’s elbow or hand in your eye.
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  • Wear protective eyewear when using power tools or striking tools like hammers.
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  • When you are cycling, in dusty areas or it is windy, also protect your eyes with sunglasses or other protective eyewear.

 
Susan DeRemer

Susan DeRemer, CFRE
Discovery Eye Foundation

What Is Happening In the Gas-Permeable Contact Lens Industry

The Gas-Permeable Contact Lens

The mainstay of treatment for our patients with keratoconus are gas-permeable lenses.  Corneal gas-permeable (GP) lenses have been the treatment of choice for over 40 years and fit approximately two-thirds the size of the cornea.  Corneal GP lenses translate and pump tears and oxygen under the lens with each blink.  Hybrid lenses have a GP center bonded to a soft skirt that cushions and centers the lens.  Scleral lenses are very large diameter lenses that completely vault the cornea and land on the relatively insensitive scleral tissue.  Whether they are corneal GP, hybrid, or scleral lenses, the commonality is that all of these strategies use the optics and rigidity of GP materials to provide the best vision and comfort for this challenging condition.

gas-permeable contact lens
Well-fit corneal GP lens with sodium fluorescein dye

The way that the GP industry works is that GP button manufacturers (there are 6 in the US) sell the raw material, or button, to independent laboratories (there are 39 in the US) who then craft the button using industrial lathes into hundreds of lens designs using their own intellectual property.   GP buttons are used to make corneal GPs, hybrid, and scleral lenses.  Doctors who are skilled in fitting and evaluating the lens designs craft custom made GP lenses for their patients for whatever purpose benefits the patient.

Not many people know that the GP lens industry is on fire right now.  The turmoil began when Valeant Pharmaceuticals purchased Boston Products.  Boston Products manufactures the raw material of GP lenses, GP buttons, and held around 80% of the US market share.

The independent laboratories have a trade association called the Contact Lens Manufacturer’s Association (CLMA) who have an educational wing called the Gas-Permeable Lens Institute (GPLI).  The GPLI is universally beloved by practitioners because its primary function is to educate doctors to become better doctors in a non-branded, good-of-the-industry format.  No lens design is favored over any other.  Education is free to all doctors and expertise in specialty lenses is stressed, so that patients are placed in skilled hands.  Jan Svochak, president of the CLMA, says, “The CLMA represents a longstanding group of Independent Contact Lens Manufacturers working collaboratively where we have shared goals. These include educational resources through the GPLI that work closely with Eye Care Practitioners and Educational Institutions as well as a dedication to protecting and advancing utilization of custom manufactured contact lenses.”

Next Valeant dropped the hammer on the industry.  Overnight and for no apparent reason, they sent a letter to all of the independent laboratories announcing that they were increasing the price on scleral lens-sized Boston buttons by an astounding 60% (and other buttons by multiples).  Simultaneously, they announced that they were dropping out of the CLMA.  This move stunned the CLMA member labs as it blocked them from supplying Paragon CRT lenses to doctors.  Being the market leading GP button manufacturer, dropping out of the CLMA essentially defunded the GPLI and ensured the immanent collapse of the CLMA.

The price increase sent shock waves throughout the industry.  There was a simultaneous but independent reaction from many of the key-opinion leading optometrists who fit GP lenses.  The problem with any increase in price on the GP button level is that these price increases are passed down the line through the laboratories, the doctors and eventually, to the patients.  Valeant saw a huge backlash from optometrists who essentially stopped prescribing their materials.  They admitted making a mistake, and lowered the cost of the buttons, but interestingly, not to the original level.  Instead, there was an average 16% increase in the cost of scleral lens buttons to the laboratories.  Similarly, Valeant did not rejoin the CLMA.  The cost increase has been reported to fund Valeant brand specific education.

The other members of the CLMA came together and saved the association and the GPLI.  Additionally, a key competitor to Valeant, Contamac, rejoined the CLMA.  Contamac is a button manufacturer who formerly held around 8% market share of GP buttons.  At present, key sources within the industry believe that the market share has essentially flip-flopped, so that now, Contamac has rapidly gained market share of the GP button space as doctors have largely abandoned Boston materials in protest of these moves.

In a reactionary panic, Valeant has most recently written to the CLMA, asking to rejoin, but paradoxically with demands.  The CLMA is currently reviewing whether to allow Valeant to rejoin and under what terms.  Long term, it is beneficial for the industry for everyone to work together for the common good. It is unfortunate that a large company has come into the keratoconus treatment area and is raising prices without providing any real value, such as research and development into newer and better tools.  Companies like Valeant ultimately need to realize that they are not in control of an industry.  The patients and doctors are.

 

Dr. Sonsino is a partner in a high-end specialty contact lens and anterior segment practice in Nashville, Tennessee.  For over 12 years, he was on the faculty at Vanderbilt University Medical Center’s Eye Institute.  Dr. Sonsino is a Diplomate in the Cornea, Contact Lens, and Refractive Therapies Section of the American Academy of Optometry (AAO), chair-elect of the Cornea and Contact Lens Section of the American Optometric Association (AOA), a fellow of the Scleral Lens Education Society, board certified by the American Board of Optometry (ABO), and an advisory board member of the Gas Permeable Lens Institute (GPLI).  He lectures internationally, publishes in peer-review and non-peer-reviewed publications, and operates the website: TheKeratoconusCenter.org.  He consults for Alcon, Art Optical, Allergan, Johnson & Johnson, Optovue, Synergeyes, Visionary Optics, Visioneering, and formerly for Bausch & Lomb.

3/30/16

Sonsino Headshot

Jeffrey Sonsino, OD, FAAO
The Contact Lens Center at Optique Diplomate
Cornea, Contact Lens, and Refractive Therapies,

Having Trouble with Your Scleral Lenses?

Scleral lens have become very popular and while many enjoy the comfort and vision correction they provide, some find it difficult to apply (insert) and remove these large diameter RGP lenses. If you are one of the many who are having difficulty managing to get your scleral lenses in or out, there are a number of tools available to help.

The Scleral Lens Education Society website provides a wealth of information about the care and handling of these lenses trouble with your Scleral Lenses as well as an excellent video. There are photos demonstrating various ways to hold the lens while applying it …some you may not have tried! If you have trouble with your schleral lenses, see below.

Troubleshooting tips and tricks:

    • If you are unable to maintain fluid in the bowl of the lens as you bring it towards your eye, make sure that your face is fully parallel to the floor. It may seem like you are nearly standing on your head when you’re in the correct position to apply the lens.
    • Lid control is essential; use one hand to hold lids completely out of the way, and don’t release the lids until the lens is actually fully in place and the plunger (or your finger tripod) has been removed.
    • If you are unable to successfully apply a solid lens with saline, you could practice applying the lens after filling the bowl of the lens with Celluvisc™ or another non-preserved viscous lubricant. These viscous lubricants will blur your vision compared to saline, however, so you may simply want to use them to practice lens application. Once you’ve mastered this step, switch to saline to give you better vision.
    • Try to keep both eyes open as you apply your lenses. This may also help you to position the lenses correctly.
    • If you are using a bulbed (DVM) plunger, and can see the opening in the center of the suction cup, look directly at the hole as you bring the lens into position. This will help you to position the lens correctly.

    Many find the DVM plungers helpful. They are readily available at your doctor’s office and online. These are just a few of the places to find them: DMV Corp, Dry Eye Zone, and Amazon.

    trouble with your schleral lensesAnother variation to the standard lens inserters is a ring-style lens applicator by EZI Scleral Lens. It was designed by a post-transplant patient who like so many, had trouble inserting his scleral lens without getting a bubble. Read Tim’s story.

    If you have tried the above techniques and still have trouble applying scleral lenses there are a number of devices available that may help. Dalsey Adaptives has developed the See-Green devicetrouble with your schleral lenses that can be used to help successfully apply scleral contact lenses. The See-Green system comes with a stand that holds a lighted plunger (Figure 2). Using this system, you don’t hold the lens, you lower your eye onto it, which leaves both hands free for improved lid control. The light at the center of the plunger is used as a target to help you position the lens centrally on the eye. Click here to see the detailed instruction sheet.

    Scleral lenses offer good vision and comfort but can be challenging to manage. Discuss these options with your eye care professional to get his or her recommendation for your specific situation.

    1/28/16


     

    CathyW headshotCathy Warren, RN
    Executive Director
    National Keratoconus Foundation

Wearing Contact Lenses in Winter

Wearing Contact Lenses in Winter This has been a cold winter so far, and since it is only January, it is bound to get colder. The extreme cold, combined with winds, snow, rain and other environmental factors, can really take a toll on your eyes. And while it may be snowing or raining, winter air is actually drier than any other season. This can be especially difficult if you wear contact lenses. Here is what you should know about wearing contact lenses in winter.

  • Wear sunglasses for protection from UV rays and wind. Your eyes can become sunburned which cause blurry vision and can make your eyes feel like they are burning (think of your sunburned skin feels) for 24 to 72 hours. It will also protect your eyes from snow, rain or anything else the wind can send your way.
  • Avoid direct sources of heat such as heating vents and fireplaces. Indoor heating can draw the moisture out of the air, so consider a humidifier to help maintain the correct amount of moisture in the air to help keep eyes moist. Cool-air humidifiers have less of a tendency toward mold and bacteria.
  • Speaking of hydration, we also tend to drink less water in the winter months, so make a concentrated effort to keep up your water intake.
  • If it is so dry, why are my eyes watering? This is a common question and the answer may be a bit counter-intuitive. Anything that irritates your eyes, including dryness, causes a tearing reflex. Your tear glands go into overdrive trying to replace the moisture to your cornea. To try and reduce the tearing, you can use eye drops or artificial tears specifically designed for use with contact lenses.
  • Your eyes are not the only thing that dries out in the winter, so does your skin. Try to put in your contacts before moisturizing your skin, especially your hands. So wash your hands, put in your lenses and then use your creams and lotions.
  • Change out your contact lenses regularly in cold weather according to the recommended schedule, be it daily, every two weeks or monthly. This will allow them to better conduct oxygen, reduce irritation and increase comfort.
  • Take a break from your contacts and wear your eyeglasses. Putting them on when you get home from work can make a big difference. Contact lenses dry your eyes out on their own, when you add cold weather it gets that much worse.
  • Get plenty of sleep, which also helps with the dryness and fatigue. This will help you start the day with your eye refreshed and ready for the many things you will put them through throughout the day ahead.

Do you have any other suggestions that have helped you cope when wearing contact lenses in winter?

1/15/16


  Susan DeRemerSusan DeRemer, CFRE Vice President of Development Discovery Eye Foundation

Tear Film Health is Essential for People with Keratoconus

People afflicted with keratoconus (KC) are often obligated to wear contact lenses in order to obtain functional vision. Unfortunately, wearing contact lenses can have detrimental effects on the ocular surface and tear film layers over the course of decades, ultimately reducing lens tolerance. Therefore, any intervention prolonging the comfortable wear time of contact lenses should be aggressively pursued. The tear film covers the surface of the eye, provides lubrication and is the primary defense against foreign bodies and infection. Without a robust and healthy tear film, safe and comfortable contact lens wear is not possible. This article will describe the structure of the tear film and review simple remedies that can keep it healthy throughout life.

Tear Film Layers

The tear film is a complex, triple layered structure comprised of mucus, water and oil. The surface of the cornea and conjunctiva contain cells specialized to secrete a sticky mucoid substance. These so called goblet cells produce the mucin layer of the tears, which creates a “Velcro” type interface and allows the overlying watery component to stick to the ocular surface without washing away.

The bulk of the tear film is comprised of the watery, or “aqueous” layer which is secreted primarily by the lacrimal gland. This specialized structure is located near the eyebrow. This gland continuously releases small amounts of watery fluid that also contains enzymes and antibodies to help fight infection and wash away contaminants.

The lipid layer is the final, outermost layer of the tears. If the tear film is the first line of defense for the ocular surface, then the lipid layer is the first line of defense for the entire tear film and the ocular surface combined. Because of that role, it is extremely important and helps stabilize the tear film by preventing evaporation. This thin, lipid based layer is released by the meibomian glands, which are modified sebaceous glands that reside in the upper and lower lids. In each lid there are 20-30 glands. These glands open up onto the lid margin and through the action of a complete blink, release the lipid secretion to ocular surface which gets spread with the upward motion of the upper eyelid.

Each one of these layers contributes to the structure of the tear film, and a problem with any one of these structures (goblet cells, lacrimal gland or meibomian glands) will negatively impact the corresponding tear layer.

Tear Film
Image 1 -Layers of the tear film across the ocular surface & Meibomian glands of the eyelids. (Picture courtesy of TearScience™)

Tear Film Issues

Because the tear film is so thin, each individual component is necessary to maintain the integrity of the tears as a whole. When any layer of the tear film is deficient, the tear film becomes unstable and the ocular surface becomes irritated and can progress to developing classic symptoms of dry eye. This includes burning, stinging, redness, tearing, fatigue and contact lens intolerance.

Deficiencies in the mucin layer are uncommon, and are typically the result of chemical or thermal insult, or scarring. An aqueous deficiency, primarily from a lacrimal gland related etiology, is also relatively uncommon, and can arise from autoimmune and inflammatory causes such as Sjögren’s Syndrome. The most common reason for a poor tear film is linked with excessive evaporation of our tears due to a lack of sufficient lipid secretions from non-functioning or obstructed meibomian glands. It is understood that many factors contribute to why these glands stop performing optimally.

One factor has been linked to our habitual working environments. The compressive force exerted by the muscles of our eyelids that control blinking are essential for lipid secretion. However, the use of computers or wearing contact lenses has been shown to negatively impact our blinking habits, both by reducing the number of blinks and making blinks less complete. With an incomplete blink, the upper and lower lids do not make contact. The negative consequences of this are 1) the meibomian glands do not release their lipid contents, 2) the lower part of the eye is chronically exposed to the air, increasing evaporative stress and 3) dead skin cells accumulate on the lid margin which can clog the meibomian gland openings.

When increased evaporation of the tear film occurs chronically, the integrity of the entire ocular system becomes compromised over time and problems to the health of the eye become permanent attributes. This condition is known as Meibomian Gland Dysfunction or MGD and is linked with 86% of all dry eye sufferers.

Image 2 - Histology slide of a Meibomian gland with a terminal duct blockage
Image 2 – Histology slide of a Meibomian gland with a terminal duct blockage

Contact lenses have been shown in multiple studies to have a negative impact on the integrity of the tear film. To begin with, placement of a lens onto the eye divides the tears into two sections, referred to as the “post” (behind) and “pre” (in front) lens tear films.

The characteristics of the post lens tear film can differ depending on the type of lens that is worn. For example, soft lenses and scleral lenses have very little turnover of this post-lens tear film. This can cause issues related to the build up of toxic waste and bacterial elements that ultimately aggravate the corneal surface. Conversely, rigid gas permeable lenses are designed to have substantial tear turnover behind the contact lens with every blink.

The pre-lens tear film is also greatly affected by the type of lens material, as well as the interaction between the lid and the contact lens surfaces. Eye doctors know that without a healthy tear film, chances for contact lens intolerance increases. The rate of contact lens intolerance substantially increases as patients enter their fourth decade of life, primarily because of MGD caused by years of poor blinking habits.

Tear Film Care

Fortunately, simple interventions can prevent and/or limit the severity of MGD altogether or help to manage it once it occurs. Just like brushing and flossing one’s teeth can prevent gum disease, attention to complete blinking and lid margin hygiene can improve the tear film and prevent contact lens intolerance problems.

Because partial blinking is strongly linked with developing MGD, it is vitally important that the two lids touch when blinking. It is best to practice this several times throughout the day as well as when you are reading or using the computer.

Akin to flossing the teeth, it is also important to clean the lid margins with a Q-tip soaked in saline solution or a bit of mineral oil by gently brushing the Q-tip across the lid margin 10-20 times each night. It is easiest to get the lower lid.

Finally, performing warm compresses daily can provide heat to the Meibomian glands to soften the hardened oil that can plug the meibomian gland ducts. Warm compresses need to be done continuously for at least 10 minutes with consistent heat in order to attain a temperature that is sufficient to melt the oil that clogs the glands. We recommend folding 5-6 small towels or facecloths into a rectangular shape and wrapped together into a circular bundle, similar to the appearance of a cinnamon roll. The towels should be damp and moist, placed in a microwaveable safe dish with a lid and heated for approximately 1 minute and 50 seconds. After removal, wait a minute or two and then proceed to use the outermost cloth and cover the rest. Replace the first cloth after two minutes and grab the next outer most towel from the bundle, continuing this until all towels are used. In this way, the temperature can be adequately maintained for the full 10 minutes. The high temperatures applied to the lid are transferred to the cornea and very often cause temporary deformation, a phenomenon characterized by transient visual blur immediately following compress application. Therefore, it is vitally important, especially for patients with keratoconus, that pressure never be exerted onto the globe of the eye with a compress or massage administered to the lids of closed eyes after a compress.

It is becoming apparent that MGD is developing in patients at earlier ages. Because of this, the condition has likely been present for decades by the time the patient becomes symptomatic. It may take significant time and effort to rehabilitate not only the glands themselves, but also to reduce the resulting inflammation of the ocular surface.

Meibography is the technique used to image Meibomian glands. In chronic cases of MGD, we see abnormal changes to gland structure, in the form of atrophy or loss of gland tissue and/or dilation of glands where obstructed material causes glands to become widened. In severe cases, the prognosis for recovery is guarded.

The visual clarity that contact lenses provide for patients with keratoconus is incredibly important. But the ability to comfortably wear contact lenses is reliant on our body’s ability to provide a sufficiently thick protective tear film. Taking a small amount of time daily to attend to the lipid producing Meibomian glands by proper blinking habits, exfoliation of the lid margin with a Q-tip and warm compresses will help to extend the number of hours, and ultimately the number of years, that contact lenses can be safely and comfortably worn.

10/20/15

tear filmAmy Nau, OD
Korb and Associates, Boston, MA
Contact lens fitting for keratoconus, other ocular surface disorders and dry eye
 
 
 
 
 
 

tear filmDavid Murakami, MPH, OD, FAAO
Tear Science, Inc.
Researcher, Dry Eye

Which Eye Care Specialist Do You Need?

It’s time to get your eyes checked – do you go to an ophthalmologist, optometrist or optician? Your optometrist sees the beginnings of age-related macular degeneration, but is sending you to see and ophthalmologist, why?
eye care specialist
One of the most confusing things about taking care of your eyes can be differentiating between an ophthalmologist, optometrist and optician. Each eye care specialist has a very important part to play in the health of your eyes and here is a quick synopsis of what each does so you can choose the best one for your vision issues and treatment.

Ophthalmologist
These specialists are fully trained medical doctors that have completed the eight years of training beyond a bachelor’s degree. Their training has included a full spectrum of eye care, from prescribing glasses and contact lenses and giving eye injections, to carrying out intricate eye surgeries. Many doctors may also be involved eye research to better understand vision, improve eye disease treatments or potentially find a cure. They are easily identified by the MD following their name.

Optometrist
These medical professionals have completed a four-year program at an accredited school of optometry. They have been trained to prescribe and fit glasses and contact lenses, as well as diagnose and treat various eye diseases. They provide treatments through topical therapeutic agents and oral drugs, and are licensed to perform certain types of laser surgery, such as Lasik. They are easily identified by the OD following their name.

Optician
These eye care professionals are not licensed to perform eye exams, medical tests or treat patients. Their purpose is to take the prescription from the ophthalmologist or optometrist and work with you to determine which glasses or contact lenses work best for you. If you suffer from an eye disease like keratoconus, these specialists can make the difference between a relatively normal life, or one that is dictated short periods of vision because of contact lens pain. These eye care professionals may hold and associate optician degree or have apprenticed fore required number of hours.

While each one of these eye specialists has their own area of expertise, they can form a team whose only concerns are your eye health and the ability to see as clearly as possible.

8/11/15

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Eye Issues For Every Age Recap

Vision is something we take for granted, but when we start to have trouble seeing it is easy to panic. This blog has covered a variety of eye issues for every age, from children through older adults. Here are a few articles from leading doctors and specialists that you may have missed and might be of interest.
Artistic eye 6
Bill Takeshita, OD, FAAO – Visual Aids and Techniques When Traveling

Michelle Moore, CHHC – The Best Nutrition for Older Adults

Arthur B. Epstein, OD, FAAO – Understanding and Treating Corneal Scratches and Abrasions

The National Eye Health Education Program (NEHEP) – Low Vision Awareness
Maintaining Healthy Vision

Sandra Young, OD – GMO and the Nutritional Content of Food

S. Barry Eiden, OD, FAAO – Selecting Your Best Vision Correction Options

Suber S. Huang, MD, MBA – It’s All About ME – What to Know About Macular Edema

Jun Lin, MD, PhD and James Tsai, MD, MBA – The Optic Nerve And Its Visual Link To The Brain

Ronald N. Gaster, MD FACS – Do You Have a Pterygium?

Anthony B. Nesburn, MD, FACS – Three Generations of Saving Vision

Chantal Boisvert, OD, MD – Vision and Special Needs Children

Judith Delgado – Driving and Age-Related Macular Degeneration

David L. Kading OD, FAAO and Charissa Young – Itchy Eyes? It Must Be Allergy Season

Lauren Hauptman – Traveling With Low Or No Vision  /  Must Love Dogs, Traveling with Guide Dogs  /  Coping With Retinitis Pigmentosa

Kate Steit – Living Well With Low Vision Online Courses

Bezalel Schendowich, OD – What Are Scleral Contact Lenses?

In addition here are few other topics you might find of interest, including some infographics and delicious recipes.

Pupils Respond to More Than Light

Watery, Red, Itchy Eyes

10 Tips for Healthy Eyes (infographic)

The Need For Medical Research Funding

Protective Eyewear for Home, Garden & Sports

7 Spring Fruits and Vegetables (with some great recipes)

6 Ways Women Can Stop Vision Loss

6 Signs of Eye Disease (infographic)

Do I Need Vision Insurance?

How to Help a Blind or Visually Impaired Person with Mobility

Your Comprehensive Eye Exam (infographic)

Famous People with Vision Loss – Part I

Famous People with Vision Loss – Part II

Development of Eyeglasses Timeline (infographic)

What eye topics do you want to learn about? Please let us know in the comments section below.

7/21/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Scleral Lens Education Society

Scleral Contact Lenses have taken over a century to evolve into one of the best options for managing eye diseases such as keratoconus. This evolution began in the late 1800’s, with blown glass lenses. However, until the advent of highly oxygen permeable plastics, scleral lenses had very limited application. Now, with current technology and materials, scleral lenses have become a mainstream and rapidly growing lens option.
SLES_Logo_final
Scleral lenses are becoming more popular due to the exceptional comfort they can provide even to the most unusual eye shape. This comfort is attributable to their large size that allows them to tuck behind the eyelids, their relative lack of movement with eye blinks, and their fluid reservoir that keeps the cornea hydrated and does not actually touch the fragile corneal tissue in individuals with keratoconus.

As utilization of and demand for scleral lenses began to grow last decade, it became apparent that there was a need for more professionals trained in fitting scleral lenses, as well as someone to provide a consensus opinion for the eye care world on what the standard of care should be for these lenses. In addition, a process for providing a credential for those that attained a level of expertise in scleral lens fitting would allow those seeking experts in the field of fitting sclerals to find an experienced professional.

The Scleral Lens Education Society (SLS) was established in 2009 as an organization to help bring professional consensus to the suddenly rapidly growing area of scleral lenses. The mission statement of the SLS reads: “The Scleral Lens Education Society (SLS) is a non-profit organization 501(c)(3) committed to teaching contact lens practitioners the science and art of fitting all designs of scleral contact lenses for the purpose of managing corneal irregularity and ocular surface disease. SLS supports public education that highlights the benefits and availability of scleral contact lenses.”

Beginning with the founding board which included world renown experts in scleral lens fitting such as Greg DeNaeyer, OD, Christine Sindt, OD, and Bruce Baldwin, OD, PhD, the SLS has worked to spread the word about the potential benefits of scleral lens wear to both providers and patients alike. Professional education has included scleral lens webinars, workshops, and lecture series that are always standing room only events.

Currently, the SLS has over 2000 member contact lens practitioners as well as over 50 fellows, or certified scleral lens fitters that have demonstrated their expertise through a peer reviewed process of case reports, publications, and lectures. Many of these members and fellows are international, with SLS fellows from 11 countries, 5 different continents, and 20 different states in the US. Members hail from all 50 states, 6 continents, and over 40 countries.

In addition, the SLS has numerous industry sponsors that support the mission of the society to provide patient access to experienced fitters across the world. The sponsors provide the resources that allow the educational opportunities for practitioners as well as the website and patient resources that are available.

SLS board members are elected to serve in various capacities, including fellowship, public education, and international relations, and are elected to one year terms. The current board consists of:
President, Muriel Schornack, OD, Mayo Clinic, Rochester, MN
Vice President, Melissa Barnett, OD, University of California, Davis
Secretary, Michael Lipson, OD, University of Michigan
Treasurer, Mindy Toabe, OD, Metrohealth, Cleveland, OH
Immediate Past President, Jason Jedlicka, OD, Indiana University
Fellowship Chair, Pam Satjawatcharaphong, OD, University of California, Berkeley
Public Education Chair, Stephanie Woo, OD, Havasu Eye Center, Lake Havasu, AZ
International Chair, Langis Michaud, OD, University of Montreal

For more information about scleral lenses and the Scleral Lens Education Society, please visit the website at www.sclerallens.org. If you or someone you know might benefit from scleral lenses, you can locate a fitter in your area through the website as well. If you are unable to locate a fitter near you on the website, please contact the SLS and we will try to locate options in your local area.

7/2/15


Dr. JedlickaJason Jedlicka, OD
Clinical Associate Professor, Chief of Cornea and Contact Lens Service
Indiana University, School of Optometry

Vision Recap Of Previous Articles of Interest

Besides the comments that we get, one of the best parts of putting together this blog is the wonderful group of guests who share their expertise and personal stories. I want to thank all of the eye care professionals and friends that have contributed to make this blog a success.
Vision Recap
Here is a quick vision recap of some of the articles we had in the past that you may have missed.

Jullia A. Rosdahl, MD, PhDCoffee and Glaucoma and Taking Control of Glaucoma

David Liao, MD, PhDWhat Are A Macular Pucker and Macular Hole?

Kooshay MalekBeing A Blind Artist

Dan Roberts15 Things Doctors Might Like Us To Know

Jennifer VilleneuveLiving With KC Isn’t Easy

Daniel D. Esmaili, MDPosterior Vitreous Detachment

Donna ColeLiving With Dry Age-Related Macular Degeneration

Pouya N. Dayani, MDDiabetes And The Potential For Diabetic Retinopathy

Robin Heinz BratslavskyAdjustments Can Help With Depression

Judith DelgadoDrugs to Treat Dry AMD and Inflammation

Kate StreitHadley’s Online Education for the Blind and Visually Impaired

Catherine Warren, RNCan Keratoconus Progression Be Predicted?

Richard H. Roe, MD, MHSUveitis Explained

Sumit (Sam) Garg, MDCataract Surgery and Keratoconus

Howard J. Kaplan, MDSpotlight Text – A New Way to Read

Gerry TrickleImagination and KC

In addition to the topics above, here are few more articles that cover a variety of vision issues:

If you have any topics that you would like to read about, please let us know in the comments section below.

6/23/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

What Are Scleral Contact Lenses?

In the beginning…of contact lenses…there were scleral lenses…only.

In the year 1887 a great gift was given to the world of sufferers of distorted vision resulting from corneal tissue that was irregular in shape from disease or trauma.
scleral lenses

The contact lens was invented nearly simultaneously by physicians working separately in Germany and in France. Working from drawings of Leonardo da Vinci (1508) and ideas of the British astronomer Sir John Herschel (1828), August Müller and separately Adolph Fick and Eugene Kalt blew glass shells to fit the outer eye and to some extent remedy their visual difficulties. These lenses rested on the conjunctiva of the eye above the sclera or white of the eye and were thus the first scleral contact lenses — the first contact lenses of any sort.

What are Scleral Contact Lenses?

The design and manufacture of scleral lenses has been a story of technological development significant for improvement in comfort, material, and affinity for the ocular surface.

For many years the lenses were partially molded and partially ground from the material of which hard contact lenses are made: PMMA (poly-methyl methacrylate) known as Plexiglas or Perspex. To form these lenses, like tooth implants, a plaster cast is made from a negative mold prepared from dental impression putty. The plastic would be heated and given the shape of the fitting surface of the lens from the plaster cast and then the power and edge curves would be ground onto the outside surface of the lens. Later came preformed trial sets not unfamiliar to those which we use today.

The current generation of scleral lens fitting began sometime in the last fifteen years with the mating of advanced corneal topography measurements, computer driven lathes and the observations of some very clever contact lens scientists. Proprietary designs of scleral lenses offering a variety of diameters, fitting philosophies, and multiple parameters are filling the gaps contact lens specialists have been wrestling with using smaller corneal contact lens designs for decades with less than optimal results. Most recently a firm has begun manufacturing lenses with a 3-D printer from an image generated from the eye. One eye…one lens, the lens is meant to fit like a fingerprint.

When discussing contact lens treatment, experts are experts because they agree that, any sort, size, or design of lens will have both positive and negative effects on the eyes and the tissues surrounding them. While it is true that many of the fitting and comfort issues confronted with corneal lenses of any size and design can be managed well with scleral designs, the scleral lens can also be difficult for some patients; for some eyes; for some conditions.

From the outset the larger size of the today’s scleral lens provides comfort on par with soft contact lenses for exactly the same reason: their size. Also, like soft contact lenses the scleral will not move around on the surface of the eye allowing the wearer a much more relaxed contact lens experience — there is no necessity to balance small corneal lenses between tense eyelids – vision can be enjoyed in any direction of gaze. The lenses will not fall off the eye and the increased size is a clear plus in finding a dropped contact lens.

On the other hand the quality of vision gained with scleral lenses specifically in cases of distorted corneae is far more comparable to that achievable with corneal GP lenses than with soft contact lenses in most cases.

Over the years my keratoconus patients have benefited from a series of contact lens breakthroughs that have variously improved the quality of their vision, their comfort with contact lenses, or in some other way the health of their eyes. Some years ago I “re-invented” the piggy-back system of contact lens wear which I summarized in 2008 in an article published in the Contact Lens Spectrum. Piggy-backers would place their vision restoring firm contact lens on top of a disposable daily wear lens of minimal focusing power. The soft lens would reduce the sensation of the firm lens while in many cases preventing the contact lens from abrading the cornea. More recently I have been successfully moving patients to scleral lenses because there is certainly less bother (only one lens per eye) and far less worry over corneal abrasions as the lens rests on the conjunctiva over the sclera and maintains a fluid cushion over the cornea itself.

Scleral lenses are finding their place in the world of contact lens fitting primarily to remedy vision problems from very irregular or otherwise damaged corneae both those caused by developing disease and trauma through injury or surgery. More and more, these lenses are requested by patients with normal eyes who want to enjoy the benefits provided by these lenses while participating in sports or other activities.

Scleral lenses are renowned for their greater comfort. In many cases a correctly fitted lens can be worn for many waking hours. Many patients have found that they benefit from exchanging the fluid from the reservoir from time to time throughout the day. The fluid that fills the lens-cornea space is sterile, non-preserved normal saline or in some cases saline with a non-preserved tear substitute added when needed for improved comfort.

A proper care regimen for scleral lenses is not different from that for any other contact lens manufactured from a firm oxygen permeable material. The lenses require cleaning upon removal, soaking in a recommended solution appropriate to the material of the lens and a periodic treatment to remove protein deposits. Of course, the exact care specifications will vary from patient to patient according to the evaluation of their contact lens specialist.

Just like any lens modality, the fitting requires expertise. Many who fit and dispense contact lenses rely on boxed soft lenses for their patients. When corneae become distorted those lenses will hardly fill the need. Greater expertise is required to fit rigid corneal lenses needed for these more problematic surfaces. The decision of the corneal lens expert to move on to the world of larger lenses is not of the same magnitude as that from boxes to corneal GP lenses. The investment is more a matter of time spent in discussion with the manufacturer’s fitting consultants, some reading, a webinar or two and keeping up to date with the lens designs that are available.

I was not among the first to use the current generation of scleral lenses, but when the opportunity knocked some years ago, I realized the importance of this form of contact lens and I believe I have positively influenced the quality of life of many of my patients.

5/28/15

Bezalel Schendowich - scleral lensesBezalel Schendowich, OD
Medical Advisory Board of the National Keratoconus Foundation
Fellow of the International Association of Contact Lens Educators
Clinical Supervisor & Specialty Contact Lens Fitter, Sha’are Zedek Medical Center, Jerusalem, Israel