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.

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 DeRemer, CFRE
Discovery Eye Foundation

What Is Happening In the Gas-Permeable Contact Lens Industry

The Gas-Permeable Contact Lens

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

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

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

Women’s Eye Health

With this being Women’s History Month, we thought it appropriate to discuss women’s eye heath. Your vision is one of the most important things in your life. Vision loss can make everyday tasks more difficult, impede your work and lead to depression.

According to Prevent Blindness America (PBA), 66% of people who are blind or visually impaired are women. This is primarily due to the fact that women have more risk factors for vision loss than men. Sadly the same study also revealed that only 9% of women realize this. Early intervention can help prevent blindness in many cases. Many blinding eye diseases can be treated to prevent blindness and almost all eye injuries can be prevented.

Here is a closer look at why women are affected more than men, and what condition they need to be aware of for early diagnosis and sight-saving treatments.

Why Women Lose Vision

They live longer than men and many eye diseases are age-related. Examples are cataracts, macular degeneration and diabetic retinopathy. The rates of these diseases are increasing as the baby boomer population ages.

Some eye diseases are intrinsically more prevalent among women, like dry eye syndrome which is believed to be linked to hormones. It is 2-3 times more likely in women than men. Hormonal changes can influence vision changes across the life span of a woman, from pregnancy to post-menopause.

Women have higher rates of autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis. The serious side effects of these conditions can affect your eyes, causing vision loss.

Social and economic factors can access to health care for women restricting early detection and treatment which could prevent or limit vision loss.

While behavioral and environmental factors are not restricted to women, poor nutrition and obesity can cause diabetes and subsequent diabetic retinopathy; while smoking is also a proven risk factor for eye diseases such as cataracts and macular degeneration. Women under 23 are the fastest growing segment of new smokers.

Eye Conditions More Prevalent in Women

Cataracts are the world’s leading cause of blindness. They are the result of a clouding of your eye’s normally clear lens. They can be treated with cataract surgery, where the cloudy lens is replaced with a clear synthetic lens.

Glaucoma is the second-leading cause of blindness in the Us. It is called the silent thief of sight because there is no warning. It happens when pressure in the eye — intraocular pressure or IOP — is too high, damaging the optic nerve which sends vision signals to the brain. Open-angle glaucoma, the most common type, affects men and women equally. But women are 2-4 times more likely than men to get closed-angle glaucoma. One of the possible reasons for this is that the front chamber between the iris and cornea is shallower in women than men and can block fluids from draining out of the eye, thus increasing pressure. Glaucoma is also genetic, meaning you are at higher risk if someone in your family has had glaucoma. When caught early, there are treatments that can help control your IOP. If it is not controlled early, blindness can result and it is irreversible.

Age-related macular degeneration (AMD) is the number one cause of vision loss in people over 40 in the US. One of the reasons women are at higher risk is because they tend to live 5-7 years longer than men. AMD gradually destroys the central part of your sight that helps you read or drive. There are two types of AMD. Dry AMD, which occurs when drusen accumulate under the retina. There is no treatment for dry, yet accounts for 90% of the cases. Wet AMD occurs when new blood vessels grow and leak between the retina and eye’s outer layer. There is a treatment of anti-VEGF injections for this version of AMD. The earlier the disease is diagnosed and treated, the better the results. Like glaucoma, it is an inherited eye disease.

Diabetic retinopathy is a result of diabetes. When blood sugar levels are too high, the vessels that feed the retina weaken and eventually leak, which cause the macula to swell. In its most dangerous form the retina may detach from the back of the eye leading to blindness. Diabetes is also hereditary, but controllable with early diagnosis and treatment.

Dry eye syndrome occurs when your eyes produce too few tears. Your eyes may burn, sting or feel gritty, making your vision blurry or you may blink more. Contrary to the name, you may appear weepy as the dryness may stimulates more tear production. Thanks to hormones, women are more susceptible. In postmenopausal women, the shift in balance between estrogen and progesterone can be responsible.

Pregnancy-related eye changes, like menopause, are caused by hormone shifts and can cause several temporary eye conditions, such as dry eye and corneal swelling.

3/10/16

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

The Brain and the Eye – How They Work Together

The Brain and the Eye

The eye works like a camera. The iris and the pupil control how much light to let into the back of the eye, much like the shutter of a camera. When it is very dark, our pupils get bigger, letting in more light; when it is very bright our irises constrict, letting in very little light.

The lens of the eye, like the lens of a camera, helps us to focus. But just as a camera uses mirrors and other mechanical devices to focus, we rely on eyeglasses and contact lenses to help us to see more clearly.

The focus light rays are then directed to the back of the eye, on to the retina, which acts like the film in a camera. The cells in the retina absorb and convert the light to electrochemical impulses which are transferred along the optic nerve to the brain. The brain is instrumental in helping us see as it translates the image into something we can understand.

The eye may be small, but it is one of the most amazing parts of your body. To better understand it, it helps to understand the different parts and what they do.

Choroid
A layer with blood vessels that lines the back of the eye and is between the retina (the inner light-sensitive layer that acts like film) and the sclera (the outer white part of the eyeball).

Ciliary Body
The muscle structure behind the iris, which focuses the lens.

Cornea
The very front of the eye that is clear to help focus light into the eye. Corrective laser surgery reshapes the cornea, changing the focus to increase sharpness and/or clarity.

Fovea
The center of the macula which provides the sharp vision.

Iris
The colored part of the eye used to regulate the amount of light entering the eye. Lens focuses light rays onto the retina at the back of the eye. The lens is transparent, and can deteriorate as we age, resulting in the need for reading glasses. Intraocular lenses are used to replace lenses clouded by cataracts.

Macula
The area in the center of retina that contains special light-sensitive cells, allowing us to see fine details clearly in the center of our visual field. The deterioration of the macula can be common as we age, resulting in age related macular degeneration.

Optic Nerve
A bundle of more than a million nerve fibers carrying visual messages from the retina to the brain. Your brain actually controls what you see, since it combines images. Also the images focused on the retina are upside down, so the brain turns images right side up. This reversal of the images Is a lot like what a mirror does in a camera. Glaucoma can result when increase pressure in the eye restricts the flow of impulses to the brain, causing optic nerve damage and makes it difficult to see.

Pupil
The dark center opening in the middle of the iris changes size to adjust for the amount of light available to focus on the retina.

Retina
The nerve layer lining the back of the eye that senses light and creates electrical impulses that are sent through the optic nerve to the brain.

Sclera
The white outer coating of the eyeball.

Vitreous Humor
The clear, gelatinous substance filling the central cavity of the eye.

3/3/16

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Having Trouble with Your Scleral Lenses?

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

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

Troubleshooting tips and tricks:

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

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

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

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

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

1/28/16

Cathy Warren, RN
Executive Director
National Keratoconus Foundation

Wearing Contact Lenses in Winter

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

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

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

1/15/16

Susan DeRemer, CFRE Vice President of Development Discovery Eye Foundation

The Importance of An Eye Exam

Why You Need An Eye Exam

The end of the year is fast approaching – when was the last time you had an eye exam? Was it a comprehensive eye exam?

To keep your eyes healthy and maintain your vision, the American Optometric Association (AOA) recommends a comprehensive eye exam every two years for adults ages 18 to 60, and annual exams for people age 61 and older. However, if you have a family history of eye disease (glaucoma, macular degeneration, etc.), diabetes or high blood pressure, or have had an eye injury or surgery, you should have a comprehensive exam every year, unless otherwise indicated by your doctor.
Also, adults who wear contact lenses should have annual eye exams.

An important part of the comprehensive eye exam is the dilated eye exam to look inside your eye. Drops are placed in each eye to widen the pupil and allow more light to enter the eye. This gives your doctor a clear view of important tissues at the back of the eye, including the retina, the macula, and the optic nerve. This allows for early diagnosis of sight-threatening eye diseases like age-related macular degeneration, diabetic retinopathy, glaucoma, etc.

To better understand the importance of the dilated eye exam, here is a video from the National Eye Institute (NE) that explains what to expect.

At the end of your comprehensive eye exam your doctor should raise any concerns he has with you. But it is up to you to be prepared to react and ask questions for peace of mind and to help save your vision.

Questions To Ask After Your Eye Exam

It is always important to know if anything about your eyes have changed since your last visit. If the doctor says no, then the only thing you need to know is when they want to see you again.

If the doctor says the have been some minor changes, you need to know what questions to ask, such as:

Is my condition stable, or can I lose more sight?
What new symptoms should I watch out for?
Is there anything I can do to improve or help my vision?
When is the next time you want to see me?

If the doctor sees a marked change in your vision or give you a diagnosis of eye disease, you would want to ask:

Are there treatments for my eye disease?
When should I start treatment and how long will it last?
What are the benefits of this treatment and how successful is it?
What are the risks and possible side effects associated with this treatment?
Are there any foods, medications, or activities I should avoid while I am undergoing this treatment?
If I need to take medication, what should I do if I miss a dose or have a reaction?
Are there any other treatments available?
Will I need more tests necessary later?
How often should I schedule follow-up visits? Should I be monitored on a regular basis?
Am I still safe to drive?

Your vision is a terrible thing to lose, but with proper diet, exercise and no smoking, along with regularly scheduled eye exams, you improve your chances of maintaining your sight.

11/5/15

Susan DeRemer, CFRE

Tear Film Health is Essential for People with Keratoconus

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

Tear Film Layers

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

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

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

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

Tear Film Issues

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

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

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

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

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

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

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

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

Tear Film Care

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

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

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

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

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

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

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

10/20/15

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

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

Increased Awareness for Saving Vision

The following is a survey done by Essilor (a French company that produces ophthalmic lenses along with ophthalmic optical equipment) and a large marketing research firm in the UK, YouGov. While the focus in on people living in the UK, the results would probably be similar to the US population. Even with increased access to the Internet, many people are still not aware of the risks associated with eye disease and what they can do to help retain their vision. Increased awareness of informational resources are important for saving vision.

There are a number of websites with easy to understand information about taking care of your vision that I have listed under Resources to Help Save Vision at the bottom of this article. And while there are eye diseases that are hereditary, you can slow the onset and progression by making good lifestyle choices about smoking, diet and exercise. Your eye care specialist is also an excellent source of information about what you can to do reduce your risk of vision loss, at any age.

Increased Awareness for Saving Vision

A YouGov poll conducted with Essilor reveals that most Britons are unaware of damage to their eyes by surrounding objects, activities, and devices. This widespread lack of awareness means fewer people seeking methods of prevention and avoidance, and for those that are aware of risks, most are not informed of existing preventative measures.

The poll has shown* that many British people remain uninformed about the various ways in which eyes are damaged by common daily factors, despite evidence that eye health is affected by blue light, UV rays (reflected from common surfaces), diet, obesity, and smoking.
Of the 2,096 people polled, the percentage of respondents aware of the link between known factors affecting and eye health were:

Poor diet – 59%
Obesity – 35%
Smoking tobacco – 36%
UV light, not just direct from the sun but reflected off shiny surfaces – 54%
Blue light from low energy lightbulbs and electronic screens – 29%

More than one in ten people were completely unaware that any of these factors could affect your eyesight at all.

72% of respondents own or wear prescription glasses but only 28% knew that there were lenses available (for both prescription and non-prescription glasses) to protect against some of these factors; specifically, blue light from electronic devices and low energy light bulbs, and UV light from direct sunlight and reflective surfaces.

76% admitted they haven’t heard of E-SPF ratings – the grade given to lenses to show the level of protection they offer against UV.

Just 13% have lenses with protection from direct and reflected UV light, and only 2% have protection from blue light (from screens, devices, and low energy bulbs).

Poll results showed that younger people were most aware of the dangers of UV and blue light, yet least aware of how smoking tobacco and obesity can affect your eye health. Within economic sectors, middle to high income people are more aware of the effects of smoking & obesity on eyesight than those with low income –

39% of people with middle to high income compared to 33% of people with low income are aware of the impact of smoking tobacco.
38% of people with middle to high income compared to 31% of people with low income are aware of the impact of obesity.

Awareness of the impacts of smoking and obesity on eye health is significantly higher in Scotland (47% & 49% respectively) than anywhere else in the UK (35% & 33% in England and 40% & 38% in Wales).
Essilor’s Professional Relations Manager, Andy Hepworth, has commented: “The lack of awareness about these common risks to people’s eyes is concerning. Not only would many more glasses wearers be better protected, but also many people who do not wear glasses would likely take precautions too, if made aware of the dangers and the existence of non-prescription protective lenses.”

To see the full results of the poll, please visit the Essilor website.

For more information on the protection offered from blue light and UV through specialist lens coatings, for both prescriptions and non-prescription glasses, please see here for UV & Blue Light Protection options.

*All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,096 adults. Fieldwork was undertaken between 21st and 24th August 2015. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

Resources To Help Save Vision
All About Vision
Macular Degeneration Partnership
National Eye Institute (NEI)
Prevent Blindness

10/16/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Help DEF Unlock
$100,000
Matching Gift

Discovery Eye Foundation

Cornea

13 Tips for Using Eye Makeup

What Is Happening In the Gas-Permeable Contact Lens Industry

The Gas-Permeable Contact Lens

Having Trouble with Your Scleral Lenses?

Wearing Contact Lenses in Winter

Top 10 Articles of 2015

Tear Film Health is Essential for People with Keratoconus

Tear Film Layers

Tear Film Issues

Tear Film Care

Help DEF Unlock$100,000Matching Gift

The Gas-Permeable Contact Lens

The Brain and the Eye

Why You Need An Eye Exam

Questions To Ask After Your Eye Exam

Tear Film Layers

Tear Film Issues

Tear Film Care

Increased Awareness for Saving Vision

Help DEF Unlock
$100,000
Matching Gift