Dry or Irritated Eyes?

With each passing year since the advent of the computer, dry eye symptoms have multiplied significantly across the broad spectrum of society.  And as device use spreads to younger and younger ages, symptoms of eye irritation associated with dryness is also drifting towards younger and younger ages.

Thankfully,  there has also been an explosion of treatments for these issues, and a better understanding of what the underlying root causes are…

Understanding the Causes

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There are many potential causes in our daily routines which can contribute to Dry Eye Symptoms.  Understanding these risk factors can help your eye doctor begin the diagnosis process.

  1. Aging:  The eye is no stranger to new issues associated with aging.  The average patient is best educated about the risk factors associated with cataracts and aging, but dry eyes can also have a grounding in this.  Our eyes have meibomian glands which secrete meibum.  Meibum is a lipid based component to our tears which act as a lubrication and also a protective barrier against irritants or infectious agents damaging the eye.  As we age, the meibomian glands can clog to the point of not secreting any meibum.  As we lose the meibum, the dry, burning, irritation symptoms multiply.
  2. Gender:  While the full cause of the gender split on dry eye symptoms are not fully understood it is suspected that the compounding factors of hormone release changes as we age, as well as lifetime use of eye makeup can significantly increase the risk factors of dry eye disease for women.
  3. Allergies:  Use of antihistamines can help to reduce allergy symptoms, but their ability to “dry out” your sinuses can also contribute to a loss of meibum flow, and more eye irritations associated with dry eye disease.
  4. LASIK: The laser correction of your prescription can dramatically increase risk of dry eye disease.  If you’ve had LASIK in the past, you may want to be evaluated for potential dry eye treatments.
  5. Reading: If you already have one or more of these risk factors AND you enjoy to read a lot, the prolonged use of your near vision can put additional strain on your dry eye disease.  We tend to blink less when focusing on something close, like the words on a page.  The less we blink, the less opportunity for the meibomium glands to do what they need to do.
  6. Cold/Dry/Low Humidity: Cold, dry, windy, or low humidity environments mean that you need to blink much more frequently to keep your eye properly lubricated with meibum.  While more frequent blinking can help, in extreme environments that just not enough.  If you enjoy the winter sports frequently, you may have dry eye disease.
  7. Prolonged Computer/Screen Time:  Similar to the issues associated with reading, when we look at a screen our blink rate can reduce by as much as half.  Less blinking, means less tear film, means less meibum to keep your eye lubricated and comfortable.  You may have heard me mention the 20-20-20 rule before (for every 20 minutes of screen time, take a 20 second break looking 20 feet away), and while this can help, if you are on a screen a significant amount of time, you may need a treatment to restore your meibum flow.
  8. Contact Lens Wear: Any contact lens wearer will tell you that the lenses can be super convenient for many aspects of our lifestyle, and can really change your look, but they also tend to make our eyes much drier.  The extra work the eye has to do to keep the eye lubricated may need assistance from a dry eye treatment.

So, How Can My Problem Be Treated?

As you might expect there are many forms of treatment available for Dry Eye Disease.  From simply over the counter solutions, to prescription medications and in-office treatments.  The answers are plentiful enough that it can be challenging to navigate without some guidance.  My goal here is not to tell you the best treatment.  How to handle your Dry Eye needs really should come down to a discussion with your Eye Doctor to find the most appropriate treatment for you.  I hope to help establish the variety of ways your situation can be handled.  If you have had a failure with one of these treatments, it does not mean you just need to suffer.  There may be other paths for your relief.

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Over The Counter (OTC)

There are literally hundreds of Over The Counter (OTC) eye drops on the market.  And many of them can actually be harmful to your eyes.  Some products, such as Visine or ClearEyes only mask a problem by reducing the appearance of symptoms without addressing the underlying dry eye condition, allowing your eyes to become even more problematic.
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Don’t worry, though, there are many which can actually help your eyes by replenishing the type of tears you need.  Specifically the tears with the lipid content to maintain tear film and reduce irritation.  Some of these products include Systane, Refresh, and Blink–just to name a few.

If you wear contact lenses, it’s also important to make sure any eye drops you use are compatible with contact wear.  Some can actually become dangerously painful if used when wearing contacts.  It’s important to look for the term “Rewetting drop” if you are looking for a eye drop designed to work with contact lenses.

In addition there are drops specifically designed to assist with allergy issues.  These work well for mild to moderate eye allergy symptoms.  They don’t necessarily help well for severe issues.  These products aren’t designed to treat dry eye symptoms, other than the fact that allergy problems can increase dry eye symptoms.  Chief among this category are Zaditor and Alaway

 

Prescription Medications

Several excellent prescription medications have recently been created to help treat dry eye syndrome, and its symptoms.  You’ve probably seen commercials for some of these products over the past 10-15 years.  While each tries to tackle the issue from slightly different angles, their goal is to improve your eyes’ natural ability to produce and maintain a quality tear film.

Restasis was first approved by the FDA for treatment of dry eye syndrome in 2002.  It’s designed to treat the meibomium gland dysfunction, as well as Sjögren syndrome.  It’s had excellent efficacy for many patients, but some have had issue with either the side effects (including eye irritation, burning, itchiness, etc.).  As with so many prescription medications, side effects can mimic the disease symptoms you’re trying to prevent.

For those who don’t find comfort in the treatment from Restasis, there is treatment available visa Xiidra as well.  Xiidra is targeting the inflammation associated with dry eye disease by blocking T cell interaction with irritants in the eye.  The most common side effect is a bit of a bitter aftertaste draining through the sinuses.

Avenova takes an entirely different approach to eye irritation concerns.  They are focused on addressing the proliferation of mites on the eyelid.  It’s natural for us to have fauna growing on our skin, but if they overproduce there can be problems with the disruption of tear flow.  These natural biome mites are called Demodex.  Avenova is a way of cleaning the lid surface and reducing the proliferation of these mites.  Common causes of the growth of mites can be a buildup of eye makeup which can clog the pores which produce the meibomium tear film.

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Blepharitis can be caused by a proliferation of demodex, which disrupts the natural tear film by leaving “dandruff” which flakes onto cornea

As with all prescription medications, consult your optometrist or physician to find if they are the best course of action for yourself.

 

Alternative Therapies

There is a common first step in the treatment of dry eye issues.  It’s the warm compress.  The simplest form of this therapy is to run a wash cloth under a hot tap, and, after wringing it out, place it on your eyes.  The heat, combined with moisture can clear clogged ducts and pores around the eyes.

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If you are suffering from dry eyes syndrome, then you may need a  more intensive version of this treatment.  The first step up would be using a Bruder Mask.  These are relatively heavy beaded masks which, after microwaving, release a steady and moist heat to clear your meibomium ducts.

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The MiBoFlo heat therapy in use, on my eye

If this isn’t sufficient to address your symptoms, then taking the next step up may be right for you.  MiBoFlo is an intensive, office visit version of this treatment.  With MiBoFlo your doctor will run a heated sterling silver pallet across your lids, after applying a small amount of ultrasonic gel to it.  This reaches a temperature and duration you cannot achieve at home.  Typical treatment is 4 visits, spread across a month.  After the intensive, month-long treatment, then a routine follow up ever 6 months or so can maintain the improvements.

Many Ways to Help

As you can see there are many ways your Eye Care Professional can help address  your particular case of Dry Eyes.  Which solution is best, will depend on your symptoms and what is causing those symptoms.  This is best addressed with a visit to your Eye Doctor.

What’s most important is to realize you don’t have to suffer in silence!  Talk it over with your doctor and find some relief to this all-too-common problem!

 

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Know Your Frames

In our modern world, we have thousands of eyewear frames to choose from, and hundreds, if not thousands, of frame manufacturers for all of those frame lines.  Despite what 60 Minutes wants you to believe, there is not just one company.  And knowing something about where your frames come from, can help you make educated choices of how well your glasses might hold up, and how good the warranty may be.

Where do your Frames come from?

Country of origin can tell you a lot about what was involved in manufacturing your frames.  Generally speaking, frames that originate anywhere in Europe and/or Japan have a level of craftsmanship that is significantly better than other nations.  They are usually handmade, not just hand assembled.  For example, the manufacturing of acetate (plastic) frames can be very detailed and time consuming when done by hand.  This short YouTube video gives you a glimpse into the process.

While Luxottica is a very large manufacturer and has great reach in the global optical industry, they are far from the only frame manufacturer available for you.  Along with several other large companies which help to create very popular design lines such as Tom Ford (Marcolin), Kate Spade, Hugo Boss (both Safilo), etc. there are also many independent lines from amazing smaller companies producing very high quality products, such as Salt Optics, Barton Perreira, Francis Klein, and DITA to name a few.

As you might expect, when frames come from these countries, they tend to cost more.  These costs are partly due to the generally higher wages for workers, but also due to the level of skill and craftsmanship that goes into handmade frames.

Also a note about the “CE” logo.  the CE marking used to be a good indication of frame manufacturing somewhere within the European Union.  It is now used to indicate a product is eligible for sale within the EU, so products can be manufactured in China, Korea, etc. and still have the CE marking.
CE Temple

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What’s it made of?

This made sound odd, but there’s more than one type of “plastic” frame!  The type of plastic can dramatically change how comfortable the frame is, as well as how adjustable it is.  The most common, high quality plastic used is acetate.

Acetate

Acetate frames are actually made from a type of salt which can be heated and mixed with other compounds to produce a strong, pliable form of plastic.  Acetate frames allow for adjustability and are not painted to create their colors, it is infused directly into the material, thus they cannot chip off to expose a different color underneath.  Generally considered the highest quality of “plastic” frames this material type, this can sometimes translate into a higher price on your frames.  This additional cost also means the frames tend to last longer and can be re-lensed more times. In addition, to add structure, and the ability to hold a curve around your ear, the temple has a wire running through it of a malleable metal.
Wire in Temple
One drawback of acetate is associated with aging.  As it gets older, there can be a dull white coating which can build up, indicating that the material is drying out and becoming too brittle to be reshaped easily.  However, it can also be polished to bring back some of its original shine.

Acetate Nose

Acetate frames have the nose pad added at the end by molding on clear plastic. Note how the color does not match the frame front.

Optyl

Optyl is a unique thermosetting plastic exclusively from the Safilo Group.  What makes this material unique is its response to heat.  Typically your optician will heat a plastic frame to make it malleable and adjust it to fit you.  Optyl needs to be heated to a very specific temperature (140 degrees F).  Once it reaches this temperature it becomes EXTREMELY soft and can be reshaped.  If held in the new shape, it will retain that shape, if left to its own devices, it will return to its original shape.  In addition Optyl is not painted yet can maintain a beautiful shine, including in transparent options.  It’s very lightweight as well.  One trade-off is that it is very difficult to tell when the material is getting weak from age or over-working.
Optyl Nose

Optyl frames can have a very high gloss shine.  Note that the nose pad is exactly the same color as the body of frame front.

Nylon

Nylon is another popular “plastic” frame type.  The advantages for Nylon frames is flexibility and durability.  These frames tend to be very resilient to accidental manipulation (i.e. sleeping in glasses, falling off your bike, etc.).  They also tend to be very lightweight.  Colors are typically matte in finish, given the way the material is made, it is difficult to polish up to a shine.  In order to allow the frame to be adjustable at all, there is usually a different temple component added with a metal wire inserted into the nylon, and then covered with a silicon or rubber temple end.  This allows for adjustability around the ears, but it can also mean a potential weak point for the frame to break (where the metal inserts into the nylon)

Nylon Frames from Maui Jim

Nylon frames are very lightweight and flexible. They are a resilient solution for an active lifestyle.

In the next few days I will break down metal frames and their options.

As always, if you have any questions for me, please don’t hesitate to reach out and please follow me on Instagram, Twitter, and Facebook for all the latest.

Insurance can be Confusing

We just had an experience in the office today which inspired me to return to the blog. I’d like to begin by apologizing for the extended gap between posts. Sometimes life finds a way…and as the father of a Girl Scout during Cookie Season, well, let’s just say I’m sorry I was away.
Asking For Forgiveness

Now back to business. There can be much confusion for patients about insurance. It’s bad enough trying to understand the nuances of deductibles and copays when dealing with medical visits, but it gets even more complicated when you go to your eye doctor.
What most people don’t understand is that we almost never work with medical insurance at your optometrist’s office. Unless you are coming in to treat an infection, stye, or other medical issue, we don’t need your medical insurance, and we cannot bill it for your routine eye exam. Your eye exam is billed using a Vision Insurance.

Which Vision Insurance Do I Have?

This dichotomy in insurances can create confusion when you schedule your appointment, or when we request your insurance information. Most optometrist offices will want BOTH your medical and vision insurances. Even though we will only bill the Vision plan for your routine eye exam, we like to have the medical on file in case you need to be seen for an infection or emergency situation.

Figuring out which Vision Plan you have is where things can start to get a little tricky and confusing. Knowing your medical insurance almost never tells us which vision plan you. It can give us an idea where to start, but not always. Each individual Medical Insurance contract can have a “subcontractor” for the Vision plan which can be any number of insurance carriers.

For example, let’s say you have United Health Care (UHC) for your medical insurance. The associated vision plan can be Spectera, VSP, EyeMed, or even something more obscure.

All of this is made even more confusing when your medical insurance insists on naming their Vision Plans with “branded” names which actually aren’t what they are. Blue Shield can have “BlueView Vision” which is actually EyeMed, or United Health can have “United Vision” which is actually Spectera.

Confusion And Anger
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Unfortunately all of this can be extremely confusing to patients, and as eye care professionals we have to ask questions you may not even know the answer to. This can sometimes lead to heated conversations at the front desk as we try and sort through which Vision Plan you actually have. Please be patient with the front desk staff. It’s just as frustrating for us. In the end, we just want to make sure you are charged appropriately and we can see you for your visit.

A Word about Frame Adjustment and Maintenance

I know I announced my brief hiatus, but I wanted to talk a little bit about frame adjustment and its importance to the wearer.

If your eyeglasses are not fitting properly on your face, not only are they uncomfortable, but it also adversely affects the quality of your vision through a variety of ways.

Examples

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If you have any astigmatism correction, and your glasses are crooked, then you are getting the incorrect prescription. As discussed in my previous article on correction found here, astigmastism correction is set on a specific axis. If the glasses are crooked you have changed the angle of that astigmatism correction on each eye, negatively impacting the clarity of your vision.

Glasses are made to sit on your face at a certain distance from the eye. If that distance is elongated, you are changing the magnitude of the correction. So, as glasses slide down your nose, you actually make your lenses less nearsighted, or more farsighted. Whatever your real correction is, this is something you want to avoid.

Glasses need to have a certain amount of tilt towards your cheeks. This provides the best clarity. If your glasses end up too tilted towards the cheeks, or not enough, then you reduce your clarity again.

Progressives compound all of these issues. If a progressive is worn crooked, then you end up with one eye looking through the distance, while the other looks through the intermediate. AND your astigmatism correction is also wrong at the same time!

Take Away

So what’s the lesson here? You take your car in for a tune up and oil change every 5-10,000 miles, why don’t you take your glasses in for a tune up too? A good rule of thumb is every 3 months or so. The frequency may vary based on your local weather. Hotter climates tend to mean frames will stretch out and get crooked faster. Going in frequently also means that your optican can tighten all screws, give the frames an ultrasonic bath to remove makeup and sweat build-up, and your glasses can be inspected for scratches or warranty issues.

Your optician is your friend. Visit him or her frequently!

Very Brief Hiatus for the #JediLine

As most of you know I am intimately involved with LiningUp.net and the Star Wars lines we produce at the TCL Chinese Theatre IMAX in Hollywood California.  As our line for The Last Jedi starts in just one week, I will be tied up with many responsibilities to help this charity event take place and will be putting this blog on a very brief hiatus.  I will be back up with new posts after December 16th. You can follow my exploits as member of the Social Media Team on Twitter and Facebook. And if you would care to support our endeavors to raise money for Starlight Children’s Foundation, you can donate here! Since 1999 we have raised over $100,000 for this excellent charity.

In the meantime, I will continue to respond to any messages or emails you may have for me.  May The Force Be With You

Review Update on Varilux X Design

I posted an initial review of the latest progressive lens from Varilux, the X Design, when it first launched back in late August/early September.  My initial review can be found here.  After wearing the lenses for a couple of months, I wanted to provide an update based on my continued observations.

Review of Varilux X Design…Continued

As you may recall, my initial review of the latest progressive lens from Varilux, the X Design, was glowing.  My experience of the near and intermediate zones was phenomenal.  After wearing continuously for over two months, I still find this to be true, but I do wish to get a little more detailed on the experience.

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Breaking down the Distance

I believe I have found how they improved the intermediate and near so much.  The width of the distance zone is noticeably smaller.  While it’s not so small I would call it problematic, I think it’s important to note that if your needs are exceptional crispness and width of field in the distance, you may want to pause before going with the Varilux X series.

My initial thought when I noticed the smaller distance zone, was that perhaps my glasses weren’t properly aligned.  I suspected that my pupils might be sitting on the edge of the intermediate zone and that was why I was having issues.  But I remarked my lenses and took note of placement…even making small adjustments to how they sat on my face…and I could not increase the width of my distance vision.

The vast majority of my visual lifestyle takes place in the intermediate and near zones.  All of my work with patients, on computers, and phone/reading.  However, I am also exceptionally picky about my distance vision and I am a dominant eye-turner.  Rather than holding my eyes straight ahead and move my neck to align my vision, I tend to look out of the corner of my eye and expect to see sharply.

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Note the black dots on lenses to note corridor position

This has led me to rethink my initial glowing review of the X series.

Intermediate – Arms Length

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The zone of the lens dedicated to arms length (think your computer monitor, or dashboard in your car) is excellent.  Both the width of this zone, as well as the depth of field is very good.  The depth in the corners of this zone is not quite as good as the center.  So, if you need to see something closer than you’d expect at that height, it needs to be in the center of the zone, and not out of the corner of the eye.  Still enough quality width, clarity, and depth to highly recommend if this distance is critical for you.

I have noted that patient experiences have varied a bit on the quality of this zone, based upon how tall their lens is (how much distance from their pupil to the bottom of the frame).  Those with a longer corridor, or a stronger add (over +2.25) seem to find their intermediate zone a little lower.  This can still be fixed with adjustment of fit to a great degree, but it is something to consider if the frame you choose has your eyes very close to the top of the lens and it’s oversized.

Near Zone – How’s the Reading?

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The reading-or near zone, has a similar wearing experience as the intermediate.  The width of the zone is very very good.  If you want to see something at arms’ length, then you’ll want it closer to the middle of your lens.  But there are a couple of spots in the periphery where the intermediate distance becomes quite good.  You do have to hunt for this location just a bit.  When it pops in for intermediate it’s very very good though.

Does it Work for All Prescriptions?

So far, after fitting this as my primary progressive lens for over two months, I have found that there seems to be a broad range of prescriptions which can wear this lens design effectively.  So much so that I would not say there is any specific power limitations for a good wearing experience.

Take Away

I still feel that the X Design lens is an excellent choice for the vast majority of patients.  I still love wearing the lens.  There is a peripheral loss of clarity in the distance portion of the lens, but it’s still far enough to the corners of the lens that I don’t find it exceptionally annoying or distracting.  If you need to have super crisp edge to edge distance vision, this lens design may not be for you.

While every lens design that comes out claims to be the salvation that fixes all the problems for all patients, this has yet to be true.  The X series comes very very close to doing this, but it’s still not quite the magic pill.

*please note that I have been wearing and testing the Varilux X Design.  The X series refers to a collection of 3 related lens designs, the X Design, the X Fit, and the X Fit 4D.  I have not tried the other two lenses in the family of products.

Lens Materials Advantages and Disadvantages

First things first, I would like to apologize for my extended absence.  Halloween season with a 9 year old means lots of time spent on costumes and parties.  Pair that with a small round of being sick and, well, here we are a few weeks later.

Today I’d like to spend a little time discussing the many materials that can be used to make prescription lenses.  There are many solutions to fit the many needs of different prescriptions and lifestyles.  There is no, one single best choice.  But I will break down the advantages and disadvantages on each material to help you navigate the best choice for your needs.

Abbe Value

No, Abbe isn’t a girl who works at the lab.  This is a number used to define how much aberration (distortion and/or color separation) occurs in a lens material.  The lower the number, the more distortion there is inherent in the material.

 

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Now, I know these numbers by themselves won’t mean much to you.  But the essence of these numbers is that glass has the best optical quality available.  The trade off, however, is that glass is also excessively heavy (especially for a higher prescription), and it’s less safe as a rule given the brittle nature of the material.

Herein lies the rub.  The best optics almost always come with a trade off on weight and durability.  The lighter and thinner materials are more comfortable and cosmetically look better for higher prescriptions, but that does come with an optical clarity trade-off.

Index of Refraction

Refraction is the term used to describe how much light is bent when it enters a medium.  When we are talking about glasses, we’re always talking about the lens material.

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The a 1.0 index of refraction would indicate that the light is not bent at all.  Any number of 1.0 is indicating that the light is entering a different material which bends the light more dramatically.  The higher the number, the more the light is bent, and therefore the less material needed to correct for a high prescription.  Thus a 1.74 hi index plastic bends the light more than a 1.50 standard plastic (CR39).

The more the light is bent, the thinner and generally lighter the lens material is, but that extreme bending also means some light is lost to the prism effect (color aberration).  That is to say, lower abbe values separate white light out into its separate color components and you may actually see a small rainbow effect around the edges of things.

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This aberration is why it’s so important to take the additional measurements of not just pupil horizontal position, but also vertical position on a patient with a higher prescription.  These chromatic  aberrations can become very intrusive with hi index materials.

 The Polycarbonate Reputation

Polycarbonate has traditionally had a very bad reputation.  In part this is the same old story as Transitions.  The older versions of the material from 30 years ago were quite inferior.  Lots of aberration, chromatic distortions and very small optical centers.  In part it was the manufacturing process used at the time.  Over the past couple of decades the manufacturing of this material has improved dramatically.  You can still get “bad batch” versions with terrible distortion, but they are relatively few and far between.  I think it does say something to the improvement of the material that I wear polycarbonate almost exclusively in my glasses, and have for the past 10 years. It can be a good choice as long as your prescription isn’t too strong.

Choosing the Material for You

As you can probably guess from all the above material, the general rule of thumb is to go with the highest abbe value (meaning the least amount of aberration).  But this has to be balanced against the power of the prescription, and the impact resistance necessary for lifestyle.

For these reasons, polycarbonate (for better or worse) has become the most common lens material in the optical industry…at least in the USA.  While it does not have the best abbe value, it does have impact resistance.  It has a relatively wide range of prescriptions which can be corrected before chromatic aberration becomes an issue, and it is has a plentiful number of lens design solutions available (Transitions, progressive designs, glare treatments, etc.).  Is it the best solution?  I’d say probably not.  Is it the easiest solution?  It’s the safest bet of protecting the eye and giving decent visual acuity, while still having access to all the different ways of correcting vision needs.

All things being equal, I think I’d prefer to work with Trivex for most moderate corrections, but the limitations on progressive designs and transitions colors available keeps me from going to it frequently myself.  In fact, I wear polycarbonate for my lenses.

However, if your prescription is either above a +3.00 or a -4.00 I generally recommend considering high index to control some of the chromatic aberration and to provide a cosmetically thinner lens.

Take Away

There are many lens materials available, and finding which one best suits your needs comes down to how strong your prescription is, and how shatter resistant do you need your lenses to be…but in the end polycarbonate is often used just because of accessibility and safety, even if it isn’t always the best optical choice it’s still a decent choice for most common prescriptions.

Questions on Light Sensitivity

A friend recently sent me a Facebook Messenger question, and allowed for me to share it.  Here is our conversation on light sensitivity…

A.L.:  Hey Ric I have a professional question for you. I seem to be very sensitive to bright lights especially flashing ones. I can’t handle strobe lights or white fireworks. I also need to have sunglasses when I’m outside when it’s bright. I know a lot of people want sunglasses but I feel like I really need them. And I know other people don’t seem to have the issues with strobes and fireworks that I do. I’m wondering if there’s anything that I can actually do about this or if I just need to continue living with it and dealing with it. I thought you might have some insight.
And to be clear when I say I can’t handle strobe lights or fireworks I mean they cause me actual physical pain.

O.J.:  You’re not the first one I heard about having this issue. There isn’t a way to make it go away necessarily

You will want to spend the money on good sunglasses.
A.L.:  That’s kind of what I figured. [SPOUSE] had to lead me through some parts of the mazes with my eyes closed because of the strobes.
O.J.:  Night stuff is harder to deal with. Perhaps using a blue blocker lens for those situations.  Something like an Eyezen with a good Anti-Reflective, which filters just a specific band of blue light without altering the colors you perceive too much.  If that doesn’t work using a lens with more of a yellow filter like Prevencia or GUNNAR lenses might help. Though a Gunnar solution will change your color perception quite a bit.

I highly recommend Maui Jim for sunglasses. You can’t find better
A.L:  Cool. I never really knew which brands were expensive for the sake of being expensive and which were actually quality.
O.J.:  Maui does not have sales or discounts other than discontinued models at Costco.
A.L.: OK
O.J.:  Their lens tech is patented and better than any other. Probably suggest either the true grey or HCL lens color.
A.L.:  Thank you! I’ll look into those.

Anti-Reflective Coating is much more than you think!

Through a couple of recent conversations with blog readers and patients, it’s become clear that many do not fully appreciate just how complicated anti-reflective treatments are to manufacture.  I hope to dispel some of this misconception today…

More than a Dip!

Since so much of lens treatments can be cone by dipping a lens in a hot vat of some near-boiling liquid, it’s easy to understand how you might think that’s all there is to an anti-reflective coating.  But, believe it or not, even the most inexpensive (read: easily scratched) coatings require a multi-stage process to apply to a lens.

This video showing the application of Crizal Avance will give you a little window into the process of applying a no glare treatment to lenses.

Lenses need to enter a dust free room similar to those in the manufacture of microprocessors. Then they must go through a multi-stage bath system to remove any and all dust, residue, oils, or items with the potential of producing blemishes on the lens. Once the lenses are fully cleaned, then they are placed in a tray inside a vacuum chamber and blasted with various ionic elements so that they can adhere fully to the lens, and provide both the light bending action to minimize reflection, as well as provide the scratch, oil, and water resistance layers.  For the best coatings this is 9-15 layers to complete this process.

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Inside Chamber.png

Once the lenses are removed from the chamber, then they are given a visual inspection to make sure the coating adhered properly.  Any speck of dust left on the lens before entering the chamber will ruin the coating, creating a drip point from which the coating cannot adhere properly.

AR Layers

The Number of Layers in a Crizal Alize Coating

 

Take Away

There are many dozen variations on anti-reflective manufacturing, but all of them, even the most inexpensive simple solution, requires an elaborate process of cleaning, dust-free rooms, and vacuum chambers to apply the coating.  In great part, this helps to explain just why anti-reflective coatings cost so much.

 

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The Importance of Retinal Imaging

Over the past 15 years, the use of retinal imaging has become more and more prevalent in the modern optometric practice.  Unfortunately, most vision insurance plans don’t cover it.  So, it’s almost always an additional expense.  For this reason, sadly, many patients opt out of receiving this additional procedure.

The additional procedure of retinal imaging (and it’s associated cost) are not a way for the eye doctor to pad your bill, however.  It’s actually an incredibly useful tool for eyecare professionals to not only diagnose additional vision issues, but also greater health concerns.

Why Are Retinal Images Important?

Doctors need to take a look at your retina during your exam.  This is important for spotting issues which could adversely affect your vision.  But possibly even more important, the retinal exam allows the doctor to spot overall health issues.  The smallest visible blood vessels in the entire body are located in your retina.  Because so many of our health issues present themselves in blood flow, this allows your eye doctor to spot health problems such as diabetes and high blood pressure before even your primary care doctor can spot them.

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Anecdotally, I even once treated a patient who had his physical the same week as his eye exam.  The physical presented that he had a clean bill of health and no concerns.  Our retinal exam spotted a blood clot…a stroke waiting to happen.

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Example of Arteriosclerosis in digital retinal image

So Why Digital Imaging?

Before the advent of modern digital imaging, doctors had to dilate your eyes, and view your retina while wearing the BIO (Binary Indirect Ophthalmoscopy).  The doctor would view your retina using a magnifying lens and a head lamp.  This would allow the doctor view the retina in very high detail, but viewing very small segments at a time.

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The advent of more and more advanced digital imaging, such as optos, now allow for the retinal exam to happen without dilation being necessary.  Not only this, but the digital retinal imaging allows us to capture the entire retina in a single image.  By capturing the entire map, there’s no question of anything being missed while sweeping across the retina with a smaller view.

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Healthy Retina captured on optos

One of the most valuable aspects of a digital retinal image is overlay.  When you have the image taken over subsequent years, each image can be digitally dropped on top of the original image, and any minute changes can be compared and documented.  Some of the most concerning aspects of retinal damage can most easily be spotted when comparing images from year to year.  When you opt for a dilated exam, instead of the digital image, we cannot overlay images because all the doctor gets to see is the retinal with their own eye and cannot document it with a photograph.

Digital Image Critical for Diabetics

For a diabetic, it is absolutely critical to get the digital retinal image every year.  I am diabetic myself, and even though I’m only in my mid-40’s my most recent optos image found the beginning stages of diabetic retinopathy.  This particular eye condition has an end result of partial blindness and can be minimized by better maintenance of blood sugar levels.

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Diabetic Retinopathy (red dots)

This is a great example of an eye condition which can be managed and observed best by comparing images from one year to the next.  This allows your eye doctor to track any small changes in the growth of the retinopathy, and recommend treatment based on the advancement.

You’ve also seen me talk about the dangers of Harmful Blue Light and it’s relationship to developing Age Related Macular Degeneration (AMD).  This is another eye condition most easily diagnosed and treated with the comparison of digital images from year to year.

Take Away

There is tremendous value for the eyecare professional, as well as for you, the patient, in getting the digital retinal images at your routine annual eye exam.  It’s not an upcharge to grift more money out of you.  This is an invaluable tool which allows your doctor to diagnose and treat not just vision related concerns such as detached retinas, but also overall health concerns such as diabetes, hypertension, and even blood clots!  It’s a very small price to pay for the peace of mind which could prevent much great vision and health concerns later on.

Thank you to optos for providing imagery in this post

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