Three Generations of Saving Vision

In Discovery Eye Foundation’s spring e-newlsetter there was an article entitled Surgery for the Surgeon, where a leading ophthalmologist talks about convincing himself to have cataract surgery. That eye doctor was Dr. Nesburn, who was willing to share with us his family’s long tradition of saving vision.

Brainwashed by Medicine

“I was brainwashed from the age of 5,” says Dr. Anthony Nesburn, medical director of The Discovery Eye Foundation (DEF). “My dad would take me on rounds at the hospital and to his office. He introduced me to medicine at a really early age.”

Nesburn saving vision
Dr. Anthony Nesburn in UC Irvine lab
Dr. Henry Nesburn was an ophthalmologist in Los Angeles for more than four decades, and he passed his love of the specialty to his son. “I really looked up to my dad,” the younger Nesburn says. “He loved ophthalmology for the same reasons I do: You get to do medical diagnosis; you get to do wonderful surgery, where you keep people from going blind or restore vision; and you can work with people from newborns to the very elderly — they all need eye care.”

Nesburn received a telegram while he was an undergrad at UCLA, telling him he’d been accepted to Harvard Medical School. His mother started crying: “You’re going to Boston! We’re not going to see you anymore!” While he “was loathe to leave Southern California,” Harvard was too good to pass up.

Drafted by the Army out of his ophthalmology residency at Harvard in 1960, Nesburn joined the Navy instead. He followed in his father’s footsteps again, becoming a Navy flight surgeon. (Henry had volunteered during World War II.)

He went on to a Boston Children’s Hospital fellowship in infectious disease, working with Nobel laureate Dr. John Enders, whose work led to the polio vaccine and changed the face of virology. Nesburn then did his residency at Massachusetts Eye and Ear. “I was part of a special program that allowed us to do research, and I was running a research laboratory while I was a resident,” he says. “It gave me the start I needed.”

“At Mass Eye and Ear, I worked for an up-and-coming ophthalmologist and researcher to prove there was a substance that could treat herpes eye infections. We wrote a paper that included the very first antiviral ever described, and it was against herpes virus. It is the basis for today’s herpes antivirals,” Nesburn says. “I was hooked.”

He went back to Los Angeles and received NIH funding to continue his research on ocular herpes. In 1968, he joined his father’s practice half-time, spending the rest of his time doing research.

Two years later, he received a generous offer, when Rita and Morris Pynoos started DEF to fund his research. The Pynooses were grateful to Nesburn for diagnosing their son, Jon, with keratoconus (KC). “I was a second-year resident at Mass Eye and Ear, and Jon Pynoos was an undergraduate at Harvard. His parents went to see my dad, because Jon couldn’t see well, and no one could figure out what was wrong with his vision. My dad said, ‘Send him over to Tony; he’ll figure out what’s going on!’ I said to myself, ‘Holy mackerel! What happens if he has something really complicated? I’m just a newbie!’” Nesburn remembers. “Jon came in; I looked at him, and the keratoconus was so clear and easy to spot. I couldn’t imagine how his doctors didn’t see it. We got him contact lenses, and he was able to see again. When I came back to LA, the Pynooses wanted to do something to help.”

At first, DEF research focused on KC and the herpes research Nesburn was working on at the time. It soon broadened to include macular degeneration and retinal disease.

“My dad had to retire from the practice of ophthalmology at the age of 70, because of bad age-related macular degeneration (AMD). His mother and older sister had had it, as did several cousins. There was no treatment back then that helped,” Nesburn says.

“AMD is the most common cause of permanent vision loss in the elderly in the developed world. I could see where the need was,” he says. “We moved forward at DEF with two driving mantras: We wanted to do something significant in macular degeneration research and to find the cause of keratoconus.”

As a virologist in research and a corneal surgeon, Nesburn realized he needed a corneal biochemist to help with the KC research. He met Dr. Cristina Kenney at an Association for Research in Vision and Ophthalmology meeting. She joined DEF, and within 15 years, they found the chemical cause of keratoconus; they also got married.

Now nearly 80 years old, Nesburn spends most of his time “wearing three hats”: fundraising for DEF, lab research and clinical practice. His daughter, Kristin, is the third generation to join the family ophthalmology practice.

“While I’m still able, I want to try to make a difference in medicine, particularly in macular degeneration,” Nesburn says. “Macular degeneration affects so many people. This is where I want to put my energy. Luckily, as strong as it is in our family, I don’t have it … yet.

“As a researcher, my interest in putting together a program for macular-degeneration diagnosis and treatment has been because it’s a great public health problem. Yes, if I should ever get it, it might be able to help me or my family, but the first thing, as a scientist, is to try to get something to help humankind. I know it sounds sappy, but it’s true.”

3/26/15


Anthony B. Nesburn, MD, FACSAnthony B. Nesburn, MD, FACS
Medical Director, Discovery Eye Foundation
Professor & Vice Chairman for Research, Ophthalmology
Gavin Herbert Eye Institute, University of CA, Irvine

Protective Eyewear for Home, Garden & Sports

Spring is here and it is always a good time to review important ways to protect your eyes now that you will be spending more time outdoors, enjoying sports, gardening or just basking in the warm spring sunshine.

Protective Eyewear for Home, Garden & Sports

protective eyewear - sunglasses
Sunglasses and wide brimmed hats are the first things to consider as you go outdoors. The damage from UVA/UVB rays from sunlight is ever present, even on cloudy days. It is also cumulative and can lead to cataracts and age-related macular degeneration. Don’t forget to use sunscreen generously, helping to prevent a painful sunburn and skin cancer. If you perspire a great deal, think of a waterproof sunscreen that will not run into your eyes causing blurry vision and irritation.
protective eyewear - goggles
In your backyard or garden it is wise to use safety glasses or goggles when operating a chain saw, axe or hedge clipper. They will help to prevent small flying objects, dirt and debris from getting into your eyes. Tree sap and plant secretions can also be hazardous to your eyes. Wearing gloves should make you think twice about rubbing your eyes, or at least you can remove them if you can’t resist.

Home maintenance and spring cleaning offer some of the same threats as gardening. Beware of using any regular or power tools, paints and chemicals without protective eyewear because of flying debris, drips, splashes and sprays. Besides the general eye irritations and painful corneal scratches, you could permanently impact your vision. Also take care if your children are helping or playing nearby, they could also be at risk.
protective eyewear - sports
Spring is a great time to get outdoors and enjoy your favorite sports, but if you engage in any activities that involve throwing and catching balls, “flying” arms and elbows (such as karate), swinging bats, sticks or clubs, or anything that involves shooting (such as paintball or airsoft), you need protective goggles that wrap around and protect you from all angles. Not every threat will be coming from directly in front of you.

For these sports and recreational activities prescription eyeglasses, sunglasses and even occupational safety glasses are not enough to protect your eyes. You will need a highly impact-resistant polycarbonate to avoid a lens that can shatter and cause additional danger to your eyes. Consult your eye care professional to choose the right kind of eye protection for your warm weather activities.

3/24/15


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

Do You Have a Pterygium?

A pterygium (pronounced tur-IJ-ee-um) is a wing-shaped, fleshy growth of tissue that grows from the conjunctiva (the clear thin covering of the sclera or white part of the eye) onto the cornea (the clear front of the eye). The word pterygium comes from the Greek, pterygos, which means little wing. Pterygia are quite common and can be seen in surfers (hence the common reference as surfer’s eye), sunbathers, landscape architects and other outdoor people who do not adequately protect their eyes from the damaging ultraviolet radiation from the sun. Furthermore, people living closer to the equator have been shown to have a higher incidence of pterygia. Prolonged exposure to eye irritants such as wind and dust are also risk factors for the development of pterygia.
pterygium before & after
Pterygia usually grow slowly or follow an indolent course and can be asymptomatic or can flare up from irritation. Early on, pterygia may not be even noticed and may not be serious. Or, there can be signs of dry eyes, such as mild burning, tearing and itching due to irregular tear wetting of the surface of the eye. As the pterygium grows in size, the lesion will become more noticeable and may become cosmetically unpleasant, irritating to the patient and may give the sensation of a foreign body in the eye. Pterygia may cause visual symptoms if they induce astigmatism as they approach the center of the cornea or visual axis. Once the pterygium grows towards the visual axis, where vision could be compromised, various surgical procedures can be employed to remove it.

Having an ophthalmologist (an eye MD) examine your eyes is the first step to making the correct diagnosis and receiving the appropriate treatment, if it is necessary. Your ophthalmologist will examine the front of your eyes with a slit lamp, a specialized microscope for eye examination. Early in the disease process, most ophthalmologists will take a conservative approach and treat with lubricating eye drops and recommend protective eye wear (to prevent further UV exposure) and use of a wide-brimmed hat. If the pterygium enlarges and grows onto the cornea towards the visual axis, the ophthalmologist will consider surgical intervention to halt any more damage and scarring to the eye. Sometimes, a more aggressive pterygium may induce astigmatism on the cornea (causing the cornea to become more oval or football-like in shape as compared to more round in shape like a basketball). Astigmatism may cause blurred vision and, if left untreated, may not be reversed even with surgical intervention. Long-lasting pterygia may cause irreversible scarring of the underlying cornea, which may leave the cornea with a thin white film, or scar, even after the removal of the pterygium. If this scar is out of the visual axis, then vision may not be affected.

There are several different surgical techniques that are commonly used to remove aggressive pterygia. Microsurgical techniques can be done safely and comfortably on an outpatient basis in an eye surgery center using local anesthesia with mild sedation. The most common surgical technique involves surgical removal of the pterygium, placement of a preserved amniotic membrane graft (from the placenta) or a small graft of the patient’s own conjunctiva taken from the superior (upper) part of the conjunctiva to cover the area where the pterygium was removed, and using fibrin glue and/or small sutures to hold the graft in position. This procedure usually takes 30 minutes to one hour to perform, depending its complexity, with little discomfort for the patient. Post-operatively, the patient usually wears a patch for one day and can return to work after a few days (avoiding eye rubbing, swimming and hot tubs). Topical antibiotic and steroid drops and/or ointments are used for several weeks or months on a tapering dosage schedule per your ophthalmologist. Steroid medications reduce inflammation and chance of recurrence and should be used as directed. Careful follow-up for a year after surgery is recommended.

The main risk of pterygium surgery is recurrence of the pterygium after removal with a regrowth of abnormal tissue onto the cornea. When an amniotic membrane graft or conjunctival auto-graft is not used, the recurrence rate is quite high and has been reported from 25% to over 50%. However, when these grafts are used, the recurrence rate can be as low as 5 to 10%. For recurrent pterygium removal, however, the recurrence rate can be much higher and other adjunctive therapy may be utilized. Intraoperative mitomycin C (MMC) is often used in addition for recurrent pterygium excision to inhibit the regrowth of the pterygium. Some ophthalmologists use MMC eye drops after excision. Discuss these options with your ophthalmologist before your surgery. Be sure to see your ophthalmologist if you have a pterygium so that it can be properly assessed and appropriate treatment can be performed.

3/19/15

Ronald Gaster, MD, FACSRonald N. Gaster, MD, FACS
Gaster Eye Center
Beverly Hills and Huntington Beach, CA

Medical Research Funding Needs Individual Donors

The Need for Medical Research Funding

About 1.75 million U.S. residents currently have advanced age-related macular degeneration with associated vision loss, with that number expected to grow to almost 3 million by the year 2020.

About 8.4 million individuals worldwide are blind from primary open-angle glaucoma, with that number expected to grow to almost 11 million by the year 2020.

About 22 million Americans have cataracts affecting their vision, with that number expected to grow to more than 30 million by the year 2020.

The economic impact of this increase of people with vision loss will be tremendous.  But right now scientist are working on ways to treat and eventually cure many eye diseases.  The only problem is the funding necessary to support this sight-saving research. Here is a look at the decline of medical research funding in the US and what you can do to help.
medical research funding

3/17/15


 

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

The Optic Nerve And Its Visual Link To The Brain

The optic nerve, a cable–like grouping of nerve fibers, connects and transmits visual information from the eye to the brain. The optic nerve is mainly composed of retinal ganglion cell (RGC) axons. In the human eye, the optic nerve receives light signals from about 125 million photoreceptor cells (known as rods and cones) via two intermediate neuron types, bipolar and amacrine cells. In the brain, the optic nerve transmits vision signals to the lateral geniculate nucleus (LGN), where visual information is relayed to the visual cortex of the brain that converts the image impulses into objects that we see.
Optic Nerve
In the retinal tissues of the eye, more than 23 types of RGCs vary significantly in terms of their morphology, connections, and responses to visual stimulation. Those visual transmitting RGCs are the neuronal cells. They all share the defining properties of:

  1. possessing a cell body (soma) at the inner surface of the retina
  2. having a long axon that extends into the brain via the optic chiasm and the optic tract
  3. synapsing with the LGN. The RGCs form multiple functional pathways within the optic nerve to mediate the visual signal

Human beings can see three primary colors: red, green, and blue. This is due to our having three different kinds of color sensitive cone cells: red cones, green cones, and blue cones.

The RGCs connecting to the red and green cones are midget RGCs. They are mainly located at the center of the retina (known as fovea). A single midget RGC communicates with as few as five photoreceptors. They transmit red-green color signals to the parvocellular layer in the LGN (see Figure). The midget-parvocellular pathway responds to color changes, but has little or no response to contrast change. This pathway has center-surround receptive fields, and slow conduction velocities. Because of this pathway, we can see objects precisely in detail and in full color.
retina and optic nerve
The bistratified RGCs are likely involved in blue color vision. Bistratified cells receive visual information input originally from an intermediate numbers of cones and rods. The bistratified RGCs connect to the koniocellular layers in the LGN (see Figure). The koniocellular neurons form robust layers throughout the visual hemifield and have moderate spatial resolution, moderate conduction velocities, and can respond to moderate-contrast stimuli. They have very large receptive fields that only possess on-center regions (no off-surround regions).

Objects can be seen in the dark with motion and coarse outlines accentuated due to the parasol RGCs. At the periphery of the retina, a single parasol RGC connects to many thousands of photoreceptors (many rods and few cones). The parasol RGCs project their axons to the magnocellular layers of the LGN (see Figure) and are primarily concerned with visual perception. They have fast conduction velocities, can respond to low-contrast stimuli, but are not very sensitive to changes in color.

Finally, humans can see objects in three-dimension courtesy of the crossing over of optic nerve fibers at the optic chiasm. This anatomic structure allows for the human visual cortex to receive the same hemispheric visual field from both eyes (see Figure), thus making it possible for the visual cortex to generate binocular and stereoscopic vision.

Recently, a new type of RGC, called photosensitive RGCs, was discovered. The photosensitive RGCs contribute minimally to our vision, but play a key role in vision regulation. Photosensitive RGCs axons do not have connections to the LGN, but form the retino-hypothalamic tract, and synapse to three other locations in the brain for specific vision regulation functions:

  1. Pretectal nucleus: involved in reflexive eye movements, thereby helping to target what we want to see
  2. Midbrain nuclei: involved in controlling the size of the pupil, thus helping to adjust the brightness of objects; and coordinating movement of the eye for focusing
  3. Suprachiasmatic nucleus: involved in regulating the sleep-wake cycle

A fully functional optic nerve is essential for vision. Obviously, any damage of the optic nerve will sever the precise transmission of visual information between the retina and brain, directly leading to vision distortion and/or vision loss. Damage to the optic nerve can result from:

  1. Direct/indirect physical damage (e.g. ocular trauma)
  2. Acute/sub-acute physiological lesion (e.g. infection or inflammation, or malignancy (cancer))
  3. Chronic neuronal degeneration (e.g. glaucoma, a most common cause of optic nerve damage)

Moreover, the optic nerve is also a very important vivo model for studying central nervous protection and regeneration. At the cell biology level, the RGC axons are covered with myelin produced by oligodendrocytes (rather than Schwann cells of the peripheral nervous system) after exiting the eye on their way to the LGN and thus part of the central nervous system. Scientists have recently acquired more and more evidence that certain types of damage to the optic nerve may be reversible in the future. Therefore, the optic nerve provides a potential window to explore more complicated neuronal degenerative diseases, such as Alzheimer’s disease and Huntington disease.

3/12/15

Jun Lin, MD, PhD
Assistant Professor,
Department of Ophthalmology
New York Eye and Ear Infirmary of Mount Sinai
Icahn School of Medicine at Mount Sinai

—–

James Tsai, MD, MBA
Chair, National Eye Health Education Program Glaucoma
Subcommittee President, New York Eye and Ear Infirmary of Mount Sinai Chair
Department of Ophthalmology
Icahn School of Medicine at Mount Sinai

The Future of Keratoconus

The National Keratoconus Foundation, a program of the Discovery Eye Foundation, has been serving the keratoconus (KC) community for over 27 years. They have been a leading source of information on KC, while also providing support and educational programs, such as the OC Keratoconus Seminar this Saturday, March 14th. One of the reasons for the timely, quality information they are able to share, are their relationships with leading eye care professionals around the world.
future of keratoconus
We are happy to report that a new professional organization for eye care professionals treating KC and other forms of corneal ectasia has been formed, the International Keratoconus Academy of Eye Care Professionals. It is our hope that we can join together in in providing accurate information on KC as well as find future treatments and cures, defining the future of keratoconus. Here is more information about the new organization.

Establishment of the International Keratoconus Academy of Eye Care Professionals

The International Keratoconus Academy of Eye Care Professionals (IKA) was recently established to promote ongoing professional education and scientific development in the area of keratoconus and other forms of corneal ectasia. Its mission is to promote and develop the knowledge base and awareness of the state of the art pertaining to the diagnosis and management of keratoconus and other forms of corneal ectasia. And further to promote the awareness and understanding of the most appropriate and effective treatment strategies for the management of these diseases. According to S. Barry Eiden, OD, FAAO, co-founder and president,” I.K.A. is dedicated to providing comprehensive education to the eye care professions and to foster ongoing clinical research in order to improve the lives of patients suffering from these diseases. “

I.K.A. will accomplish its mission by providing an array of educational initiatives which will include live events, web-based education, social media activities and publications in the professional literature. It will also be dedicated to supporting ongoing clinical research. I.K.A. will function as a complementary entity to other organizations that support patients with these diseases such as the National Keratoconus Foundation (NKCF). These organizations will work cooperatively to establish a comprehensive effort to advance knowledge, awareness and quality of care.

The founding executive board of the International Keratoconus Academy of Eye Care Professionals is comprised of a group of highly regarded experts in the field including:

  • S. Barry Eiden, OD, FAAO
  • Andrew Morgenstern, OD, FAAO
  • Timothy McMahon, OD, FAAO
  • Joseph Barr, OD, FAAO
  • William Tullo, OD, FAAO
  • Clark Chang, OD, FAAO
  • Eric Donnenfeld, MD
  • Yaron Rabinowitz, MD

An international physician’s advisory board comprised of expert optometrists and ophthalmologists is being formed. For more information or questions about IKA, please contact them at info@keratoconusacademy.com.

3/10/15

Susan DeRemerSusan DeRemer
Vice President of Development
Discovery Eye Foundation

It’s All About ME – What to Know About Macular Edema

“You’ve got the macular? I’ve got some but my sister, she’s got all kinds!” Even as the word retina has become commonplace, the macula and its diseases are often feared and misunderstood. The retina is the light-sensitive layer of cells that line the inside of the eye. The many layers of the retina work together to convert what we see into an exquisitely coded signal that travels to the brain. There the message is decoded and directs us to take action – “that’s a fine looking piece of pie!”

The macula is the part of the retina that helps us see fine detail, far away objects, and color. It’s packed with more photoreceptors than any TV or monitor which is why it is prized real estate. It is the small, central area of the retina that’s worth the most – the bullseye of sight. When things happen to the macula, it gets an “r”. Macular edema, macular degeneration, macular hole, pucker, drusen, scar, fibrosis, hemorrhage, and vitreomacular traction are common conditions that involve the macula. When present, distorted vision (metamorphopsia), blank spots (scotoma), and blurred vision are common symptoms.

Four. Ang. - Macular Edema
Figure 1: Fluorescein angiography: Macular edema may be seen as a pinpoint leak (left, large arrow) in mild cases. In serious cases, ME may diffusely involve the macula. Note how the image becomes brighter as more dye leaks from damaged macular capillaries. (Center and Right)

Macular edema refers to an abnormal accumulation of fluid in the layers of the macula. From the side, it looks like the snake that ate the pig. Like a droplet of water on your computer screen, images are distorted by the swollen retina – making it more difficult to see clearly. The more widespread, thicker, and severe the swelling becomes, more likely one will notice visual symptoms. If untreated, chronic macular edema can lead to irreversible damage to the macula and permanent vision loss.

OCT - Macular Edema
Figure 2: Optical Coherance Tomogrphy and Macular Edema: OCT is a useful test to study macular edema (ME)
-The top image has is normal. Note the even layers and gently sloping dip of the macula called the fovea. This eye has excellent vision.
– The middle OCT has ME, black-appearing cysts (arrows) which threaten the normal fovea. This eye also has good vision.
– The bottom OCT shows ME involving the macula. Because ME involves the macular center (the fovea), vision is poor (large red arrow).

Macular edema is not a disease but the result of one. As with other conditions where abnormal fluid accumulates (leg swelling, pulmonary edema, hives, and allergy), macular edema can be caused by many conditions including metabolic (diabetes), aging (macular degeneration), hereditary (retinitis pigmentosa), inflammatory (sarcoidosis, uveitis), toxic, neoplastic (eye tumors), traumatic, surgical, and unknown causes (idiopathic, macular hole, macular pucker, vitreomacular traction). Macular edema occurs when the retina’s ability to keep fluid out of the retina is overwhelmed by the fluid leaking into it. (If more rain falls on the lawn than it can handle, you get puddles of fluid. In the retina, blisters of fluid form and swell the retina – this is macular edema. Fluorescein angiography (Figure 1) and optical coherence tomography (Figure 2) are two common tests to evaluate macular edema.

Macular edema is typically caused by increased leakage or growth of abnormal blood vessels. The most effective treatment strategies address the underlying cause (diabetes, blood vessel occlusion, neovascularization, inflammation, etc) as well as the hyperpermeability of the capillaries in and around the macula. Eye drops, laser, placement of long-acting medication implants, and surgery are effective in many diseases but the mainstay of treatment is now intravitreal injections (IVI). The IVI is an office procedure painlessly performed under topical anesthesia in which medication is placed inside the eye by a very small needle. IVI should be performed by a trained retina specialist with meticulous monitoring of treatment efficacy and of extremely rare but potentially serious complications. IVI is considered one of the most commonly performed procedure in the world.
Lucentis, Eyelea, and Ozurdex are the trade names of the three most common FDA-approved medications for the treatment of the common conditions causing macular edema. Avastin is not FDA approved but has also been extensively studied in large, well-designed, federally-funded clinical trials and is felt to have efficacy and safety no less than any of the other available options. Each option has a considerable track record of success and works by decreasing the amount of fluid leaking from abnormal blood vessels.

Macular edema is a common finding in many diseases of the retina, most which can be treated to improve vision. The physician’s therapeutic armamentarium continues to expand. There has never been a more successful time in the treatment of macular edema and macular disease. While much has been discovered, many promising therapies await.

3/5/15


Dr. Suber HuangSuber S. Huang, MD, MBA
Chair, National Eye Health Education Program
Philip F. and Elizabeth G. Searle – Suber Huang MD Professor
Case Western Reserve University School of Medicine
Past-President American Society of Retina Specialists
CEO, Retina Center of Ohio

10 Tips For Healthy Eyes

In honor of Save Your Sight Week, here are 10 tips for healthy eyes. There are some simple things you can begin to do today to help your retain your vision. Also there are no warning signs for many of the leading eye diseases (age-related macular degeneration, glaucoma, cataracts), yet most people don’t see an eye doctor until they have a problem seeing. Unfortunately, by that time, irreparable damage has been done.
10 Tips For Healthy Eyes

3/3/15


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

Selecting Your Best Vision Correction Options

Today technology has evolved to a point where patients either with normal refractive errors such as nearsightedness, farsightedness, astigmatism and presbyopia or those with ocular diseases that require specialized vision correction options such as those with keratoconus all have spectacular alternatives to maximize their visual performance. With the multitude of choices available, how does an individual make the decision which to take advantage of? Well let’s begin by saying that the input from your eye care professional is critically important. You need to be properly educated not only about the various options that are applicable to your individual situation but about the advantages and disadvantages of these options.eye glass fitting vision correction options

Normal Refractive Error Options

Let’s begin by discussing vision correction options available to those with normal refractive errors. Basically stated, these individuals have the ability to utilize spectacles, contact lenses or if they are appropriate candidates, consider the refractive surgical alternatives.

Glasses
Today spectacle lens technology has evolved to the point where exceptional vision quality can be achieved with lens designs that allow for the selection of almost any frame size or shape. Thin lens technologies have enabled those with high prescription powers to not only see amazingly well, but to wear glasses that remain quite thin and attractive even with some of the most extreme prescription powers. Your eye care professional can discuss the various lens material options that best work for your situation. New high index materials are not only thin but are very light weight. A concern for some however can be the significantly higher costs associated with these lens materials. For those who need multifocals, new digital and free form progressive addition lenses (PALs) have dramatically increased the success rates associated with adaptation to PALs.

Contact Lenses
Contact lens alternatives for those with normal refractive errors have also dramatically developed technologically over the past years. Today virtually every patient with normal refractive error is a candidate to wear contact lenses. Developments such as astigmatic contacts, multifocal contacts, and hybrid (rigid center / soft periphery) contact lens designs along with the introduction and the tremendous growth in the use of single use daily disposable contacts has made one form or another of contact lenses something to consider for almost everyone. Today’s CLs are healthier, more comfortable and provide better vision than ever before. CLs have the advantage of superior peripheral vision, more natural vision “sensation” and obvious advantages for demanding physical activities. With contemporary contact lens materials and designs we have successfully addressed issues that limited many people in the past such as concerns of poor comfort due to dryness, contact lens vision instability and contact lens induced complications associated with over-wear and over-use of lenses. Your eye doctor should always present contact lens options to you regardless if you ask or not. So often patients think that they can’t wear contacts, so it does become the responsibility of your doctor to inform and educate you about CL alternatives.
contact lens vision correction options
Combination of Glasses and Contact Lenses
So how do you decide if you should be a contact lens wearer or a glasses wearer? Who said you have to? The two vision correction options are not mutually exclusive; in fact they are quite synergistic. All contact lens wearers should have an excellent pair of glasses to use. Contacts may be more cosmetically acceptable to many, they may be much better for various physical activities such as sports, however there are many times when glasses may be preferred such as at the end of a long day of contact lens wear, first thing in the morning before inserting your CLs, or on those days you just don’t want to bother with your CLs or simply prefer the look of your glasses for some situations. Today even the person who predominantly wears glasses can consider part time contact lens wear. Single use daily disposable (DD) CLs are the perfect option for such an individual. DD CLs are now even available in astigmatism and multifocal designs!

Refractive Surgery
Refractive surgery is also developing and is more effective and safer today than ever before. An experienced and skilled eye doctor is in the best position to consult with you in order to determine if you are an excellent candidate for the various refractive surgical options available. Again, having refractive surgery does not always eliminate your need for glasses or contact lenses. Although that would be the optimal outcome, many patients still use glasses and contact lenses after having refractive surgery. Typically the glasses and contact lenses are far less strong and are used significantly less often than prior to surgery. Some patients need them due to complications of surgery while others need them when outcomes did not perfectly correct vision and of course refractive surgery does not stop eyes from changing over the years, so many patients who had successful refractive surgery may experience vision changes years after surgery that require the use of glasses, contacts or both.

Irregular Refractive Error Options

Specialty Contact Lenses
Next let’s talk about choices in vision correction for those with irregular corneas and other conditions that are termed “medically necessary” vision correction cases. Individuals with irregular corneas such as those with keratoconus or post LASIK or other refractive surgery induced ectasias often require contact lenses that in essence “mask” the irregularity of the cornea. In the past this equated with the fitting of rigid corneal contact lenses, however today many other alternatives can be considered such as the fitting of scleral large diameter gas permeable contacts, hybrid CLs designed for irregular corneas and even combination systems of soft lenses with corneal gas permeable lenses (called “tandem” or “piggyback” CL systems). These CL alternatives provide advantages such as improved comfort, improved eye health response by limiting contact lens to cornea bearing, and improved contact lens positioning and stability which positively impacts visual performance.

Combination of Contact Lenses With Glasses
It should be clearly stated that spectacle lens alternatives still can have a significant role in the treatment of individuals with irregular corneas. Often glasses can be prescribed that provide adequate vision if even for part time and limited applications. While less severe cases may perform quite well with glasses as their primary modality of vision correction. Your doctor may need to modify the power of your glasses prescription in order for you to adapt to wearing glasses, however even a modified prescription power can frequently allow for some degree of visual function and allow for the ability to reduce the number of contact lens wearing hours during the day.

Surgical Procedures
Application of certain surgical and medical procedures such as intra-corneal ring segments (Intacs TM) or corneal collagen cross linking (CXL) for corneal irregularity can often help these patients in various ways and may allow for perhaps a less complex contact lens application or easier adaptation and improved function with glasses. Management of these diseases and conditions is quite complex and requires the expertise of doctors with extensive experience. Your doctor, if appropriately skilled and experienced can provide you with all of the required information and education so that you both can jointly decide on the best vision correction options for you.

In conclusion, patients today have numerous options for their vision correction. These options each have advantages and disadvantages but in most cases can be utilized synergistically. The role that your eye care professional plays in consultation and education of the vision correction alternatives applicable to you cannot be over stated. Vision is a precious gift and you should experience the highest quality of visual performance possible.

2/26/15


Barry Eiden OD, FAAOS. Barry Eiden, OD, FAAO
Medical Director, North Suburban Vision Consultants, Ltd.
NSCV Blog: www.nsvc.com/blog
President and Founder, International Keratoconus Academy of Eye Care Professionals

Watery, Red, Itchy Eyes

Do you have watery, red, itchy eyes?

As brutal winter weather continues to grip many parts of the US, we just want to remind you to protect your eyes – see our post on Winter Weather and Your Eyes. But there are other conditions that can cause excessive tearing and itchy eyes.
wiping eyes watery, red, itchy eyes
While tears are an important element in clear vision and healthy eyes, helping to keep eyes moist, wash away foreign objects and spread nutrients across the eye; this is not the case if there are too many tears and they are accompanied by redness, discharge, puffiness and an itchy, burning sensation.

Here are three common causes you should be aware of:

1. Allergies – In the US, eye allergies affect one in five people. There are two types of eye allergies, seasonal that generally happen early spring to late fall, and perennial that occurs throughout the year. Triggers for seasonal allergies include airborne pollens from grasses, trees and weeds. Perennial triggers include dust mites, feathers, animal dander, cosmetics, perfumes and smoke.

The first thing you should do is limit your exposure to the allergens. This could include:

  • Stay indoors when pollen count is highest, usually mid-morning or early evening.
  • Close all windows and use air conditioning in both your home and car.
  • Consider an air purifier for your home.
  • Wear wraparound sunglasses to help shield your eyes from pollen.
  • Limit exposure to dust mites by enclosing pillows, comforters, mattresses and seat cushions in allergen-impermeable covers.
  • Have your pet spend as much time outside as possible, and keep it out of your bedroom – don’t let it share your bed.
  • Clean floors with a damp mop – sweeping just stirs up the allergens.
  • Don’t rub your eyes as it will likely make the symptoms worse. Try a cold compress instead.
  • Remove your contact lenses and wear glasses during allergy season because the surface of the lens can attract and accumulate airborne allergens. If you must wear contacts, consider daily disposable contacts to avoid the build-up of allergens on your lens.
  • Sterile saline rinses and eye lubricants.
  • Oral antihistamines such as Claritin or Zyrtec.
  • Eye drops can also provide relief. In most cases you can use over the counter (OTC) eye drops, but be aware that overuse of decongestant eye drops can cause a “rebound effect” where the situation could get worse. You are better off asking your doctor to recommend an OTC eye drop. However, if the problem persists or gets worse, you need to contact your eye doctor for prescriptions eye drops tailored to your needs. Here you can learn more about types of eye drops and how to successfully get them in your eyes.

    • watery, red, itchy eyes

2. Dry Eyes – It seems counterintuitive, but if your eyes feel dry and gritty your tear glands go into overproduction as a protective response. This can become even more of a problem as you age and your tear ducts tend to shrink. For more information on dry eye and treatment options see Dr. Arthur Epstein’s article on Dry Eye and Tear Dysfunction.

3. Blepharitis – Chronic blepharitis is generally caused by seborrheic dermatitis, an oil build-up because of excessive oil secretion. While this results in dandruff on your scalp, near the eyes it leads to eye irritation, redness, burning, itchy and dry eyes. The best treatment is to keep the eyelid area clean and free of discharge. This is done with the application of a warm compress to the outer eyelid and cleansing the eyelids with eyelid cleaner. If a bacterial infection occurs you will need your eye doctor to prescribe an antibiotic ointment.

Blepharitis doesn’t usually damage your eye or affect your vision, but if a bacterial infection is left untreated you can develop ulcerative blepharitis which can result in the loss of eyelashes, eyelid scarring and inflammation of the cornea. Eyelid hygiene is the key with treating blephartis.

These are just three causes of watery, red, itchy eyes. While most are not a serious threat to your vision, you can relieve the discomfort yourself through lifestyle choices, good hygiene and OTC options. However, if you have tried to manage on your own and the condition does not seem to improve within a week, or gets worse, you should contact your eye care professional immediately.

2/24/15

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