Ask Dr. Weaver -- Eye Info Blog

Common Contact Lens Problems, Proper Contact Lens Care

2008-07-14T11:56:00.002-04:00

Newspaper Article about Contact Lens Care

Contact Lens Problems, Anyone?

You finally took the big step and switched from wearing eyeglasses to contact lenses. You heard the numerous positives points about wearing contacts and wanted to give it a try. But now that you’re finally in contact lenses, why is it that your vision doesn’t seem as clear? Or why do your eyes feel dry towards the end of the day? Or why does your vision fluctuate when you’re reading or using a computer for hours at a time?

The primary issue that affects the quality of vision and comfort-related complications is how well a person takes care of their contact lenses. When people start having visual complaints or problems with redness, dryness and intolerance issues, one main reason is that the lenses are taken care of poorly.

Overwear is one problem that leads to contact lens complications. If you are wearing the contact lenses every waking moment, or even sleeping in them, you are cutting off the supply of oxygen to the cornea, the part of the eye on which the contact lens sits. Decreasing the oxygen supply to the cornea principally causes inflammation and dryness, but can also lead to the formation of corneal ulcers and bacterial infections that could potentially be sight threatening.

Poor cleaning habits also lead to contact lens problems. The contact lens case that you have should be replaced frequently. Whenever you purchase contact lens solution, it always comes with a new case, so use it. Old contact lens cases harbor nasty bacteria, so replacing your contact lens case regularly reduces your exposure to bacterial eye infections. Also, it is important to throw out the used solution in your contact lens case every morning and let the case air dry. Re-using solution for days at a time allows bacteria to proliferate in the dark, warm and moist environment, essentially turning your case and your contact lenses into a Petri dish.

However, a lot of people are very responsible and do take care of their contact lenses very well. Using artificial tear lubricating drops may help them, but they may still have issues. There are literally hundreds of different brands of contact lenses out on the market, and obviously, they are not all manufactured in the same way. If you weren’t fitted recently with contact lenses by your eye doctor, chances are you aren’t wearing the latest and greatest contact lens technology. These new contact lens materials allow more oxygen to cross the contact lens to your cornea, greatly reducing the risk of dryness and comfort problems. There are also contact lens cleaning solutions that are available that are preservative-free. Many times, people develop a hypersensitivity to the preservatives found in many multi-purpose cleaning solutions, and just switching to a different solution takes care of their problems.

So, if you are having any contact lens related problems, it is recommended that you seek the advice from an eye care professional, certainly someone who specializes in contact lenses. Your eye doctor can examine your eyes and contact lenses and make the proper recommendations to improve your situation with contact lenses.

Brendon J. Weaver, O.D.
Berks Eye Physicians & Surgeons, LTD.
1802 Papermill Rd.
Wyomissing, PA 19610
610-372-0712askdoctorweaver@yahoo.com

Computer Vision Syndrome (CVS)

2008-07-14T11:53:00.001-04:00

Computer Vision Syndrome

By Brendon J. Weaver, O.D.

As people continue to become more reliant on technology, computer use is increasing among all age ranges, especially with baby boomers and seniors. Whether it’s for playing games, entertainment, e-mail, news, weather or general information, using computers can be a time-intensive hobby. As the recent years have passed, you may have found yourself using the computer more and more. With this continued computer usage, you may be unknowingly suffering from computer vision syndrome (CVS).

Computer vision syndrome involves fluctuating, doubled or blurred vision, eye redness and dryness, eye strain or fatigue, and headaches. Some people develop one or many of these symptoms, which can arise after a few hours or as quickly as a few minutes. Even if you are wearing updated corrective lenses (eyeglasses or contacts), you can still experience CVS.

There are two main causes to computer vision syndrome. One reason is a problem with an eye’s ability to accommodate, or to focus properly. The other problem is the ability of both eyes to work well together, to form a single, clear image. This usually occurs when your eye muscles weaken or get tired. Whether it is late in the day or you are doing excessive reading or computer work, one or both of these functions may break down and cause the numerous symptoms of CVS.

The best way to relieve eyestrain is to have your vision evaluated by an eye care professional, so that he/she may be able to examine your eye muscle function and your ability to accommodate. Your eye doctor may recommend a separate pair of eyeglasses for computer tasks, to make everything more clear and comfortable. But there are other things that you can do on your own to alleviate symptoms of extended computer use.

The main goal is to minimize glare. Sometimes you can’t change the position of the computer monitor. But if you can, position the monitor directly in front or slightly below eye level. This minimizes reflections from lights on the ceiling. There are also anti-glare screens that can be placed on the monitor, but you can also adjust the brightness and the contrast levels to make the viewing area more comfortable to your eyes. Also, you should check the refresh rate level of your computer screen. If it’s too low, the screen will flicker and be very bothersome. A refresh rate level of 70 Hz or higher should be adequate. Finding the right resolution of the monitor’s display is also important. High resolution is best, but sometimes if it’s too high, the print and pictures may appear very small.

Unwanted light reflections can add to glare issues and CVS. If possible, use window blinds or curtains to reduce bright reflections of incoming sunlight. Desk lamps should be pointed away from your eyes and the computer screen to also reduce glare.

It is important to remember to blink regularly and keep your eyes from drying out. When people concentrate—either from reading or looking at a computer screen—their eyes tend to become dry, usually a result from a decrease of their normal blink rate. You can also use artificial tear lubricating eyedrops (brands such as Systane, Refresh, Optive work well) if your eyes feel dry or tired, especially if you are a contact lens wearer. Taking scheduled breaks from staring at the computer screen will also allow your eyes to relax. Optimally, it would be great to take a 5-10 minute break and look away from the computer screen into the distance for every one hour of computer work.

These are just some of the tips recommended for computer vision syndrome. First and foremost, if you suffer from symptoms relating to CVS, I would strongly recommend that you get your eyes checked out from an eyecare professional. Any slight blur in your eyeglass or contact lens prescription will cause symptoms of CVS, and updating your prescription may be enough to alleviate your complaints. But if you are still having problems after seeing your eye doctor, feel free to try some of the tips mentioned above to see if you notice an improvement.

Contact:
Brendon J. Weaver, O.D.
Berks Eye Physicians & Surgeons, LTD.
1802 Papermill Rd.
Wyomissing, PA 19610
610-372-0712
askdoctorweaver@yahoo.com

Uh oh! Flashes and floaters!!!

2008-07-14T11:51:00.002-04:00

Dear Dr. Weaver,

A few days ago, I experienced an episode of flashing lights that lasted for a few seconds. The flashes have since gone away, but now I see a very large, annoying dark spot in my vision, which moves back and forth, but never goes away. What’s going on?

Sincerely,
Becky

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Dear Becky,

Any symptoms of new floaters or flashing lights can be a result of serious conditions involving the retina. So if you have not seen an eye professional regarding this, please do so immediately.

Floaters are usually a result in a change of condensation of the vitreous, which is a clear gel-like material housed within your eye. The vitreous gel is formed in your eye since birth, and some changes can occur to that gel as you age. Once a uniform, consistent material, portions of the vitreous can “break-down” and “pull-away” from the retina in the back of the eye. When light enters the eye, the areas of condensed vitreous develop faint shadows on your retina. Most people notice small dark specks or strands that move back-and-forth in their vision. The reason for this is because the vitreous is freely movable inside the eye, which allows the “floaters” to bounce around or “float” in your visual field.

Most people who are nearsighted (myopic) commonly have floaters, due the anatomy of their eye. The floaters are highlighted most when looking into the sky, peering at a computer screen, or when reading a book or magazine. After a period of time, the brain develops the ability to ignore the annoying floaters. However, the formation of any new floaters is of concern.

The most common condition affecting the vitreous due to aging is called a Posterior Vitreous Detachment, or PVD. The initial symptoms include repeated flashes of light followed by the formation of a large, globular or ring-shaped floater. I mentioned before that the vitreous is freely moveable in the back of the eye, but it is attached to a few areas of the retina. One of these locations is near the optic nerve. As the vitreous pulls away from the area near the optic nerve, the tugging or traction causes the appearance of flashing lights. Once the vitreous finally pulls away, there is no more traction, so that is why the flashing light subsides. But once the vitreous does pull away, there is a large area of condensed vitreous that contributes to the large floater. This floater is very annoying, because it is new and it is very close to the center of your vision. The floater does not go away; it is there indefinitely, but your brain learns to ignore it over time, which can take weeks to months.

The major concern when people notice flashes and floaters are that those symptoms could reflect a serious problem occurring with the retina. The three main conditions are retinal holes, retinal tears and retinal detachments.

A retinal hole is a small opening in the retina, which could be caused by trauma or the tractional force of the vitreous. The formation of a retinal hole can cause a brief flash of light, followed by a floater. However, these changes usually occur at the edge of the retina and do not always show any symptoms. The symptoms and causes of a retinal tear are also similar to that of a retinal hole, but the flash of light may appear more light a lightening streak. Treatment for either can include monitoring the area, but is usually involves the application of laser treatment around the hole/tear to seal it off from causing a retinal detachment.

A retinal detachment is a serious eye condition that is vision threatening. This is when the retina actually lifts off from the back surface of the eye. With a retinal tear or hole, fluid can actually seep through the opening of the retina and lift it off. When this occurs, symptoms can include flashes, a large shadow and/or loss of vision. Referral to a retinal specialist is recommended immediately for surgical repair, but if vision is affected, there is a possibility that the vision may not be restored to its original state.

Flashing lights do not always indicate a problem with floaters or the retina, but it usually does. Dryness from contact lenses, the optical material of eyeglasses, cataracts or any diseases or dystrophies of the cornea, can contribute to an uneven focusing of light, depending on the angle at which the light enter the eye. The type of small flashes associated with this is usually only noticed at night or dark environments, but not always.

If you are experiencing any light flashes or floaters that seem new or unusual, it is urgent that you obtain a comprehensive eye examination, including dilation. The dilating drops allow the eye doctor to get a more complete view of the retina and the back of your eye. He/she may then diagnose your symptoms more appropriately and refer you to a retinal specialist if any treatment is needed.

Eyeglasses, Tints, Special Coatings, Bifocals Article

2008-02-18T15:07:00.003-05:00

Article about Eyeglasses from The Second Wind

Dear Doctor Weaver,

I recently had my annual eye exam, and I have a lot of questions about getting new eyeglasses. My doctor recommended special features for my new bifocals to improve my problems with night-time driving and light sensitivity, but I’m confused about all of the different coatings and tints. Could you help explain what he’s talking about so that I can make a better decision about my new glasses?

Sincerely,
Frank

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Dear Frank,

When getting new eyeglasses, it can be daunting when trying to decide what kind of special tints and coatings you need on your eyeglass lenses, let alone selecting the style of frame that goes with them. I do not know your specific eye history, but I will give a general description of the special eyeglass lens options to help you make an informed decision.

The first choice is to decide between a bifocal and a trifocal option. A bifocal lens allows you to see at two separate points, far distance (driving, watching TV) and near (usually between 12 to 16 inches). A trifocal has a third section in the middle portion of the lens that allows a clearer view of an intermediate distance (between 2 to 3 feet) that is typically “washed-out” or blurred when trying to look through bifocals. The typical bifocal and trifocal are called “lined” bifocals or trifocals, because there is an actual line that is visible on the lens that separates the distance and near portions of the lens.

The next decision involves either choosing the “lined” bifocal/trifocal or going with a “no-line” progressive lenses. There are benefits to both types of lenses. With a line bifocal/trifocal, it is usually easier to switch between the reading and distance portion of the lens. The “lined” bifocals/trifocals are also usually less-expensive compared to the specialty design of progressive lenses and have a quicker adaptation period.

Progressive lenses are cosmetically appealing, because there are no lines visible on the lens. These types of lenses also provide the most complete range of vision, allowing you to see from far distance all of the way to your reading vision, depending on where you look through the lens. People typically had trouble adapting to the older styles of progressive lenses. However, progressive lens designs have gotten better over the last few years, causing less distortion and better adaptation.

After selecting the type of bifocal you would like, there are different types or lens materials, coatings and tinting options. What you decide on depends on your lifestyle and the type of work and hobbies in which you participate.

Most lens materials are made out of plastic, which is very safe, but not shatter-resistant. If you do a lot of work that requires a great deal of eye safety, polycarbonate is the most shatter-resistant material available. Children and those who are monocular should be in this material because it is the safest lens option. And in case you were wondering, glass lenses are still available. It is the most expensive option and most places have switched over to prescribing plastic and polycarbonate lenses due to their lighter weight and their safety. A high index plastic lens is lightweight and thinner than all other lens materials. Individuals with a very high prescription always had to deal with thick lens edges in glasses that would weigh heavily on the bridge of the nose. The high index can be used for any prescription, but it is especially recommended for those individuals with high prescriptions to allow the glasses to be lighter and more cosmetically appealing.

If you use your glasses extensively, or tend to throw them around a bit, you may want to consider a scratch-resistant coating. This can be placed on any type of lens material, but is always recommended for polycarbonate, since it tends to scratch more easily than other materials.

I always recommend an anti-reflective coating, which is also called an anti-glare coating. This coating reduces reflections on the eyeglass lenses, and helps in a variety of ways. The anti-glare coating reduces night-time glare from headlights or streetlamps, reduces eye fatigue from moderate reading or computer use, and can reduce light sensitivity during the day and at night. Some people refuse getting this because the coating “flaked-off” or “pealed-off.” Older types of coatings would do this after a few years. However, some of the new coatings are actually molded into the material itself, so that this problem is not a major issue anymore.

If you are outdoors a lot, you may want an ultraviolet coating, or UV coating. This is not a tint. It is a clear coating on the lens that protects your eyes while you are outside from harmful UV rays. From certain eye studies, UV rays are thought to play a role in the development of macular degeneration and cataracts. The UV coating is also a great option to help protect against any eye and eyelid lesions that can develop from extensive UV exposure.

Tinting is also a great feature if you spend a lot of time outdoors or are a person who is light sensitive. There are solid tints that are same color throughout the whole lens and graded tints that are darker at the top and lighter at the bottom of the lens. There are also many different color options when prescribing a tint. Certain colors are preferable to specific activities, such as fishing, hunting and playing golf to enhance contrast and reduce glare. There are also lenses that darken when activated by sunlight. These types of lenses are called transitions, or photograys. The older style of these lenses used to take a long while when changing from dark to light, but the newer technology allows this change to occur much faster.

Polarized lenses reduce the amount of reflected glare, allowing for clearer vision and reduced light sensitivity. It is definitely recommended for boaters or fishermen to reduce the issues caused by the sun reflecting off of the water’s surface. However, polarized lenses also reduce glare for many other activities, such as driving, skiing, golfing, and running.

So, as you can see, the added features are very helpful in a variety of ways. Your eye doctor, along the help with the optical department, can assist you in selecting the special features that would aid you the most.

Ocular Allergies, Allergic Conjunctivitis

2008-02-18T10:46:00.003-05:00

Article about Ocular Allergies from The Second Wind

Dear Doctor Weaver,

I’ve been having a real problem with allergies this year, but the over-the-counter eye drops I typically use aren’t working well. Is there anything that you would recommend to help me out?

Sincerely,
Judy

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Dear Judy,

As you are already aware, Berks County is synonymous with allergies. The pollen from the blossoming plants in the Spring to the mold of decaying leaves in the Autumn can affect Berks County residents all year long.

The hallmark symptom of allergic conjunctivitis is itching. Other common symptoms include excessive tearing, as well as redness and swelling of the conjunctiva and eyelids. Many individuals seek ocular allergy relief with over-the-counter eye drops, but most non-prescription drops have a short duration of action, can cause rebound redness, and can potentially cause symptoms to last longer than they should.

Your primary care physician may also prescribe oral anti-histamines if you suffer from seasonal allergies. These medications work very well to reduce the systemic symptoms of allergies, such as congestion, sneezing, and runny nose. However, the action of the oral anti-histamine medications can actually cause dry eye symptoms to occur, which can mimic allergic conjunctivitis. These added symptoms can include irritation, burning, tearing, and foreign body sensation, which are especially dreadful to contact lens wearers.

The simplest way to self-treat mild allergic conjunctivitis is with the use of lubricating, preservative-free artificial tears and cold compresses. The artificial tears should be preservative-free because some preservatives can cause a sensitivity reaction to cause redness and irritation. The artificial tears will wash away the allergens that can accumulate on the surface of your eye and in your natural tears. The cold compresses helps to constrict the blood vessels to decrease the amount of redness and also aids in reducing swelling and itching.

If this doesn’t help, and your over-the-counter eye drops aren’t relieving your symptoms, I would seek an eye examination in order to obtain a prescription allergy eye drop medication. Your doctor will probably prescribe a combination allergy eye drop that is a mast cell stabilizer and an anti-histamine. These two mode of actions greatly reduce symptoms of acute ocular allergy in a short amount of time. If you suffer from chronic allergies, your eye doctor may also add steroid eye drops to relieve your symptoms.

The ocular allergy treatment is tailored to each individual, so what may work for someone may not work for you. So if your over-the-counter eye drops aren’t working, I would take a break from them and use plenty of cold compresses and preservative-free artificial tears. Then, if you are still having issues, go seek an eye examination to obtain professional advice and treatment.

Diabetes and the Eyes

2008-02-18T10:44:00.002-05:00

Dear Doctor Weaver,

Recently, I was diagnosed with diabetes and my family doctor recommended that I get an eye examination. Could you please explain?

Sincerely,
Felicia

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Dear Felicia,

Diabetes is a condition that affects your entire body. It is a result of the body not being able to regulate appropriate blood sugar levels, due to the poor production or deficient activity of insulin. Your doctor has probably explained to you the different types of diabetes, which are type 1 (insulin dependent) and type 2 (non-insulin dependent).

Those with type 1 require the use of insulin to modulate suitable blood sugar levels in the body. Individuals with type 2 typically have the ability to control their blood sugar levels by changing their lifestyle habits, by eating a healthy diet, losing weight and exercising. If the blood sugar levels are still high, oral medications would be used to control blood glucose.

The best way to see if your blood sugar levels are in the normal range is to see your family doctor for a physical evaluation. Your doctor would then order blood tests that would include a fasting blood glucose and hemoglobin A1c. The fasting blood sugar is taken in the morning, prior to eating anything that day. This is similar to the home-screening tests that diabetics have to monitor their blood sugar levels throughout the day. The fasting blood glucose shows how your body processed sugar from your diet the day before. The hemoglobin A1c provides greater information to the physician, for it shows how well your body processed glucose over the previous three months.

Uncontrolled blood sugar from diabetes can cause cardiovascular disease with an increased risk of stroke, neuropathy that can result in limb amputations, kidney failure, skin ulcerations, depression, ocular complications, as well as many other problems.

The most common ocular complication is fluctuating vision. If a patient has diabetes and comes in for an eye examination, it is important for his/her blood sugar levels to be normal and stable to get an accurate eyeglass prescription. If the patient had high or fluctuating blood glucose the time of the exam, his/her vision will change when the blood sugar level normalizes. Therefore, the eyeglasses prescribed during the eye exam would be useless.

More seriously, diabetes affects the eyes by causing the blood vessels in the retina to become “leaky.” Early changes in the retina from diabetes would include microaneurisms and very small, pinpoint hemorrhages, called diabetic retinopathy. These signs usually resolve in time, and do not progress as long as the blood glucose is maintained at normal and stable levels. If the blood sugar remains high or fluctuates, the blood vessels can allow even more fluid to escape, which can cause retinal edema that can potentially result in vision loss or even blindness. These advanced changes in the retina would require co-management with a retinal specialist for treatment.

Diabetes can also accelerate the formation of cataracts as well. If you remember from a previous article, cataracts cause decreased vision as well as light sensitivity problems, such as haloes and glare. If glasses or contact lenses no longer provide clear, crisp vision, cataract surgery would be recommended.

High uncontrolled blood sugar levels can also cause the formation of new “leaky” vessels in a process called neovascularization. The vessels can grow in different parts of the eye. If in the retina, they can contribute to fluid accumulation or large hemorrhages in the retina. The neovascularization can also occur in the iris and in the angle, the drainage area of the eye. This will raise the intraocular pressure and cause neovascular glaucoma, which is a severe form of glaucoma that can lead to blindness.

It is advised for those with diabetes to have an annual dilated eye examination to monitor for any ocular changes related to this disease. It is possible that many of these signs can occur with no symptoms experienced by the patient, so it is important to seek routine care with your eye doctor and family physician to ensure that diabetes is diagnosed and treatment is initiated when necessary.

Glaucoma, What is it?

2008-02-14T13:17:00.002-05:00

Article from The Second Wind

Dear Dr. Weaver,

A few of my friends have mentioned to me that they were recently diagnosed with chronic open angle glaucoma. I haven’t had an eye exam in years. So, I was wondering how I can tell that I’m developing glaucoma.

Sincerely,
Edith

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Dear Edith,

Chronic open angle glaucoma is an insidious disease that damages the optic nerve over a period of time. The optic nerve contains millions of nerve fibers leading from the retina to the brain. Damage to the optic nerve from glaucoma affects these nerve fibers, which thereby affects a person’s vision. The nerve fibers responsible for a person’s peripheral vision are lost first. Since people are not usually susceptible to vision changes in their peripheral visual field, the loss of these nerve fibers go unnoticed. Eventually, prolonged damage to the optic nerve causes more and more of the retinal nerve fibers to lose function. When the disease is quite advanced, glaucoma will start damaging the nerve fibers responsible for a person’s central vision. This is when aggressive treatment must be initiated as soon as possible, because any vision that is lost is not recoverable.

When you go in for an eye examination, the eye doctor is looking for a multitude of risk factors that would indicate that you have glaucoma or are a suspect of developing glaucoma. Some of these risk factors are a high intraocular pressure and cupping (loss of nerve fibers) of the optic nerve. Other risk factors are increased age and a family history of glaucoma.

To gain more information about a person’s risk of developing glaucoma, the eye doctor will usually order a battery of tests. These typically include a peripheral visual field test, a photo or computerized scan of the optic nerve, a scan of the nerve fibers in the retina, and an ultrasound of the cornea to determine its thickness. After interpreting all of this information, the doctor will then determine if treatment is necessary.

The only risk factor that the doctor can directly control is the intraocular pressure. The goal is to lower the pressure inside the eye to a level that the doctor believes will reduce or halt damage to the optic nerve, to preserve as much remaining vision as possible. What may be a high pressure for one person may be entirely normal for someone else. Everyone is different, so the treatment also differs.

The pressure inside the eye can be thought of as water in a kitchen sink. Controlling the amount of fluid (water level) in the eye is the inflow (faucet) and the outflow (drain). When the intraocular pressure increases, this occurs by too much water coming into the sink, something clogging the drain, or a combination of both. This eye pressure can be reduced with prescription eyedrops that act on both the inflow and outflow mechanisms to lower the eye pressure. However, patient compliance with using eyedrop medication daily can be an issue, especially since the patient usually has no symptoms in early glaucoma. Poor control results in a higher intraocular pressure, allowing glaucoma to progress. If the pressure is not controlled well, your eye doctor may also recommend a non-invasive procedure involving laser treatment to increase the outflow to lower the intraocular pressure. It is possible that a person may still require eyedrops after laser treatment, depending on how well the intraocular pressure was lowered.

Glaucoma is one disease out of a multitude of eye conditions that exhibit symptoms only when it is very advanced and severe. Individuals diagnosed with glaucoma and treated appropriately can live their entire life without any noticeable vision loss. It is extremely important to seek an eye exam yearly so that your eye doctor may ensure that your eyes are healthy, or to establish a treatment regimen to preserve the vision that you have.

Cataracts and Cataract Surgery

2008-02-14T13:06:00.004-05:00

Article from The Second Wind

Dear Doctor Weaver,

Recently, I was told by my eye doctor that I have cataracts. It was recommended that I get cataract surgery, but I am very nervous about any form of eye surgery. What exactly is a cataract and can you share any information to help relieve my apprehensions about surgery?

Thanks,
Marion

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Dear Marion,

Everyone is born with a natural lens inside each eye. Like a camera lens, this natural lens focuses light and images that allows you to see. During childhood, this natural lens is very clear. As a person ages, the lens can change in shape, size, and color.

There are many different types of cataracts that affect different parts of the lens. Cataracts can be a darkening/clouding of the color of the lens or a physical change of its surface. Either of these changes affects the quality of vision by scattering light or letting less light into the eye.

Cataracts develop for many reasons. Some studies believe that long-term UV exposure contributes to the progression of cataract development. Systemic conditions, such as diabetes, also affect metabolic processes that cause cataracts to form more quickly. Injuries, such as blunt trauma to the eye, can also cause cataracts to develop. Typically, cataracts are an age-related condition, which means that the longer a person lives, the more likely he/she will develop cataracts.

When cataracts form, vision that was once clear now becomes hazy or blurry. Some people notice this especially when driving at night. During dark light conditions, the pupils dilate. This occurs to allow more light to enter the eye in order to see better at night. However, a cataract scatters light and reduces the amount of light entering the eye, which leads to the night-driving complaint or halos and glare. Cataracts also cause problems with vision during the day as well. Bright sunny days (especially with snow-covered ground) can cause a high amount of glare that makes it difficult to see comfortably.

Initially, when a cataract develops, this can cause a change in the shape of the lens. This, in turn, causes a change in a person’s eyeglass or contact lens prescription. So, if a patient comes in for an eye examination with a blurry vision complaint and early cataracts are present, the patient may only require a change in his/her eyeglasses to make things clearer. But when cataracts advance and cause an increase in the darkening/clouding of the natural lens, the vision is blurred because less light is entering the eye, not because the prescription has changed. At this point, cataract surgery is typically recommended.

Cataract surgery involves the removal of the natural lens (containing the cataract) and replacing that with an artificial lens implant, called an intraocular lens. The power of this lens is carefully calculated based on non-invasive measurements that are performed at the surgeon’s office. There are two types of intraocular lenses: monofocal and multifocal. Monofocal lenses allow you to see at distance, requiring the use of bifocals or reading glasses to allow you to read up close. The advancement of new technology has allowed multifocal lens implants to provide both distance and near vision, possibly eliminating the need for eyeglasses completely.

During the surgery, a very small incision is made and typically no stitches are required. Cataract surgery used to require an overnight stay in a hospital, but now, it is an out-patient procedure performed at a surgical center. The actual surgery takes only about 10-15 minutes. The patient returns for regularly scheduled follow-up visits to ensure that the vision is acceptable and to monitor for any ocular complications. All patients are given drops to use routinely before and after the procedure to help minimize infection and inflammation. Typically, a new eyeglass prescription is determined one month after cataract surgery if needed.

To conclude, cataract surgery is an elective procedure. Your eye doctor may make a recommendation for surgery based on his/her findings, but the ultimate decision is up to you. Cataracts definitely affect the quality of vision as well as quality of life. So if you have cataracts and you are not seeing well with your current eyeglasses, I would recommend that you make an appointment with your eye doctor to review his findings with you and go from there.

Dry Eye, Artificial Tears, Other Treatment Options

2008-02-14T11:18:00.008-05:00

Newspaper article from The Second Wind

Dear Doctor Weaver,

Recently, I have been experiencing a lot of dryness in both of my eyes. Is there anything that you would recommend? And why do my eyes seem to feel worse during the winter months?

Margaret

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Dear Margaret,

Dry eye can cause many symptoms, such as burning, tearing, redness, foreign body sensation, irritation, and temporary blurred vision. Many people experience dry eye symptoms all year-round, with certain periods of the year being more bothersome. Some people are affected by environmental conditions, such as the wind and decrease in humidity found during the winter. Others are affected by dry air heat that is commonly found in most homes and work environments. In either case, there are many solutions that can help you out.

The easiest solution is the use of artificial tears, or lubricating eye drops. These eye drops are formulated to coat the front surface of the eye like your natural tears. Such name brands include Systane, Refresh Tears, Bion Tears, and Tears Naturale, just to name a few. Most come packaged in a multi-dose bottle. However, some people are sensitive to the preservatives that are found in this kind of packaging. For those individuals, there are single-dose vials that do not contain any preservatives, which may feel more comforting to the eye.

These over-the-counter eye drops can be used on a regular bases (such as four times a day) or as needed. There are also gel formulations (ointments) that are more viscous. The thicker gel tends to blur vision more so than the lubricating drops, which is why it is typically reserved for use right before bed and first thing in the morning.

But if you’ve already tried these products, and are still having problems, there are other options available.

If you are a contact lens wearer, you should consider changing lens materials if you haven’t already done so. The newest technology for contact lenses now allow much more oxygen to travel through the contact lens to the eye, drastically reducing symptoms of dryness. Such examples of these contact lenses are Ciba’s Focus Night & Day, Bausch & Lomb’s Purevision, and Vistakon’s Acuvue Oasys.

However, even changing contact lenses may not be enough. The truth is, as the body ages, changes in the anatomy occur everywhere, including the eyelids. It is possible that the natural oil glands of the eyelids aren’t producing enough tears, or possibly that those tear ducts are clogged. Using a hot wash cloth on the eyelids while the eyes are closed sometimes stimulates tear production and unclogs static oil glands. Doing this on a routine basis, such four times a day for five minutes at a time, usually helps.

There are oral nutritional supplements that have been found to be beneficial for people suffering from chronic dryness. These over-the-counter supplements include Theratears Nutrition, Dry Vites, and Hydroeye to name a few. They basically contain omega-3 fatty acids, which are thought to keep the tear production system healthy. A diet can be changed to include more omega-3 fatty acids, or using the nutritive supplements containing flax seed oil or fish oils would also work.

It has recently been discovered that dry eye symptoms can be the result of inflammation. If you have tried over-the-counter drops and gels and are still having symptoms of dryness, you should seriously consider seeing your eye doctor for more specific treatment. Your eye doctor may prescribe a low-dose steroid eye drop in addition with your lubricating drops to help control this inflammation. He/she may also prescribe a topical cyclosporin medication called Restasis to help with moderate/severe dry eye.

Essentially, dry eye symptoms can occur in anyone, at any time of year. If left untreated, it can cause unnecessary discomfort and vision problems. It is recommended that you consult with your eyecare professional for guidance and assistance in this matter.

Contact Lenses, Monovision and Multifocals (Bifocals)

2008-02-14T11:06:00.005-05:00

Article from The Second Wind

Dear Dr. Weaver,

I used to wear contact lenses many years ago, but once I started wearing bifocal glasses, I had to give up on wearing contact lenses. I was wondering if there are any options out there for me, because I would love to give up wearing eyeglasses altogether.

Sincerely,
Maggie

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Dear Maggie,

My first recommendation would be to get a contact lens exam from an eye care professional to review your options. There are many contact lens options for individuals in your situation. As long as your eyes are healthy and you have a desire to get back into wearing contact lenses, it doesn’t matter what age you are. Even for people who have never worn contact lenses, it’s never too late to try.

There have been advancements in contact lens design and convenience since you discontinued wearing contact lenses. Both the rigid gas permeable lens type and soft contact lens type are still available, but they are made with more “breathable” materials, allowing more oxygen to reach the front of the eye. This “breathable” material reduces symptoms of dryness, redness, burning, and irritation; some of the main reasons why people stop wearing contact lenses in the first place.

However, some people stop wearing contact lenses because they can no longer read or do any close work without using a pair of magnifying reading lenses. This creates the hassle of having to wear contacts in combination with glasses. This goes against the reason why people switch to contact lenses in the first place; so they don’t have to wear glasses. So what can be done about this?

As everyone ages, the eye’s ability to focus gets weakened. This is the reason why most people depend on some form of magnification for close work, such as reading glasses or bifocals. Recently, there have been new options with multi-focal (or bifocal) contact lenses. Most patients fitted with these types of lenses still maintain excellent vision, enough to be legally allowed to drive at night as well as read newspaper size print. However, your eye doctor may require you to return for follow-up visits to fine-tune your vision at distance and/or near. These lenses usually work 100% of the time for all vision tasks. But certain light situations (like a dimly lit restaurant) or the size of the print you are trying to read (stock listings in a newspaper’s business section) may require a mild boost in the magnification by adding the use of low power reading magnifying lenses.

Another option that is available is called “monovision.” This describes the use of contact lenses, where one eye is optimized for distance and the other is prescribed for near. As with multi-focal contact lenses, this option usually requires an adjustment period, just like any new pair of eyeglasses.

The adaptation to monovision and multi-focal contact lenses is variable. Basically, you won’t know if it works or not unless you try it out. So if you are willing to get back into wearing contact lenses, or if you are doing so for the first time, set up an appointment with an eye doctor that specializes in contact lenses so that he/she can review options that are best for you.

Age-Related Macular Degeneration (ARMD)

2008-02-14T09:27:00.006-05:00

Newspaper article from The Second Wind

Dear Doctor Weaver,

I have a relative that was recently diagnosed with macular degeneration. What is the risk of getting this disease? Also, I’ve heard that there are two types, dry and wet. What’s the difference and is there any treatment for either?

Annie

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Dear Annie,

Macular degeneration describes a condition in which the area of the retina responsible for your central vision (the macula) undergoes changes. Essentially, the longer that you live, the more likely you are to develop macular degeneration. Also, long-term UV exposure has been thought to be a risk factor for macular degeneration. Individuals with high blood pressure, high cholesterol and heart disease also have a higher risk. Current smokers or any history of smoking has been shown to increase the risk of developing the disease.

There is a normal pigment contained beneath the retina called the retinal pigmented epithelium (RPE), and macular degeneration causes a change in this pigment as well as the formation of crystal-like deposits of varying shapes and sizes called drusen. This actually causes damage to the nearby retina, resulting in blurry or distorted central vision. This is called Dry Age-Related Macular Degeneration. Sometimes, this damage can also result in the formation of fluid (edema). When this occurs, the condition is named Wet Age-Related Macular Degeneration.

The dry form requires careful monitoring by an eyecare professional. If there are signs of early macular degeneration, the patient may be given a testing device containing crossed lines, like a checkerboard. This is called an Amsler Grid. Following the instructions of the doctor, the Amsler Grid is checked every day for any perceived changes in those crossed lines and is an important tool in detecting any subtle change in vision. There is no surgical treatment for dry macular degeneration. However, there was a study called the Age-Related Eye Disease Study (AREDS) that showed a certain combination of specific vitamins could slow down the progression of advanced disease. Two common over-the-counter multivitamins include Ocuvite Preservision by Bausch & Lomb and ICaps by Alcon. (You should first consult with your eye doctor if any of these multivitamins are right for you.)

The wet form requires the referral to a retina specialist for evaluation and treatment. The development of fluid greatly increases the risk of retina damage, which can lead to blindness. The fluid typically develops from the formation of leaky blood vessels that grow in the macula as a response to the degenerative changes. A retina specialist may use a laser to seal off the leaky blood vessels to reduce the fluid accumulation. An injection with a steroid or a compound that prohibits blood vessel formation may also be used.

To conclude, it is important for you to get a yearly eye examination in order to detect any signs of macular degeneration, or any other eye conditions that can cause blurry vision. Any history of smoking increases the risk of developing macular degeneration, so halting this habit is beneficial to the health of your body and eyes. Also, seeing your family doctor on a regular basis will allow him/her to diagnose, treat and monitor health conditions (such as high blood pressure, high cholesterol and heart disease) that are risk factors for macular degeneration.