Pediatric Contact Lenses

8/14/14

Because August is Children’s Eye Health Month we are pleased to present a four-part series on pediatric vision issues and contact lenses by Buddy Russell, FCLSA, COMT. With over thirty years experience fitting contact lenses, Buddy is currently an associate of the specialty contact lens service at Emory University Eye Center in Atlanta, Georgia. Buddy is a clinical instructor in Emory’s Ophthalmic Technology Program and teaches students and ophthalmology resident’s contact lens technology. 

Child refractive exam - pediatric contact lensesHe is a licensed dispensing optician, a Fellow member of CLSA and has been certified by JCAHPO as a Certified Ophthalmic Medical Technologist. He lectures at national and international meetings on contact lens related topics. Buddy has written articles for a number of publications, two chapters for CLSA’s advanced training manual and is a peer reviewer for the Cornea publication. He is also a contributing editor for CLSA’s Eyewitness journal. His current areas of research include pediatric aphakia and keratoconus. He joined the faculty at TVCI in 2006.

The first article will examine that pediatric contact lenses for children go beyond vision correction, the second will explore lenses as a treatment option, the third will look at a variety pediatric eye conditions and the final post will discuss the contact lens fitting challenges you face when you work with children.

Introduction

Working with the pediatric patient and their caregivers / family can be challenging, rewarding, fun, and yet sometimes frustrating. Many of these cases often include factors that are unique to the young patient. In addition to the technical challenges of obtaining the objective data, the fear of uncertainty is often present. The uncertainty of the unknown can either paralyze you or motivate you to step up and simply do what must be done.

The Definition May Vary

The definition of pediatric contact lens fitting can be different to different people. The fitter who works with the occasional twelve-year-old neophyte wearer will define pediatric fitting different from the person that works with babies on a routine basis. Pediatrics is generally defined as a branch of medical care that deals with infants, children and adolescents. The word pediatrics is derived from two Greek words (pais = child and iatros = healer), which means healer of children. Are you a “healer of children” or do you tend to feel better about someone else assuming the challenge and responsibility? This article will discuss some of the conditions, contact lens indications, fitting techniques and challenges that are present with the young patient.

Refractive Indications

What age is “appropriate “ to fit a contact lens on a child? In the absence of a medical indication, Jeff Walline, OD and his colleagues have addressed the answer to this question in the published literature. In addition, the American Academy of Optometry published a position paper in 2004 that stated that by the age of eight, a child was able to handle contact lenses and assume some degree of responsibility. We are all aware that not all eight year olds are capable of dealing with contact lenses. For that matter, not all eighteen year olds are mature enough to assume responsibility for anything. Some of the concerns that a contact lens practitioner may have in fitting these young children include the risk of safety to the child’s health, too much chair time, physical limitations, lack of hygiene, and lack of maturity. These are all legitimate concerns when you consider the child can see well with spectacles.

What does the literature reveal concerning these questions and concerns? Are the answers there?

CLIP Study

The Contact Lens In Pediatrics study compared 169 neophyte wearers in two age groups (children age 8-12 and teens age 13-17) over a period of three months. The summary of the clinical findings in the publication is that adverse events was low and the younger children took a little longer to train application and removal of the contact lenses. The more impressive outcomes from this study was determined by a tool used more frequently in child psychology referred to as the Pediatric Refractive Error Profile (PREP) survey. The PREP survey is a clinically validated quality of life instrument to assess how a child “sees” him or herself. This 26-question survey revealed that contact lenses improved the child’s self image in regards to their appearance, increased confidence in themselves while participating in activities and overall satisfaction of their form of vision correction. These findings were consistent in both age groups. More than 80% of both age groups found contact lenses easy to clean and take care of as all participants were fitted with 2-week disposable soft lenses and used a multipurpose disinfection care system.

The ACHIEVE Study

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) were published in 2009. Jeff Walline, OD and his colleagues designed this study to find out the effects that glasses and contacts had on the self-perception of the child. This study examined 484 myopic children 8-11 years. The participants were randomized to spectacles (n=237) or contact lenses (n=247) and followed for three years. The children were evaluated at baseline, 1 month and every 6 months for three years by a validated psychology tool for self-perception referred to as the Self-Perception Profile for Children (SPPC). The SPPC instrument allows a 4 point self-assessment in 6 categories; scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. The participants revealed the most dramatic areas of improvement with contact lenses compared to spectacles in the areas of physical appearance, athletic competence, scholastic competence and social acceptance. Similar to the low occurrence of adverse events with contact lens wear found in the CLIP study, over the three year period there were only 13 adverse events among 9 subjects. In addition, the ACHIEVE study found very similar rates of myopic progression in both groups of patients over the three year period (1.08D spectacle group and 1.27D contact lens group).
What can we conclude from these two studies?

One is that we are in a position to not only help a young person see but we are also in a position to do it safely and assist the child by instilling more confidence in themselves at a young age that may impact them as they mature into an adult who feels good about themselves. Young children are accustomed to following rules. When properly trained, these same young patients may grow into some of the most compliant patients that we have in our practice. There are some practical considerations for prescribing contact lenses to the younger patient. Mary Lou French, O.D. has stated the three M’s are important for success; Maturity (good hygiene, good communication skills, signs of responsibility), Motivation (why do they want contacts? Does the child want them or just the mom or dad? Are they active in activities where freedom from spectacles is important?), Mom (is the mom / dad / older sibling willing to help?). Don’t let age be the deciding factor. Consider your position as one that may positively impact the young patient in how they “see” and feel about themselves.

Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center

I See You

8/12/14

This is the second article from Kooshay Malek, a blind therapist in Los Angeles. Her first article, The Habit of Seeing, discussed losing her vision and her choice of becoming a marriage and family therapist. Here she discusses at how she uses her vision loss to help her patients.

When I started as a therapist, I was really concerned about my blindness. I had faced prejudice in other jobs. With my first few clients, I gave them this whole spiel at the beginning, explaining about being blind and about why I wear dark glasses.Therapy cloud - blind therapist My supervisor said not to work so hard to explain. He thought it was a nonissue: “If you were blonde and blue-eyed, would you be describing that over the phone to them?” he asked. He was right. It didn’t faze most people. In the 11 years I’ve been practicing, only a few people had a problem with it. To this day, once in a while, it may come out organically that I’m blind. Most of the time, I don’t tell them beforehand.

I think I pick up on certain nuances sighted therapists may miss. I sense shifts in energy in the room. I have very strong attunements: I notice the slightest change in tone of voice — or even in their silences — and I know something’s going on. If necessary, we talk about my blindness, and we process my blindness in the session. I don’t leave it as an elephant in the room. The main concern of everybody who comes to therapy, whether they are seeing a blind person or not, is, “Am I going to be heard and understood?” In this case, they may wonder if my blindness will affect whether I can hear and understand them. I say: “Well, we’ll have to wait and see. If there is something you think I can’t understand, would you be able to tell me?” That makes them self-sufficient in asking for help or expressing a need. Many patients tell me they find it so much easier to talk to me, because I don’t have my eye on them, so to speak, like a microscope. They find it close to the traditional psychoanalyst’s couch, where the therapist would sit behind them and not look at their face. They find out I see them better than anyone else in their life. That’s the reward of it. Especially with clients who have self-image and self-esteem issues. I get to see who is inside, not who is outside, and that’s powerful by itself. People open up more easily. My blindness is a really quiet, subtle intervention in the room at all times. It’s always present. It’s a gift I carry in there with me, and I use it.

Kooshay Malek - seeingKooshay Malek
Marriage and Family Therapist
Los Angeles, CA

Nystagmus In Children

8/7/14

Nystagmus is a condition of uncontrolled eye movements. Patients with nystagmus are unable to maintain their eyes in a fixed position of focus. The movements can be pendular, swaying evenly side to side, or, jerk into one direction and drift toward the opposite direction. It can be present early in life or acquired as an adult. It can occur in eyes with poor vision from other anomalous development, or eyes that appear perfectly normal. In almost all patients the vision is compromised to some degree. In some patients, the eye movement is less, and the vision better, in an eccentric position that causes the patient to adopt a face turn, tilt or head posture so they can use this quieter position (“null point”) to navigate during their daily activities. To date there have been no consistently effective treatments for this condition.

Lingua and Grace - nystagmus
Dr. Lingua and Grace Nassar

Treatment efforts have been either medical (drugs to reduce the amplitude of the nytagmus movement) or surgical (to move the “null point” into straight ahead gaze to eliminate a head turn, or, directed at reducing the effective contracture of all the eye muscles to reduce the amount of movement). In general, surgical treatment of nystagmus has been disappointing.

In 2002, Dr. Robert Sinskey, noted cataract surgeon and phacoemulsification pioneer, proposed a revolutionary concept, that nystagmus could only be truly effectively controlled by removing the forward portion of the eye muscle and detach it completely from the eye. Since the twitching eye muscles were controlled by nerves sending that pulsatile information, any operation that allowed the muscles to remain attached to the eye would never quiet the movement. He performed this novel surgery in 2000 and published the results in 2002. It did not receive attention in the nystagmus surgery community, as most experts worried that the surgery would limit normal eye movements excessively. The operation does remove the forward portion of the eye muscle but, surprisingly, the eyes are still able to move to allow reading, computing, and driving.. In 2012, I had the opportunity to view a patient he operated 10 years prior and was impressed with how successful the results were even after 10 years. Coincidentaly, I was caring for a 17 year-old patient with nystagmus who had already undergone the 2 currently accepted eye muscle procedures for nystagmus without success. His movements remained uncontrolled, he could not maintain eye contact with anyone, and is his vision was less than that needed for a drivers license. In 2013, I offered him the Sinskey procedure and the results were remarkable. His nystagmus was quieted, his vision improved (20/25) enough to qualify for a drivers license and to return to school.

Since 2012, we have adapted, augmented and perfected the procedure and performed the surgery on over 12 patients with similar remarkable results. All patients experience a marked reduction in the amplitude of the nystagmus (60-100%), and all patients demonstrate improved vision (1-8 lines of the acuity chart), especially at the reading position.

Visit the YouTube posting “Meet Grace” for an example of how this surgery can impact a child’s life and the hopes of their parents. Visit www.eye.uci.edu for further information, contact information and scientific data on the procedure.

Robert Lingua, MDRobert W. Lingua, MD
Director, Pediatric Ophthalmology and Strabismus
Gavin Herbert Eye Institute, UC Irvine

32 Facts About Animal Eyes

8/5/14

For something different, and a little fun, here some interesting facts about animal eyes that you may not have known.Animal Eyes

  1. Shark corneas are similar to human corneas, which is why they have been used in human transplants.
  2. A worm has no eyes at all.
  3. An owl can see a moving mouse more than 150 feet away.
  4. Guinea pigs are born with their eyes open!
  5. Scorpions can have as many as 12 eyes, but the box jellyfish has 24!
  6. Camels have three eyelids! This is to protect their eyes from sand blowing in the desert.
  7. Most hamsters only blink one eye at a time.
  8. Owls are the only bird which can see the color blue.
  9. Goats have rectangular pupils to give them a wide field of vision.
  10. A scallop has around 100 eyes around the edge of its shell to detect predators.
  11. Snakes have two sets of eyes – one set used to see, and the other to detect heat and movement.  They also don’t have eyelids, just a thin membrane covering the eye.
  12. The four-eyed fish can see both above and below water at the same time.
  13. Owls cannot move their eyeballs – which has led to the distinctive way they turn their heads almost all the way around.
  14. A dragonfly has 30,000 lenses in its eyes, assisting them with motion detection and making them very difficult for predators to kill.
  15. Dolphins sleep with one eye open.
  16. The largest eye on the planet belongs to the Colossal Squid, and measures around 27cm across.
  17. Geckos can see colors around 350 times better than a human, even in dim lighting.
  18. The eyes of a chameleon are independent from each other, allowing it to look in two different directions at once.
  19. A camel’s eyelashes can measure up to 10cm long, to protect its eyelashes from blowing sand and debris in the desert.
  20. An ostrich’s eye is bigger than its brain.
  21. Dogs can’t distinguish between red and green.
  22. Polar bears have a third eyelid that helps filter UV light.
  23. Human eyes are not the most highly evolved. The mantis shrimp has four times as many color receptors as the human eye and some can see ultraviolet light.
  24. Pigeons can see millions of different hues, and have better color vision than most animals on earth.
  25. Cat’s eyes have almost 285 degrees of sight in three dimensions – ideal peripheral vision for hunting.
  26. Although color blind, cuttlefish can perceive light polarization, which enhances their perception of contrast.
  27. A moth’s eyes are covered with a water-repellant, anti-reflective coating.
  28. An ant only has two eyes, but each eye contains lots of smaller eyes, giving it a “compound eye.”
  29. Eagles have 1 million light-sensitive cells per square millimeter of the retina – humans only have 200,000.
  30. A honeybee’s eye is made of thousands of small lenses. A drone may have up to 8,600 and the queen be can have 3,000-4,000 lenses.
  31. The night vision of tigers is 6 times better than humans.
  32. Eyes on horses and zebras point sideways, giving them tremendous peripheral vision, to the point of almost being able to see behind them, but it also means they have a blind spot right in front of their noses.

 

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

How To Choose A Home Care Agency

7/31/14

When life changes due to vision loss, illness, accident or aging, it can be difficult to maintain your independence and personal care as you once did. Help with errands, grocery shopping, doctor’s appointments, personal care, medication reminders, meal preparation, laundry, housekeeping and more can relieve much of the stress you and your loved ones may be experiencing. Care provided by a qualified, professional home care agency can be the best option for many individuals and their families.
Caregiver for home care
But with so many aspects to consider, the task of selecting an agency to bring into your home can be daunting. So what should you look for and what questions should you ask when selecting a home care agency to provide services to you or your family?

Qualifications

  • Is the agency licensed by the state? Most states — but not all — require agencies to be licensed and reviewed regularly. Reviews may be available on request through your state health department. If your state is a non-licensure state (such as California), you will need to be more vigilant in screening potential agencies.
  • Does the agency meet federal requirements for health and safety with such things as OSHA, HIPAA, infection control, a disaster plan? If not, ask why.
  • What type of employee screening is done? To ensure caregivers are reliable and honest, drug and alcohol tests, extensive background checks, should be performed on all new hires and we are insured and bonded.
  • Are the caregivers experienced? The very best agencies hire experienced caregiver or have a Personal Care training program written by a Registered Nurse with extensive experience in home care and education.
  • Do the caregivers receive health, skill and competency testing? A good home care agency will test employees to assure their personal health, skills and capability. Standard testing should include competency testing, TB tests, pre-employment health screening and skills competency testing, and drug testing.

Quality of care

  • Does the agency value a caregiver bond? A great caregiver becomes part of the family, and a good company will recognize that and try to match you with one or more caregivers with a regular schedule to promote the development of this bond.
  • Does the agency provide training and continuing education? A quality home care company will provide an opportunity for continuing Personal Care training as well as specialized training in specialized areas such as dementia and Alzheimer care, chronic and acute illnesses, and best practices and procedures.
  • Is there supervision and unscheduled visits by the agency’s supervisor to evaluate the quality of home care? A good home care agency will provide supervisors or care coordinators who perform unscheduled supervision visits to help make sure that you are receiving the best care possible. The field nurse supervisor visit is also a good time to communicate any concerns you may find uncomfortable discussing with your caregiver.
  • As part of the agency’s quality assessment, do they have a client satisfaction survey system? For peace of mind you need an agency that has a process to know you are satisfied and keeps you and your family informed. Some agencies work with a third party to make calls to ensure your satisfaction with our caregivers and our agency. Caregivers should also be trained to alert family members regarding any changes or concerns regarding the client, in addition to responding to clients’ or family members’ concerns.
  • What happens if my caregiver does not show up? One of the most common problems that people have with the average home care agency is that the caregivers don’t show up. Choose an agency that has a system to handle the caregivers who cannot fill their shift such as incentives and/or pay bonuses for perfect attendance and have “on-call” caregivers.

Costs

  • How does the agency handle expenses and billing? Ask for literature explaining all services and fees, as well as detailed explanations of all the costs associated with home care.
  • Will agency fees be covered by health insurance or Medicare? Find out what arrangements are in place for specific health insurance plans. Although home care agencies do not bill Medicare there are many other insurances that will pay for service such as the Veteran’s Aid and Attendance, Long-term care insurance, Work Comp insurance and some traditional plans.

Understanding services

  • Will you receive a written care plan before service begins? The care plan should include details about medical equipment and specific care needs, contain input from your or your loved one’s doctor, and be updated frequently.
  • Will you receive a list of the rights and responsibilities of all parties involved? This is sometimes known as a client or patient’s bill of rights.
  • Will the agency work directly with you or your loved one, family members and health care providers? Look for a company that will coordinate your care with everyone involved.
  • When will service be provided? Is care available round-the-clock, if necessary? Care is provided to you as planned during your initial in-home visit from our Care Coordinator. The agency should be able to provide for 24 hour care either by shifts or a live in situation, if the setting is right.
  • What procedures are in place for emergencies? Ask how the agency or home health aide will deliver services in the event of a power failure or natural disaster. Your agency and caregivers should be prepared for emergencies and practice in ensure your and their safety.
  • How are problems addressed and resolved? Who can you or another family member contact with requests, questions or complaints? Ensure the agency provides you with contact information and that their phones are answered 24 hours every day!
  • When can services begin? A quality agency should work with you to create a schedule which will fit your needs and can be flexed if your family is in town or you go on vacation.

Monitor your home care services

After you’ve found a home care services provider, monitor the situation. If you’re concerned about the care or services provided, discuss it promptly with the agency. If necessary, involve your doctor or your loved one’s doctor as well.

Robert Mahoney - home careRobert Mahoney
Owner
First Light Home Care

Learning-Related Vision Problems

7/29/14

Next month is Children’s Eye Health Month, and to kick it off a little early we are taking a look at learning-related vision problems. Next month children start heading back to school, so now is the perfect time to make sure you child has had a recent comprehensive eye exam.
child eye exam - Learning-related vision problems
Vision and learning are closely related. About 80% of what a child learns in school is presented visually, and 25% of school-aged children already have vision problems (5-10%of preschoolers do). By scheduling a comprehensive eye exam for your child before school starts, you will help your child be more successful and happier in school.

When children have difficulty in school, from being able to see what is written on the whiteboard to learning to read, it not only makes the learning difficult, but it also makes the child frustrated and can affect their love of learning as well. While most schools perform a quick eye check at some point during the school year to determine simple refractive errors such as nearsightedness, farsightedness and astigmatism, there are other visual disorders that can make learning difficult.

Vision is a complex process that involves the eyes working well with the brain. Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input. The third primarily affects visual processing and integration.

  1. Refractive vision problems. Your child holds a book close to their face when reading or they have difficulty seeing things that are far away. These are generally refractive issues and include nearsightedness, farsightedness and astigmatism, but could also include more subtle optical errors called higher-order aberrations.
  2. Functional vision problems. This type of problem refers to a variety of specific functions of the eye and the brain’s control of these functions, such as eye teaming (using the eyes together), fine eye movements, and focusing skills, peripheral awareness and eye-hand coordination. These issues can cause blurred or double vision, eye strain and headaches.
  3. Perceptual vision problems. Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. Examples would include recognizing words that you have seen before and being able to form a mental picture of the words you see.

Because most routine school and pediatrician eye exams evaluate only the refractive vision problems, it is wise to see optometrist who specializes in children’s vision problems to evaluate functional vision problems and perceptual vision problems that may affect learning.

Color blindness is not considered a learning-related vision problem, but it can cause problems for very young children if color-matching or identifying specific colors are part of the classroom activities. For this reason, make sure your child’s eye exam includes a color blind test prior to starting school.

Symptoms of Learning-Related Vision Problems:

  • Headaches, eye strain, excessive blinking or rubbing the eyes
  • Blurred vision or double vision
  • Crossed eyes or if the eyes move independently of each other
  • Holding a book very close to their face for reading
  • Bending way over a table to get closer to what they are drawing or writing
  • Using only one eye by tilting the head or covering the other eye
  • Losing their place while reading, or needing to use a finger to stay on line
  • Slow reading speed or poor reading comprehension
  • Omitting or repeating words, or confusing similar words
  • Persistent reversal of words or letters (after second grade)
  • Difficulty remembering, identifying or reproducing shapes
  • Poor eye-hand coordination
  • Distracted in class

If your child shows one or more of these symptoms, they could indicate a learning-related vision problem. To find out see an eye doctor who specializes in children’s vision for a comprehensive evaluation. If no vision problem is detected, your child’s problems could be caused by a non-visual issues, such as dyslexia or a learning disability, in which case you would need to contact an educational specialist for an evaluation.

Treatment of Learning-Related Vision Problems

If your child is diagnosed with a learning-related vision problem, treatment generally consists of an individualized and doctor-supervised program of vision therapy. Special eyeglasses also may be prescribed for either full-time wear or for specific tasks such as reading.

Remember that when children have a difficult time learning, especially while other classroom friends have no visual issues to impair learning, they may experience emotional problems as well, such as anxiety, depression and low self-esteem.

Reassure your child that learning-related vision problems do not relate to how smart they are and with the proper treatment and/or eyeglasses, things will become easier.

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

Children Can Wear Contact Lenses Too

7/24/14

Several studies have shown that children as young as eight years are able to wear gas permeable,[1-3] corneal reshaping,[4-8] and soft contact lenses.[9-12] Gas permeable (hard) contact lenses were originally thought to slow the progression of nearsightedness, but two randomized clinical trials have shown that they do not slow the growth of the eye,[1, 3] so they are primarily fit on children who have difficulty handling soft contact lenses or who have highly irregular corneas (the clear window on the front of the eye) possibly from trauma or eye problems such as keratoconus. children - contact lens for childrenCorneal reshaping contact lenses are worn during sleep only. They temporarily flatten the cornea so that a nearsighted child can see clearly throughout the day with glasses or contact lenses. These contact lenses have been shown to slow eye growth in children.[4-7] Typical soft contact lenses have no effect on the progression of nearsightedness,[13] but soft bifocal contact lenses (typically worn by adults over the age of 40 who otherwise have difficulty seeing clearly at near) have been shown to slow the growth of the eye.[14-17]

Children also benefit from contact lens wear other than slowing the progression of nearsightedness. Children feel better about their athletic abilities, their appearance, and their peer interactions when they wear contact lenses than when they wear spectacles.[11] They even feel smarter if they wear contact lenses than if they wear spectacles, but only if they originally didn’t like to wear spectacles. Children also report that they prefer to participate in activities while wearing contact lenses more than while wearing spectacles, and the most-preferred vision correction is contact lens wear.

It has even been shown that most children (8-12 years of age) require only about five extra minutes to learn how to insert, remove, and care for their contact lenses when compared to teenagers (13-17 years of age). They also show similar benefits as the older group. In fact, children between the ages of 8 and 18 years of age are less likely to require discontinuation of contact lens wear due to problems encountered and also less likely due to experience irritation of the eye due to contact lens wear than college students between the ages of 19 and 25 years.[18, 19] After wearing soft contact lenses for 10 years, those fit as children (7 to 12 years of age) reported similar rates of painful red eyes that required visits to the eye doctor than those fit as teenagers (13 to 17 years of age), and those fit as children as exhibited similar eye health as those fit as teenagers.[20]

Personal experience, backed up by scientific evidence, shows that children as young as eight years can routinely wear contact lenses. When considering contact lens wear for your child, determine the primary reason you would like your child to wear contact lenses. If it is to slow the progression of nearsightedness, then corneal reshaping and soft bifocal contact lenses are the most effective methods. Unfortunately, neither of these contact lenses comes in a daily disposable modality. If your child doesn’t like to wear glasses or finds it difficult to participate in recreational activities with glasses, then daily disposable contact lenses may be best for your child. Contact lenses that are thrown away daily eliminate the need to clean and care for the lenses, reducing care of the lenses to insertion in the morning and removal at bedtime.

Some doctors believe that children should not be fit with contact lenses until they are teenagers. However, there is considerable evidence that indicates children are very capable of contact lens wear, and they experience significant benefits, visually and socially. Talk to your eye doctor about contact lens wear for your child, and if your doctor says that children should not be fit with contact lenses, consider a second opinion.

References
[1] Katz J, Schein OD, Levy B, et al. A randomized trial of rigid gas permeable contact lenses to reduce progression of children’s myopia. Am J Ophthalmol 2003;136:82-90. (Go Back)
[2] Khoo CY, Chong J, Rajan U. A 3-year study on the effect of RGP contact lenses on myopic children. Singapore Med J 1999;40:230-7. (Go Back)
[3] Walline JJ, Jones LA, Mutti DO, et al. A randomized trial of the effects of rigid contact lenses on myopia progression. Arch Ophthalmol 2004;122:1760-6. (Go Back)
[4] Cho P, Cheung SW. Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial. Invest Ophthalmol Vis Sci 2012;53:7077-85. (Go Back)
[5] Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res 2005;30:71-80. (Go Back)
[6] Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Refractive and Biometric Changes. Invest Ophthalmol Vis Sci 2012. (Go Back)
[7] Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol 2009;93:1181-5. (Go Back)
[8] Walline JJ, Rah MJ, Jones LA. The Children’s Overnight Orthokeratology Investigation (COOKI) pilot study. Optom Vis Sci 2004;81:407-13. (Go Back)
[9] Rah MJ, Walline JJ, Jones-Jordan LA, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci 2010;87:560-6. (Go Back)
[10] Walline JJ, Gaume A, Jones LA, et al. Benefits of Contact Lens Wear for Children and Teens. Eye Contact Lens 2007;33:317-21. (Go Back)
[11] Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-32. (Go Back)
[12] Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci 2004;81:255-9. (Go Back)
[13] Walline JJ, Jones LA, Sinnott L, et al. A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmol Vis Sci 2008;49:4702-6. (Go Back)
[14] Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011;118:1152-61. (Go Back)
[15] Lam CS, Tang WC, Tse DY, et al. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol 2014;98:40-5. (Go Back)
[16] Sankaridurg P, Holden B, Smith E, 3rd, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci 2011;52:9362-7. (Go Back)
[17] Walline JJ, Greiner KL, McVey ME, et al. Multifocal contact lens myopia control. Optom Vis Sci 2013;90:1207-14. (Go Back)
[18] Wagner H, Chalmers RL, Mitchell GL, et al. Risk Factors for Interruption to Soft Contact Lens Wear in Children and Young Adults. Optom Vis Sci 2011;88:973-80. (Go Back)
[19] Wagner H, Richdale K, Mitchell GL, et al. Age, behavior, environment, and health factors in the soft contact lens risk survey. Optom Vis Sci 2014;91:252-61. (Go Back)
[20] Walline JJ, Lorenz KO, Nichols JJ. Long-term contact lens wear of children and teens. Eye Contact Lens 2013;39:283-9. (Go Back)

Jeffrey Walline - contact lenses childernJeffrey J. Walline, OD, PhD
Associate Professor
Chair, Research and Graduate Studies
The Ohio State University College of Optometry

The Habit of Seeing

7/22/14

We often take our vision for granted – and if you lose it, your life is turned upside down. I met Kooshay Malek at a Pacific Palisades Lions Club meeting and was amazed by her story. She has agreed to share with you how she “gave up seeing.” This three-part series will explore losing her vision, how it affected her career choice and how she expresses her creative nature.
kooshay malek
My eyes are what brought me to the US. I was 16 when my father and I came here from Tehran, Iran, for eye treatment. My case was an unusual case: We still, to this day, don’t have a name for it, but it’s retinal tumors of some sort. My case had been through Europe, Russia, Israel, to different conferences, and they sent me to the US as a final recourse. During that time, in 1982, it was the Iran-Iraq war, and the airports were not open. My dad and I had to get special permits to get out for medical reasons. Then to get American visas, we were stuck in Frankfurt for a couple of months waiting. It was a very challenging time. Long story short, we got to Boston, and I started receiving treatments on my left eye. It didn’t respond well, and I became totally blind on the left side. Meanwhile, I could still see 20/20 on my right side. We moved to LA, where we had friends for support, and my mother and sister joined us. I was 18 when my right eye started going bad, and I started going to UCLA/Jules Stein for treatment. I went blind in that eye when I was 22.

My father passed away two years after I lost my sight. I finished college and went through independence training at Foundation for the Junior Blind in LA. I eventually decided to go back to school to get a master’s degree in psychology, because I realized I’m a good listener and I’m always wanting to help people, so I thought it would be a good way to channel that. And as a blind person, I didn’t think I had too many career choices.

I’ve been licensed as a marriage and family therapist for the past five years. I have a part-time practice, I do volunteer work at the clinic where I did my internship, and I help train up-and-coming therapists. I think one of the reasons I was so drawn to this field is the fact that when I became totally blind while I was in college, I was able to receive free counseling through school. But once I got out, I was looking for support groups and the camaraderie I had found during independence training — being around other blind people and helping each other emotionally. I couldn’t find anything like that. The only support groups I found were for seniors, so I just found a low-fee therapist to get some support. I’d lost my dad, lost my eyes, lost my country. I was dealing with so many losses. I think that’s why I’m so passionate about doing volunteer work in this area. I tried to pull together a support group for some blind clients, but it didn’t work out, partially due to transportation and location and the same stuff blind people always run into, but I do offer low- or no-fee counseling to them. I also have good relationships with some rehab counselors who refer people to me. I think therapy is an important part of rehabilitation; you have to approach this holistically.

I’ve always been very proactive and resourceful. I’ve often thought, “If only there were a 12-step program for blind people.” I’ve always been able to relate to people in these types of programs: They have to give up a habit that’s no longer working for them, and they have to put their lives back together, step by step, day by day, one day at a time. I really related to that: I had to give up the habit of seeing.

Kooshay Malek - seeingKooshay Malek
Marriage and Family Therapist
Los Angeles, CA

Ways to Reduce the Harmful Effects of Sun Glare

During the height of summer sunshine (and heat!), it’s helpful to discuss the importance of eye protection, including ways to reduce the harmful effects of sun glare.

Fundamentally, we need light to see. Approximately 80% of all information we take in is received through the sense of sight. However, too much light – and the wrong kind of light – can create glare, which can affect our ability to take in information, analyze it, and make sense of our surroundings.

Facts about Sunlight

Every type of light has advantages and disadvantages, and sunlight is no exception:

Advantages:

• Sunlight is the best, most natural light for most daily living needs.
• Sunlight is continuous and full-spectrum: the sun’s energy at all wavelengths is equal and it contains all wavelengths of light (explained below).

Disadvantages:

• It is difficult to control the brightness and intensity of sunlight.
• Sunlight can create glare, which can be problematic for many people who have low vision.
• Sunlight is not always consistent or reliable, such as on cloudy or overcast days.

Visible Light and Light Rays

An important factor to consider is the measurement of visible light and light rays, beginning with the definition of a nanometer:

• A nanometer (nm) is the measurement of a wavelength of light.
• A wavelength is the distance between two successive wave crests or troughs:

Wavelength - glare

• A nanometer = 1/1,000,000,000 of a meter, or one-billionth of a meter. It’s very small!

The human visual system is not uniformly sensitive to all light rays. Visible light rays range from 400 nm (shorter, higher-energy wavelengths) ? 700 nm (longer, lower-energy wavelengths).
Visible Light Spectrum - glare
The visible light spectrum occupies just one portion of the electromagnetic spectrum, however:

• Below blue-violet (400 nm and below), is ultraviolet (UV) light.
• Above red (700 nm and above), is infrared (IR) light.
• Neither UV nor IR light is visible to the human eye.

Ultraviolet Light and Blue Light

Ultraviolet (UV) light has several components:

• Ultraviolet A, or UVA (320 nm to 400 nm): UVA rays age us.
• Ultraviolet B, or UVB (290 nm to 320 nm): UVB rays burn us.
• Ultraviolet C, or UVC (100 nm to 290 nm): UVC rays are filtered by the atmosphere before they reach us.

Blue light rays (400 nm to 470 nm) are adjacent to the invisible band of UV light rays:

• There is increasing evidence that blue light is harmful to the eye and can amplify damage to retinal cells.
• You can read more about the effects of blue light at Artificial Lighting and the Blue Light Hazard at Prevent Blindness.

A new study from the National Eye Institute confirms that sunlight can increase the risk of cataracts and establishes a link between ultraviolet (UV) rays and oxidative stress, the harmful chemical reactions that occur when cells consume oxygen and other fuels to produce energy.

Sunlight and Glare

Glare is light that does not help to create a clear image on the retina; instead, it has an adverse effect on visual comfort and clarity. Glare is sunlight that hinders instead of helps. There are two primary types of glare.

Disability glare

• Disability (or veiling) glare is sunlight that interferes with the clarity of a visual image and reduces contrast.
• Sources of disability glare include reflective surfaces (chrome fixtures, computer monitors, highly polished floors) and windows that are not covered with curtains or shades.

Discomfort glare

• Discomfort glare is sunlight that causes headaches and eye pain. It does not interfere with the clarity of a visual image.
• Sources of disability glare include the morning and evening positions of the sun; snow and ice; and large bodies of water, (including swimming pools).

Controlling Glare

You can protect your eyes from harmful sunlight and minimize the effects of glare by using a brimmed hat or visor in combination with absorptive lenses.

• Absorptive lenses are sunglasses that filter out ultraviolet and infrared light, reduce glare, and increase contrast. They are recommended for people who have low vision and are also helpful for people with regular vision.
• Lens colors include yellow, pink, plum, amber, green, gray, and brown. Ultra-dark lenses are not the only choice for sun protection.
• Lens tints in yellow or amber are recommended for controlling blue light.
• NoIR Medical Technologies: NoIR (No Infra-Red) filters absorb UVA/UVB radiation and also offer IR light protection.
• Solar Shields: Solar Shields absorb UVA/UVB radiation and are available in prescription lenses.
• You can find absorptive lenses at a specialty products store, an “aids and appliances store” at an agency for the visually impaired, or a low vision practice in your area. Before you purchase, it’s always best to try on several different tints and styles to determine what works best for you.

More Recommendations

• Always wear sunglasses outside, and make sure they conform to current UVA/UVB standards.
• Be aware that UV and blue light are still present even when it is cloudy or overcast.
• Make sure that children and older family members are always protected with UVA/UVB-blocking sunglasses and brimmed hats or visors.

Maureen Duffy-editedMaureen A. Duffy, CVRT
Social Media Specialist, visionaware.org
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

20 Facts About Eye Color and Blinking

7/15/14

Eye color is one of the first things a person notices about another person, but blinking is so automatic we rarely think about it. Here are some intriguing facts about eye color and blinking:

1. The world’s most common eye color is brown.

2. Brown eyes are actually blue underneath.

3. Melanin affects the color of your eyes so brown eyes have more melanin than blue eyes.
Person with different colored eyes - eye color and blinking
4. Heterochromia is when you are born with two differently colored eyes.

5. Blue-eyed people share a common ancestor with every other blue-eyed person in the world.

6. We blink more when we talk.

7. It is impossible to sneeze with your eye open.

8. The average person blinks 12 times per minute or about 10,000 blinks per day.

9. The eye is the fastest muscle in the body – in the blink of an eye. They are also the most active muscles in the body.

10. A blink usually lasts 100 to 150 milliseconds making it possible to blink five times in a second.

11. You blink less when you’re reading.

12. Infants blink 10 times less than adults.

13. One blink isn’t always the same as the next.

14. Our eyes close automatically to protect us from perceived dangers.

15. The older we are the less tears we produce.

16. Tears are made of three main components – fat, mucous and water. This is so tears won’t evaporate.

17. Your nose gets runny when you cry as the tears drain into your nasal passages.

18. You blink on average 4,200,000 times a year.

19. Tears kill bacteria because they contain lysozyme, a fluid that can kill 90 to 95 percent of all bacteria.

20. A newborn baby will cry, but not produce any tears. Babies do not produce tears until they are around six weeks old.

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