Hybrid Contact Lenses

Contact lens technology has come a long way with new designs and materials.  Contact lenses were first “hard”, made of a non-permeable to oxygen material.   Rigid gas permeable (RGP) contact lenses then followed allowing more oxygen through the lens and to the eye.  Soft lenses soon emerged offering increased comfort and tolerability.  And now, we have hybrid contact lenses.

What are the Benefits of  Hybrid Contact lenses?

Hybrid contact lenses combine the benefits of both rigid gas permeable contact lenses and soft contact lenses all into one lens.  It has the all-day comfort of a soft contact lens and it has the crisp and stable vision a rigid gas permeable contact lens provides, all in one oyygen breathable contact lens material that rigid gas permeable contact lenses are known for.

The center of the lens is made of a rigid gas permeable (RGP) material and the lens has a soft skirt that extends from the central RGP.   The  RGP corrects vision while the soft skirt gives the all-day comfort of a soft contact lens.  RGPs are able to provide crisp and stable vision because they can correct corneal astigmatism and their optics are unaffected by blink or gaze shifts.  Blink or gaze shifts may produce unstable or fluctuating vision in some soft toric contact lens wearers because blinking could make the lens rotate on the eye causing some patients to experience unstable vision correction.   Hybrid contact lens wearers are unaffected by these lens rotations or blink or gaze shifts providing consistently clear vision all the time.

Who can Benefit from Hybrid Contact Lenses?

• Anyone with astigmatism or those currently using soft-toric lenses to correct astigmatism and are dissatisfied with their vision.
• Current RGP wearers who are dissatisfied with their comfort and are seeking improved comfort.
• Current Soft multifocal and monovision contact lens wearers who are dissatisfied with their close-up or far vision or who have astigmatism and are currently dissatisfied with their vision or who are seeking improved vision at all distances.
• Current contact lens wearers who want their vision corrected for both far and near, or who have tried multifocal contact lenses and were either dissatisfied with the vision it provided or with its comfort.
• Any new contact lens wearer desiring the benefits of both RGP and soft all in one lens.

Many things need to be considered when selecting the type of contact lens that may be right for an individual including one’s lifestyle, work,  physical activities and vision correction needs. 

There are new options to consider that may better fit your needs even if you currently wear contact lenses or if you’ve been told you cannot wear contact lenses.  With newer available designs and materials, it may now mean you could start to enjoy wearing contact lenses.

emPower! Electronic Focusing Eyeglasses

emPower! is the world’s first electronic eyewear that will allow the wearer to have the type of vision they need, when they need it.  If you currently wear bifocals or progressive lenses, emPower! will transform the way you see and give you unprecedented control over your vision.   emPower! allows you to control when you want your reading zone of your lens on or off.  The ability to electronically turn off the reading zone with a push of a button, allows you to do simple things like walking down the stairs or play golf without the typical blurriness you have experienced with other lenses – you can see the ground!  While progressives can produce distortion and restrict your field of vision, emPower! solves this problem by allowing you to turn the reading zone on or off as needed.  Using LCD technology, you can tap the frame to turn the reading zone on and off,  or  activate an accelerometer in automatic mode to trigger the change with a tilt of your head. 

empower! technology is found in many of today’s high-end consumer electronics, including composite lenses with a thin transparent LCD layer, microchips, accelerometers and rechargeable batteries.

empower! lenses have two modes of operation: automatic and manual.  In automatic mode, the switch between full or partial reading prescription depends on where the wearer looks.  The wearer looks down and the full reading prescription turns on; the wearer looks straight ahead and the lens returns to the partial reading prescription – focusing in the blink of an eye.

In manual mode, the person decides when to adjust the glasses to a reading prescription.  Control of the manual mode is performed on the right temple of the eyeglasses and simply requires a tap of the finger.

Just like your cell phone, emPower! will need to be charged every few days.  Battery life will depend on the amount of usage of the electronic add zone.  Typically, a single charge should last between 2 and 3 days.  To charge, simply place the eyewear in the special charging tray; leave it overnight and it will be fully charged the next day.

Click the link below to learn more about this impressive and innovative product:

http://www.nbclosangeles.com/news/health/Eelctronic-Eyeglasses-128355373.html

Glaucoma

When it comes to our eyes, we have all heard of the term glaucoma in some way or other.  We may know of family and friends who have glaucoma and are being treated for it.  Some of us associate it with the air-puff test that measures our eye pressures inside our eyes during an eye exam.  There are several types of glaucoma.  In this article, I will only be discussing primary open angle glaucoma which forms about 90% of all glaucomas.

What is Glaucoma and what is the eye pressure inside the eyes?  Glaucoma is one of the leading causes of blindness in the United States.  Nearly 3 million people have it. Glaucoma is a group of eye diseases that damages the optic nerve inside the eye and thereby slowly and progressively causes vision loss.  It is caused by an eye pressure that is higher than the eye can endure.  This high eye pressure slowly damages the nerve cells in the optic nerve that is responsible for transmitting visual signals to the brain.  As more and more nerve cells are damaged, one progressively loses more side vision.  As the disease progresses, the loss in the side or peripheral vision gradually creeps into the central vision.  It is only when central vision is affected, does one notice the symptoms of vision loss.  Vision loss in glaucoma is irreversible.  Therefore, early detection and treatment is the only way to prevent further loss.  Glaucoma is also known as the “silent thief of sight”.  Additional risk factors of glaucoma are family history of glaucoma, age, race and ethnicity and having hypertension or diabetes.

Inside the eye, there is a constant eye pressure that maintains and keeps the eye structures healthy.  Fluid called aqueous humor is produced and it is drained through a structure called schlemm’s canal at the trabecular meshwork which is at the angle between the iris and cornea.  The production and drainage of aqueous humor maintains a normal eye pressure.  If more aqueous humor is being produced than can be drained or if there is an obstruction at the trabecular meshwork, the pressure inside the eye rises.  If the optic nerve cannot tolerate this higher pressure, damage to its structure and nerve cells will result in glaucoma.

Check out this video on more on glaucoma:

http://www.youtube.com/watch?v=BXC64Whs9KE&feature=youtube_gdata_player

How is glaucoma detected?  Since there are no symptoms of glaucoma in its early stages, glaucoma is usually detected during an eye exam.  The optometrist or ophthalmologist will look at the optic nerve with a special magnified lens with the use of a biomicroscope to detect any structural damage to the optic nerve.  The eye doctor will also measure the eye pressures inside the eye.  If there is any suspicion of glaucoma, a glaucoma workup visit will be scheduled so that additional testing and investigating can be done.

The glaucoma workup consists of several additional tests:

• Visual Field Testing:  The patient has his or her head placed in an instrument and he or she pushes a button every time a presented light can be detected using one’s side vision. The purpose of the test is to map out any peripheral or visual field loss. This test forms a baseline and is compared to further tests that are done in the future.  In glaucoma, one can have 50% nerve cell damage before it may start to affect the visual field.
• Dilated Exam:  When the eye is dilated, the optic nerve and its structures can be better viewed with increased detail and magnification.
• Gonioscopy:  A lens is placed on the patient’s eye so that the eye structures responsible for the drainage of fluid can be viewed for any obstruction that may be causing the increase in eye pressures.
• Central Corneal Thickness:  The central cornea thickness is measured with an instrument called a pachymeter.  Having a thin cornea is an increased risk factor for developing glaucoma.
• HRT, GDX and OCT:  These are a group of instruments that scans and measures the nerve fiber layer and optic nerve for any structural damage.
• Optic Nerve Photos:  Photos are taken of the optic nerves to establish a baseline and they are used to compare them with photos taken in the future.  Progressive optic nerve damage can be determined by this comparison.

How is Glaucoma treated and monitored?  If glaucoma is diagnosed, treatment is usually started with eye drops that will decrease the eye pressures to a level that hopefully does not cause further vision loss and optic nerve damage. 

How do we know that further vision loss and optic nerve damage is not occurring?  Follow ups every 3 months are necessary to check on the eye pressures to ensure the pressures are at the level they are targeted to be at,  and to make certain the patient is compliant with using the eye drops.  Visual field testing and an OCT, HRT or GDX are done every 6 months to monitor for any progressive vision loss or optic nerve changes.  If further loss is occurring, a second eye drop can be added to decrease the pressures further or a laser surgery procedure can be done.  It is important to realize that glaucoma is a disease that needs to be managed, monitored and followed-up upon.

Since glaucoma is usually detected at a routine eye exam, it is crucial that we get our eyes examined once a year.  In view of the fact that glaucoma is a progressive disease, it is imperative we remain compliant with using our drops and critical we do not miss our follow-up appointments.

Punctal Plugs for Dry Eyes!

Dry eyes is a chronic progressive eye surface disease that affects a large number of us.  There are a lot of risk factors and causes.  Inflammation on the eye surface and eyelids are some of the main causes of dry eyes.  This inflammation affects the ability of the eye to make good quality tears.   If the eye surface does not have good quality tears, the tears evaporate quickly off the eye producing dry spots and thereby resulting in dry eyes.

Another cause of dry eyes is the inability of the eye to produce a sufficient quantity of tears.  Tears drain through a small tear duct or opening in the eyelid called a puncta.  When more tears are drained through the puncta than can be produced by the eye, it results in dry eyes.

If we could somehow block the puncta with a medical device, we could prevent the tears from draining.  We would keep more of the tears on the eye surface and prevent the eye from drying out.  This medical device is called a punctal plug.   An optometrist or ophthalmologist can insert punctal plugs at their office and the procedure is painless and only takes several minutes. 

A temporary punctal plug is tried and inserted first.  They are made of collagen and are dissolvable.  This is to determine that the permanent ones will relieve the patient’s dry eye symptoms and that they do not cause excessive tearing.  The patient tries them for several days to ensure that their dry eye symptoms are indeed diminished.  When the punctal plugs dissolve, he or she should also feel their dry eye symptoms getting worse once again.  This confirms the effectiveness of the punctal plugs and the patient returns in 10 days to have the permanent ones inserted.

A primary reason for contact lens dissatisfaction and contact lens discontinuation is dryness and discomfort.  Dry eyes often gets worse if one is on the computer several hours a day.  The goal of managing contact lens related dry eyes and discomfort is to keep the patient in contact lenses and this involves medically managing the dry eyes.  Management may require quite a few follow-up visits and a number of treatment strategies and punctal plugs has certainly remained a successful and viable option to treat dry eyes.

Children’s Eye Exam and Why Your Child Needs One?

We are constantly hearing about the importance of children’s back to school eye exams.  Why are these exams so important?  What are we as eye doctors looking for?  What are we trying to prevent?

The reason that an eye exam is so important is that 80% of a child’s learning in school  is done through his or her eyes.  This means that if there is any kind of problem with your child’s eyes, your child’s learning in school may be impaired.

What are some of the eye problems or concerns eye doctors look for during a child’s eye exam? 

The first thing we will check is visual acuity to ensure the child has good vision in each eye.  If vision is good in each eye, then we have ruled out amblyopia or lazy eye, which is our number one enemy.  Amblyopia is a condition in which visual acuity is reduced in an eye and not completely correctable by glasses or contact lenses.  If vision is 20/30 or less in an eye, it is diagnosed as amblyopia or lazy eye. 

Another concern is strabismus where the two eyes are not aligned in the same direction at the same time.  Strabismus is commonly known as an eye-turn or squint. 

A further concern is anisometropia which is a significant difference in vision or refractive error between the two eyes.  What this means is that one eye is significantly more nearsighted, far sighted or has more astigmatism than the other eye. 

Amblyopia is caused by anisometropia, strabismus or high refractive error in one or both eyes.  Therefore, during a child’s eye eyam, we are not only looking for vision problems that are correctable with glasses or contact lenses, but we are also looking for amblyopia and its causes.

There is a 6.7% prevalence of amblyopia and strabismus and they are the most common visual abnormalities in children.  Approximately 50% of childhood strabismus starts within the first year of life, with the rest starting before the age of 5 or 6.  The earlier amblyopia is detected, the easier it can be treated.  This is because there is a critical period up to the age of about 6 or 7 during which visual development occurs where it is much easier to reverse the effects of amblyopia.  After this visual development period, it becomes more difficult to treat amblyopia although it is still possible.  That is why we hear of adults with a lazy eye whose vision in one eye cannot be fully corrected, even with their glasses or contact lenses.  The brain favors the retinal image of the good eye and starts to suppress the image of the bad eye.  When this happens, the visual cells in the bad eye do not fully develop during this critical visual development period.  The eye becomes lazy and amblyopia forms.  New research, however, has shown that adults have been able to correct their amblyopia with vision therapy.

Another eye disorder in children is retinoblastoma.  Retinoblastoma is an eye tumor that is screened for during an eye exam.  Children can also have congenital cataracts and other disorders.

The American Optometric Association recommends that a child’s eyes should first be examined at 6 months of age.  It is highly recommended that you have your child’s eyes examined at least before the age of 3 and again before the age of 5, and then every year thereafter.  Your eye doctor will use completely different methods and techniques during your child’s eye examination compared to the eye examination of an adult.

I hope this article helps illucidate the importance of the back to school eye exams that we hear so much about at this time of year and why it is so important to have your child’s eyes examined by an optometrist or ophthalmologist.

Meyer Izaac, O.D.

http://www.visionsource-izaaceyes.com/

 

 

Red, Itchy and Watery Eyes?

  Do you suffer from red, intensely itchy and watery eyes?  If you do, then you probably have eye allergies.  Your symptoms may run concurrently with a runny nose and you may blame it on a “cold” you keep getting when in fact you have allergies and don’t know it.

How do you know it is not pink eye or dry eyes?  Patients with pink eye report some itching.  Those with eye allergies describe intense itching.  Pink eye, which is usually caused by a bacteria or virus, typically starts in one eye and affects the other eye (although not as badly) after a few days.  By contrast, eye allergies involve both eyes from the beginning.

Bacterial pink eye causes a yellowish discharge and your eyelids may be stuck together in the morning.  Bacterial pink eye is most common in infants and toddlers whose immune systems are not yet fully developed, and in those with compromised immune systems, such as seniors.  Viral pink eye is generally accompanied by a watery discharge and other signs on the eye surface, such as follicles (or dendrites in the case of herpes viral infections that affect the eyes), that can be used by an optometrist or ophthalmologist to differentiate it from the bacterial form. Viral pink eye is the most common conjunctivitis seen in school-aged children.  Viral pink eye may also affect the lymph nodes.  More often than not, those with viral pink eye have been recently ill with an upper respiratory infection.

Both bacterial and viral pink eye are highly contagious and can be transmitted by contact with family or friends with recent pink eye.

The hallmark of eye allergies, on the other hand, is profound or intense itching causing the patient to rub his or her eyes very frequently and occasionally even with the knuckles.  This is not to be confused with dry eyes, where the patient may experience some minor itching,  but dry eyes typically present as a foreign body sensation, burning, grittiness and tearing and the eyes are not as red as they are with eye allergies or pink eye.  Dry eyes and eye allergies may go hand in hand — if you have dry eyes, then you don’t produce enough tears to flush out the allergens in your eyes, which may lead to eye allergies.  In such cases, your eye doctor may need to treat your dry eyes in order to treat your eye allergies.  If you have allergies or dry eyes, and you wear contact lenses, your best option is 1-day disposables.

Contact lens related red eyes are usually caused by poor contact lens hygiene and compliance, overuse of contact lenses, sleeping with contact lenses and allergic reactions to contact lens solutions.

Inflammatory conditions such as iritis or an auto-immune disorder such as rhuematoid arthritis etc. can also cause red eyes.

Often, patients see an optometrist or ophthalmologist for red or intensely itchy and watery eyes only after trying (unsuccessfully) over-the-counter eye drops.  However, over-the-counter eye drops will not treat bacterial or viral infections of the eyes, including herpes viral eye infections and chlamydia bacterial eye infections.  It is also important to be aware that some over-the-counter eye drops have vaso-constrictors in them: vaso-constrictors reduce redness by constricting the blood vessels in the eyes.   Although eyes may appear to be less red, the eye drops may not be treating the cause of the redness.  Further, sustained use of vaso-constrictors can actually cause rebound hyperemia – chronic red eyes. 

Anti-histamines, such as Claritin and Allegra, may help with eye allergies but they also dry up eye tissue, causing dry eyes. 

Eye allergies that lead to vigorous eye rubbing is not a good thing because there is an association between vigorous eye rubbing and a condition called keratoconus, a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and become more conical in shape.  

 

In conclusion, red eyes can be caused by:

• Infection – bacteria and viruses.
• Non infection – allergies and dry eyes
• Improper use of contact lenses and contact lens solutions
• Inflammation

The importance of seeing an optometrist or ophthalmologist for professional diagnosis and treatment cannot be over-emphasized.  An optometrist or ophthalmologist can prescribe drops that can provide relief from the symptoms of eye allergies within 3 minutes! OR, prescribe drops for bacterial ,  some viral infections of the eye, dry eyes or eye inflammations should that be the case.

So if you have red, intensely itchy and watery eyes, you now know that it may be allergies and not that same cold you keep getting.

Meyer Izaac, O.D.

http://www.visionsource-izaaceyes.com/

Keratoconus

Keratoconus causes a bulging of the cornea from its normal shape to a cone shape causing the person to see blurry and distorted. Keratoconus usually starts during adolescence and slowly progresses, causing the cornea to continually bulge forward, making the cornea thin and causing scar tissue and thereby making vision progressively worse.

What causes keratoconus?  The exact cause is unknown. There are many theories based on research, but no one theory can explain it all. It is believed that genetics, the environment and the endocrine system all play a role in keratoconus. It is estimated that 1 in every 2000 people have it.

• Eye Rubbing: It has been suggested that keratoconus corneas are more easily damaged by minor trauma such as eye rubbing as well as poorly fitted contact lenses that continually rub on the cone.

• Allergies: Many who have keratoconus report vigorous eye rubbing and also have allergies. Their allergies cause eye itching and irritation, leading to eye rubbing. However, the link to allergic disease also remains unclear. A higher percent of keratoconic patients have atopic disease such as hay fever, eczema, asthma, and food allergies. Those with keratoconus are advised to avoid eye rubbing as much as possible because there seems to be an association with eye-rubbing and keratoconus.

What are the Symptoms? The first symptoms are blurring or distortion of vision and frequent changes in your spectacle prescription especially the astigmatism correction. In the early stages, glasses can be used to correct the vision. As the vision gets progressively worse, rigid gas permeable contact lenses, hybrid contact lenses or scleral contact lenses are the only way to provide adequate vision correction. Fortunately, in most cases, this is a permanent remedy. Surgical implants is another method that can be used to help.  In about 10% of cases, a corneal transplant becomes necessary.

Scleral Contact Lenses for Keratoconus: I have found that scleral contact lenses provide the best option in most cases. It is fitted so that it does not touch the cornea at all. There is therefore no contact on the bulging cone making this the most comfortable option for the patient. The patient usually reports not feeling the lenses. The lenses usually come in a large diameter so that they rest on the peripheral white part of the eye avoiding contact with the cone and cornea completely. The area between the lens and the cornea is filled with the patient’s tears and this in effect becomes a moisture chamber that does not evaporate easily into the air making it a great option for those that have severe dry eyes as well.  Scleral lenses have provided good vision results too. The initial fitting process may take several follow-up visits and close monitoring for the best outcomes. Check out this youtube video on more about scleral lenses.

http://www.youtube.com/watch?v=SGdhHAZHwmI

Since keratoconus seems to be associated with eye rubbing and allergies, the best advise you can provide to your friends and family is to share this article with them and to caution them against eye rubbing especially those in their young teenage years.

Meyer Izaac, O.D.

http://www.visionsource-izaaceyes.com/