Low Vision Awareness Month

Low vision affects millions of Americans — including many older adults. People with low vision aren’t blind, but because of their vision loss, they may not be able to do everyday tasks like driving or reading even with glasses.

What is Low Vision?

When your eyesight is impaired to the degree that you struggle with daily tasks like reading or cooking – or that you have difficulty recognizing faces, you may have a medical condition referred to as low vision. Someone with low vision can’t simply put on a pair of glasses or contacts and see well; this condition is beyond the typical loss of vision that occurs with aging.

Individuals experiencing low vision can struggle with maintaining independence; hobbies, reading and even socializing may become challenging as vision loss progresses. Because of the impact low vision can have on your life, it is important to have your eyes checked by a low vision specialist if you have any concerns.

Since it is unusual to be able to restore vision once it is lost, screenings can help preserve the vision you have and help you access adaptive lenses and devices if you need them. While there is not a cure for low vision, your specialist can help you adapt and if needed, create a vision rehabilitation program designed to meet your specific needs.

Low vision is often caused by one of these conditions:

  • Age-related macular degeneration (AMD) –AMD is a progressive eye condition affecting as many as 15 million Americans. The disease attacks the macula of the eye, where our sharpest central vision occurs, affecting reading, driving, identifying faces, watching television, safely navigating stairs and performing other daily tasks. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision. Read More (link to DEF website)
  • Diabetes– Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid or blood inside the eye. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. Read More (link to DEF website)

  • Glaucoma– glaucoma is a disease that causes damage to the major nerve of the eye called the optic nerve, a part of the central nervous system that carries visual information from the eye to the brain.

The eye experiences a gradual increase of intraocular pressure (IOP) due to an imbalance of the fluid produced in the eye and the amount of fluid drained. Over time, elevated IOP can cause vision loss. The most common form of glaucoma is primary open angle glaucoma which affects about 3 million Americans. However, there are other types including narrow angle, congenital, normal tension, and secondary glaucoma. (link to DEF website)

  • Injury to the eye can also be a cause

Regular eye exams are essential for all adults; it is recommended that adults over the age of 60 have eye exams each year. For older adults, diabetics and anyone with the risk factors above, a visit with a low vision specialist may be warranted as well. This specialist differs from a conventional optometrist and is trained to detect low vision and offer solutions to help you retain or regain independence and the ability to do things you enjoy again.

While Low Vision Awareness Month is the ideal time to learn about this condition and about the risk factors you could be facing, you should get in touch with a low vision specialist any time you have concern about your eyesight. Any time you notice a change in vision, if you receive a new diagnosis or have one or more of the risk factors detailed above you should schedule an appointment right away.

Low Vision Resources from the National Eye Institute

It can be hard to describe low vision. Visit our website Vision Simulation to see what life is like with common causes of low vision, like age-related macular degeneration, diabetic retinopathy, and glaucoma.

Kids and Sunglasses: Why it’s important!

Due to widespread awareness about the dangers of ultraviolet (UV) rays, most parents have been very cautious about protecting kids’ skin with sunblock, hats and clothing. However, what is usually overlooked is a good pair of sunglasses. 

Children are more susceptible to damage from UV exposure, which can penetrate deep into the eye and can increase the onset of eye problems in the future.  It’s really important we protect their vision, especially because kids spend lots of time outside and their eyes haven’t fully developed yet. More importantly, sunglasses may save their skin and eyes later in life by blocking the sun’s powerful UV rays.  Children under age 10 are at a high risk for skin and eye damage from UV exposure. The skin on their eyelids and around their eyes is more delicate and vulnerable than adult skin. 

UV ray damage builds over time, so the sooner you start protecting your children’s eyes from the sun, the lower their risk will be of ever developing future eye problems.

Here are a few tips to follow to help you find the right sunglasses for your kids:

  • UV Protection – Sunglasses for children should block 100% of UV radiation as well as between 75 – 90% of visible light. Any sunglasses you buy should have this information provided in the packaging 
  • Durability – Kids run, trip and fall. Their sunglasses should match this active lifestyle. Lenses should be made of a high impact material such as polycarbonate to prevent any breakages or scratches. Frames should be bendable but unbreakable. Make sure the glasses fit snugly, close to the face.
  • Spring hinges – Hinges that extend beyond 90 degrees and have a spring action to keep the fit of the frame snug will decrease the risk of your child’s sunglasses falling off or getting damaged during sports and other play.
  • Let them choose – You’re not the one who has to wear the glasses or hear other kids’ comments on them. Children and especially older kids/teens – are likelier to actually wear them if they select them themselves.
  • Fit & Comfort – Children’s sunglasses should offer good eye coverage and fit comfortably. Allow your child to try on various pairs to find something that is comfortable and fits correctly.
  • Set an Example – Kids at a young age look up to their parents so set a good example! Ensure you’re wearing your sunglasses every time you go outside if you want your child to do the same.

If your child has prescription sunglasses, be sure they are made with UV blocking clear lenses. You can get them a second pair with tinted polycarbonate lenses, or you can get photochromic lenses that change from light to dark to avoid having two pairs.

Sunglasses do not have to be expensive.  Many inexpensive children’s sunglasses provide excellent UV protection because they include polycarbonate lenses which blocks 100 percent of UV.

Beware because some cheap brands of sunglasses for children can include an unacceptable level of lead and usually are not durable or as high-quality as other sunglasses.

Start with an eye exam – because children’s eyes change so rapidly, make sure your child is seeing well.  Children who do not need vision correction should have an eye exam at least every two years.  Children who need glasses or contact lenses should have an eye exam annually or as recommended by your eye doctor.

 

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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.

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.
women's eye health
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.

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  • 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.

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  • 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.

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

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  • 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.

women's eye health
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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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

Wearing Contact Lenses in Winter

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 DeRemerSusan DeRemer, CFRE Vice President of Development Discovery Eye Foundation

Smoking and Your Eyes

Smoking is the single largest preventable cause of eye disease.
smoking and your eyes
On the third Thursday of November each year, smokers across the nation take part in the Great American Smokeout, sponsored by the American Cancer Society. This might be the ideal time for you to stop smoking and ACS has information and resources you may find helpful.

Here are some things you should know about smoking and your eyes.

  • Smoking at any age, even in your teens or twenties, increases your future risk for vision loss.

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  • The more you smoke, the higher your risk for eye disease.

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  • If you quit smoking, your risk for these eye diseases decreases considerably.

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  • Smoking increases your risk for cardiovascular diseases that indirectly influence your eyes’ health.

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  • Women who smoke during pregnancy increase their chance for a premature birth and a potentially blinding eye disease called retinopathy of prematurity (ROP).

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  • A smoker is two times more likely to develop macular degeneration compared with a nonsmoker.

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  • Smoking double your chance of forming cataracts and the risk continues to increase the more you smoke.

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  • Smoking doubles your diabetes risk which can lead to the blinding eye disease, diabetic retinopathy.

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  • Smokers are more than twice as likely to be affected by dry eye syndrome as a non-smoker.

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  • Second-hand smoke also makes dry eye worse, especially for contact lens wearers and post-menopausal women.

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  • If you smoke you can have a three-fold increase in the risk of developing AMD compared with people who have never smoked.

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  • Smoking appears linked to the development of uveitis with smokers having more than twice the risk of non-smokers.

If you are looking to stop smoking you may also want to check out Smokefree.gov which provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.

11/19/15

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

Treatments for Dry Eye Disease

This is the third and final installation of the comprehensive series we have presented on dry eye disease. Dr. Wade first discussed the symptoms you might experience if you have dry eye and the Dr. Garg explained the process of diagnosing they type of dry eye disease you might have. In this article Dr. Farid reviews treatment options based on your diagnosis of dry eye disease.treatments for dry eye

Treatments for Dry Eye Disease

As our understanding of dry eye disease expands, so do treatment options. We now know that dry eye disease is a multifactorial disease. There is no one cause so there is no one magic cure. Treatments aim to improve tear composition, reduce eye surface inflammation, and target eyelid margin disease. Here, we will review many treatment options, but the treatment combination or “cocktail” that is appropriate for you will depend on your specific type of dry eye disease. This is usually determined after some testing by your eye care provider.

Environmental, Dietary, and Medication Adjustments
Before going into specific dry eye treatments, there are modifiable causes and preventative methods to improve dry eyes. Simple changes in the environment, diet, and medications can be easy ways to improve symptoms.

Environmental Changes
As expected, a dry environment will worsen dry eyes. Humidifiers and moisture goggles have been shown to help alleviate these symptoms. Furthermore, situations that cause decreased blinking, such as prolonged use of computer screens, can worsen dry eyes. Patients should take frequent breaks from computer screens and reading, allowing their eyes to rest and resume normal blinking. When in windy, smoky, or dusty situations, sunglasses can act as a barrier to the eyes, reducing dry eye symptoms. Avoiding wind, fans, or any source of air blowing into the eyes may also help.

Dietary Changes
Drinking adequate water keeps patients hydrated and reduces exacerbations of dry eye symptoms. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown in many clinical studies to improve dry eyes. It is believed that these fatty acids help inhibit inflammatory mediators. Essential fatty acids cannot be synthesized and must be ingested through diet. Foods rich in omega-3 fatty acids include fish, other seafood, and flaxseed oil. Supplements are also available.

Adjusting Medications
Many medications are associated with dry eyes, and patients may benefit from adjusting doses or finding alternative treatments. You can work with your physician to weigh the costs and benefits about modifying your current medications if they are suspected to worsen dry eyes. Some of these medications include: hypertensive drugs, antihistamines, decongestants, antidepressants, acne medications, birth control, and hormone replacement therapy. Eye drops with preservatives, such as glaucoma medications, can also worsen dry eyes.

Lubricating Treatments
For patients with decreased tear production, supplementation of tears or reduction of tear drainage will improve symptoms.

Artificial tears, gels, and ointments
Artificial tears, gels, and ointments are readily available over the counter. Artificial tears are eye drops that are used throughout the day as needed, up to eight times for dry eyes. You must make sure to get “lubricating” drops. There are multiple available brands that are excellent and equivalent in providing artificial moisture. Avoid “redness relief” brands as they are focused on reducing appearance of the vessels in the eyes as opposed to actual dry eye relief. Gels and ointments are thicker and very effective but can blur vision. Non-commercial comparison testing between brands has not been done. Because the ingredients, preservatives, and consistency vary from brand to brand, it is recommended for patients to choose the best option that works well for them based on trial and error.

Preservatives are used in many eye drops to help them to last longer. Unfortunately, they can be irritating to the eyes, especially when used often (more than 4 drops/day) or with other drops containing preservatives (ie. glaucoma medications). Patients who frequently use eye drops are recommended to use preservative-free (PF) drops. Unfortunately, preservative-free drops are more expensive because they come in “single use” containers. You may be able to extend the life of each single use container by spreading out its contents over multiple uses throughout the day.

Lipid-containing lubricants, such as those with castor oil, attempt to mimic the oils found in the tears, reducing evaporative dry eyes, but more research is necessary to study their efficacy.

Punctal Plugs
Your ophthalmologist can place small plugs at a clinic visit into the punctum, a small hole at the upper and inner lids that drain tears from the eyes. One plug can be added initially, and if more tear retention is required, another plug can be added. There are absorbable and non-absorbable types. Absorbable types are made of collagen and last 1 week to 6 months. Once placed, they are not visible or removable. Non-absorbable plugs are usually silicone, and permanent. They are easily placed by your ophthalmologists and remain visible in follow-up exams. Some patients feel the plugs, and there may be mechanical rubbing, especially when the plug is not the proper size. Some patients may also experience excessive tearing with plugs. If problematic, patients can wait for the plugs to dissolve if absorbable or they can be removed with forceps if non-absorbable.

Autologous Serum
Serum is extracted from a patient’s blood and turned into an eye drop. The growth factors, vitamins, and antibodies present in serum are the same as those in natural tears. Evidence is showing significant promise in alleviating symptoms and signs of chronic dry eye disease. A good collaboration between a phlebotomy lab and compounding pharmacy is necessary to make the products. The products must be kept refrigerated or cold between uses. They can be frozen for long-term storage. Each blood draw provides a supply of drops that can last 3-6 months.

Hydroxypropyl Cellulose Ophthalmic Inserts (Lacrisert)
An insert is available for people who find regular artificial tear use to be difficult. A physician can order the inserts through a pharmacy. The patient places the insert in the inferior fornix of the eye, the area between the lower lid and sclera of the eye. It slowly dissolves over 24 hours, giving constant lubrication.

Anti-inflammatory Treatments
Inflammation is now being recognized as a major underlying cause of chronic and worsening dry eye disease. Many patients who have been suffering from chronic dry eyes, particularly those with autoimmune diseases like Sjogren’s Syndrome, will do well on treatments that reduce the amount of inflammation in the tear film and ocular surface. Your physician can order these medications for you if needed.

Cyclosporine A (Restasis)
The FDA approved Restasis for dry eyes in 2002. This is an immunosuppressive and anti-inflammatory eye drop medication. Relief is not instant, and may take 6-8 weeks of sustained use for improvement in dry eye symptoms. Less than 20% of patients may experience a burning sensation with the drops, but the safety and tolerability profile is otherwise excellent.

Antibiotics
Doxycycline and minocycline are used for inflammatory ocular surface and eyelid disease. The antibiotics have a dual effect: they act as anti-inflammatories and anti-microbials. As an anti-microbial, these medications can improve meibomian gland function. They can decrease lid bacterial flora, reducing a cause of meibomian lipid breakdown. A low-dose (doxycycline 20 mg BID) regimen for 1-2 months has been shown to be effective. Side effects are usual mild but include stomach upset, yeast infections, and photosensitivity.

Steroids
Steroids act as anti-inflammatories. Because steroids are associated with complications in long-term use, they are mainly used in short pulses either at the initiation of treatment or as rescue during exacerbations. A short 4-6 week course is generally well tolerated as a “rescue treatment,” or an urgent treatment, to relieve intolerable symptoms quickly before resorting to other treatment options.

Meibomian Gland Treatments
Meibomian glands produce oils that are crucial in preventing our tears from evaporating too quickly. Treatments that target the glands can help patients with meibomian gland dysfunction or lid margin disease.

Warm compresses and lid scrubs
Warm compresses provide heat that warms the oils in the glands, unclogging the glands and improving oil flow. Warm washcloths, small rice bags heated in the microwave, or commercial hydrogel pads are all effective, and no studies have been done to compare the different methods. The heat. The compress should be placed over the eyes for 5-10 minute. Gentle circular or rolling massage of the eyelids can help express the oils from the glands.

Lid scrubs are useful particularly in cases of blepharitis, or mild inflammation of the lids, that cause them to become crusted. There are excellent over the counter commercial lid soap formulations that work well to clean the lid margins. Alternatively, baby shampoo and a washcloth gently applied to the lids can work as well.

Thermal pulsation (Lipiflow)
Lipiflow is an FDA approved in-office treatment for meibomian gland dysfunction and dry eyes. During the 12-minute procedure, a device is placed over the eye and eyelids that provides localized warmth and pressure on the lids (Figure 1).

treatments for dry eye
Image 1 – Lipiflow treatment

The procedure is 100% safe and very effective at clearing out the trapped oil glands and allowing smooth flow to be re-established. After approximately one month, the consistency of the oils in the tear flow will have improved remarkably with associated improvement in dry eye symptoms. With one procedure, the effects last between 12-24 months.

Intense Pulsed Light (IPL)
Originally approved for acne and rosacea dermatologic disease, IPL uses bursts of light to minimize blood vessel size. It can be used off-label for ocular rosacea and meibomian gland dysfunction, but results have not been reported.

Summary
There are many treatment options for dry eye disease. Generally, conservative over-the-counter treatments should be tried first. Commonly, environmental changes, dietary changes, artificial tears, and warm compresses will improve the majority of dry eye symptoms to tolerable levels. However, when these options are exhausted, there are many additional options for patients. Work closely with a trusted health professional to determine the optimal treatment combination as each patient is different.

8/25/15


treatments for dry eyeMarjan Farid, MD
Director of Cornea, Cataract, and Refractive Surgery
Vice-Chair of Ophthalmic Faculty
Director of the Cornea Fellowship Program
Associate Professor of Ophthalmology
Gavin Herbert Eye Institute, University of California, Irvine

 

 

treatments for dry eyePriscilla Q. Vu, MS
Medical Student
University of California, Irvine School of Medicine

Dry Eye Diagnosis

As covered earlier by Dr. Wade, the symptoms of dry eye disease (DED) can be variable. Simply put, dry eyes can be separated into two categories: aqueous tear deficient (ATD) or dysfunctional tear syndrome (DTS). More commonly there is a combination of the two that I like to refer to as ocular surface disease (OSD). Lucky for you, as clinicians, we have several tools that will allow us determine what type of DED you have.

Steps In A Dry Eye Diagnosis

First is a review of your symptomatology. This is crucial to determining if you 1) have DED, and 2) what type you have. This determination can drive our treatment plan that is individual to you. In addition, we utilize various questionnaires that can help us hone in on your OSD.

Second is the ocular examination. We use a microscope (slit-lamp) to carefully examine the surface of the eye. When we look at your tear film we are looking to see the amount and health of your tears, how well they are working, and what effect they are having on the ocular surface (conjunctiva and cornea). Not only do we look at your tears, but we pay special attention to your eyelids. In your eyelids, there are oil producing glands called Meibomian Glands. These glands are responsible for creating a key component to the tear film: lipid. Human tears are very complex, but simply put, tears have 3 main components – water, mucus, and oil. I like to describe tears like salad dressing. In order to have tasty salad dressing, there needs to be a balance of oil, vinegar, and spices. Human tears are very much similar. In order for your tears to work properly, There needs to be the proper balance of the aqueous component (water), lipid component (from the Meibomian glands), and mucus component (image 1).

dry eye diagnosis
Image 1 – A relatively healthy meibiomian gland examination

If there is an imbalance in your tears, this will reflect in their function, and ultimately cause signs and symptoms of ocular surface disease. To highlight the appearance and function of the tears on the ocular surface, clinicians often use special stains that can aid us in determining the amount and function of your tears. Two of the most common stains are fluorescein and lissamine green. Each of these stains has particular characteristics that help determine the severity and extent of your ocular surface disease. For example, if you have significant staining near the bottom part of your cornea, your eyes maybe slightly open when you sleep, and therefore you may benefit from using an ointment at nighttime. Alternatively, if your tears appear to break up very quickly on your ocular surface, there is likely an imbalance in the tear composition that may benefit from institution of warm compresses along with tear replacement in the form of artificial tears.

Third is the use of ancillary testing to help confirm our clinical diagnosis. We are fortunate to have access to several commercially available OSD diagnostics at the Gavin Herbert Eye Institute. A brief description of if you have these diagnostics follows.

    1) Schrimer Testing – This is a very simple and common method of determining whether a patient has hey aqueous tear deficiency. Essentially, the eye is numbed and a sterile piece of special paper is placed in the lower outer corner of the eye. After a specified amount of time, the amount of tears is recorded, and if under a threshold value (generally 10 millimeters at five minutes) there is a high suspicion of aqueous tear deficiency. Treatments for this subtype of OSD will be covered in the next blog.
    2) Tear osmolarity – The most available tear osmolarity system is from TearLab. With this test, we look at the integrity of the tears by determining the osmolarity – essentially the ultrastucture of the tears. If the tear osmolarity is high (hyperosmolar), we know that the tears are not functioning properly. With proper institution of treatment, the osmolarity can normalize indicating a healthier tear film. This test is very noninvasive, requiring only a tear sample of 50 nanoliters – less than the volume of a single tear!
    3) InflammaDry – Inflammation has long been accepted as a hallmark of dry eye disease/ocular surface disease. As such, many of our treatment modalities have focused on treating ocular surface inflammation (discussed in the next installment of this blog). Prior to having access to the InflammaDry test, we would have to assume that there was inflammation involved in an individual’s OSD. Now, however, we can test the ocular surface for inflammatory markers and have an answer within just a few minutes. This test not only allows us to custom tailor treatments to an individual, but also we are able to see if our treatments are working. Again, this test is minimally invasive requiring the small sample of tears for testing.
      4) LipiView II – This test allows us to Image of the structure and function of the meibomian glands in vivo. The images obtained allow for several things. First, we are able to determine the extent of meibomian gland dysfunction. Second we are able to determine the extent of meibomain gland drop out (image 2).
dry eye diagnosis
Image 2 – Significant dropout of meibomian glands
    And third we are able to educate our patients so they can see the importance of treatment of their MGD. Again, this information can help us custom tailor treatment options for the individual patient.

In conclusion, as you can see diagnosis of ocular surface disease can be quite intricate. We are fortunate to be in and age where there has been significant improvements in our tools to help us better diagnose our patients and use this information to individualize treatment options. Stay tuned for the next installment of this blog focusing on treatments for ocular surface disease.

8/20/15


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

Symptoms of Dry Eye Disease

Introduction

If you could be a fly on the exam room wall of your local ophthalmologist, you would hear patient after patient report symptoms of dry eye disease.

Some patients come in already knowing they have dry eyes. However, the variability of symptoms that can occur from dry eye disease is so wide many patients don’t even use the word “dry.” We will cover some of these symptoms in this article.

symptoms of dry eye
Redness often associated with dry eye

Underlying Factors

Dry eye disease has many underlying factors including an inadequate production of tears, rapid evaporation of tears, poor eyelid function and an imbalance in the tear composition of water, oil, and mucus. Dry eye disease can be associated with systemic conditions such as Sjogrens disease, Sarcoid disease and sleep apnea among many others. It is more common in females especially after hormonal changes such as menopause.

Exacerbating Influences

Many medications can exacerbate dry eye disease. Over the counter antihistamines are one example.

Environmental factors may also worsen dry eye symptoms. These include dry climates, windy weather conditions, smoky environments and the dry air found in airplanes.

Modern life includes hours and hours of focusing our eyes on everything from cell phones to computer screens to television. Prolonged focusing reduces the blink rate resulting in more tear evaporation and worsening of dry eye symptoms. Increased evaporation can also occur with exposure to heating, air conditioning, fans and rolling down the car windows while driving.

Symptoms Fluctuate

It is very common for dry eye symptoms (especially blurred vision) to wax and wane throughout the day. Symptoms can even change from blink-to-blink. Dry eye disease which is predominately due to insufficient tears tends to worsen throughout the day with symptoms worse at night. Dry eye disease that is more associated with blepharitis can be worse in the morning. Blepharitis is associated with burning and itching of the eyes.

Visual Symptoms

The front surface of the eye is the most powerful focusing surface of the eye. Thus, a dry ocular surface will produce visual symptoms. These symptoms can include:

Blurred vision: A decrease or fluctuation in visual acuity. This is manifested in the inability to see fine detail. Objects at both near and far may appear out of focus.

Sensitivity to light: Sensitivity to light is termed photophobia. It occurs because a dry ocular surface has more irregularities than a health surface. These irregularities scatter light entering the eye. This scattered light can cause significant discomfort. The inability to tolerate light may lead to squinting and headaches.

Difficulty with nighttime driving: During low light conditions, such as at night, the pupil enlarges and allows more light into the eye. When the ocular surface is dry, the incoming light becomes unfocused and scattered. Many of these abnormalities are filtered out by the small size of the pupil during the day. However, at night, the larger pupil size allows more light abnormalities to pass through to the retina. This results in nighttime glare and halos. Glare is a decreased tolerance of bright lights. Halos present as circles or auras around a bright source of light. Glare and halos from the headlights of oncoming traffic are especially troublesome.

Physical Symptoms

The front surface of the eye is richly supplied with nerve endings. As such, a dry ocular surface can result in significant symptoms of discomfort. In addition to feeling dry, these symptoms include:

Foreign body sensation: Patients may feel as if there is something present in the eye.

Redness of the eye: Enlarged blood vessels on the ocular surface cause the eye to look red.

Ocular and periocular pain: Pain from dry eye can be mild or severe. Pain from dry eye can be felt on the ocular surface. Pain can also be felt in structures around the eye such as the eyelids or scalp.

Periocular irritation: Stinging, burning, or itching sensations of the ocular surface and eyelids.

symptoms of dry eye
Watery eyes can be a symptom of dry eye

Watery eyes: Patients typically raise an eyebrow or two when I explain how the tearing they are experiencing is from dryness. “How can my eyes be dry if they are watering all of the time?” Although this may seem counter-intuitive, when the ocular surface is very dry it will overproduce the watery component of the tears as a protective mechanism.

Eye fatigue: A tired sensation of the eyes and heaviness of the eyelids.

Decreased tolerance of sustained visual focusing: As noted earlier, any activity that requires prolonged visual attention will decrease the blink rate and increase tear evaporation.

Discomfort while wearing contact lenses: Individuals may experience pain and irritation in the eyes while inserting or wearing contact lenses.

Inability to cry: Tears associated with emotional discomfort or watching a sad movie may be decreased in some types of dry eye disease.

Stringy discharge from the eye: A dry ocular surface can result in the overproduction of a sticky, mucus discharge.

Conclusion

There are many symptoms of dry eye disease. Some symptoms affect vision and others affect ocular comfort. If symptoms persist, an evaluation by your eye care provider can help clarify the cause and offer information on treatment options.

It is important to remember the symptoms of dry eye disease can overlap with the symptoms of other ocular conditions. One example is cataracts which, like dry eye disease, can also cause blurred vision and nighttime glare. The next post in this series will review how dry eye disease (and its sub-types) are diagnosed.

As a final note, while the name “dry eye disease” may sound innocuous, the symptoms of dry eye disease can be very severe in many patients. If you suffer from dry eye disease, you are not alone. Today there are many treatment options which can be very helpful. Significant research is underway to continue improving our ability to treat dry eye disease.

 

Matthew Wade, MD - toric intraocular lensesMatthew Wade, MD
Assistant Professor of Ophthalmology
Gavin Herbert Eye Institute

 

 

 

Minal Reddy was also a contributor to the is article.

Dry Eye and Tear Dysfunction

4/24/14

With an aging population and increasing awareness of the condition, dry eye has become one of the hottest topics in eye care today. There have been numerous advances in our understanding of the condition as well as several breakthroughs in treatment.
eye drops in eye
Lets start with the most fundamental question. Why do we have tears? Tears serve many functions, but perhaps the most important is that they create a perfectly smooth optical surface at the front of the eye to allow sharp focusing. The sharper your vision the more quickly you can spot and run from a predator or find a supply of food. Hence, a stable tear film is critical for survival. As a result, the body has evolved many ways to help keep the tears healthy and intact.

When I describe the tears to a patient I describe it as a structure. Tears have a foundation that anchors them to the eye’s surface, an elastic protective support section not that different than the walls in a building and even a roof, just like a house has. Like a house, problems with any structural part can adversely impact the entire building.

Over the past few years the most important breakthroughs in understanding dry eye have focused on the outer portion of the tear structure – what you might think of as the roof. When a roof develops holes and it rains, water gets in which can destroy the entire structure of the house. With the tears, holes in the “roof” can let moisture evaporate causing the structure to collapse and become unstable.

The outer layer of the tears consist of lipid or oil produced by the meibomian glands – glands that run radially through the lids and express small amounts of complex oil with each blink. When these glands work properly, the oils they produce coat the tears, preventing evaporation and stabilizing and lubricating. When the glands become blocked – which can occur for a number of reasons including decreased blinking due to excessive computer use, the lack of oil can lead to a down spiral of damage to the eye’s surface with symptoms that can range from annoying to life altering.

Lets talk for a moment about symptoms. We know that dry eye is progressive and, if left untreated will worsen over time, so the sooner we know about it, the sooner treatment can begin. I am often surprised that even with increased awareness, most patients don’t recognize that they suffer from dry eye until the condition is fairly advanced. One reason is that many people think that the symptoms of dry eye are a normal and expected part of aging. For the most part they are not. If you experience, burning, irritation, unstable vision, grittiness or any change in your vision or eye comfort, you should bring this to the attention of your eye care practitioner.

One of the most common signs of dry eye is excessive tearing. Patients often complain that their eyes are too wet and I have to explain that the excessive tearing is the eye’s way of trying to correct for dryness and prevent further damage. Unfortunately excessive tearing further destabilizes the tears and makes matters worse.

Lipiview System
Lipiview System

Perhaps the greatest advance today is the recognition that meibomian gland dysfunction causes or contributes to nearly 90% of all dry eye. Many eye care providers are adding high tech tools like meibography which can show the actual state of the meibomian glands like an X-Ray and LipiView which measure the actual thickness of the lipid layer of the tears. As a result diagnostic ability has improved.

Lipiflow Device
Lipiflow Device

Recently introduced eyedrops like Alcon’s Systane Balance and Allergan’s Refresh Optive Advanced Formula drops can help restore absent or deficient oils in the tears. And new treatments including moist heat goggles like Tranquileyes by EyeEco can help improve comfort. LipiFlow, a technology pioneered by TearScience, offers a breakthrough treatment that can clear blocked and reset meibomian glands. It can produce amazing improvement.

There have also been significant advances for contact lens wearers suffering from dry eye. Scleral lenses are especially helpful for patients with advanced dry eye who also must wear contact lenses to see, such as those who have keratoconus. The large scleral lens serves as a barrier that protects the eye and provides sharp stable vision. In fact, scleral lens designs are used as a treatment for severe dry eye and ocular surface disease.

Finally, if you have been diagnosed with dry eye previously and are still suffering despite treatment, this may be a good time to return to your eye care provider to discuss your condition and explore the possibility of new treatment options.

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™