Proper Contact Lens Care Provides Best Vision, Comfort and Ocular Health

9/18/14

Proper contact lens care is essential for the best contact lens wearing experience. Mr. Ward, Director of the Emory Contact Lens Service has shared some valuable information about taking care of your contact lens in the article below. On Tuesday join us for additional tips for people who wear contact lenses and wear cosmetics.contact lens case - proper contact lens care

Contact lenses provide alternatives to spectacles, and contact lens wearers report better peripheral vision, depth perception and overall vision quality. Contact lenses can correct near-sightedness, far-sightedness, astigmatism and even correct the need for reading glasses. They are also used to manage some ocular surface diseases.

Contact lenses fall into two basic material types: soft contact lenses (SCL) and rigid gas-permeable (GP) lenses. Soft lenses account for the great majority of the contact lens market. GP lenses require more precise fitting and are often used as specialty devices to correct high prescriptions and/or to manage various ocular disorders and may require longer lens-adaptation time. Regardless of lens type, careful attention to lens care instructions can provide good vision and life-long lens wearing comfort.
Proper lens care depends on the lens type, wearing schedule and other factors. Single-use or daily-disposable soft lenses are prescribed to be worn once and discarded. This is theoretically the safest lens wearing modality in that no lens cleaning, lens care or storage case is required for this modality. Other daily wear soft lenses may be replaced every 2 weeks, monthly or by other schedule. Any and all lenses that are removed each day must be cleaned and disinfected prior to their reuse. Your eye care practitioner should provide specific instructions relative to your lens wear and care needs. General lens care instructions and Dos and Don’ts are bullet-listed below.

A word of caution –
Contact lens wear is quite safe as long as proper lens and storage case care are followed. However, improper lens wear and care can put the lens wearer at risk for serious consequences. Sight-threatening microbial keratitis (corneal ulcer) is the most significant adverse event associated with contact lens wear and is largely preventable. The contact lens storage case is the most likely potential reservoir for contact lens related ocular infections. Therefore, lens storage case care should be high on the list of important lens wearing instructions. Contact lens cases are not meant to be family heirlooms; cases should be replaced regularly, at least every 1-3 months.

The Bullet List of Contact Lens Care Recommendations

  • Hand washing: Always wash your hands before handling contact lenses. Use mild, basic soap and avoid antibacterial, deodorant, fragranced or moisturizing liquid soaps (many liquid soaps have moisturizers that can contaminate your contacts from handling).
  • Cleaning, rinsing, and disinfecting: Digital cleaning (rubbing the lens with your finger in your palm) removes dirt and debris and prepares the lens surfaces for disinfection. Rub & rinse thoroughly, even if the product is labeled “No Rub”. Lens storage solutions contain chemicals that inhibit or kill potentially dangerous microorganisms while the lenses are soaked overnight.
    • Contact lenses should be cleaned when removed from the eye.
    • Do not re-use old solution or “top-off” the liquid in the lens storage case. Empty the storage case daily and always use fresh solution.
    • Do not use lens care products beyond their expiration dates. Discard opened bottles after 28 days.
    • Do not allow the tip of the solution bottle to come in contact with any surface, and keep the bottle tightly closed when not in use.
    • Do not transfer contact lens solution into smaller travel-size containers.
  • Keep your contact lens storage case clean (inside and out).
    • All lens storage cases should be emptied, rinsed, wiped, and air-dried between uses.
    • Keep the contact lens case clean and replace it regularly, every one to three months.
    • Do not use cracked or damaged lens storage cases.
    • Take care to remove residual solution from surfaces of lens case and solution bottles.

Other Dos and Don’ts

  • Do not wear your lenses during water activities (swimming, hot tubs, showering, etc).
  • Soft contact lenses should not be rinsed with or stored in water. Soft lenses will change size and shape if exposed to water.
  • Do not put your lenses in your mouth.
  • Do not use saline solution or re-wetting drops in an attempt to disinfect lenses. Neither is capable of disinfecting contact lenses.
  • Wear and replace contact lenses according to the prescribed schedule.
  • Follow the specific contact lens cleaning and storage guidelines from your eye care professional.
  • Do not change lens care products without first checking with your eye care practitioner.
  • Spare rigid (GP) lenses should be stored dry for long term storage { clean, rinse, dry}. New or dry-stored GP lenses should be re-cleaned and disinfected prior to lens wear.
  • Do not store soft lenses in the storage case for an extended period of time. “Spare” soft contact lenses should be new and stored in their original and unopened packaging.
  • Do not sleep in your contact lenses unless specifically approved to do so by your eye care practitioner.

For information from the Centers for Disease Control and Prevention, see:
www.cdc.gov/contactlenses/
www.cdc.gov/contactlenses/cdc-at-work.html

Michael Ward - proper contact lens careMichael A. Ward, MMSc, FAAO
Director, Emory Contact Lens Service
Emory University School of Medicine

 

The Way Eyes Work

9/16/14

Eyes are an amazing part of your body and not just because of what they do helping you see. The are also fascinating be because of the way eyes work. Here are 20 facts about how your eyes function.
Colorful eye - the way eyes work

      1. The pupil dilates 45% when looking at something pleasant.

2. An eye’s lens is quicker than a camera’s.

3. Each eye contains 107 million cells that are light sensitive.

4. The light sensitivity of rod cells is about 1,000 times that of cone cells.

5. While it takes some time for most parts of your body to warm up their full potential, your eyes are always active.

6. Each of your eyes has a small blind spot in the back of the retina where the optic nerve attaches. You don’t notice the hole in your vision because your eyes work together to fill in each other’s blind spot.

7. The human eye can only make smooth motions if it’s actually tracking a moving object.

8. People generally read 25% slower from a computer screen compared to paper.

9. The eyes can process about 36,000 bits of information each hour.

10. Your eye will focus on about 50 things per second.

11. Eyes use about 65% or your brainpower – more than any other part of your body.

12. Images that are sent to your brain are actually backwards and upside down.

13. Your brain has to interpret the signals your eyes send in order for you to see. Optical illusions occur when your eyes and brain can’t agree.optical illusion - the way eyes work

14. Your pupils can change in diameter from 1 to 8 millimeters, about the size of a chickpea.

15. You see with your brain, not your eyes. Our eyes function like a camera, capturing light and sending data back to the brain.

16. We have two eyeballs in order to give us depth perception – comparing two images allows us to determine how far away an object is from us.

17. It is reported that men can read fine print better than women can.

18. The muscles in the eye are 100 times stronger than they need to be to perform their function.

19. Everyone has one eye that is slightly stronger than the other.

20. In the right conditions and lighting, humans can see the light of a candle from 14 miles away.

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

Contact Lens Fitting For Children

8/26/14

Fitting Techniques

The techniques the contact lens professional utilizes to fit an adult with a GP lens must be altered to fit an infant or small child. The ability to capture a reliable image with a topographer or accurate keratometric readings is often impossible to obtain in small children. Keratometric readings obtained at the time of surgery or an exam under anesthesia should only be considered as a starting point or a guide to the initial diagnostic lens. The application and evaluation of a diagnostic lens is the best method to obtain an appropriate fit in small children. I utilize diagnostic lenses that do not have a UV filter.Contact Lens Fitting for Children I find these lenses allow me to better interpret the fluorescein pattern when using a handheld burton lamp or LED cobalt flashlight. Once the appropriate fit has been determined, the lens is remade incorporating a material that provides an ultraviolet filter. I find it easier to determine the approximate corneal shape and curvature initially with a relatively flat fitting lens on the eye. If the diagnostic lens being evaluated vaults the anterior corneal surface, the interpretation and extrapolation of corneal curvature is difficult if not impossible. As in any GP fitting, the goal is to equally distribute lens mass and provide peripheral fulcrums to maintain stability and a central position. This central position of the lens is especially important in higher powers to minimize spherical aberrations. In recent years, I have found myself fitting looser and larger GP diameters. A general rule to follow with small children and GP lenses is that a tight lens will tend to dislodge from the eye and a loose fitting lens will tend to displace off the cornea onto to bulbar conjunctiva.

As with GP fitting on small children, soft lens fitting techniques are also a bit different. In order to determine appropriate movement of a soft lens on a small child, the “spring back” test may be helpful. With the soft lens on the eye, digitally displace the lens off center. If the lens immediately “springs back” into place on the cornea, the lens may fit too tightly on the ocular surface. If the lens stays off center while manually closing the lids to mimic a blink, the lens may be fitted too loosely on the ocular surface. In addition, retinoscopy over the soft lens to determine if the reflex maintains clarity during the blink is a finding seen with a well fitting lens. If the reflex is clearer with a blink, the fit may be too steep. If the reflex is worse with a blink, the fit may be too flat. The reflex seen with a well-fitted soft lens will maintain the same clarity before, during and after a blink. The retinoscope is not only used to determine the final lens power with any type of lens but also an important instrument to guide you to the best cornea lens relationship. Pediatric fitters of contact lens should be proficient with a retinoscope.

Little Lenses for Little People?

The pediatric contact lens professional is not limited to “off the rack” products. In addition to custom GP lenses, there are many lens manufacturers of custom made soft and silicone hydrogel contact lenses that allow us the opportunity to provide any child any parameter. In addition, liberal exchange policies implemented by these manufacturers of custom products allow us to provide these products to the patients who require them in a fair and effective manner. However, the delay in time to deliver the product to a pediatric patient in an urgent situation is a potential problem. Any delay in optical correction and visual rehabilitation with a young pediatric patient may result in permanent loss in vision.

Silicone Hydrogel Custom Products

After many years of anticipation, in 2010 Contamac received FDA approval for Definitive, a latheable silicone hydrogel material. The Definitive material can be manufactured by a limited number of laboratories in the U.S. in virtually any group of parameters. This inherently wettable, high water content and low modules material has a DK of 60. While 60 DK is not as high as other “off the rack” silicone hydrogel materials, the effective DK in many of the parameters utilized in pediatric fitting is higher than the same parameters made in HEMA-GMA materials. While this material is a welcome addition to our armamentarium of contact lens options in our practice, my clinical experience specific to pediatric indications and this material has led me to two conclusions. The application of a lens to the eye of a small child manufactured in the Definitive material is more difficult than HEMA-GMA materials and the time delay of up to ten days is often too long in an urgent case common to the pediatric patient. In time, both of these concerns can be overcome with practice and improved efficiency on the part of the patient, the practitioner and the laboratory.

New News About an Old Lens

Silicone Elastomer (Silsoft) has a long and well-documented history of being the lens of choice for the majority of pediatric professionals to manage small children following cataract surgery. The truth is that there would be many “blind” children if not for this particular lens. Silsoft Super Plus contact lenses for pediatric aphakia (>20 diopters) are available with the following parameters: diameter, 11.3mm, base curves: 7.5 mm (45.00D), 7.7mm (43.75D), and 7.9mm (42.75D), optic zone of 7.0mm and powers ranging from +23.00D to +32.00D in 3D steps. The Silsoft material has an oxygen permeability (Dk) value of 340, with oxygen transmissibility (Dk/t) of 58 at 0.61mm. One of the concerns about Silsoft has been the limited availability of parameters. As a result of the tireless efforts of Joe Barr, O.D., B+L may ultimately decide to expand the parameters of their Silsoft Super Plus product. While this announcement is far from official at the time of this article, I would like to applaud Joe and encourage you to do the same. Whether you are a proponent or opponent of Silsoft, any improved technology to provide children with the opportunity to safely develop better vision is worthy of the efforts. On behalf of the industry, the children and their families, thank you Joe.

Conclusion

As contact lens professionals, we have the responsibility, opportunity and privilege to provide products and service to young patients and their families. These products and associated services are necessary to maintain and or develop possibly the most important gift one may ever possess, the gift of sight. Again I ask you, are you a “healer of children”?

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

Common Pediatric Eye Diseases

8/21/14

In the third of this series, Buddy Russell, from the Emory University Eye Center, provides a great overview of common pediatric eye diseases.

Some Conditions Frequently Seen in Pediatrics

A basic understanding of some of the conditions that may be present in pediatric patients is important to not only know what they are but also understand well enough to explain to the parent or caregiver. The following is intended to be an overview of some of those conditions and not a complete explanation.Girl with eye chart-common pediatric eye diseases

  1. Nystagmus – Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Unusual head positions and head nodding in an attempt to compensate for the condition may accompany nystagmus. Most individuals with nystagmus can reduce the severity of their uncontrolled eye movements and improve vision by positioning their eyes to look to one side. This is called the “null point” where the least amount of nystagmus is evident. To accomplish this they may need to adopt a specific head posture to make the best use of their vision. The direction of nystagmus is defined by the direction of its quick phase (e.g. a right-beating nystagmus is characterized by a rightward-moving quick phase, and a left-beating nystagmus by a leftward-moving quick phase). The oscillations may occur in the vertical, horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus. Having nystagmus affects both vision and self-concept. Most people with nystagmus have some sort of vision limitations because the eyes continually sweep over what they are viewing, making it impossible to obtain a clear image. If a refractive error is found, contact lenses may be the most effective way of obtaining best-corrected vision.
  2. Strabismus – Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus. Strabismus is most commonly described by the direction of the eye misalignment. Common types of strabismus are esotropia (turn in), exotropia (turn out), hypotropia (turn down), and hypertropia (turn up). Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain will ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned. The goal of strabismus treatment is to improve eye alignment, which allows for better work together (binocular vision). Treatment may involve eyeglasses, contact lenses, eye exercises, prism, and / or eye muscle surgery.
  3. Amblyopia – Amblyopia, sometimes called a “lazy eye,” occurs when one or both eyes do not develop normal vision during early childhood. Babies are not born with 20/20 vision in each eye but must develop it between birth and 6-9 years of age by using each eye regularly with an identical focused image falling on the retina of each eye. If this does not occur in one or both eyes, vision will not develop properly. Instead, vision will be reduced and the affected eye(s) are said to be amblyopic. This common condition, affecting up to 4% of all children, should be diagnosed and treated during infancy or early childhood to obtain optimum three-dimensional vision and to prevent permanent vision loss. What causes amblyopia?
      • Misaligned eyes (strabismus)
        Misaligned eyes are the most common cause of amblyopia. When both eyes are not aimed in exactly the same direction, the developing brain “turns off” the image from the misaligned eye to avoid double vision and the child uses only the better eye — the dominant eye. If this persists for a period even as short as a few weeks, the eye will not connect properly to the visual cortex of the brain and amblyopia will result.
      • Unequal refractive error (anisometropia)
        Unequal refractive error is an eye condition in which each eye has a different refractive error and therefore both eyes cannot be in focus at the same time. Amblyopia occurs when one eye (usually the eye with the greater refractive error) is out of focus because it is more nearsighted, farsighted or astigmatic than the other. Again, the brain “turns off” the image from the less focused eye and this eye will not develop normal vision. Because the eyes often look normal, this can be the most difficult type of amblyopia to detect and requires careful vision screening of acuity measurements at an early age. Treatment with glasses or contact lenses to correct the refractive error of both eyes, sometimes with part-time patching of the better seeing eye, is necessary in early childhood to correct the problem.
      • Obstruction of or cloudiness (deprivation)
        Obstruction of or cloudiness in the normally clear eye tissues may also lead to amblyopia. Any disorder that prevents a clear image from being focused can block the formation of a clear image on the retina and lead to the development of amblyopia in a child. This often results in the most severe form of amblyopia. Examples of disorders that can interfere with getting a clear image on the retina are a cataract or cloudy lens inside the eye, a cloudy and or irregular shaped cornea, or a droopy upper eyelid (ptosis) or eyelid tumor.It is not easy to recognize amblyopia. A child may not be aware of having one normal eye and one with reduced vision. Unless the child has a misaligned eye or other obvious external abnormality, there is often no way for parents to tell that something is wrong. In addition, it is difficult to measure vision in very young children at an age in which treatment is most effective.To treat amblyopia, a child and their caregiver must be encouraged to use the weaker eye. This is usually accomplished by patching the stronger eye. This covering of the stronger eye with an adhesive patch, an cclude contact lens or temporary surgery often proves to be a frustrating and difficult therapy. Patching will often continue for weeks, months, or even years in order to restore normal or near normal vision and maintain the improvement in the amblyopic eye. Occasionally, blurring the vision in the good eye with eye drops or lenses to force the child to use the amblyopic eye treats amblyopia. In some cases, cataract surgery or glaucoma surgery might be necessary to treat form deprivation amblyopia. Patching may be required after surgery to improve vision, and glasses or contact lenses may be required to restore appropriate focusing.Surprising results from a nationwide clinical trial in 2005 show that many children age seven through 17 with amblyopia may benefit from treatments that are more commonly used on younger children.
        Treatment improved the vision of many of the 507 older children with amblyopia studied at 49 eye centers. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. The study results, funded by the National Eye Institute (NEI), appear in the April issue of Archives of Ophthalmology.
  4. Congenital Cataract – A congenital cataract, or clouding of the crystalline lens is present in 2-3 per 10,000 live births of children. The presence of a visually significant cataract in a child is considered an urgent disorder. The resultant form deprivation of vision requires immediate surgery to remove the obstruction, prompt optical correction and amblyopia therapy in unilateral cases. Until the 1970s, it was generally believed that there was no means of restoring the vision in an eye with a unilateral congenital cataract. However, subsequent studies demonstrated that excellent visual results could be obtained with early surgical treatment coupled with optical correction with a contact lens and patching therapy of the fellow eye. However, treatment results continue to be poor in some infants with unilateral congenital cataracts due to a delay in treatment or poor compliance with contact lens wear or patching therapy of the fellow eye. The Infant Aphakia Treatment Study (IATS) was designed to compare the visual outcomes in children 1 to 6 months of age with a unilateral congenital cataract randomized to optical aphakic correction with contact lenses or an intraocular lens (IOL). Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL had their aphakia treated with a contact lens. In previous publications we have shown that the visual results are comparable for these two treatments at 1 year of age, but significantly more of the infants randomized to IOL implantation required additional intraocular surgeries.
  5. Accommodative Esotropia – Accommodative esotropia refers to a crossing of the eyes caused by farsightedness. Accommodative esotropia is a type of strabismus. Children who are farsighted easily and automatically focus on objects at distance and near through accommodation. As a result, a child who is farsighted usually does not have blurred vision. However, in some children who are farsighted, this accommodative effort is associated with a reflex crossing of the eyes. Accommodative esotropia can begin anywhere from 4 months to 6 years of age. The usual age of onset is between 2 and 3 years of age.Full-time use of the appropriate hyperopic glasses prescription or contact lenses will often control the esotropia. When wearing the correction, the child will not need to accommodate and hence the associated eye-crossing reflex will disappear. However, after removing the prescribed correction, the crossing will reappear, perhaps even more than before the child began wearing the correction. Sometimes the correction will only cause the crossing to disappear when the child views a distant object. However, when gazing at near objects, crossing may persist despite the use of the correction. In these circumstances, a bifocal lens is often prescribed to permit the child to have straight eyes at all viewing distances. One potential advantage of contact lenses compared to spectacles when correcting hyperopic powers is the decrease in accommodative demand. The increased effort to converge the eyes with spectacles requires one to over come the resultant base out prism when viewing a near object.

 

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

Treatment Options For Children

8/19/14

Here is part two in Buddy Russell’s series; this one focusing on contact lenses as a treatment option for children.

We Are Not Born With Good Vision

The human visual system at birth is poorly developed, but rapidly becomes the remarkable combination of nerve tissue, muscles and optics that provide us with the sense of vision. Those babies born with “perfect” eyes have only the opportunity to develop normal vision. The information processed by the eyes is sent directly to the brain and is interpreted as vision.Toddler looking through glasses - treatment options for children During the first few weeks, the child sees shapes, lines and space between objects. The child’s visible world is most usable within 8-14 inches of his/her eyes. During this time, the eyes may appear to wander. After about a month or so, the normal child’s eyes will appear more coordinated and they start to show more interest in looking at objects. It is usually in the third month that a child who has normal eyes can fix and follow on a near object. The growth of the eye is a dynamic process, influenced by genetics and the environment.
Early detection of any eye problem is key to treating the disorder. The prevalence of vision problems in children is higher than you might think. For example:

  • 1 in 10 children are at risk from undiagnosed vision problems
  • 1 in 25 will develop strabismus
  • 1 in 30 will be affected by amblyopia
  • 1 in 33 will show significant refractive error
  • 1 in 100 will exhibit evidence of eye disease
  • 1 in 20,000 children have retinoblastoma

As a result of his granddaughter and her eye problem, former President Jimmy Carter initiated a program in 2002 called InfantSEE. This program allows children to have an eye exam at a very young age at no charge to the family. Participating eye doctors provide a more thorough exam than the busy pediatrician. As a result, there is a greater opportunity to detect and treat eye disorders that may otherwise go undetected.

“Have to” Contact Lenses

Fitting pediatric patients is not usually about routine visits and patients who want to wear contact lenses. It is about critical and often urgent situations and patients who have to wear contact lenses. The more common medical indications for contact lenses can be categorized into three groups; anisometropia, irregular corneal astigmatism and “large” refractive errors.

Anisometropia

One of the more common conditions potentially leading to a permanent loss of vision in a young patient is anisometropia. This difference in the refractive errors of the two eyes can lead to suppression of the less clear image. As a result of the non-focused eye, the brain of a young patient simply turns off the blurred eye. Early detection is key to successful treatment. Following the diagnosis of this problem being present, simply correcting the refractive error may be enough. However, it has been reported that as little as one diopter difference between the two eyes corrected with spectacles and the resultant anisokonia, can lead to foveal suppression impacting stereopsis and depth perception. The use of a contact lens or contact lenses alters the effective image size due to the vertex distance being zero compared to either the magnification or minification of the image size due to the vertex distance with spectacles. One of the most severe examples of this condition would be a child with a unilateral congenital cataract and managed with spectacles postoperatively.

Irregular Corneal Astigmatism

Whether acquired or congenital, the presence of irregular corneal astigmatism of the anterior curve of the cornea is best managed with a contact lens. This condition is to be considered urgent if the patient is of a young age. The eye may forever loose the opportunity to be corrected as the resultant amblyopia develops over a short period of time. By neutralizing the corneal irregularities with a contact lens, the eye of a young child will hopefully gain enough vision improvement to avoid the potential permanent loss.
Obviously, patching the better eye may also be necessary if the treated eye’s vision is not as correctable as the unaffected eye. The length of time the child is to be patched is to be determined by the pediatric ophthalmologist or optometrist, as this area of treatment is sometimes controversial. The factors that are considered include the level of vision obtained, age of the child and the condition of the other eye.

Large Refractive Errors

The optics of spectacle correction in high powers have inherent properties that include distortion, prismatic effect and minification / magnification. For instance, the decrease in image size when one views an object through high minus spectacles may result in less vision. This decrease in image size may impact the opportunity to fully develop normal vision in a young child. The smaller image size that is due to the vertex distance of spectacles may be better managed with a contact lens that has a vertex distance of zero thus providing a larger image. This larger image size often increases best-corrected vision.

“Fitting” the Caregiver

Arguably, the most important factor with young children having a good outcome is the parents / caregivers. The technical challenges that exist in these cases are secondary to the ability the fitter must possess to effectively explain and train the person or persons that will take care of the child outside of the office. They must be your partner in the child’s treatment. They must understand the urgency of the situation, they must understand the seriousness of the problem, they must be trained to properly apply, remove and care for the lens / lenses, they must also follow any and all instructions concerning the child. Many of these parents struggle with feelings of nervousness, guilt and sadness. My strategy is to be sensitive to their feelings but not let them feel sorry for themselves too long as the clock is ticking. I provide verbal instructions, written instructions, videos, my email address and a 24-hour phone number. I welcome the caregiver to ask any question at any time. I do my best to let them know that I do care and that I want them and their child to be successful. I am tough on them. There is no good excuse not to do as I have instructed them to do.

When the child and the parent / caregiver are convinced that I am confident in my ability and they know that I do care, the partnership develops as we walk the path together. I want the child to know that they are coming to see me. I want them to know I will reward their cooperation with all phases of the visit. This positive reinforcement may be in the form of a piece of candy, a small toy or just a sticker when the child allows me to see their eye, measure their cornea or intraocular pressure or they just tell me what they can see. Kids love to please us just like they love to please their parents. Reward them for it. Whether you consider this approach bribery or positive reinforcement, it works.

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

Breathing, Patience and Keratoconus

7/1/14

Besides hearing from eye care professionals and Discovery Eye Foundation staff, we also think it is important to hear from people with sight threatening eye diseases such as age-related macular degeneration, keratoconus, retinitis pigmentosa, etc. They can share their experiences with others that are newly diagnosed with eye disease, while providing insights to family members, friends and caregivers. What follows is the first of these occasional posts focusing on the experiences and insights gained from vision loss.

“The expression on my optometrist’s face was as if he was giving me a cancer sentence,” Jeanette Hasseman remembers. “I had never heard of keratoconus, but he told me it was an incurable vision disability. He said he was aware of some evolving technology, but he wanted to give me some time to absorb and research the disease.
Jeanette Hasseman - keratoconus
“When I went back three months later, he told me a about a cross-linking study that was going on not-too-far from here, but I hadn’t fully absorbed all the information I was reading yet,” she recalls. I did not understand — even though it was plainly stated in the information I was looking at — that once you lose some vision, you don’t get it back.

“I kept thinking, ‘OK, this certainly can be fixed,” so instead of getting cross-linking in July, I waited until December. I regret not acting on my doctor’s suggestion of getting in the study in July, because I lost a tremendous amount of vision by December.”

Hasseman was tested and qualified for the clinical trial in December and had epi-on cross-linking in both eyes in January 2013. “The topography scans show the KC progression has been halted,” she says. “I rejoice in that.”

While her vision seemed better shortly after the procedures, she was diagnosed one week after crosslinking with a “gouge” (4 mm corneal abrasion) in her left cornea that resulted in severe hazing. While the severity of the corneal hazing has decreased in the past year, she is waiting to find out if it is permanent. If so, she may need to have a corneal transplant at some point to restore any visual acuity.

A registered nurse, Hasseman finished her BSN degree two years ago at age 54 — just months before she was diagnosed with KC. The native Ohioan has since stopped working as a nurse, and more recently, she had to give up teaching and doing tatting — lace-making — a hobby she had enjoyed for decades.

Hasseman found the National Keratoconus Foundation (NKCF) when she first Googled “kerotoconus.” “KC-Link has been a great blessing,” she says. “I’ve downloaded information; I signed up for KC-Link and asked questions of Catherine [Warren, director of NKCF] and the moderating doctors. I found great support for my own spirit, as well as information on the latest technologies.

“When people ask questions on KC-Link, if I can relate, I answer. Just the other day, someone who was just diagnosed asked, ‘Well, what should I do?’ I wrote: ‘First thing is: Breathe. Second thing is: Ask for information from your eye doctor and ask who is the best corneal specialist in your area who is really good for keratoconus. Most of all: Be patient.’

“It’s really hard to lose your vision. Even in your own heart, you can feel isolated. KC-Link gives you a body of other people who totally understand what you’re thinking, what you’re feeling, what frustrates you. There is so much advice you can get on KC-Link regarding contacts, how to keep eyes moist, how to handle low-light driving, what type of e-reader works best for people with keratoconus — you cannot exhaust the information that is shared; you cannot exhaust the different emotions that are shared.”

Jeanette HassemanJeanette Hasseman
Keratoconus Advocate

Corneal Donor’s Age Not Critical for Transplant Success

6/17/14

In the United States, more than 40,000 corneal transplants are performed each year with a high success rate in comparison to other types of organ transplants. According to the Eye Bank Association of America (EBAA), keratoconus was the leading cause of anterior lamellar keratoplasty (DALK/ALK partial thickness transplant) and was the fourth most common indication for penetrating keratoplasty surgery in 2012 (their last reporting period).
corneal transplant-original size
Advances in technology have led to increasingly successful outcomes for all who need corneal transplants. New long-term research of corneal transplant patients have shown that the age of corneal donors is no longer as important as once thought by eye health providers. According to a study funded by the National Institutes of Health, ten years after a transplant, a cornea from a 71-year-old donor is likely to remain as healthy as a cornea from a donor half that age.

The Cornea Donor Study (see www.ClinicalTrials.gov), funded by NIH’s National Eye Institute (NEI), was designed to compare graft survival rates for corneas from two donor age groups, aged 12-65 and aged 66-75. It was coordinated by the Jaeb Center for Health Research in Tampa, Fla., and involved 80 clinical sites across the United States. The study enrolled 1,090 people eligible for transplants, ages 40-80. Donor corneas were provided by 43 eye banks, and met the quality standards of the Eye Bank Association of America. The study found that 10-year success rates remained steady at 75 percent for corneal transplants from donors 34-71 years old. In the United States, three-fourths of cornea donors are within this age range, and one-third of donors are at the upper end of the range, from 61-70 years old.

Prior to this study, many surgeons would not accept corneas from donors over 65. Since the supply of young donor corneas is limited, these study results are encouraging for those who face a corneal transplant . The high level of success rates using corneas from older donors (over age 60) greatly increases the pool of donated corneas and corneal tissue available for transplant. In 2012, corneal donors under age 31 comprised less than 10 percent of the U.S. donor pool. “Our study supports continued expansion of the corneal donor pool beyond age 65,” said study co-chair Edward J. Holland, M.D., professor of ophthalmology at the University of Cincinnati and director of the Cornea Service at the Cincinnati Eye Institute. “We found that transplant success rates were similar across a broad range of donor ages.”

“Overall, the findings clearly demonstrate that most corneal transplants have remarkable longevity regardless of donor age,” said Mark Mannis, M.D., chair of ophthalmology at the University of California, Davis, and co-chair of the study. “The majority of patients continued to do well after 10 years, even those who received corneas from the oldest donors.”

SOURCE: National Eye Institute Press Releases

For information about Eye Bank Association of America

CathyW headshotCathy Warren, RN
Executive Director
National Keratoconus Foundation

20 Facts About the Amazing Eye

6/10/14

We don’t often give our eyes as much thought as we should, that is until something goes wrong and our vision is affected. But when you learn more about eyes, you realize just how amazing they are. Here are a few facts you may enjoy:

1. Eyes began to develop 550 million years ago. The simplest eyes were patches of photoreceptor protein in single-celled animals.

2. Your eyes start to develop two weeks after you are conceived.
Brown eyes 6.10.14
3. The entire length of all the eyelashes shed by a human in their life is over 98 feet with each eye lash having a life span of about 5 months.

4. To protect our eyes they are positioned in a hollowed eye socket, while eyebrows prevent sweat dripping into your eyes and eyelashes keep dirt out of your eyes.

5. Your eyeballs stay the same size from birth to death, while your nose and ears continue to grow.

6. An eye is composed of more than 2 million working parts.

7. Only 1/6 of the human eyeball is exposed.

8. Corneas are the only tissues that don’t have blood.

9. The human eye weights approximately just under an ounce and is about an inch across.

10. An eye cannot be transplanted. More than 1 million nerve fibers connect each eye to the brain and currently we’re not able to reconstruct those connections.

11. 80% of our memories are determined by what we see.

12. Eyes heal quickly. With proper care, it takes only about 48 hours to repair a minor corneal scratch.

13. There are about 39 million people that are blind around the world.

14. 80% of vision problems worldwide are avoidable or even curable.

15. Humans and dogs are the only species known to seek visual cues from another individual’s eyes, and dogs only do this when interacting with humans.

16. A fingerprint has 40 unique characteristics, but an iris has 256, a reason retina scans are increasingly being used for security purposes.

17. People who are blind can see their dreams if they weren’t born blind.

18. “Red eye” occurs in photos because light from the flash bounces off the back of the eye. The choroid is located behind the retina and is rich in blood vessels, which make it appear red on film.

19. 80% of what we learn is through our eyes.

20. Eyes are the second most complex organ after the brain.

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

What You Need to Know About Cataracts

6/5/14

Do you feel like your vision is getting worse? Do you feel like colors are not as vibrant as they used to be? Are you having more trouble with glare? If you have any of these symptoms, you may be experiencing the effects of cataracts.

Cataracts are a normal aging process of the crystalline lens in the eye. Well you may ask — what is the crystalline lens? It is easiest to think of the eye as a camera. The eye has a lens (actually two) – the cornea (the front window of the eye) and the crystalline lens (inside the eye). It also has an aperture (the colored iris), and film (the retina). All these structures work together to focus light and allow us to see – just like a camera. When we are young (less than 40), the crystalline lens is flexible. This is why we are able to see distance and then near without the need for reading glasses. The crystalline lens is able to change its shape depending on where one is looking.

Figure 1 – Slit-lamp photo of a visually significant cataract.
Figure 1 – Slit-lamp photo of a visually significant cataract.

As we age, the crystalline lens becomes less flexible, thereby causing one’s near vision to be more blurry. This necessitates the need for reading glasses. As the crystalline lens become less flexible with age, the lens also starts to become more yellow and can also become cloudy. When the yellowing and/or clouding become visually significant, we refer to this as a cataract (figure 1).

Are cataracts dangerous? The simple answer is no. In the vast majority of cases, a cataract can be monitored until it becomes visually significant (drop in vision, glare, decreased contrast, vision related difficulties with day to day activities, etc). However, there are a few instances in which cataract removal is a medical necessity. Routine examinations by your eyecare provider can help you determine if you are at risk for these less common instances.

Figure 2 – Intraoperative photo during cataract surgery (prior to cataract removal).
Figure 2 – Intraoperative photo during cataract surgery (prior to cataract removal).

What can I expect during cataract surgery? Do you have to replace the crystalline lens with anything? Cataract surgery involves removing the clouded crystalline lens (figure 2) and replacing it with an artificial lens known as an intraocular lens (IOL) (figure 3). Surgery generally takes 10-15 minutes under a mild sedative, and you don’t have to stop any of your current medications. Anesthesia is achieved with drops and you will only feel mild pressure during the surgery. IOLs come in different styles – Standard IOLs grossly correct your vision and you can fine tune your vision (distance and near) with glasses post-operatively;

Figure 3 – Intraoperative photo during cataract surgery (after implantation of an IOL).
Figure 3 – Intraoperative photo during cataract surgery (after implantation of an IOL).

Toric (astigmatism correcting) IOLs allow for increased spectacle independence, but glasses will still be needed for distance or near; Accommodating IOLs “flex” within the eye to decrease your dependence on distance and near glasses; Multifocal IOLs allow spectacle independence for distance and near. I always counsel patients that there is no perfect IOL and you have to determine which IOL is best for your particular situation. Your doctor can help you decide which IOL is best for you. Generally, cataract surgery is extremely safe. Your doctor will discuss particular risks specific to your eye.

How do I know if cataract surgery is right for me? The best way to know if you have a cataract and if it time to consider surgery is to consult with your local ophthalmologist. If you have experienced a recent drop in vision, that is not correctable with glasses, cataract surgery may be able to restore your vision!

Garg feb 2014 thumbSumit “Sam“ Garg, MD
Medical Director
Vice Chair of Clinical Ophthalmology
Assistant Professor of Ophthalmology
Gavin Herbert Eye Institute – UC, Irvine

Little Bottle, Big Relief

6/3/14

What you need to know about eye drops.

Have you been staring at a computer all day and your eyes are tired? Have allergies been making your eyes watery and itchy? Are your contact lenses irritating your eyes? If you have experienced any of these conditions, you have probably turned to eye drops for relief.

While eye drops are an easy and effective means of treating a number of eye issues, there are many different eye drops available, both over the counter (OTC) and by prescription. It is wise to know what your underlying condition is before trying to get relief.
eye drops 6.3.14
If your eyes are red and you may want to try a decongestant eye drop, which will shrink the tiny blood vessels in the “whites” of your eyes (sclera), but they also cause dryness so may not be a good choice if you wear contact lenses.
For lens wearers you are better off with a re-wetting drop to lubricate the eye and lens making you more comfortable. Another problem with the decongestant eye drops is over use – which can cause irritation and an increased tolerance that could lead to more redness.

If you suffer from allergies and antihistamine eye drop would be the best choice for relief from itchy, watery, red and swollen eyes. They work by reducing histamine in the eye tissue.

Lubricating eye drops, also known as artificial tears, are for short-term relief caused by temporary situations such as eye strain form computer use, being tired or being outdoors in windy and/or sunny conditions. If the condition is chronic, a prescription eye drop will be the best choice.

It is important to remember that if any of the above symptoms worsen or continue for an extended period of time, it is time to see your eye doctor to determine the underlying cause of your issue and to rule out eye disease. Postponing a visit could also lead to an eye infection.

Prescription drops are used to treat a wide variety of eye diseases such as glaucoma, dry eye and the symptoms of ocular herpes. They are also used to help with healing from cataract surgery, corneal transplants, glaucoma surgery and even Lasik. it is extremely important to use them as often as your ophthalmologist recommends to improve healing and prevent infection.

Because of the ease of applying eye drops researchers are working toward using them to treat other eye diseases. Ocular herpes symptoms are sometimes treated with antiviral and steroid drops. But this only is targeted at the symptoms and not the underlying cause, the herpes simplex virus. Lbachir BenMohamed, PhD and Steven Wechsler, PhD at the University of California, Irvine, Gavin Herbert Eye Instittue have been working to determine what reactivate the herpes simplex virus and develop an eye drop that would either stop the reactivation of the virus or kill it.

Using eye drops to treat age-related macular degeneration (AMD) is also being explored. Researchers at the Institute of Ophthalmology at University College London are working with nanoparticles to deliver anti-VEGF drugs such as Lucentis and Avasitn to the back of the eye via drops. “The study shows that Avastin can be transported across the cells of the cornea into the back of the eye, where is stops blood vessels from leaking and forming new blood vessels, the basis for wet AMD.” While researchers in the Department of Ophthalmology, Tufts University School of Medicine in Boston “reported in their “proof of concept” study that topical application of a compound called PPADS inhibits damage to the tissues in the eye that impacts the individual’s ability to see color and fine detail, as well as reduces the growth of extraneous blood vessels in the back of the eye related to AMD.” It would work in both dry and wet AMD reduce the need for direct injections.

Eye drops, when properly applied, can provide temporary relief from symptoms of eye discomfort. But if the symptoms worsen or continue for an extended period of time, consult your eye doctor. To make sure you apply the eye drops correctly check out the article in our February 2013 newsletter for 12 easy steps to get the drops into your eyes and avoid infection.

One final note – keep your eye drops out of reach of children. Eye drops come in small bottles that are the perfect size for small hands and don’t have the same security tops found on other medications. The FDA has warned that ingredients found in some eye drops that relieve redness have caused abnormal heart rate, decreased breathing, sleepiness, vomiting and even comas in children five and younger that have ingested them. If you child has swallowed eye drops, call the Poison Help Line 800-222-1222.

Susan DeRemerSusan DeRemer
Vice President of Development
Discovery Eye Foundation