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After cataract surgery, there are two main issues we try to control: preventing infection and controlling inflammation.  Traditionally, we prescribed antibiotic eye drops to prevent infection, as well as steroid eye drops to control post-operative inflammation. But eye drops can be hard for some patients to put into their eyes. Now we have some alternatives to using drops after surgery.   

There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better a job preventing infection as using antibiotic eye drops before and after surgery.

The FDA approved two new steroid delivery methods to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery. Those two products are called Dexycu and Dextenza.

Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery. It will not be visible in most patients because it is injected behind the iris, or the colored part of the eye.  It sometimes doesn’t stay behind the iris and you might see a small white dot in the eye initially after surgery.  It is a sustained-released medication, which is absorbed over a couple of weeks and replaces the need for post-operative steroid drops.  

Dextenza is a white pellet that is inserted into the lower punctum of the lid, which is the small opening for the drainage of tears. This insert is designed to deliver medication for up to 30 days.  It is slowly absorbed and doesn't need to be removed. Similarly, it is usually not visible and does not cause any discomfort.

If you have either a Dexycu or Dextenza implant placed and an antibiotic medication is injected inside the eye after surgery, then you may be drop free after surgery. The main difference between the two steroid injections is that Dexycu is injected inside the eye while Dextenza is deposited outside the eye.  For each of these newer options there is a chance that in your particular case there may still be too much inflammation and you might need to take eye drops for a while, but the majority of the time you would not need drops.

If you are going to have cataract surgery and would like to be drop free after the procedure, then ask your surgeon if you would be a candidate for either the Dexycu or Dextenza implant.

Article contributed by Dr. Jane Pan.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Choosing a new pair of eyeglasses can be a daunting task.

Making a decision on what style glasses you will be wearing for the next year until your vision is checked again can be stressful. This is one of the many reasons opticians are here for you. In many ways, this may be the most important task for the optician, because keeping you happy with the way you look motivates you to wear your glasses daily.

Most people’s reaction is to play it safe with new glasses and stick with something relatively similar to what they are currently wearing.

While not necessarily a bad decision, this isn’t something opticians try to promote. Opticians often spend time meeting with frame representatives and browsing the Internet to keep up with the ever-changing trends in the world of eyeglass frames. And it’s a great feeling to successfully “update” your image with a new set of frames. Many patients are amazed at the difference a well-fit and -styled pair of glasses makes on their overall look.

There are many simple tips and tricks to consider when starting to browse for your next pair of frames.

The goal of this article is to improve your starting point when beginning to choose frames. That way, once the optician gets involved, the process is already well under way. Keep in mind that these are guidelines and “outside the box” thinking can be good as long as it fits within the required parameters of your prescription.

The first step is successfully identifying what face shape category you seem to fit into.

This image shows the most common face-shape categories. The following is a general guideline to help decide which frames will most likely appear to fit the best.

Oval - Oval faces are considered to be the “most versatile” because most frame styles and sizes fit well on this face type. As a general rule, and especially for oval faces, avoid choosing frames that extend past the widest part of your face. Stick with moderate-sized frames.

Upside Down Triangle - To even out the proportions of this face shape, choosing semi-rimless frames is always a positive. Less attention to the bottom half of the frame helps enhance the natural curves of this face shape. Frames that stay wide at the bottom and do not taper inward will also help even out this face.

Oblong - Being longer than it is wide, this face shape enjoys having larger frames on it. A lower bridge will help shorten the nose, and solid dark colors are a positive as well.

Square - A strong jaw line is the focus of this face shape, so to work with that, choosing smaller, narrow frames is a positive. Ovals and rounds work better than squares.

Diamond - Broad cheekbones are the focal point of this face shape. Being quite rare, the best style of frames to put on these faces are in the cat eye family. Following the face’s contours, flare-top frames, semi-rimless frames, and fun colors tend to work well with this shape.

Round - Rectangular frames work best on round faces. Wide bridges help separate the eyes and bring symmetry to the face. Make sure the frames are wider than they are deep.

Triangle - Cat eye frames work exceptionally well with this face shape also. Frames that have a lot of style and accents to the upper part of the frames and temples are a plus as this brings attention to the naturally narrow forehead.

Along with shapes and styles, some believe that certain colors work best with certain faces.

All people are considered to have either cool (blue) or warm (yellow) skin tones. Some people feel customers should stick within their family of coloring. Again this is only a recommendation since you should wear what you like. This is just strictly a guideline for those struggling to choose a frame for themselves. Based on experience, eye color can make a difference as well. People with lighter eyes tend to prefer lighter frame colors, and vice versa for people with darker eyes. Also, hair color can be considered. Patients with lighter or grey hair tend to shy away from darker frames unless looking to make a statement.

At the end of the day you have to choose what is most comfortable for you. Opticians’ suggestions and educated opinions can help steer you in the right direction. There is much to consider, but always keep in mind that comfort and functionality are the priorities.

Some people believe plastic or zyl frames are more comfortable than metal or semi-rimless. Having nose pads, metal frames feel “heavy” to some. Others cannot wear plastic due to oily skin. Plastic frames may slide as the day progresses so metal may be better suited.

Don’t be overwhelmed. Follow some simple guidelines, and remember to enjoy the process. There are infinite styles and options to get you seeing well and looking great. And while you’re considering lenses for your regular lenses, don’t forget to look for sunglasses frames!

 

Article contributed by Richard Striffolino Jr.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Don't be one of the thousands of parents every year who think, "I wish I had realized sooner that my child coudn't see properly!"

Did you know that early intervention in children's vision is the key to success?

  • 80% of learning comes through vision.
  • During the first year of life, and then again by age 3 or 4, each child needs a comprehensive eye exam.
  • 6 months old is not too early.

Even though a school vision screening, nurse evaluation, or pediatrician screening is important, it doesn't take the place of a comprehensive eye exam by an eyecare professional. Some symptoms of an undetected vision problem include: decreased performance in school, aversion to reading, excessive blinking, eye rubbing, headache, or inability to see 3-D movies properly.

This could indicate conditions such as amblyopia (lazy eye), nearsightedness (myopia), astigmatism, or farsightedness (hyperopia) that can be corrected with glasses.

Surger might even be required for more serious conditions, such as esotropia, where the eye turns in, or exotropia where the eye turns out.

Although school screenings, nurses, and pediatricians are extremely valuable, they don't take the place of a comprehensive eye exam by an optometrist or ophthalmologist.

In fact, school screenings can give a false sense of security. There are visual skills necessary for reading that aren't diagnosed easily just by reading an eye chart. If a child frequently lose his or her place while reading, he or she may benefit from glasses, vision exercises, or therapy.

Vision Therapy involved training the eyes and brain to help alleviate issues that glasses alone can not.

A comprehensive exam can also reveal more serious threats to vision and health in children. A more rare, but life threatening condition is a fast growing eye tumor called retinoblastoma. The proximity of the eye to the brain makes fast intervention critical. This is a condition that parents might notice by looking at pictures and noticing a "white pupil."

Here are some resources to find out more information on children's vision--

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Knowing the difference between the various specialties in the eye care industry can be confusing, especially given the fact that they all start with the same letter and in many ways sound alike.

So, here’s a breakdown of the different monikers to make life a little less confusing for those wanting to get an eye exam.

Ophthalmologists

Ophthalmologists (pronounced “OFF-thal-mologists”) are eye doctors who went to four years of undergraduate university, four years of medical school and four to five years of ophthalmic residency training in the medical and surgical treatment of eye disease.

Many ophthalmologists then go on to pursue sub-specialty fellowships that can be an additional one to three years of education in areas such as cataract and refractive surgery, cornea and external disease, retina, oculoplastic surgery, pediatrics, and neuro-ophthalmology.

Ophthalmologists are licensed to perform eye surgery, treat eye diseases with eye drops or oral medications, and prescribe glasses and contact lenses.

Optometrists

Optometrists are eye doctors who went to undergraduate university for four years, then went on to optometry school for four years.

Many optometrists choose to pursue an additional year of residency after optometry school, though this is not a requirement for licensure. Optometrists are licensed in the medical treatment and management of eye disease, and prescribing glasses and contact lenses. The ability to prescribe varies by state law.

In some states, optometrists can perform certain minimally invasive laser surgical procedures, but on the whole, optometrists do not perform eye surgery. In addition, optometrists usually have different sub-specialties from ophthalmologists, including vision therapy, specialty contact lenses, and low vision.

The analogy I use most often in comparing optometrists to ophthalmologists is that of a dentist and oral surgeon. Many people choose to have optometrists as their primary eye care provider doctor for medical treatment of eye disease, but when surgery is needed, they are referred to the proper ophthalmologist.

Opticians

Opticians specialize in the fitting, adjustment, and measuring of eye glasses. Some states require that opticians are licensed, and others do not.

If you have any questions about which professional is the right fit for your needs, check with your eye-care professional’s office and they’ll be happy to answer them for you.

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Who is Charles Bonnet?  He was a Swiss naturalist, philosopher, and biologist (1720-1793) who first described the hallucinatory experiences of his 89-year-old grandfather, who was nearly blind in both eyes from cataracts.  Charles Bonnet Syndrome is now the term used to describe simple or complex hallucinations in people who have impaired vision.  

Symptoms

People who experience these hallucinations know they aren't real.  These hallucinations are only visual, and they don't involve any other senses. These images can be simple patterns or more complex, like faces or cartoons.  They are more common in people who have retinal conditions that impair their vision, like macular degeneration, but they can occur with any condition that damages the visual pathway.  The prevalence of Charles Bonnet Syndrome among adults 65 years and older with significant vision loss is reported to be between 10% and 40%.  This condition is probably under reported because people may be worried about being labeled as having a psychiatric condition. 

Causes

The causes of these hallucinations are controversial, but the most supported theory is deafferentation, which in this case is the loss of signals from the eye to the brain; then, in turn, the visual areas of the brain discharge neural signals to create images to fill the void.  This is similar to the phantom limb syndrome, when a person feels pain where a limb was once present.  In general, the images that are produced by the brain are usually pleasant and non-threatening.

Treatment and prognosis

If there is a reversible cause of decreased vision, such as significant cataract, then once the decreased vision is treated, the hallucinations should stop.

There is no proven treatment for the hallucinations as a result of permanent vision loss but there are some techniques to manage the condition.  Give these a try if you have Charles Bonnet Syndrome.

  • Talking about the hallucinations and understanding that it is not due to mental illness can be reassuring.
  • Changing the environment or lighting conditions.  If you are in a dimly lit area, then switch on the light and vice versa. 
  • Blinking and moving your eyes to the left and right and looking around without moving your head have been reported as helpful.
  • Resting and relaxing.  The hallucinations may be worse if you are tired or sick.
  • Taking antidepressants and anticonvulsants have been used but have questionable efficacy. 

Over time, the hallucinations become more manageable and can decrease or even stop after a couple of years.

If you experience any of these symptoms, please get evaluated by your eye doctor to make sure there is not a treatable eye condition.  Don’t be embarrassed or ashamed—your issue is likely caused by a physical disturbance and we are here to help!

Article contributed by Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

We commonly see patients who come in saying that their eyes are bleeding.

The patient is usually referring to the white part of their eye, which has turned bright red. The conjunctiva is the outermost layer of the eye and contains very fine blood vessels.  If one of these blood vessels breaks, then the blood spreads out underneath the conjunctiva. This is called a subconjunctival hemorrhage.

A subconjunctival hemorrhage doesn't cause any eye pain or affect your vision in any way. Most of the time, a subconjunctival hemorrhage is asymptomatic.  It is only noticed when looking at the mirror or when someone else notices the redness of the eye.  There should not be any discharge or crusting of your lashes.  If any of these symptoms are present, then you may have another eye condition that may need treatment.  

What causes a subconjunctival hemorrhage?  The most common cause is a spontaneous rupture of a blood vessel.  Sometimes vigorous coughing, sneezing, or bearing down can break a blood vessel.  Eye trauma and eye surgery are other causes of subconjunctival hemorrhage.  Aspirin and anticoagulant medication may make patients more susceptible to a subconjunctival hemorrhage but there is usually no need to stop these medications.  

There is no treatment needed for subconjunctival hemorrhage.  Sometimes there may be mild irritation and artificial tears can be used.  The redness usually increases in size in the first 24 hours and then will slowly get smaller and fade in color.  It often takes one to two weeks for the subconjunctival hemorrhage to be absorbed.  The larger the size of the hemorrhage, the longer it takes for it to fade.

Having a subconjunctival hemorrhage may be scary initially but it will get better in a couple of weeks without any treatment. However, redness in the eye can have other causes, and you should call your eye doctor, particularly if you have discharge from the eye.

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

YOUR EYES.......You only have two of them so treat them well and learn how to keep them safe from harm. Here is a list of five vital ways to prevent injuries to one of your most precious assets, your vision.

  1. Wear Safety Glasses. Failure to wear protective eye wear is one of the main causes of job related injuries to the eye according to OSHA (Occupational Safety & Health Administration). Well-made safety glasses are made from a polycarbonate material which can withstand the impact of a .22 caliber bullet. Safety glasses at work protect you from foreign bodies and chemical exposure to the eye area. Wearing protective eyewear for yard work, weed eating, and cutting wood keeps injury from high velocity foreign bodies to a minimum.
  2. Wear Sunglasses with UVA and UVB protection. Doing so protects the thin skin around the eyes from sunburn, and also helps protect your ocular system. It has long been stated that excessive exposure to sunlight causes cataracts, so using ultraviolet (UV) protection in your sunglasses is vital. Many sunglasses, especially for children, do not contain adequate UV filters. These inferior sunglasses can actually harm your eyes more than not wearing any, since the dark lenses cause the pupil to dilate, thereby letting in more of the harmful rays. Buyer beware: not all sunglasses are created equally.
  3. Make sure children’s glasses are made of polycarbonate material and have UV protection. This ensures a minimum exposure of ultraviolet rays which will pay off when they are older by helping prevent cataracts. The polycarbonate lens material gives maximum protection against breakage.
  4. Don’t obstruct vision with a child’s costume. During Halloween, opt for face paint instead of a mask that could occlude or obstruct vision.  Bulky masks that accompany halloween costumes can be a deterrent to the child seeing out of the mask. During Halloween or costume parties, keep it fun and safe by “seeing and being seen.”
  5. Use the wisdom of preventative maintenance. Get yearly eye examinations where the entire retina is evaluated with a a dilated exam. Routine check ups, sunglasses, vitamins, and smoking cessation will keep those peepers healthy and clear.

Applying these pointers can keep your eyes healthy and safe.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

1. Vision is so important to humans that almost half of your brain’s capacity is dedicated to visual perception.

2. The most active muscles in your body are the muscles that move your eyes.

3. The surface tissue of your cornea (the epithelium) is one of the quickest-healing tissues in your body. The entire corneal surface can turn over every 7 days.

4. Your eyes can get sunburned. It is called photokeratitis and it can make the corneal epithelium slough off just like your skin peels after a sunburn.

5. Ommatophobia is the fear of eyes.

6. You blink on average about 15 to 20 times per minute. That blink rate may decrease by 50% when you are doing a visually demanding task like reading or working on a computer – and that’s one reason those tasks can lead to more dry-eye symptoms.

7. Your retinas see the world upside down, but your brain flips the image around for you.

8. If you are farsighted (hyperopia) your eye is short, and if you are shortsighted (myopia) your eye is long.

9. An eyelash has a lifespan of about 5 months. If an eyelash falls out it takes about 6 weeks to fully grow back.

10. One in every 12 males has some degree of “color blindness.”

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

What do amblyopia, strabismus, and convergence insufficiency all have in common? These are all serious and relatively common eye conditions that children can have.

Did you know that 80% of learning comes through vision? The proverb that states ”A picture is worth a thousand words” is true!  If a child has a hard time seeing, it stand to reason that she will have a hard time learning.

Let’s explore amblyopia, or “lazy eye.” It affects 3-5% of the population, enough that the federal government funded children’s yearly eye exams through the Accountable Care Act or ObamaCare health initiative. Amblyopia occurs when the anatomical structure of the eye is normal but the “brain-eye connection” is malfunctioning. In other words, it is like plugging your computer into the outlet but the power cord is faulty.

Amblyopia need to be caught early in life--in fact if it is not caught and treated early (before age 8) it can lead to permanent vision impairment. Correction with glasses or contacts and patching the good eye are ways it is treated. Most eye doctors agree that the first exam should take place in the first year of life. Early detection is a key.

Strabismus is a condition that causes an eye to turn in (esotropia), out (exotropia), or vertically. It can be treated with glasses or contacts, and surgery, if needed. Vision therapy or strategic eye exercises prescribed by a doctor can also improve this condition.

When we read, our brain tells our eyes to turn in to a comfortable reading posture. In convergence insufficiency, the brain tells the eyes to turn in, but they instead turn out, causing tremendous strain on that child’s eyes while reading. Another tell tale sign of this condition is the inability to cross one's eyes when a target approaches. The practitioner will see instead, that one of the eyes kicks out as the near target approaches. This condition can be treated with reading glasses or contacts, and eye exercises that teach the muscles of the eye to align properly during reading. Vision therapy is the treatment of choice for convergence insufficiency.

It is important to understand the pediatric eye and all the treatments that can be implemented to augment the learning process. Preventative care in the form of early eye examinations can mean the difference between learning normally or struggling badly. Remember, a young child can’t tell you if he has a vision impairment. For the success of the child, be proactive by scheduling an early vision exam.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Is making an appointment for a comprehensive eye exam for your children on your back-to-school checklist? It needs to be.

No amount of new clothes, backpacks, or supplies will allow your child to reach their potential in school if they have an undetected vision problem. 

The difference between eye exams and vision screenings

An annual exam done by an eye doctor is more focused than a visual screening done at school. School screenings are simply "pass-fail tests" that are often limited to measuring a child’s sight clarity and visual acuity up to a distance of 20 feet. But this can provide a false sense of security.

There are important differences between a screening and a comprehensive eye exam.

Where a screening tests only for visual acuity, comprehensive exams will test for acuity, chronic diseases, color vision and eye tracking. This means a child may pass a vision screening at school because they are able to see the board, but they may not be able to see the words in the textbook in front of them.

Why back-to-school eye exams matter

Did you know that 1 out of 4 children has an undiagnosed vision problem because changes in their eyesight go unrecognized? 

Myopia, or nearsightedness, is a common condition in children and often develops around the ages of 6 or 7. And nearsightedness can change very quickly, especially between the ages of 11 and 13, which means that an eye prescription can change rapidly over a short period of time. That’s why annual checkups are important.

Comprehensive eye exams can detect other eye conditions. Some children may have good distance vision but may struggle when reading up close. This is known as hyperopia or farsightedness. Other eye issues such as strabismus (misaligned eyes), astigmatism, or amblyopia (lazy eye) are also detectable. 

Kids may not tell you they're having visions issues because they might not even realize it. They may simply think everyone sees the same way they do. Kids often give indirect clues, such as holding books or device screens close to their face, having problems recalling what they've read, or avoiding reading altogether. Other signs could include a short attention span, frequent headaches, seeing double, rubbing their eyes or tilting their head to the side.

What to expect at your child's eye exam

Before the exam, explain that eye exams aren’t scary, and can be fun. A kid-friendly eye exam is quick for your child. After we test how he or she sees colors and letters using charts with pictures, shapes, and patterns, we will give you our assessment of your child’s eyes. 

If your child needs to wear glasses, we can even recommend frames and lenses that would be best for their needs.

Set your child up for success

Staying consistent with eye exams is important because it can help your kids see their best in the classroom and when playing sports. Better vision can also mean better confidence because they are able to see well. 

Because learning is so visual, making an eye examination a priority every year is an important investment you can make in your child's education. You should also be aware that your health insurance might cover pediatric eye exams.

Set your child up for success and schedule an exam today!

What's one of the most common questions people ask when a baby is born? "WHAT COLOR ARE HIS EYES?is usually right up there.

What makes the color of our eyes appear as they do? What role do genetics play? What if you don’t like your eye color--can you change it? Are there any medications that can change eye color? Get ready to explore the science behind eye color by starting at the beginning.......

Baby’s eye color can change. A baby can start out with blue eyes, for example, that change to brown as she ages. It’s all dependent on a brown pigment called melanin which develops as a child grows. The more melanin present, the darker the eye color. Brown eyes have the most pigment saturation, green/hazel eyes have less melanin, and blue eyes have the least pigment. The color of eyes is dependent upon genetics. Genetics are complicated, but generally speaking brown trumps blue if there is a brown-eyed parent. This is because darker pigment is the dominant trait in genetics. This isn’t to say that two brown-eyed parents could not have a blue-eyed child......it's just not very common.  In recent years, scientists have found many genes that play a role in determining eye color.  For example, in March 2021, researchers announced that they had discovered 50 new genes that play a role.  So yeah...it's more complicated than was thought.

So what if you don’t like your eye color? Can you change it? Yes, you can. The most common way is through cosmetic colored contact lenses. It’s possible to change almost any eye color, even changing brown to blue. A special colored dye is injected into the contact lens material, creating magnificent colors. There are also surgical methods for changing iris color but the risks far outweigh the benefits, so it is not recommended. Furthermore, contact lenses are medical devices that alter cellular tissue, which makes it really important to get your color contacts by obtaining a prescription for a legitimate brand from an eyecare practitioner.

Some medications can change eye color. A class of medication called prostaglandins, used to treat glaucoma, has a side effect of darkening the iris color. This same class, in a weaker strength, is used to lengthen eyelashes. Studies have shown that in a certain percentage of patients, light blue and green eyes have turned brown.

So maybe Crystal Gayle was looking into a crystal ball when she sang "Don’t It Make My Brown Eyes Blue," predicting eye color changing medications to come.

Only future science holds the key to permanent eye color change. But in the meantime, genetics, medication, and cosmetic colored contact lenses can enhance and change the color of your eyes. 

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

The retina is the nerve tissue that lines the inside back wall of your eye. Light travels through the pupil and lens and is focused on the retina, where it is converted into a neural impulse and transmitted to the brain. If there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss.

Symptoms

The three 3 F’s are the most common symptoms of a retinal detachment:

  • Flashes: Flashing lights that are usually seen in peripheral (side) vision.

  • Floaters: Hundreds of dark spots that persist in the center of vision.

  • Field cut: Curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision.

Causes

Retinal detachments can be broadly divided into three categories depending on the cause of the detachment:

1. Rhegmatogenous retinal detachments: Rhegmatogenous means “arising from a rupture,” so these detachments are due to a break in the retina that allows fluid to collect underneath the retina. A retinal tear can develop when the vitreous (the gel-like substance that fills the back cavity of the eye) separates from the retina as part of the normal aging process.

The risk factors associated with this type of retinal detachment:

  • Lattice degeneration – thinning of the retina.

  • High myopia (nearsighted) - can result in thinning of the retina.

  • History of a previous retinal break or detachment in the other eye.

  • Trauma.

  • Family history of retinal detachment.

2. Tractional retinal detachments: These are caused by scar tissue that grows on the surface of the retina and contraction of the scar tissue pulls the retina off the back of the eye. The most common cause of scar tissue formation is due to uncontrolled diabetes.

3. Exudative retinal detachments: These types of detachments form when fluid accumulates underneath the retina. This is due to inflammation inside the eye that results in leaking blood vessels. The visual changes can vary depending on your head position because the fluid will shift as you move your head. There is no associated retinal hole or break in this type detachment. Of the three types of retinal detachments, exudative is the least common.

Diagnostic tests

  • A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the eye to examine the peripheral retina.

  • A scan of the retina (optical coherence tomography) may be performed to detect any subtle fluid that may accumulate under the retina.

  • If there is significant blood or if a clear view of the retina is not possible for some other reason, then an ultrasound of the eye may be performed.

Treatment

The goal of treatment is to re-attach the retina to the eye wall and to treat the retinal tears or holes.

In general, there are four treatment options:

  • Laser: A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment.

  • Pneumatic Retinopexy: This is an office-based procedure that requires injecting a gas bubble inside the eye. After this procedure, you need to position your head in a certain direction for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is performed around the retinal break. This procedure has about 70% to 80% success rate but not everyone is a good candidate for a pneumatic retinopexy.

  • Scleral buckle: This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure.

  • Vitrectomy: In this surgery, the vitreous inside the eye is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place. The gas bubble will slowly dissipate over several weeks. Sometimes a scleral buckle is combined with a vitrectomy surgery.

Prognosis

Final vision after retinal detachment repair is usually dependent on whether the macula (central part of the retina that you use for fine vision) is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that patients with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome tends to be.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

The sun does some amazing things.  It plays a role in big helping our bodies to naturally produce Vitamin D. In fact, many people who work indoors are directed to take Vitamin D supplements because of lack of exposure to the sunshine. 

But being in the sun has risks, as well...

If sunglasses are not worn, there is a greater risk for cataracts or skin cancers of the eyelids. It is important to know that not all sunglasses are made alike. UVA,UVB, and UVC rays are the harmful rays that sunglasses need to protect us from.

However, many over the counter sunglasses do not have UV protection built into the lenses, which can actually cause more damage than not wearing sunglasses, especially in children. 80% of sun exposure in our lives comes in childhood. Without UV protection in sunglasses, when the pupil automatically dilates more behind a darker lens, more of the sun's harmful rays are let in.

The whole point is that consumers should be aware that it is vital to buy sunwear that has UV protection built into the lenses.

Polarization is another option to add to sunglasses to protect the eyes from glare from the road and water. Fisherman love polarized lenses because you can see the fish right through the water. People who boat also claim their vision is better because glare off the water is reduced.

There are so many reasons to wear good sunglasses!  Plus, they just look fabulous!

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Fireworks Eye Injuries Have Skyrocketed in Recent Years

Fireworks sales will be blazing across the country from now through the Fourth of July. As retailers begin their promotions, we and the AAO are shining a light on this explosive fact: The number of eye injuries caused by fireworks has exploded in recent years.

Fireworks injuries caused approximately 15,600 emergency room visits each year, according to data from the U.S. Consumer Product Safety Commission. The injuries largely occurred in the weeks before and after the Fourth of July. The CPSC’s fireworks report showed that about 2,340 eye injuries related to fireworks were treated in U.S. emergency rooms in 2020, up from 600 reported in 2011.

To help prevent these injuries, the Academy is addressing four important things about consumer fireworks risks:

  1. Small doesn’t equal safe. A common culprit of injuries are the fireworks often handed to small children – the classic sparkler. Many people mistakenly believe sparklers are harmless due to their size and the fact they don’t explode. However, they can reach temperatures of up to 2,000 degrees – hot enough to melt certain metals. 
  2. Even though it looks like a dud, it may not act like one. At age 16, Jameson Lamb was hit square in the eye with a Roman candle that he thought had been extinguished. By age 20, Lamb had gone through multiple surgeries, including a corneal transplant and a stem cell transplant to try to restore partial vision to the eye. 
  3. Just because you’re not lighting or throwing it doesn’t mean you’re out of the firing line. An international study of fireworks-related eye injuries showed that half of those hurt were bystanders. The researchers also found that one in six of these injuries caused severe vision loss. 
  4. The Fourth can be complete without using consumer fireworks. The Academy advises that the safest way to view fireworks is to watch a professional show where experts are controlling the displays.

If you experience a fireworks eye injury:

  • Seek medical attention immediately.
  • Avoid rubbing or rinsing the eyes or applying pressure.
  • Do not remove any object from the eye, apply ointments, or take any pain medications before seeking medical help.

Watch the AAO’s animated public service announcement titled “Fireworks: The Blinding Truth.”

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

There are many things that can cause your eye to turn red.

The eye looks red when the blood vessels that are in the conjunctiva (the mucous membrane that covers the white of your eye and the backside of your eyelids) becomes dilated.

Those blood vessels often dilate when the eye gets irritated. This irritation can originate from a problem occurring inside the eye or factors from outside the eye.

The most common external factors that can cause the eye to become red are exposure to infectious organisms (mostly viruses and bacteria), environmental irritants (smoke, chemicals, sunlight), or allergens.

Infectious organisms can cause infectious conjunctivitis, or what is more commonly referred to as “pink eye.” This condition often presents with the eye being red and a mucous discharge being produced, often to such a degree that the eyelids are crusted over upon awaking in the morning. Infectious conjunctivitis can be extremely contagious and it is often advised that you severely limit your exposure to others while the problem is active. Infectious conjunctivitis caused by bacteria can be treated with antibiotic eye drops but viral conjunctivitis currently has no treatment and must run its course like the common cold.

Environmental irritants can make the eye look red for a short period of time during and immediately after exposure. The irritation is usually self-limited but may resolve more quickly with the use of over-the-counter lubricating drops or artificial tears. It is very important to understand exactly which irritant you were exposed to because there are some chemicals (acids and bases) that can cause extreme damage to the eye. So if you’re exposed to a caustic chemical you need to immediately rinse your eye out with water and seek emergency medical attention.

Allergens can cause allergic conjunctivitis, which can look very similar to pink eye but usually has significantly less mucous discharge and is usually accompanied by fairly severe itching. Allergic conjunctivitis is not contagious and can usually be treated with anti-allergy eye drops.

Infectious and allergic conjunctivitis can cause mild discomfort and itching but they rarely cause significant pain or loss of vision. A red eye with significant pain, especially when accompanied by severe light sensitivity and vision loss, often indicates more significant problems such as iritis, angle closure glaucoma or a corneal ulcer, all of which require immediate medical attention. If your eye is red and there is significant pain do not assume you have pink eye--see your eye doctor immediately!

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Ready or not...here are 13 more jokes to make you groan!

1. Patient: "What’s that floater doing in my eye, doctor?"  Doctor: “The sidestroke.”

2. Doctor: “Have your eyes ever been checked before?”  Patient: “No, they’ve always been hazel.”

3. Why did the cyclops have to close his school?  He had only one pupil!

4. Why wouldn’t the optometrist learn any jokes?  He had heard that a joke can help break the eyes.

5. What is it called when you poke your eye with safety glasses?  Eye-rony!

6. Did you here about the new website for people with chronic eye pain?  It’s a site for sore eyes.

7. When are your eyes not eyes?  When an onion makes them water!

8. Why do beekeepers have such beautiful eyes?  Because beauty is in the eye of the bee holder!

9. Why were the teacher’s eyes crossed?  Because she couldn’t control her pupils.

10. What's your eye doctor's favorite treat?  Candy cornea!

11. What has four eyes and a mouth?  The Mississippi.

12. Did you know that your left eye isn't real?  It's just in your head.

13. What did the optometrist say when the patient complained he made too many jokes?  “Bad puns are how eye roll.”

 

The majority of cataract surgeries performed in the U.S. are done with a local anesthetic and IV sedation.

The local anesthesia may be accomplished in one of two ways: either an injection of anesthetic around the eye or anesthetic eye drops placed on the eye, often combined with an injection of a small amount of anesthetic into the front of the eye at the very beginning of surgery.

The injection of anesthetic around the eye generally produces a deeper anesthesia for the surgery than the topical method but it also comes with increased risk. There is a very small chance of potentially serious bleeding behind the eye and a rare chance of inadvertent penetration of the back of the eye with the injection needle.

The topical anesthesia has lower risk but does not provide quite as deep of an anesthesia, although the overwhelming majority of people having cataract surgery with a topical anesthetic do not experience any significant pain during the procedure. 

The other difference between the two anesthesias is that with topical anesthesia you maintain your ability to move your eye around whereas with injection anesthesia the eye muscles are temporarily paralyzed so your eye doesn’t move during the surgery.  When you have topical anesthesia it is important for you to try to stare straight ahead at the light in the microscope above you. Most people accomplish this quite easily.

Along with the anesthetic to the eye, in most cataract surgeries an anesthetist will also give you some mild sedative medication through an IV. This relaxes you but does not put you “out,” although some people do fall asleep during the procedure from the effects of the sedation.

Many people who have cataract surgery with IV sedation don’t remember some of the surgery because of the amnesiac effect that occurs from the sedative. This often doesn’t happen when you return for surgery on your second eye. 

Despite often getting the exact same dose of sedative on the second surgery you have significant less amnesia the second time. This is caused by a quick buildup in tolerance to the medication. 

When they have their second surgeries, many patients feel that the surgery was significantly different than the first time even though it was done exactly the same. The reason is just that you remember more the second time.

On rare occasions people need to have general anesthesia to have their cataracts removed. Today, that is mostly done for people who are incapable of cooperating and staying still for the surgery. For everyone who can cooperate it is generally not worth the risks, which include death, to put people to sleep for a surgery that is easily done under a local anesthetic.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

What Is Intraoperative Aberrometry?

Yes, that is a mouthful, but the concept isn’t quite as hard as the name.

An Intraoperative Aberrometer is an instrument we can use in the operating room to help us determine the correct power of the implant we put in your eye during cataract surgery.

Cataract surgery is the removal of the cloudy natural lens of your eye and the insertion of a new artificial lens inside your eye called an intraocular lens (IOL).

The cloudy cataract that we are removing has focusing power (think of a lens in a camera) and when that lens is removed, we need to insert an artificial lens in its place to replace that focusing power. The amount of focusing power the new IOL needs has to match the shape and curvature of your eye.

To determine what power of lens we select to put in your eye, we need to measure the shape and curvature of your eye prior to surgery.  Once we get those measurements, we can plug those numbers into several different formulas to try and get the most accurate prediction of what power lens you need.

Overall, those measurements and formulas are very good at accurately predicting what power lens you should have. There are, however, several eye types where those measurements and formulas are less accurate at predicting the proper power of the replacement lens.

Long Eyes: People who are very nearsighted usually have eyes that are much longer than average.  This adds some difficulty with the accuracy of both the measurements and the formulas. There are special formulas for long eyes but even those are less accurate than formulas for normal length eyes.

Short Eyes: People who are significantly farsighted tend to have shorter-than-normal eyes.  Basically, the same issues hold true for them as the ones for longer eyes noted above.

Eyes with previous refractive surgery (LASIK, PRK, RK): These surgeries all change the normal shape of the cornea.  This makes the formulas we use on eyes that have had previous surgery not work as well when the normal shape of the cornea has been altered.

This is where intraoperative aberrometry comes in. The machine takes the measurements that we do before surgery and then remeasures the eye while you are on the operating room table after the cataract is removed and before the new implant is placed inside the eye. It then presents the surgeon with the power of the implant that the aberrometer thinks is the correct one.  Unfortunately, the power that the aberrometer selects isn’t always exactly right, but with the combination of the pre-surgery measurements and the intra-surgery measurements the overall accuracy is significantly enhanced.

The intraoperative aberrometry is also very helpful in choosing the power of specialty lenses like multi-focal and toric lenses.

We would encourage you to consider adding intraoperative aberrometry to your cataract surgery procedure if you have either a long or short eye (usually manifested as a high prescription in your glasses) or if you have had any previous refractive surgery.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

In our modern world, people spend hours on end staring at computer screens, smartphones, tablets, e-readers, and books that require their eyes to maintain close focus.

For most people (all except those who are nearsighted and aren’t wearing their glasses), their eyes’ natural focus point is far in the distance. In order to move that focus point from far to near, there is an eye muscle that needs to contract to allow the lens of the eye to change its shape and bring up-close objects into focus. This process is called accommodation.

When we accommodate to view close objects, that eye muscle has to maintain a level of contraction to keep focused on the near object. And that muscle eventually gets tired if we continuously stare at the near object. When it does, it may start to relax a bit and that can cause vision to intermittently blur because the lens shape changes back to its distance focal point and the near object becomes less clear.

Continuing to push the eyes to focus on near objects once the focus starts to blur will began to produce a tired or strained feeling in addition to the blur. This happens very frequently to people who spend long hours reading or looking at their device screens.

An additional problem that occurs when we stare at objects is that our eyes’ natural blink rate declines. The average person blinks about 10 times per minute (it varies significantly by individual) but when we are staring at something our blink rate drops by about 60% (4 times per minute on average). This causes the cornea (the front surface of the eye) to dry out faster. The cornea needs to stay moist in order to see clearly, otherwise little dry spots start appearing in the tear film and the view gets foggy. Think about your view through a dirty car windshield and how much that view improves when you turn the washers on.

So what should you do if your job, hobby, or passion requires you to stare at a close object all day?

Follow the 20-20-20 rule. Every 20 minutes, take 20 seconds and look 20 feet into the distance. This lets the eye muscle relax for 20 seconds, and that is generally enough for it to have enough energy to go back to staring up close for another 20 minutes with much less blurring and fatigue. It also will help if you blink slowly several times while you are doing this to help re-moisten the eye surface.

Don’t feel like you can give up those 20 seconds every 20 minutes? Well if you don’t, there is evidence that your overall productivity will decline as you start suffering from fatigue and blurring. So take the short break and the rest of your day will go much smoother.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Nowdays, many people prefer shopping online to shopping in stores for many of their needs.

With technology constantly improving and evolving, people like the convenience of shopping online. Whether it’s clothing, electronics, or even food, you can easily find almost everything you need on the Internet.

Eyeglasses, unfortunately, are no different. Many online shops have been popping up in recent years, offering people that same convenience. But what they don’t tell you is that it comes at a price, and this article’s purpose is to shine a light on the negatives of shopping online for eyeglasses.

Here are some important reasons to avoid the temptation of ordering glasses online.

  1. Accuracy- Instead of saving the most important point for last, we will focus on the main reason that ordering eyeglass online is not the best choice. Product accuracy is a huge reason that the online market has not completely taken off. Every person who needs eyeglasses needs to understand the process for how their prescription is obtained in order to truly understand why shopping online is not ideal. It is called an eyeglass prescription for a reason. Your ophthalmologist or optometrist is prescribing your lenses as if they were prescribing any form of medication. To take that prescription and hand it over to a website that does not require licensed workers to interpret the prescription is not the wisest choice. Equally as important as the prescription itself are the pupillary distance (PD) and the optical centers measurements. These measurements are not given at the time of the examination by the eye doctor, but instead are administered by the optician at the point of sale. Not having these measurements done accurately will negatively affect the quality of vision as much as an error in the prescription.
  2. Quality- The quality of the product you are purchasing is often affected when making the decision to purchase online. Websites rely on low overhead, high volume, and lack of quality control. The online experience pales in comparison to the quality you will receive in a professional office. Skilled opticians who interpret and manufacture your eyeglass prescriptions are generally held to a much higher standard than an online website.
  3. Warranty- Due to their low prices, many of these websites do not include much in the way of product warranty or guarantee. Local eyecare practices, however, stand behind your purchase. If there are issues with adjustment or a patient not being comfortable in a specific lens or product, professional optometrists and opticians are willing to work with you. This personal experience is not attainable on the web.
  4. Coordination with Your Doctor- With the complexity of eyeglass lenses, the ease of working in house is always a benefit worth keeping in mind. Eyeglass lenses can be very complex products. Having the benefit of being able to work directly with the doctor gives the optician the best chance to put you in the exact lenses you need. There is a substantial difference in the percentage of error between shopping online and the care you get in a private practice.
  5. Personal Experience- The biggest factor for many people is that the customized experience you get when shopping in person is something you cannot obtain by using the Internet. Dealing with the same opticians year in and out is something patients emphasize and appreciate. Just like people tend to keep the same doctors over the years, patients like knowing that the same people will be in charge of making/ordering their glasses. Shopping online will not offer that experience.

All of these factors should be carefully weighed when making the decision to shop online. While the initial price difference could entice you at first, know that it does come at a price. Whether it be a warranty, quality, or convenience issue, all of these are very important factors when buying glasses. People sometimes tend to discount how intricate eyeglasses are.

Purchasing eyeglasses is handled best in person by professionals who can provide you with the utmost care and quality.

 

Article contributed by Richard Striffolino Jr.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Dry Eye Disease affects more than 5 million people in the United States, with 3.3 million being women and most of those being age 50 or over. And as people live longer, dry eye will continue to be a growing problem.

Although treatment options for dry eyes have improved recently, one of the most effective treatments is avoidance of dry eye triggers.

For some that might mean protecting your eyes from environmental triggers. To do that experts recommend using a humidifier in your home, especially if you have forced hot-air heat; wearing sunglasses when outside to help protect your eyes from the sun and wind that may make your tears evaporate faster; or being sure to direct any fans  - such as the air vents in your car - from blowing directly on your face. For others, it may mean avoiding medications that can cause dry eyes.

There is one other trigger that may need to be avoided that doesn’t get as much notice: the potentially harmful ingredients in cosmetics.

Cosmetics do not need to prove that they are “safe and effective” like drugs do. The FDA states that cosmetics are supposed to be tested for safety but there is no requirement that companies share their safety data with the FDA. There are also no specific definition requirements for labeling cosmetics as “hypoallergenic,” “dermatologist tested,” “ophthalmologist tested,” “sensitive formula” or the like, making most of those labels more marketing than science.

Things to watch out for in your cosmetics if you have dry eye include:

Preservatives

Preservatives are important to prevent the cosmetics from becoming contaminated but many are known to exacerbate dry eye. Common preservatives in cosmetics that could be adding to your dry eye problems (Periman and O’Dell, Ophthalmology Management August 2016) are: BAK (Benzalkonium chloride); Formaldehyde-donating (yes, Formaldehyde!) preservatives (often listed as DMDM-hydantoin, quaternium-15, imidazolidinyl urea, diazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol); parabens; and Phenoxyethanol.  All of these preservatives in sufficient quantities can cause ocular irritation or inhibit the function of the Meibomian Glands that produce mucous that coats your tear film and keeps it from evaporating too quickly.

Alcohol

Alcohol is used in cosmetics mostly to speed the drying time but the alcohol can also dry the surface of the eye.

Waxes

Waxes can block the opening of the Meibomian Glands along the eyelid margin. If these glands are blocked they will not be able to supply the mucous and lipids necessary to the tear film to prevent it from drying too quickly. If you have trouble with dry eye it would be advisable not to apply eye liner behind the eyelashes along the lid edge where the Meibomian gland openings are.

Anti-aging products

While these may be safe and effective for the skin of the face they should not be used around the eyes. Most of these products contain some form of Retin A. These products have been shown to be toxic to the Meibomian glands and could be contributing to your dry eyes.

These components of cosmetics do not adversely affect everyone. However, if you suffer from dry eye and are not effectively able to keep your eye comfortable and your vision clear, you should investigate your cosmetics as a potential contributor to your problem.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

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