Too Much Screen Time:  Is it bad for kids?

Children and their phones, iPads and gaming devices are inseparable today. Most are growing up with a wide selection of electronic devices at their fingertips. They can’t imagine a world without the internet, smartphones and tablets.  Although, all that reading and playing games on their handheld devices may be harmful.  But it’s not just kids who are getting too much screen time. Many parents struggle with over use of screen time themselves.  So it’s important to understand how too much screen time could be harming everyone in the family.

Children can experience at least one of the following symptoms after being exposed to more than two hours of screen time per day:

  • Headaches
  • Neck/shoulder pain
  • Eye strain, dry or irritated eyes
  • Reduced attention span
  • Poor behavior
  • Irritability

Any of these symptoms could potentially affect academic performance and social interactions.

The worldwide rapid rise of nearsightedness has been linked to increased use of and exposure to electronic devices. However, spending more time outdoors, especially in early childhood, can decrease the progression of nearsightedness.

Blue Light can be harmful

The LED screens of computers and portable digital devices emit a broad spectrum of visible light. Most of these light rays are harmless, but a portion of the light emitted by these screens is relatively high-energy visible light called “blue light.”

Blue light has shorter wavelengths and higher energy than other visible light rays. Some laboratory research suggests certain bands of blue light may be harmful to the light-sensitive retina of the eye over time.

Blue light also plays an important role in regulating our body’s circadian rhythm. This basically is an internal clock that’s running in our brain and cycles between alertness and sleepiness at regular intervals over a 24-hour period.

Too much exposure to blue light at the wrong time of day can disrupt a person’s normal sleep/wake cycle, which can have serious health consequences.  Sleep disruption can be especially problematic for children, leading to daytime drowsiness and poor performance in school. Some authorities feel that disruption of the sleep/wake cycle also can eventually lead to weight gain and obesity-related health problems.

Research has shown that people who experience disrupted 24-hour cycles of sleep and activity also are more likely to have mood disorders, lower levels of happiness and greater feelings of loneliness.

How to cut back on screen time

  • Set a limit on daily screen time. Make it clear to your kids and stick to it.
  • Encourage your child to spend some of that screen-free time outdoors while it is still light.
  • Establish screen-free zones: For example, no smartphone use for anyone in the family in the car,  at restaurants, or at the dinner table.
  • No screens in the bedroom when it is time for bed. No exceptions.
  • As parents you can be a model for moderate screen use. Show your children, with your own behavior, how to live a rich, varied and healthy life where all habits are practiced in moderation.

It is also very important to teach your child good eye habits, below are few tips from experts:

  • You can set a kitchen timer or a smart device timer to remind them.
  • Alternate reading an e-book with a real book and encourage kids to look up and out the window every two chapters.
  • After completing a level in a video game, look out the window for 20 seconds.
  • Pre-mark books with a paperclip every few chapters to remind your child to look up. On an e-book, use the “bookmark” function for the same effect.
  • Avoid using a computer outside or in brightly lit areas, as the glare on the screen can create eye strain.
  • Adjust the brightness and contrast of your computer screen so that it feels comfortable to you.
  • Use good posture when using a computer and when reading.
  • Encourage your child to hold digital media farther away, 18 to 24 inches is ideal.
  • Create a distraction that causes your child to look up every now and then.
  • Remind them to blink when watching a screen.

Finally, it is very important to make sure your child gets a regular eye exam by a pediatric ophthalmologist or optometrist.  This will help monitor your child’s vision and eye health.

My Best Gift!

The other day my daughter Blythe asked me which Christmas I consider to be my favorite.  I had to think a minute, because as a family, the Sullivan’s have had some great ones.  I was about to say the first time you and your brother Tom were old enough to really get into Santa, being absolutely sure that the fat man brought your presents right down the chimney.  I was about to say that, and then I remembered. 

The greatest Christmas I ever enjoyed was a ski trip in Winter Park, Colorado, when our children were teenagers and our friend, the marvelous Betty White, joined us for a Christmas Eve sleigh ride none of us will ever forget.  The night was perfect.  It had snowed earlier that day, and the air had a feeling of Christmas that you could almost taste.  Oh, sure, it was cold, but we were bundled up under tons of blankets as two beautiful Clydesdale horses with bells jingling took us through the woods to a magical barn where dinner would be served and carols sung. 

It was on the way home that my Christmas was made complete.  We had stopped to let the horses breathe, and everyone was quiet, just allowing the feeling of togetherness envelope us in that special night.  It was Betty who broke the silence. 

“Tom,” she said almost to herself, “I wish I may, I wish I might, let you see the stars tonight.  I feel like we could almost reach up and touch them.  That’s how bright and close they are.  I guess when you’re this high in the Rocky Mountains, it just feels like they’re right here.”

I could hear how much my friend wanted me to see such a heavenly display, but we both knew that could never happen.  I have no complaint about being blind, no one could have a better life, but I would be lying if I didn’t admit at this holiday season that I’d love to be able to take it all in, all the special sights of Christmas. 

Every day in laboratories around this country, researchers are working to solve the multiple eye diseases that make it impossible for millions of people to see the joys of Christmas.  At this holiday season, my best gift would be that all of us donate to the Discovery Eye Foundation with its goal to preserve vision and eradicate blindness around the world.  During this season of giving, may your hearts be light and your sight be bright. 

Merry Christmas!

Tom Sullivan
DEF’s Ambassador of Vision
sullivanvision.com

 

Keep Your Eyes Comfortable During the Cold Winter Months

Harsh weather conditions can reduce the natural moisture in your eyes and the irritation usually results in a burning or itching sensation that often leads to rubbing or scratching your eyes which can worsen the symptoms. Sometimes it feels like there is a foreign object in your eye and for some, dry eyes can even cause excessive tearing, as your eyes try to overcompensate for their lack of protective tears. Prolonged, untreated dry eyes can lead to blurred vision as well. Between the harsh winter winds outside and the dry heat radiating inside, our eyes are very quickly irritated and dried in the winter months.  The result is itchy, dry eyes that may cause pain, blurred vision, a burning sensation, or even watery vision as our eyes try to compensate for the dryness.

What Are The Symptoms?

  • Uncomfortable, stingy, burning or scratchy feeling.
  • Stringy mucus in or around your eyes
  • Increased eye irritation from smoke or wind
  • Eye fatigue
  • Sensitivity to light
  • Eye redness
  • A sensation of having something in your eyes
  • Difficulty wearing contact lenses
  • Periods of excessive tearing
  • Blurred vision, often worsening at the end of the day or after focusing for a prolonged period

10 TIPS TO KEEP YOUR EYES COMFORTABLE DURING THE WINTER MONTHS

Whatever the symptoms, dry eyes can cause significant discomfort during the long winters and relief can seriously improve your quality of life.

  1. To keep eyes moist, apply artificial tears/eye drops a few times a day. If you have chronic dry eyes, speak to your eye doctor about the best product for your condition.
  2. Drink a lot of fluids – keeping your body hydrated will also help maintain the moisture in your eyes.
  3. If you spend a lot of time indoors in heated environments, use a humidifier to add some moisture back into the air.
  4. Try to situate yourself away from sources of heat, especially if they are blowing. While a nice cozy fire can add to the perfect winter evening, make sure to keep your distance so dry eyes don’t ruin it. 
  5. Staring at a computer or digital device for extended amounts of time can further dry out your eyes. If you spend a lot of time staring at the screen, make sure you blink often and practice the 20/20/20 rule – every 20 minutes, look 20 feet away for 20 seconds. Use artificial tears often to lubricate eyes during long periods of using your eyes.
  6. Avoid air blowing in your eyes. Don’t direct hair dryers, car heaters, air conditioners or fans toward your eyes. In your car, direct heat to floor vents and away from your eyes once your windshield is defrosted.
  7. Stop smoking and avoid smoky environments.
  8. Don’t rub your eyes! This will only increase irritation and can also lead to infections if your hands are not clean.
  9. Give your eyes a break and break out your glasses. If your contact lenses are causing further irritation, take a break and wear your glasses for a few hours or days. Also talk to your optometrist about switching to contacts that are better for dry eyes.
  10. Protect your eyes. If you know you are going to be venturing into harsh weather conditions, such as extreme cold or wind, make sure you wear protection. Try large, 100% UV protective eyeglasses and a hat with a visor to keep the wind and particles from getting near your eyes. If you are a winter sports enthusiast, make sure you wear well-fitted ski goggles.

If you find that after following these tips you continue to suffer, contact your eye doctor.

I Can Only Imagine

I can only imagine my wife’s beautiful face.  Oh sure, I’ve touched it and kissed it many times.  I’ve felt the lines with the tips of my fingers, tracing our lives together, and I’ve heard her smile.  I understand that’s not really seeing it.  It’s not seeing her eyes as they sparkle with something funny I said; or, when she looks at me with love reserved only for those who are truly in love.

She’s often tried to explain the flash and colors of a sunset and the cotton softness of clouds as they drift across the sky.  And, what about a rainbow made up of all the colors that somehow promise all of us that things in the world will get better. 

How amazing it would be to see my daughter Blythe skiing her favorite Colorado Mountain trail or my son Tom riding a California wave, both so secure and happy enjoying the sports they love. 

There is so much more I wish I could see, but it’s not going to happen because I am blind.  I am left with only imagining what it’s like to have the gift of sight.

I can only empathize with how a person feels when their vision is threatened by glaucoma or diabetic retinopathy, retinitis pigmentosa, and the most devastating of all, macular degeneration.

At the Discovery Eye Foundation (DEF) our researchers are working every day to overcome the loss of vision and preserve your ability to treasure all the beauty that surrounds you.  I’ve heard it said that the eyes are the windows to the soul.  I don’t know if that’s true, but I am sure that they are the single most important sense in the group of five, and that saving vision is a cause that must be supported.

DEF is committed to that mission, and with your help, answers to all forms of eye disease will be discovered.  It’s up to all of us to support the research that’s bringing us ever closer to those solutions.

If you want to help, please click the button below or download donation form to donate by mail, click here: DEF donation form

DonateNow 

 

 

Tom Sullivan
DEF’s Ambassador of Vision
sullivanvision.com

Beware of Costume Contacts

Costume Contact Lenses such as cat eyes or zombie may make your Halloween costume a bit more frightful although wearing those lenses without a prescription can be more terrifying, as it could result in vision loss or even blindness.

You can buy contact lenses, including decorative contact lenses, from your eye doctor or on the Internet.  It’s very important that you only buy contact lenses from a company that sells FDA-cleared or approved contact lenses and requires you to provide a prescription.  Even if you don’t wear corrective lenses you still need to get fitted properly.

Remember — Buying contact lenses without a prescription is dangerous!

Right now there are a lot of products that you can buy without a prescription but they may not be safe or legal.

You should NEVER buy lenses from:

  • street vendors
  • salons or beauty supply stores
  • boutiques
  • flea markets
  • novelty stores
  • Halloween stores
  • convenience stores
  • beach shops
  • internet sites that do not require a prescription

Know the Risks –

Wearing costume contact lenses can be risky, just like the contact lenses that correct your vision. Wearing any kind of contact lenses, including costume lenses, can cause serious damage to your eyes if the lenses are obtained without a prescription or not used correctly.

These risks include:

  • A cut or scratch on the top layer of your eyeball (Corneal Abrasion)
  • Allergic reactions like itchy, watery red eyes
  • Decreased vision
  • Infection
  • Blindness

Signs of possible eye infection:

  • Redness
  • Pain in the eye(s) that doesn’t go away after a short period of time
  • Decreased vision

If you have any of these signs, you need to see a licensed eye doctor (optometrist or ophthalmologist) right away!  An eye infection could become serious and cause you to become blind if it is not treated.

This Halloween season DEF wants to remind you of the importance of eye safety and to make sure to take the proper steps in ensuring the proper contact lenses. 

A New Commitment to Vision

Meet Tom Sullivan – DEF’s Ambassador of Vision

Over the last 40 years, I’ve been committed to working on behalf of blind children and their families.  My involvement has spanned the entire gamut of participation – from direct involvement in the classroom and counseling parents to hosting organized 10K races and celebrity golf tournaments that carried my name.  In that time, my wife and I raised just over $8 million thanks to the generosity of so many people.  Though my commitment to this cause has not changed, I’ve chosen to take on a new challenge that has in every way re-energized my passion. 

I’ve recently become the Ambassador of Vision for the Discovery Eye Foundation (DEF), a remarkable organization that funds cutting edge research that I believe someday will eliminate many forms of blindness.  The principle reason for my enthusiastic commitment is largely due to the fact that DEF directly funds researchers and avoids institutional restrictions.

As of this blog, DEF is engaged in ongoing efforts to understand 5 main eye diseases – Retinitis Pigmentosa, Macular Degeneration, Keratoconus, Diabetic Retinopathy, and Glaucoma.  I can honestly tell you that breakthroughs are not only on the horizon, but in many cases they are imminent.  Over the weeks and months I’ll be telling you much more, specifically about our individual research projects.  

Any help you may choose to give on behalf of people struggling with vision loss will be deeply appreciated. I look forward to having many of you join my fight for sight. Your help can make a difference! Click here to donate.

 

Tom Sullivan
DEF’s Ambassador of Vision
sullivanvision.com

 

 

Who’s On First For My Eye’s

The Difference Between an Optometrist and an Ophthalmologist

There are a number of players on your eye-health team, among them your optometrist and your ophthalmologist. It’s not always obvious, however, what position each plays and when you should call on which professional. 

 

Optometrists 

An optometrist holds a doctor of optometry (OD) degree. An optometrist generally completes a four-year college program in the sciences, plus four years of postgraduate professional training in optometry school.

Optometrists examine eyes for vision and health problems, and correct refractive errors with glasses and contact lenses. Some optometrists also provide low vision care and vision therapy. In the United States, optometrists may prescribe medications to treat certain eye problems and diseases, and their scope of care can differ by state. While not licensed to perform eye surgery, optometrists can play a role in pre- and post-operative care, if you have eye surgery performed by an ophthalmologist.

 

Ophthalmologists

An ophthalmologist is a medical doctor (MD) or a doctor of osteopathic medicine (DO), who specializes in eye and vision care. Ophthalmologists complete four years of college, four years of medical school, one year of internship and at least three years of residency in ophthalmology. Some ophthalmologists also have one or two years of additional training to become specialists in cornea, retina, glaucoma, oculoplastics, pediatrics or neuro-ophthalmology.

Ophthalmologists perform eye exams, diagnose and treat diseases, prescribe medications and perform eye surgery. They also prescribe corrective lenses.

 

Which one do I call?

Both optometrists and ophthalmologists perform routine eye exams, and are both trained to detect, diagnose and manage eye diseases. Both can prescribe corrective lenses, and both must fulfill continuing education requirements to maintain their licenses.

If your eyes are healthy, which type of professional to see is a matter of personal preference. If you already have a medical eye problem, such as diabetes, or a family history of AMD or glaucoma, you should consider seeing an ophthalmologist. While most optometrists offer medical treatment for common eye problems and chronic eye diseases, such as pink eye, dry eye or allergies, certain eye disorders require treatment by an ophthalmologist, particularly if you need surgery, laser therapy or other specialized care.

In some cases, your optometrist and ophthalmologist may work as a team. In such a setup, the optometrist is the equivalent of your primary-care doctor, who monitors your ongoing condition and care, and the ophthalmologist is your specialist, who manages your condition medically and/or performs surgery. For routine care, you may want to check with your insurance provider to see which, if either, professional they cover and for what services.

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 Brain and the Eye

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 DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Understanding and Treating Corneal Scratches and Abrasions

Corneal Scratches and Abrasions

Call it a scratch, an abrasion or erosion; no matter how you describe it or what the cause, damage to the cornea most always causes pain.

So what exactly is the cornea and why can even a small scratch hurt so much? The cornea is the clear dome at the very the front of the eye. Its primary job is to surface the tears and with them, focus light into the eye. It then passes through the crystalline lens and on to the retina where it is transformed into electrical impulses that are ultimately transformed by the brain into sight.

Because vision is so essential for survival and the cornea so critical to seeing, it is among the most richly innervated and exquisitely sensitive of all tissues. Even the smallest piece of dust that finds its way into the eye and touches the cornea can cause significant discomfort, irritation and copious tearing in an attempt to wash it away. A healthy cornea is transparent and consists of several layers that give the cornea its smooth dome like shape. The outermost layer, the epithelium, is designed to break away to protect the delicate deeper layers if scratched or abraded.
cornea layers - corneal scratches and abrasions

Looking For the Cause

The most common causes of corneal scratches are accidents. Tiny infant fingers and fingernails are a common cause of abrasions in young parents, tree branches are a frequent source of abrasions in hikers and lovers of the outdoors, and makeup brushes are a typical cause in women. Scratches can also be caused by foreign objects that get into the eye and then work their way on to the inside of the upper lid – causing a scratch that occurs with each blink. That’s why its important to carefully investigate the cause of every corneal scratch.

A scratch pr abrasion usually produces near instantaneous pain and tearing as the eye tries to wash away the irritant. Light sensitivity soon follows and can be so intense that the eye can involuntarily shut. This is actually nature’s way of “patching” the eye to facilitate healing.

To confirm you have a scratched cornea, a doctor or other health care professional will often apply a wetted fluorescein strip to the inside lid or white of the eye. Fluorescein is a dye that glows bright green when exposed to black light. The dye is absorbed by damaged areas, clearly showing the area if the scratch or abrasion.

Getting On the Mend

The good news is that most scratches will rapidly heal on their own, especially smaller and more superficial ones. The confocal microscope, a high tech device that provides extreme magnification views of living tissue, has been used to observe corneal healing in real time. The video captures are breathtaking as individual corneal cells can be seen literally stretching over each other to mend and seal the corneal surface.

If an abrasion is larger or deeper it may require patching to help healing. The traditional eye patch applied with tape to keep the eye shut has largely been replaced by the bandage contact lens which is far more comfortable and allows some vision and easier observation during follow up examination. It also allows medication to be applied if needed. Because there is a risk of infection whenever the outer boundaries of the body are breached, topical antibiotics are often used as a precaution in treating scratches of the cornea and ocular surface.

Most commonly the cornea heals quickly and completely, but not always. In rare cases damaged areas of the cornea may not heal fully, leaving the outer layers of the cornea susceptible to coming off again for no apparent reason. This is thought to be more common after scratches caused by organic material such as a tree branch. Called recurrent corneal erosions, they often occur during sleep waking the person with a sudden sharp pain and excessive tearing. There are a variety of treatments for recurrent corneal erosion.

Conclusion

Most people will sooner or later experience a scratched cornea. Most scratches will be minor and will resolve with minimal treatment. However, some can be serious and have significant consequences. The best way to avoid problems is to be aware that they can occur and take measures to protect the eyes in situations where the risk of eye trauma is higher. This includes: wearing safety glasses while working with power tools, or sports where eye contact is possible. This includes cycling and sport shooting.

Be aware of active infants with little fingers that seem to have a magnetic attraction of their parents eyes. If you use eye makeup, leave enough time to properly apply it without rushing and potentially scratching your cornea in the process.

Finally, if you experience a scratched cornea and the pain doesn’t rapidly abate, see an eyecare specialist. Urgent care centers are fine for most things, but when it comes to the eyes finding a knowledgeable eye care professional is wise.

2/10/15

AArthur B. Epstein, OD, FAAO
co-founder of Phoenix Eye Care
and the Dry Eye Center of Arizona
Fellow of the American Academy of Optometry
American Board of Certification in Medical Optometry
Chief Medical Editor of Optometric Physician™

Cataract Surgery and Keratoconus

1/8/15

The eye works like a camera, specifically a digital camera. There is the front lens of the camera (cornea), the aperture (iris), the film (retina), and a cable to take the image to the brain (optic nerve). This “camera” also has an additional lens – the natural crystalline lens, which lies behind iris. This natural lens is flexible when we are young, allowing us to focus at distance then instantaneously up close. Around age 40-45, this natural lens starts to stiffen, necessitating the need for reading glasses for most people. This stiffening is the beginning of the aging process that eventually leads to formation of a cataract. We refer to the lens as a cataract when it becomes sufficiently cloudy to affect ones quality of vision.cataract surgery and keratoconus-Cataract diagram In general, cataract surgery is one of the safest and most successful of all surgeries performed. The basics of cataract surgery in eyes with keratoconus is very similar to non-keratoconic eyes.

Keratoconus (KC) affects this “camera” by causing the front lens (cornea) to bulge. This causes the optics to be distorted. In many cases, this can be corrected for with hard contact lenses (CL) or spectacles; in other cases a corneal transplant may be necessary. When it comes time for cataract surgery in the setting of KC, there are several factors that need to be considered.

Corneal Stability
The first thing to be considered is the stability of your cornea. In general, KC progresses more in your late teens to early twenties, and then stabilizes with age. A very exciting treatment for KC is collagen crosslinking. This treatment is meant to stiffen the cornea to prevent instability that is inherent to KC. This treatment promises to stop the progression of KC at a young age. Fortunately, with age, the cornea naturally crosslinks and stiffens, therefore when it comes time for cataract surgery, there is little chance of the progression of KC. Your doctor needs to choose the appropriate intraocular lens (IOL) to refocus your eye after surgery. Two of the most important factors in IOL selection are the length of your eye and the shape of your cornea. Long term CL wear can mold your cornea. It is important to assure that you stay out of your CLs long enough for your cornea to reach its natural shape. Depending on how long you have worn your CLs, it may take several months for the cornea to stabilize. This time can be challenging as your vision will be suboptimal (because you can’t wear CLs), and will be changing (as your cornea reaches its natural shape). When your cornea does stabilize, it is important to determine whether the topography (shape) is regular or irregular. This “regularity” is also known as astigmatism. If the astigmatism is regular, light is focused as a line – generally, this distortion can be fixed with glasses. However, if the astigmatism is irregular, light cannot be focused with glasses, and hard CLs are needed to provide optimal focusing. If you have had a corneal transplant, I generally recommend all your sutures to be removed to allow your new cornea to reach its natural shape.

IOL Selection
The second thing to be considered is the type of IOL. IOLs allow your doctor to refocus the optics of your eye after surgery. In many cases, the correct choice of IOL may decrease your dependence on glasses or CLs. There are several factors that are important when considering the correct IOL for a keratoconic patient. The amount and regularity of your astigmatism plays a very significant role in IOL selection. In general, there are four types of IOLs available in the US – monofocal, toric, pseudo-accomodating, and multifocal. In general I do not recommend multifocal IOLs in patients with KC. These IOLs allow for spectacle independence by spitting the light energy for distance and near, however, with an aberrated cornea (which is what happens in KC), these IOLs do not fare well. If there is a low amount of regular astigmatism or irregular astigmatism, your best bet is a monofocal IOL. This is the “standard” IOL that is covered by your health insurance. If you have higher amounts of astigmatism that your doctor determines is mostly regular, you may benefit from a toric (astigmatism-correcting) IOL. These IOLs can significant improve your uncorrected vision and really decrease your dependence on glasses. It is important to realize that monofocal and toric IOLs only correct vision at one distance. With a monofocal IOL you still can wear a CL to fine-tune your vision, however, with a toric IOL, in general you will need glasses for any residual error. There is a pseudo-accomodating toric IOL available, and this may be a good option if you are trying to decrease your dependence on glasses and correct some of your astigmatism. These IOLs are relatively new to the US market.

If You Had A Corneal Transplant
In the setting of a corneal transplant many of the same factors need to be considered – stability of the graft, choice of IOL, etc. In addition, the health of the graft has to be judged. Prior to cataract surgery in my patients with corneal transplants, I make sure to remove all of their sutures and give the cornea time to stabilize (just as if they were a CTL wearer). If you are a CL wearer, the same rule of being out of the TL until the topography is stable applies. The health of a transplant needs to be established prior to undergoing cataract surgery. The cornea has five main layers to it –cataract surgery and keratoconus-corneal structure the back layer (inside) is called the endothelium. This layer is responsible for “pumping” fluid out of the cornea, allowing it to stay clear. In all eyes there is a loss of endothelium cells with cataract surgery. I generally perform a “specular microscopy,” which allows me to visualize and quantify the corneal endothelium prior to surgery. This allows me to risk stratify you before your surgery. It is important to realize that corneal transplants have a lifespan and may have to be repeated in the future.

Keep in mind, there is some uncertainty in biometry (the process of selecting an IOL) in all eyes – this error can be higher in keratoconic eyes. This highlights why assuring stability is important. Equally important is picking the correct IOL for your situation. Also, keep in mind that I have discussed generalities in this article. Your individual case could be different. This is a conversation best left between you and your surgeon. In general, cataract surgery and keratoconus or a corneal transplant can be a very safe and effective way in restoring vision.

Sam Garg, MDSumit (Sam) Garg, MD
Interim Chair of Clinical Ophthalmology and Medical Director
Gavin Herbert Eye Institute at the University of California, Irvine