Cataracts, Cradles & Canines: Is My Child or Dog At Risk?

Many of us associate cataracts as a condition that affects mostly the aging human population, but animals can also be at risk for developing this vision robbing affliction. Cataracts is a disease which causes the lens to become opaque. It can result in partially or severely decreased vision, but it can usually be corrected with surgery.

While we know that most cases of cataracts affect the older generation of people, what about  younger children and dogs? Are they at risk of developing this dangerous disease?

A Dog’s Genes Genetics

The most common form of cataracts found in dogs is purely genetic, it can be present at birth or present itself at any time later in life, and the same is true for humans, which is called congenital cataracts. Be sure to check your dog’s eyes regularly and look for signs of irregularities, especially a cloudiness in their pupils.

A Dog With Diabetes

The second form of cataracts common in canines is associated with diabetes. Statistics share 80% of dogs who have diabetes will develop cataracts within one year of being diagnosed with the disease. Diabetes has also been linked with obesity, which is just one more reason we should be feeding our dogs a healthy diet and exercising with them regularly.

Rare With Human Children

Thankfully, when it comes to congenital cataracts, which can be present at birth or during childhood, statistics are in the favor of the child, since only about 0.4% of infants are born with this condition or could develop it later on in life.

While it’s recommended that infants have their first comprehensive eye examination at six months of age, parents should still be on the lookout for signs of this disease. The next recommended time for an eye exam performed by a professional is before a child enters school, usually at five or six years old. During these formative years, parents should be extra vigilant in watching for signs of vision problems in their children.

For more information on eyes for the rest of your two-legged brood, check out this infographic:

cataracts

6/2/16

cataracts

Tara Heath
Health Professional
Freelance Writer

Double Vision and Cataracts

Double Vision and Cataracts

Double vision, like all sudden vision irregularities is definitely something to take seriously, especially if you’ve had no history of it in the past. Even if it’s a temporary thing, it’s still something you should talk to your eye doctor about, just in case. double vision and cataracts

Known to the medical community as diplopia, double vision is when a person sees two images of an object where there should only be one, either some of the time or all of the time. The second image can be horizontally, vertically, or diagonally placed to the original, depending upon the cause of the doubled images.

Normal vision, called single binocular vision, works by having each eye produce its own image. Your brain allows your eyes to work together, so you can focus on a single area, then reconciles the two slightly images together, giving you clear sight.

Eye muscles that don’t work as well as they should, or nerves connected to the eye not functioning properly can very well result in double vision.

There are three basic types: physiological, binocular, and monocular.

+ Physiological double vision affects images in the background – things you are not currently focusing upon. This type of double vision can even be something the patient doesn’t notice, because the brain can compensate for it. Children are the most likely to complain about this kind of double vision.

+ Binocular double vision are cases where double vision occurs in both eyes, because they are not working together as they should. If you can cover one eye to get rid of the double vision, it’s binocular double vision.

+ Monocular double vision, in which only the images from one eye is doubled sometimes produces an effect known as ghosting, where the doubled-images appear to be very close together. If you cover the unaffected eye, you’ll still experience double vision. This is often an early sign of a cataract – a cloudy part in the lens of the eye. The light coming into your eyes can be scattered by the cataract, causing double vision in that eye. According to Prevent Blindness America (PBA), cataracts are the biggest cause of blindness in the world, and the most common reason people over 40 lose their vision. In the United States alone, more than 22 million people over the age of 40 are affected by cataracts. The number is expected to grow to more than 30 million by 2020 as the population ages.

Signs of a Cataract

Cataracts begin small, and unless you just happen to get a comprehensive eye exam just as it develops, it will be unnoticeable. As it grows, your vision may blur just a little, or become somewhat cloudy. In some cases, a cataract will cause lights to flare and seem too bright to your eyes. Colors may look faded. Sometimes, they can even briefly improve your vision. Eventually, however, you’ll notice a loss of vision quality that will necessitate a visit to your eye doctor – like double vision.

No one is sure why cataracts develop, which is one reason it’s so important to get a comprehensive eye exam at least once a year, especially if you happen to be over 40 years old. Age is one of the most common risk factors for cataracts, but other risks include family history, previous eye injuries or surgeries, use of corticosteroid medication, smoking, obesity, diabetes, hypertension, and ultraviolet radiation, just to name some.

Cataract Treatment

Medical science has been rapidly advancing over the past few decades, including the fields involving the eye. Where a cataract was once sure to cause blindness in one or both eyes, if caught early enough, they can be removed by surgery in a fairly simple procedure. At first, the effects of cataracts can even be temporarily corrected with new glasses or the right lighting, but eventually it will grow to the point where surgery should be seriously considered.

Today’s methods of cataract surgery are highly successful. Statistics from PBA state more than 3 million Americans go through cataract surgery every year, with 9 out of 10 having their vision fully restored afterwards.

The standard procedure is for the surgeon to remove the clouded lens in your eye and replace it with a clear plastic device called an intraocular lens (IOL). These IOLs are constantly being improved, so surgeons can insert them more easily, and they are more useful to the patient receiving them. In fact, even specialized IOLs are being developed. Some might block ultraviolet light to prevent retinal damage, while others may very well correct your vision so you no longer need glasses if you needed them before.

If you find the sight in one of your eyes is showing double images, it may be a cataract, but fortunately, the state of optical surgery is so well-developed today, you can have a cataract removed in the course of an afternoon, and have clearer vision for decades to come.

5/26/16

Laura O'Donnell thumbLaura O’Donnell
EyeCare 20/20

13 Tips for Using Eye Makeup

Makeup may be an essential part of your every day routine. Or it could be something you do for special occasions or to make a fashion statement. Regardless of the occasion, eye makeup needs to be used with care to prevent infection or vision loss.
eye makeup
Here are 13 tips for using eye makeup.

1. Wash Your Hands
You are constantly using your hands and touching everything, so bacteria are always on them. This means you can transfer these bacteria onto your makeup and in your eyes. Wash your hands before applying any makeup.

2. Never Share, Never Borrow
We were all taught to share when we were children. This is not a good idea when it comes to cosmetics. When you share your makeup you are also sharing bacteria. The main danger is passing on viral conjunctivitis, or pink eye. The bacteria exist before the symptoms are apparent.

3. Eyeliner Has Its Place
Eyeliner is to be used to line the eye outside the top of the lash line and not in the eyelid margin that runs along the surface of the eyeball. There are tiny pores in the margin that produce the essential oils required for stable tear film. If the pores become clogged, it can lead to a sty, dry eyes, irritated or infected eyes.

4. Mascara
Throw away any mascara after six months because it dries out and can flake off, getting into the eye. Depending on the ingredients in the mascara, those flakes may contain something that could scratch the cornea or become an eye irritant. Also be careful when applying mascara that the wand does not touch the eye to avoid contamination.

5. False Eyelashes
Be wary of putting too much glue on the lashes and not letting it dry a bit before placing them on the lid above your own lashes. If glue enters the eye it can cause abrasions, bacterial infections, or you could be allergic to the ingredients.

6. Storage Is Important
Don’t store makeup in warm or hot places such as your car or suitcase on a warm day. Heat destroys the preservatives that keep bacteria away. Hot temperatures are a breeding ground for bacteria. Even at home keep your cosmetics in a cool, dark place.

7. Shelf-Life
Just like most perishables that use preservatives, cosmetics need to be discarded after 3-4 months to prevent possible infection.

8. Keeping Clean
Wash your brushes and applicators thoroughly and regularly to keep them clean and avoid the buildup of bacteria and oils. This also includes eyelash curlers. Think about using disposable applicators that get used once and are then thrown out.

9. Know Your Ingredients
It is important to know what is in your eye makeup. Some mascara contains parabens which can cause an allergic reaction and a stinging sensation if it gets in your eye. Kohl eyeliners may contain lead. Pencils and shadows that are iridescent, glittery or shiny may contain ingredients that could scratch the cornea or irritate the eye. Never use glitter on your eyes as it can severely scratch your cornea.

10. Don’t Mix Uses Don’t use a lip pencil on your eyes or vice versa. The danger is bacteria, as the bacteria in your saliva in different from the bacteria in and around your eyes. The FDA warns to never use your saliva to moisten cosmetics such as eyeliner, mascara or eye shadow.

11. Irritated Eyes
If your eyes appear irritated or infected contact your eye doctor and suspend ALL use until directed by your doctor. Before you go back to wearing eye makeup, replace all of it to void spreading the bacteria, and wash all applicators thoroughly.

12. Don’t Be Moving
Never apply makeup in a moving vehicle. Even if you aren’t driving, another vehicle can rear-end you and any applicator will go in your eye, possibly cause the loss of an eye. Do not apply makeup when driving, as your eyes should be focused on the road and not a mirror.

13. Removing Eye Makeup
It is important to carefully and gently remove your eye makeup each night before bed to make sure that your cosmetics don’t work their way into your eye, build up and cause damage. Try not to use waterproof mascara as it is harder to remove and increases your chances of getting something in your eye. Avoid foaming options as they likely contain sodium lauryl sulfate which can dry out the skin around the eye. Also watch out for any ingredients that are known to clog pores or contain fragrances. Try not to use waterproof mascara as it is harder to remove.

5/19/16

Susan DeRemerSusan DeRemer, CFRE
Discovery Eye Foundation

 

AMD and a Healthy Diet: How they Relate

While there is still no concrete answer as to why some do not develop age-related macular degeneration (AMD) and other’s do, significant studies have proven the importance of a healthy diet and the mitochondria.

AMD is the leading cause of vision loss for those over 60 years of age in the developing countries. For decades we have studies that show the genetics and environmental factors associated with AMD. There have been over 20 genetics modification associated with AMD but there is no single gene that “causes AMD in all cases.” The genes most highly associated with AMD are found in the complement system, an important system related to controlling the inflammation in our body. A change in the complement factor H (CFH) gene from a low risk gene to a high risk gene has been associated with 43% of those developing AMD.

However, some people who have this high risk CFH gene but never develop AMD. This leads us to believe that the genetics are not the entire answer. The other factor has to do with the environment. Smoking is the leading risk factor, along with aging, exposure to sunlight and higher body mass index (obesity). But again there are obese people that smoke and never develop AMD. So, while the environmental risk factors are important, they do not answer the entire question of “why do some people get AMD but others do not?”

Recently, researchers have recognized that a major factor in the dry form of AMD is that the retinal cells begin to die off. Therefore, they have looked at important factors that keep cells alive. The mitochondria are one of the most important elements that protect the cells in the body. These subunits or organelles, produce energy for the cells, acting like batteries for the cells. And just like the batteries in a flashlight – if the batteries are not working then the flashlight dies. The same thing happens with cells – when the mitochondria are not healthy, then the cells eventually will die. Therefore to protect ourselves, it is important to keep the mitochondria healthy. One way to do this is to eat healthy foods. Over the past 20 years, the National Eye Institute (NEI) has conducted a series of studies that have identified foods and supplements that are good for the retinal cells and also the mitochondria.

 

super greens, spinachThe National Eye Institute has recommended that people who are high-risk for developing AMD eat diets rich in green leafy vegetables, whole fruits, any type of nuts and omega 3 fatty acids. Many of these foods have anti-oxidant properties that help to “turn off” genes involved with inflammation, an important factor of retinal diseases. Salmon, mackerel and sardines have the highest levels of omega-3 fatty acids. An analysis that combined the data from 9 different studies showed that fish intake at least twice a week was associated with reduced risk of early and late AMD. Other studies show that Omega-3 fatty acids improve mitochondrial function, decreases production of reactive oxygen species (free radicals that damage cells) and leads to less fat accumulation in the body. The green leafy vegetables contain important protective macular pigments (carotenoids) called lutein and zeaxanthin that reduce the risk of AMD by 43%. High levels of lipid or fat deposits in the body (obesity) can “soak-up” the lutein and zeaxanthin so that they are not available to protect the retina.

The goal is to increase the omega-3 fatty acid and carotenoid levels to protect the eye. Below is a list of foods that are eye healthy:

Foods that have lutein or zeaxanthin:

– 6mg/d of lutein and zeaxanthin – decreased

– Lutein/zeaxanthin content – ug/100g wet weight

– Kale, cooked – 15,798

– Spinach, raw – 11,935

– Spinach, cooked – 7,053

– Lettuce, raw – 2,635

– Broccoli, cooked – 2,226

– Green peas, cooked – 1350

Source: Johnson, et al 2005 Nutr Rev 63:9

 

To help kickstart an eye healthy diet, here is a list of “eye-healthy recipes” that provide nutritional support for the mitochondria and retinal cells.

Asparagus Soup
Kale Chips
Quinoa Collard Green Wraps with Summer Vegetables
Smoked Salmon Rillettes

Sources:
Geoffrey K. Broadhead, John R. Grigg, Andrew A. Chang, and Peter McCluskey Nutrition Reviews. Dietary modification and supplementation for the treatment of age-related macular degeneration VR Vol. 73(7):448–462

Chong et al., Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol 2008;126:826–33.

5/19/16

courtesy of the
SFCulinaryAcademyLogoWEB

 

 

Myopic Degeneration

Did you ever wonder while growing up what your friends with the thick glasses meant when they said they were “nearsighted”?  What exactly does it mean to be nearsighted, and what issues related to vision arise from this?

Think of your eye as a camera, which has a segment to focus the light coming into it. In the eye, this focusing segment is made up of the cornea, the clear front part of the eye, the pupil, and the natural lens inside the eye behind the pupil. Like any camera, the eye has a film to make the images, and this is the retina. The retina is a thin tissue lining the entire inside of the eye like wallpaper.

Myopic Degeneration
Figure 1. Normal retina inside the eye, the optic nerve and the blood vessels

Another term for nearsightedness is myopia. When someone is myopic, they see well up close but cannot see far away. A myopic eye is longer than average in length from the front of the eye to the back of the eye. In a sense, light and images from far away cannot reach the back of the eye where the camera film, the retina, resides. Therefore, glasses or contact lens are needed to help focus the light on to the retina to see clearly. Some people may elect to have refractive surgery to correct near sightedness. Because the eye is longer than average, the tissues inside it, like the retina, can become abnormally thinned due to stretching. It should be noted that people with myopia have an increased risk for retinal tear or detachment of the retina which can lead to rapid loss of vision. If sudden flashing lights, new floaters, or darkening of peripheral vision are seen, an eye care professional should be expeditiously consulted for an evaluation.

Myopic Degeneration
Figure 2. Myopic degeneration

Progressive thinning of the retina resulting from elongation of the eyeball is termed myopic degeneration. Individuals with more severe nearsightedness or high myopia are at greater risk for developing myopic degeneration. When thinning and atrophy occur at the part of the retina that affects central vision (macula), vision may deteriorate gradually and may not be correctable.  You can see in the Figure 2 that there are some white and black discolorations that were not present in Figure 1. These changes exemplify myopic degeneration. Glasses or contact lenses cannot correct for myopic degeneration because there is actual damage of the retina tissue when it is stretched out. There is no reversal for the actual thinning of the retina and the damage to the retina.

Myopic degeneration
Figure 3. Myopic degeneration with choroidal neovascularization

When the retina is stretched out and the eye is elongated, sometimes abnormal blood vessels can develop just below the retina. These blood vessels, termed choroidal neovascularization, can interfere with focusing of the light or bleed and can cause sudden decreased vision. The reddish discoloration in Figure 3 exemplifies bleeding from choroidal neovascularization in myopic degeneration. Fortunately there is a treatment in the form of medications that can be injected into the eye that can stop the growth of these abnormal bleeding vessels, if they are found early before permanent damage occurs to the eye.  Therefore, early diagnosis as well as treatment of choroidal neovascularization can be helpful in limiting the degree of vision loss from these bleeding blood vessels.

Not everyone with myopia develops myopic degeneration, and there is currently no algorithm to predict its development. Self-testing one eye at a time using an Amsler grid, which looks like a graph paper, to check for any distortion of straight lines on a regular basis can be a useful tool to identify any early changes. Those with myopic degeneration should have a regular dilated eye examination with an eye care professional for early detection of any treatable changes.

Image References
1.Normal Retina. Jason Calhoun MD. ASRS Image Bank.
2.Myopic degeneration. Gerrardo Garcia Aguirre MD. ASRS Image Bank.
3.Myopic degeneration and CNVM. David Callanan MD. ASRS Image Bank.

4/6/16

Judy Kim - Myopic Degeneration

Judy E. Kim, MD
Medical College of Wisconsin
NEHEP Planning Committee Member

 
 
 
 
 
Alessa Crossan - Myopic Degeneration

Alessa Crossan, MD
Medical College of Wisconsin

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,