The word “astigmatism” is used so much in the optometric world that most people have talked about it when discussing their eye health with their doctor.

“Astigmatism” comes from the Greek “a” - meaning “without” - and “stigma” - meaning “a point.” In technical ocular terms, astigmatism means that instead of there being one point of focus in the eye, there are two. In other words, light merges not on a single point, but on two different points.

This is experienced in the real world as blurred, hazy vision, and can sometimes lead to eye strain or headaches if not corrected with either glasses or contact lenses.

Astigmatism is not a disease. In fact, more than 90% of people have some degree of astigmatism.

Astigmatism occurs when the cornea, the clear front surface of the eye like a watch crystal, is not perfectly round. The real-world example we often use to explain astigmatism is the difference between a basketball and a football.

If you cut a basketball in half you get a nice round half of a sphere. That is the shape of a cornea without astigmatism.

If you cut a football in half lengthwise you are left with a curved surface that is not perfectly round. It has a steeper curvature on one side and a flatter curve on the other side. This is an exaggerated example of what a cornea with astigmatism looks like.

The degree of astigmatism and the angle at which it occurs is very different from one person to the next. Therefore, two eyeglass prescriptions are rarely the same because there are an infinite number of shapes the eye can take.

Most astigmatism is “regular astigmatism,” where the two different curvatures to the eye lie 90 degrees apart from one another. Some eye diseases or surgeries of the eye can induce “irregular astigmatism,” where the curvatures are in several different places on the eye’s surface, and often the curvatures are vastly different, leading to a high amount of astigmatism.

Regular astigmatism is treated with glasses, contact lenses, or refractive surgery (PRK or LASIK). Irregular astigmatism, such as that caused by the eye disease keratoconus, usually cannot be treated with these conventional methods. In these circumstances, special contact lenses are needed to treat the condition.

The next time you hear that either you or a loved one has astigmatism, fear not.

It is easily corrected, and although astigmatism can cause your vision to be blurry, it rarely causes any permanent damage to the health of your eyes.

If you experience blurred vision, headaches, or eye strain, having a complete eye exam may lead to a diagnosis and treatment of this easily-dealt-with condition.

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 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 is an old adage in the eye care industry--Glasses are a necessity, contact lenses are a luxury. Ninety-nine percent of the time this is absolutely true. In the absence of unusual eye disorders or very high prescriptions that don’t allow a person to wear glasses comfortably, contact lenses should only ever be worn if there is a good, sturdy, updated set of prescription glasses available, too. This is due to the fact that there are often emergencies where people cannot wear their contact lenses.

In the 21st century, contact lens technology has gotten to the point where we have drastically cut down on the number of adverse events related to contact lens wear. However, human beings were not meant to wear little pieces of plastic in their eyes. Contact lenses are still considered a foreign body in the eye, and sometimes with foreign bodies, our eyes might feel the need to fight back against the “invader.” As such, issues like red eyes, corneal ulcers, eyelid inflammation, dry eyes, and abnormal blood vessel growth can result from wearing contact lenses.

More often than I would like, I have patients who are longtime contact lens wearers come in, and when I inquire as to the condition of their glasses, they say they don’t own any. My next question is inevitably, “What happens if you get an eye infection and you can’t wear your contacts?” I then see the proverbial light bulb go off in their heads followed by a blank stare. Why? “Because I’ve never had a problem before.” Well, just because you maybe have never been in a car accident before, doesn’t mean you shouldn’t wear your seat belt!

I will therefore repeat the most important takeaway here--Glasses are a necessity, contacts are a luxury. Even if you don’t want to go “all out” and get the most expensive frames or lenses in your glasses, having a reliable pair of glasses is an absolute must for any contact lens wearer.

Article contributed by Dr. Jonathan Gerard

Ocular allergies are among the most common eye conditions to hit people of all ages.

Though typically worse in the seasons of Spring and Summer, some people suffer with allergies all year. This is especially true for people who have allergies to pet dander, mold, dust mites, and other common allergens that tend to linger throughout the year.

The hallmark sign of ocular allergies is itching.

While itching can be a symptom of other eye conditions, the likelihood that there is at least some allergy component to the condition is quite high. This seems to be particularly true when the itching occurs mainly in the inner corner of the eyes. This signals that the condition is allergy-related, whereas itching along the eyelid margin suggests other conditions.

Allergy itching is usually accompanied by redness, tearing, and string-like mucus discharge from the eye. When accompanied by rhinitis, sinusitis, and sneezing, people can truly suffer from their allergies - especially as it relates to the eye.

The good news is there are numerous avenues for relief from this annoying condition.

There are many over-the-counter antihistamine drops. Talk to your eye doctor about which ones are recommended.

In particularly severe cases, prescription antihistamine/mast cell stabilizer combination drops, or even topical steroids, can be used. In addition, cold compresses can be a great therapy in combination with the drops.

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 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.

"It was the best of times, it was the worst of times." These famous words by Charles Dickens are playing out today in the area of technology.

We are living in the best of times when it comes to obtaining knowledge at the push of a button. But smartphones, laptops, video games, tablets, etc., can really increase our daily total screen time.

What are the symptoms of too much screen time for the eye, and how can you combat these symptoms?  Research shows that screen time can adversely affect your eyes, focus, moods, and ability to sleep and relax.

Doctors are also seeing an increase in dry eye syndrome because patients do not blink often enough while they are staring at the screen for a prolonged period of time. The lack of blinking can cause burning or watery eyes, rubbing of the eyes, and frequent headaches.

The key to combatting these symptoms is to consciously blink more, use rewetting eye drops, and take frequent breaks. Make it a priority to practice the 20-20-20 rule. For every 20 minutes of screen time, take a 20 second break, focusing on a target 20 feet away. Your eye doctor might also recommend specialized computer lenses with anti-glare properties to minimize fatigue.

Lots of screen time seems to be especially bad for children, especially young ones. Pediatricians often advise no screen time for those 2 and younger, and just 1-2 hours per day for older children. In addition to other physical and mental health issues caused by too much screen time, there seems to be a higher incidence of myopia in children that spend a lot of time with digital devices. 

It is important to reiterate that screen time is not bad if used with moderation and frequent breaks. In fact, many computer programs are used to help patients strengthen their eye muscles and promote hand eye coordination.

So take frequent breaks, use preventative measures (such as re-wetting eye drops, anti-glare computer lenses, and eye exercises), and keep children engaged with the non-digital world as much as possible. Your eyes, and the eyes of those you love, will thank you!

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.”

It's pretty common for eye doctors to have older patients come in asking if the white part of their eye, the sclera, has a growth or is turning a gray color.

Usually, the culprit is senile scleral plaque, which is commonly seen in people over the age of 70. It is a benign condition and more commonly seen in women.  This condition is symmetrically found on both sides of the eye and is due to age-related degeneration and calcification of the eye muscle insertion into the eye.  In one study, the size of the senile scleral plaque increased as the person aged and was not associated with any medical conditions.  People are asymptomatic, as the plaques do not affect vision and no treatment is needed.

Another commonly asked question is: Why is the colored part of my eye turning white?  

The colored part of the eye is the iris, which is covered by a clear layer called the cornea.  It is actually the edge of the cornea that attaches to the white part of the eye that becomes grey or whitish colored.

This condition is called arcus senilis, which is seen in over 60% of people over the age of 60 and approximately 100% over the age of 80.  There is no visual impairment and no treatment is needed. Sometimes when this condition is seen in younger patients, it may be related to high cholesterol, so a visit to the primary care doctor may be needed.  

These are two very commonly encountered conditions that may cause distress for patients because it seems like their eyes are changing colors.

Thankfully, no treatment is needed for these two conditions, as they do not affect vision.  But if you notice that your eyes are changing colors, it is always a good idea to talk with your eye doctor about it!

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.

There are several different variations of glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the glaucoma, like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which we won't be discussing today, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of glaucoma we treat.

Glaucoma is a disease where the optic nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP).  Most - but not all - people diagnosed with glaucoma have an elevated IOP.  Some people have fairly normal IOP’s but show the characteristic deterioration in the optic nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP.  We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications and laser treatments. There are other places in the world where glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications, most often in the form of eye drops, or a laser treatment.

Drops

There are several different classes of medications used to treat glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s.  Some of the PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes, they are reasonably well tolerated by most people, and they are dosed just once a day. Most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option for initial treatment is a laser procedure.

Two common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT).  These treatments try to get an area inside the eye called the trabecular meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year.  Both laser treatments can be repeated if the pressure begins to rise again in the future, but the SLT works slightly better as a repeat procedure compared to the ALT.

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.

The eye holds a unique place in medicine. Your eye doctor can see almost every part of your eye from an exterior view. Other than your skin, almost every other part of your body cannot be fully examined without either entering the body (with a scope) or scanning your body with an imaging device (such as a CAT scan, MRI, or ultrasound).

This gives your eye doctor the ability to find many eye problems just by looking in your eye. Even though that makes diagnosing most problems more straightforward than in other medical specialties, there are still many things you can do to get the most out of your eye exams. Here are the top 7 things you can do to get as much as possible out of your exam.

1) Bring your corrective eyewear with you. Have glasses? Bring them. Have separate pairs for distance and reading? Bring them both. Have contacts? Bring them with you and not just the lenses themselves but the lenses prescription, which is on the box they came in. What we most want to know is the brand, the base curve (BC) and the prescription. If you have both contacts and glasses bring BOTH--even if you hate them.  Knowing what you like and hate, can help us prescribe something that you will love.

2) Know your family history of eye diseases. There are several eye diseases that run in families. The big ones are glaucoma, macular degeneration, and retinal detachments.  If you have a family history of one of these, it may change a doctor’s recommendations for intervention compared to someone without a family history.

3) Know your medical problems. There are several medical problems that correlate with certain diseases of the eye. Diabetes, hypertension, thyroid disease, multiple sclerosis, and autoimmune diseases all correlate with particular eye problems.  Knowing your medical history greatly increases the likelihood of more accurately dealing with your eye problem.

4) Know your medications. Several medications are known to produce specific eye problems. Drugs like steroids, Plaquenil, Gleevac, amiodarone, fingolamide, diuretics and Topamax, to name a few, can create problems in your eye. Knowing you are on certain medications may make it much easier for the doctor to arrive at a diagnosis of your eye condition.

5) Be calm and do your best. There are several tests we do that require your participation. The two tests that make people most anxious are the refraction (which determines glasses or contacts prescriptions) and a visual field test (which tests your peripheral vision.)  Stay calm and give your best answers. There are no perfect answers. You are not going to get shocked for a wrong answer, so don’t ramp up the anxiety.  Just give it your best try.

6) Bring someone with you when possible. There are two reasons for this. One is that it is better to not drive home if you are having your eyes dilated. Many people can do it comfortably, but some can’t. If you are not sure you can drive comfortably with your eyes dilated it is better to have someone with you who can drive home. The second reason is that is always better to have a second pair of ears to hear what the doctor is telling you - especially if the problem is significant. There are many studies that show a person often mishears or misremembers what they have been told, especially if they are anxious. Two pairs of ears are better than one.

7) Write down any questions. It’s very easy to forget to ask something you really wanted to know. You will get your questions answered much better if you have written them down prior to your appointment.

Follow these tips and you will have your best experience possible at your next exam.

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.

A wrinkle on the retina -- which is also known as an epiretinal membrane (ERM) or a macular pucker -- is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina's surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma, or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing 

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis 

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

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.

Is bilberry a wonder supplement for your macular degeneration?

The jury is still out on that question. There is some supportive experimental data but no well-done human studies that show significant benefit.

What you shouldn’t do is pass up taking the AREDS 2 nutritional supplement formula, which is clinically proven to reduce the risk of severe visual loss that can happen with macular degeneration. Almost all the data supporting the POSSIBLE benefits of bilberry in visual conditions is related to NON-HUMANS. Stick with the AREDS 2 formula that has excellent clinical evidence.

So, what is bilberry and why do some people use it?

Bilberry (Vaccinium myrtillus), a low-growing shrub that produces a blue-colored berry, is native to Northern Europe and grows in North America and Asia. It is naturally rich in anthocyanins, which have anti-oxidant properties.

It is said that during World War II, British pilots in the Royal Air Force ate bilberry jam, hoping to improve their night vision. No one is exactly sure where the impetus to do this came from, but it is believed that this story is what lead to some widespread claims that bilberry was good for your eyes.

A study by JH Kramer,  Anthocyanosides of Vaccinium myrtillus (Bilberry) for Night Vision - A Systematic Review of Placebo-Controlled Trials, reviewed most of the literature pertaining to the claim that bilberry improves night vision. He found that the four trials, which were all rigorous randomized controlled trials (RCTs), showed no correlation with bilberry extract and improved night vision. A fifth RCT and seven non-randomized controlled trials reported positive effects on outcome measures relevant to night vision, but these studies had less-rigorous methodology.

Healthy subjects with normal or above-average eyesight were tested in 11 of the 12 trials. The hypothesis that V. myrtillus improves normal night vision is not supported by evidence from rigorous clinical studies. There is a complete absence of rigorous research into the effects of the extract on subjects suffering impaired night vision due to pathological eye conditions.

Even though there is no solid evidence in human studies that bilberry produces any positive visual effects on night vision there is some experimental evidence that implies it might be useful in some ocular conditions whose mode of action is oxidative stress. There are recent epidemiologic, molecular and genetic studies that show a major role of oxidative stress in age-related macular degeneration.

There have been some studies showing oxidative protective effects of bilberry in non-human models. 

In Protective Effects of Bilberry and Lingonberry Extracts Against Blue-light Emitting Diode Light-induced Retinal Photoreceptor Cell Damage in Vitro, Ogawa et al showed that cultured mouse cells that had bilberry extract added before subjection to high-energy short-wavelength light survived better than those that hadn't received the extract. 

In Retinoprotective Effects of Bilberry Anthocyanins via Antioxidant, Anti-Inflammatory, and Anti-Apoptotic Mechanisms in a Visible Light-Induced Retinal Degeneration Model in Pigmented Rabbits, Wang et al found similarly improved survival of pigmented rabbit retinal cells when exposed to bilberry abstract prior to high-intensity light.

But bilberry is not without potential side effects.

Bilberry possesses anti-platelet activity and it might interact with NSAIDs, particularly aspirin. Excessive drinking of bilberry juice might cause diarrhea. One study of 2,295 people given bilberry extract found a 4% incidence of side effects or adverse events. Further, bilberry side effects may include mild digestive distress, skin rashes and drowsiness. Chronic uses of the bilberry leaf may lead to serious side effects. High doses of bilberry leaf can be poisonous.

Bilberry has not been evaluated by the Food and Drug Administration for safety, effectiveness, or purity.

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

Is it safe to use "Redness Relief" eye drops regularly?

The short answer is NO.

Here’s the slightly longer answer.

There are several eye “Redness Relief” products on the over-the-counter market, such as those made by Visine, Clear Eyes, and Bausch & Lomb - as well as generic versions sold by pharmacy chains.

Most commonly, the active ingredient in redness relief drops is either Tetrahydrozoline or Naphazoline. Both of these drugs are in a category called sympathomimetics.

Sympathomimetics, the active ingredient in redness relief drops, work though a process called vasoconstriction, an artificial clamping down of the superficial blood vessels on the eye surface. These blood vessels often dilate in response to an irritation. This increase in blood flow is trying to help repair whatever irritation is affecting the surface of the eye. Clamping down on those vessels by using a vasoconstrictor counteracts the body’s efforts to repair the problem.

The other downside to repetitively using redness relief drops is that after the vasoconstrictor wears off the vessels often dilate to an even larger degree than when the process started. This stimulates you to use the drops again.

All of these drops carry these same two warnings on their labels:

Do not overuse as it may produce increased redness of the eye.

Stop using and ask a doctor if you experience eye pain, changes in vision, continued redness or irritation of the eye, condition worsens or persists for more than 72 hours.

Does anyone read those warnings?  Almost never.

These drops are meant to be used for a VERY short duration - one or two days. That’s it!

They are not meant to be used indefinitely and they are certainly not meant to be used daily.

Take a good look at that first warning: MAY PRODUCE INCREASED REDNESS OF THE EYE.

If you are using redness relief drops repetitively you are likely making your eye redness WORSE, not better.

If you have been using redness relief drops daily you need to stop and replace them with an artificial tear or lubricating drop - something that DOES NOT say “gets the red out.”

After you make that switch your eyes are initially going to be red as your blood vessels take time to regain their normal vascular tone without the vasoconstrictor clamping down on them. The lubricating drop will actually help to repair the damage done by exposure to adverse conditions. This will decrease the inflammatory signals that make the vessels dilate. You will actually be doing something helpful to the surface of your eyes instead of just masking everything by artificially clamping down on your vessels and decreasing the flow of oxygen and nutrients to the front surface of your eye.

Using redness relief drops if you wear contacts is an even worse idea. If you put the drop in with your contact in, the contact will hold onto the drug and keep it on your eye surface longer, thus likely increasing the vasoconstriction. 

Your cornea has no blood vessels in it and it depends on the blood vessels in the conjunctiva over the whites of the eye to bring in nutrients and oxygen. The other source of oxygen for the cornea is what it gets from diffusion from the atmosphere and that is also cut down by the presence of the contact lens.

The redness relief drop combined with the contact lens are now BOTH reducing the levels of oxygen getting to the cornea. Decreased oxygen to the cornea is one of the biggest risks for contact lens-related infections, including corneal ulcers.

Don’t get me wrong, I’m not condemning redness relief drops if used appropriately for a very short time to soothe the eyes if they have been temporarily exposed to elements that made them irritated. For a day or two redness relief drops are fine. But for long-term use or for use while wearing your contacts they are much more likely to cause problems than to provide any benefits.

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.

We have all heard the term ”Love is in the Air,” but did you know that love can be wonderfully expressed through the eyes?  Certain chemicals (or endorphins) that help produce the emotion of love can be emitted through emotions expressed in the eyes. There are physiological changes in the eyes that occur when love is expressed between two individuals. Love for a romantic partner, a family member, or a favorite pet can all cause the same physical response: the pupil (black part in the center of the eye) dilates.

The size of the pupil can be an indication of emotional responses and messages. According to Scientific American, the autonomic nervous system (ANS), which directs our fight or flight response, causes the pupil to have a quick dilating response. The ANS is also in charge of heart rate and perspiration, and when a person is extremely interested in another person, the pupil has a dilating effect that is slightly less than the pupillary light reflex. This bounce in size is an automated response that gives scientists indication of mood or interest (or love) shown to a person or pet.

Mounting scientific evidence also shows the benefit of looking into the eyes of your pet, especially dogs. Stroking them causes you to become more healthy on all fronts, and a few minutes a day of lovingly looking at the dog and stroking the pet releases serotonin, prolactin, and oxytocin, which are "feel good" hormones.

There are also studies inspired by psychologist Arthur Aron, from over 20 years ago, that show if you stare into someone's eyes for 4 minutes you can fall in love... looking eye to eye allows you to connect with someone new or reminds you why you fell in love with this person in the first place.

Overall health is improved and years can be added to your life when looking at something or someone with love. Your eyes and autonomic nervous system play an intricate role in the expression of love.

Source:

12/07/2012 article of Scientific American entitled:

Why Do Pupils Dilate in Response to Emotional States?

By Joss Fong

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

Age-related macular degeneration, often called ARMD or AMD, is the leading cause of vision loss among Americans 65 and older.

AMD causes damage to the macula, which is the central portion of the retina responsible for sharp central vision. AMD doesn't lead to complete blindness because peripheral vision is still intact, but the loss of central vision can interfere with simple everyday activities such as reading and driving, and it can be very debilitating.

Types of Macular Degeneration

There are two types of macular degeneration: Dry AMD and Wet AMD.

Dry (non-exudative) macular degeneration constitutes approximately 85-90% of all cases of AMD. Dry AMD results from thinning of the macula or the deposition of yellow pigment known as drusen in the macula. There may be gradual loss of central vision with dry AMD, but it is usually not as severe as wet AMD vision loss. However, dry AMD can slowly progress to late-stage geographic atrophy, which can cause severe vision loss.

Wet (exudative) macular degeneration makes up the remaining 10-15% of cases. Exudative or neovascular refers to the growth of new blood vessels in the macula, where they are not normally present. The wet form usually leads to more serious vision loss than the dry form.

AMD Risk factors

• Age is the biggest risk factor. Risk increases with age.
• Smoking. Research shows that smoking increases your risk.
• Family history. People with a family history of AMD are at higher risk.
• Race. AMD is more common in Caucasians than other races, but it exists in every ethnicity.
• Gender. AMD is more common in women than men.

Detection of AMD

There are several tests that are used to detect AMD.

A dilated eye exam can detect AMD. Once the eyes are dilated, the macula can be viewed by the ophthalmologist or optometrist. The presence of drusen and pigmentary changes can then be detected.

An Amsler Grid test uses pattern of straight lines that resemble a checkerboard. It can be used to monitor changes in vision. The onset of AMD can cause the lines on the grid to disappear or appear wavy and distorted.

Fluorescein Angiogram is a test performed in the office. A fluorescent dye is injected into the arm and then a series of pictures are taken as the dye passes through the circulatory system in the back of the eye.

Optical coherence tomography (OCT) is a test based on ultrasound. It is a painless study where high-resolution pictures are taken of the retina.

Article contributed by Jane Pan 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.

One of the most commonly asked questions in an eye exam comes right after the refraction, or glasses prescription check: “What is my vision?”

Almost invariably, people know the term “20/20”. In fact, it’s a measure of pride for many people. “My doctor says I have 20/20 vision.” Or, on the other side of that same coin, having vision that is less than 20/20, say 20/400, can be a cause of great concern and anxiety. In this discussion I will describe what these terms actually mean.

To lay the foundation, let’s discuss some common terms. Visual acuity (VA) is clarity or sharpness of vision. Vision can be measured both corrected (with glasses or contact lenses) and uncorrected (without glasses or contact lenses) during the course of an eye exam. The result of an eye exam boils down to two different but related sets of numbers: your VA and your actual glasses prescription.

The notation that doctors use to measure VA is based off of a 20-foot distance. This is where the first 20 in 20/20 comes from. In Europe, since they use the metric system, it is based on meters. The 20/20 equivalent is 6/6 because they use a 6-meter test distance. The second number is the smallest line of letters that a patient can read. In other words, 20/20 vision means that at a 20-foot test distance, the person can read the 20/20 line of letters.

The technical definition of 20/20 is full of scientific jargon - concepts such as minutes of arc, subtended angles, and optotype size. If you’d like to read more of the technical details there is a well-written article with illustrations by Dr. John Ellman, you can find here.  For the purposes of our discussion here I’ll try to explain it in less technical terms.

“Normal” vision is somewhat arbitrarily set as 20/20 (some people can see better than that). Let’s say you have two people: Person A with 20/20 vision and Person B with 20/40 vision. The smallest line of letters that person B can see at 20 feet is the 20/40 line.  Person A, with “normal” 20/20 vision, could stand 40 feet away from that same line and see it. There is somewhat of a linear relationship in that the 20/40 letters are twice the size of the 20/20 letters and someone with normal vision could see a 20/40 letter at twice the distance as the person with 20/40 vision.

So how does this translate to a glasses prescription?

Eye doctors can often estimate what your uncorrected VA will be based on your glasses prescription. This works mainly for near-sightedness. Essentially, every quarter step of increasing glasses prescription (i.e. -1.25 as compared to -1.50) means a person can see one less line on a VA chart.

A prescription of - 1.25 works out to roughly 20/50 vision, -1.50 to 20/60 and so on. Anybody with an anatomically sound eyeball, meaning the absence of any kind of disease process, should generally be correctable to 20/20 with glasses or contact lenses. It is important to note, however, that rarely a person’s best corrected VA may be less than 20/20 with no noticeable signs of disease.

Far-sightedness is more difficult to estimate because it is affected by a number of other factors, including one’s age and focusing ability. But that’s a topic for another article.

So there you have it! Hopefully this has shed some light on what these measurements that we take actually mean, and it has allowed you to understand your eye health a little bit better.

Article contributed by Dr. Jonathan Gerard

There are certain eye conditions where an injection into your eye might be recommended.

Injections into the eye, specifically into the vitreous or gel-filled cavity of the eye, are called intravitreal injections.

In Part 1 of this series, we talked mostly about anti-vascular endothelial growth factor (anti-VEGF) injections. Anti-VEGF injections are probably the most commonly injected agents and they are used to treat wet age-related macular degeneration (ARMD), diabetic retinopathy, and retinal vein occlusion.  

But there are other injections that may be used as treatment.

Another injected medication used in combination with Anti-VEGF agents to treat wet macular degeneration, diabetic retinopathy and retinal vein occlusion are steroids. Additionally, steroids can be used to treat inflammation, or uveitis, in the eye. There is a steroid implant called Ozurdex, that looks like a white pellet and can last up to 3 months in the eye. The downside of steroids is that they can increase eye pressure and cause progression of cataracts.  

Antibiotics are another type of medication that can be injected into the eye. Sometimes an infection called endophthalmitis can develop inside the eye. This can occur after eye surgery or a penetrating injury to the eye. The presenting signs and symptoms of endophthalmitis are loss of vision, eye pain and redness of the eye. Bacteria is usually the cause of the infection, and antibiotics are the treatment. The best way to deliver the antibiotics is to inject them directly into the eye.  

Another relatively new injection is Jetrea, an enzyme that breaks down the vitreous adhesions that may develop on the surface of the retina. As we age, the vitreous contracts away from the retinal surface.  When this occurs over the macula, the region responsible for fine vision, the result is visual distortion. Jetrea is an injection that will dissolve the vitreous adhesions and relieve the traction on the retina.  Prior to the advent of Jetrea, the only treatment would have been surgery to physically remove the vitreous jelly and traction on the retina. 

The next time you visit your eye doctor and are told you need an injection of medication, it will likely be one of the agents, or something very similar, that we've discussed in this series.

Article contributed by Dr. Jane Pan

There are some eye conditions where your doctor might recommend an eye injection as a treatment option.

Injections into the eye, specifically into the vitreous or gel-filled cavity of the eye, are called intravitreal injections.

Anti-vascular endothelial growth factors (anti-VEGF) are probably the most commonly injected agents. They are used to treat wet age-related macular degeneration (ARMD), diabetic retinopathy, and retinal vein occlusion.

In these conditions, there are abnormal leaky blood vessels that cause fluid and blood to accumulate in and under the retina. This accumulation of fluid results in loss of central vision. The role of anti-VEGF agents is to shrink these abnormal vessels and restore the normal architecture of the retina.

Three anti-VEGF agents that are widely administered are Lucentis, Avastin, and Eylea.

Lucentis (Ranibizumab) is FDA approved for treatment of wet ARMD, diabetic retinopathy, and vein occlusion. It is specially designed for injection into the eye and is a smaller molecule than Avastin so it may have better penetration into the retina.

Avastin (Bevacizumab) was originally approved by FDA for treating colorectal cancer. It is used “off-label” for the same treatment indications as Lucentis. Off-label usage of medication is legal, but pharmaceutical companies can't promote a medication for off-label use. The amount of Avastin needed for eye injections is a fraction of the amount used to treat colorectal cancer, therefore, the cost of ophthalmic Avastin is only a fraction of the cost of Lucentis. This means that Avastin needs to be prepared sterilely into smaller doses by an outside pharmacy prior to injection into the eye.  

Eylea (Aflibercept) is the third anti-VEGF agent. It was designed to have more binding sites than Avastin and Lucentis so it may last longer in the eye than the former two.  Eylea is FDA approved for treatment of wet ARMD, diabetic disease, and vein occlusion, and therefore, the cost of Eylea is similar to the cost of Lucentis.

There are also newer agents on the market.  Your doctor will determine which might work best for you.

There is a thought that after prolonged injections, some patients may develop resistance to one particular agent but still respond to the a different agent. Therefore, your ophthalmologist will individualize your treatment.

Article contributed by Dr. Jane Pan

There have been studies undertaken over the past several years to try and understand if there are any of our day-to-day activities that either help or hurt the management of glaucoma.

Most of the studies demonstrated very little impact on the course of glaucoma. Here are some of the things researches have looked at.

Aerobic exercise: This means doing something at least four times per week for more than 20 minutes at a time that raises your pulse rate to a level that makes your heart work harder. Going from a sedentary lifestyle to active one with aerobic exercise resulted in a very slight decrease in baseline eye pressure.

Yoga: A study conducted at the Mount Sinai Health System (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144505) showed a significant increase in eye pressure with any head-down positioning. People with glaucoma would be wise to avoid any exercise that involves a position where your head is lower than your heart.

Weight lifting: Holding your breath while exerting yourself (called the Valsalva maneuver), is also a time when your eye pressure can go sky high. So if you lift weights for exercise, which is generally a good idea to maintain bone density, make it low weights with more repetitions of lifting, rather than heavy weights that make you grunt.

Wind instruments: A similar breath-holding problem applies to those playing the larger wind musical instruments like the French horn. One study suggested that there was a greater chance of glaucoma in symphonic wind players. If you play a brass instrument, it makes sense to have frequent checks of pressure, optic nerve head, and visual field.

Marijuana: Smoking marijuana can lower eye pressure. However, due to its short duration of action (3-4 hours), side effects, and lack of evidence that it alters the course of glaucoma, it is not recommended for glaucoma treatment.

Wearing tight neckties: This creates a very short-duration increase in eye pressure but doesn’t seem to have any long-term effects.

If it's been a while since your last eye exam--or if you've never had one done--it's always nice to know what testing you might have done and what issues the eye doctor looks for.  Here's the scoop on some common testing...

Visual Field

The visual field test is designed to check your peripheral vision, which is your ability to see things where you are not directly looking.

When we test your vision on the basic eye chart, we are testing how well you see right in the center and it gives us no idea if you can see out away from the center. Your peripheral vision is very important because it gives you the ability to move around your environment without running into things.

There are several diseases that can severely impact your peripheral vision while leaving central vision unaffected. Some people can have perfectly normal 20/20 central visual acuity and have almost complete loss of their peripheral vision.

The main culprits that can greatly affect your peripheral vision are glaucoma, some retinal diseases such as retinal detachments or retinitis pigmentosa, and some neurological problems like brain tumors, strokes, pseudotumor cerebri, and multiple sclerosis.  

Most visual field tests are now done on an automated machine that flashes lights in your peripheral vision while you stare straight ahead. The lights continue to get dimmer until you can no longer detect that they are there. The machine is trying to find the dimmest light you can see at each point in your peripheral vision that it is testing for.

Many patients get anxious when they take this test because everyone wants to do well on it. That can result in people not staring straight ahead but trying to look around to find the lights in an effort to do better.

That just makes the test come out worse. The machine also makes some noise as it changes location of the test light. Some people start pressing the buzzer whenever they hear a noise. They think there must be a light they missed but the machine, several times during the test, makes noise and then doesn’t put a light on to specifically see if you are trying to cheat by hitting the buzzer on the noise rather that seeing the light. Please don’t do those things - you are only cheating yourself and making it more difficult to figure out your problem.

Ocular Coherence Tomography (OCT)

The OCT really took hold in eye doctors' offices at the beginning of this century. It was the first time we were able to see anatomy and pathology inside the eye on a microscopic level without the use of any radiation.

It has been a great addition to our examination techniques and allowed us to see many causes of vision loss at a level of detail we never had before.

The two biggest uses for OCT in optical health are diagnosing diseases of the retina, particularly the area of central vision called the macula, and for diseases of the optic nerve, the most common of which is glaucoma.

For retinal disease it has been extremely helpful for macular problems such as macular degeneration (the leading cause of blindness in the U.S.), diabetic retinopathy, retinal vascular occlusions, and retinal swelling from inflammation.

The OCT allows us to see the individual cellular levels of the retina and helps in diagnosing the exact level where the pathology is occurring. If you look into the eye at the retina and see some bleeding in the macula it is difficult to judge where that blood exists without this machine. Is it superficial in the retina and coming from the retinal circulation or is it deep in and coming from the choroidal circulation under the retina?

The difference between those two locations can have a significant impact on what disease is causing the problem and what the proper treatment is. The OCT is also helpful in following the effect of treatment. If you are treating a bleeding or swelling problem in the retina, the OCT can track the degree of improvement with a level of detail that could never be matched by the human eye.

For glaucoma and other problems with the optic nerve, the OCT can precisely measure the thickness of the nerve tissue as it passes through the optic nerve. The hallmark of glaucoma is progressive loss of nerve fibers in the optic nerve.  Being able to measure the nerve thickness down to the micron level assists in both diagnosing and watching for progression of any optic nerve disease.

Fundus Photography

A picture is worth 1,000 words...

Fundus photography is just that, a regular picture of the inside of your eye. The pictures highlight the appearance of the macula and the optic nerve and record it for prosperity.

As eye doctors we make notes in the medical record of what we see when we look in the eye. The wording of anything that looks abnormal with the retina or optic nerve does vary somewhat from doctor to doctor. One of things we record is something called the cup to disk ratio (C:D) of the optic nerve. We express that ratio as a percentage. Normal is about 30% or .3. The range of normal is very wide and some “normal” eyes have a .1 cup and others can have a .7.

In glaucoma those percentages get larger over time as the person loses nerve tissue. So, if you were born with a .3 cup but in your 60’s you were found to have a .5 cup that would be a strong indicator that you might have glaucoma.  However, if you were born with a .5 cup and at 60 you still have a .5 cup then you don’t have glaucoma.  When you look at someone at 60 with a .5 cup it’s hard to be sure if this is normal for that person or did they progress from a .3 cup to a .5 cup.  If only I had a picture …  

Pictures of the back of the eye really do tell the story better than words. I can describe what the C:D looks like to me but a different doctor may describe it differently. Doctors are usually fairly consistent in their estimate of the C:D when it is the same doctor watching that C:D over time. When a different doctor estimates the C:D that consistency is just not there. My .4 C:D may be my partner’s .5. But you can’t argue with the picture.  

The same thing occurs with retinal bleeding. Rating the amount of bleeding as mild, moderate, or severe is somewhat helpful but there is a broad range of “mild” or “moderate”. When comparing two pictures taken at two different points of time it is much easier to decide if something is really getting better or worse.

We also use fundus photography to keep an eye on small tumors, called choroidal nevi, that can develop in the eye. These are increased areas of pigmentation under the retina in an area called the choroid. Most eye doctors explain these pigmented spots as “freckles in the eye.”  Most choroidal nevi are small and fairly flat. They can, however, sometimes grow larger and rarely turn into a melanoma in the eye. Serial photographs are very helpful in watching the lesions for growth.

These three tests - visual field, OCT, and fundus photography - make up the core of our testing. There are many other tests that can be performed along with your eye exam but these three we described here probably make up about 80% of the tests you may encounter, depending on your eyes.

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.

If it's been a while since your last eye exam--or if you've never had one done--it's always nice to know what testing you might have done and what issues the eye doctor looks for.  Here's the scoop on some common testing...

Visual Field

The visual field test is designed to check your peripheral vision, which is your ability to see things where you are not directly looking.

When we test your vision on the basic eye chart, we are testing how well you see right in the center and it gives us no idea if you can see out away from the center. Your peripheral vision is very important because it gives you the ability to move around your environment without running into things.

There are several diseases that can severely impact your peripheral vision while leaving central vision unaffected. Some people can have perfectly normal 20/20 central visual acuity and have almost complete loss of their peripheral vision.

The main culprits that can greatly affect your peripheral vision are glaucoma, some retinal diseases such as retinal detachments or retinitis pigmentosa, and some neurological problems like brain tumors, strokes, pseudotumor cerebri, and multiple sclerosis.  

Most visual field tests are now done on an automated machine that flashes lights in your peripheral vision while you stare straight ahead. The lights continue to get dimmer until you can no longer detect that they are there. The machine is trying to find the dimmest light you can see at each point in your peripheral vision that it is testing for.

Many patients get anxious when they take this test because everyone wants to do well on it. That can result in people not staring straight ahead but trying to look around to find the lights in an effort to do better.

That just makes the test come out worse. The machine also makes some noise as it changes location of the test light. Some people start pressing the buzzer whenever they hear a noise. They think there must be a light they missed but the machine, several times during the test, makes noise and then doesn’t put a light on to specifically see if you are trying to cheat by hitting the buzzer on the noise rather that seeing the light. Please don’t do those things - you are only cheating yourself and making it more difficult to figure out your problem.

Ocular Coherence Tomography (OCT)

The OCT really took hold in eye doctors' offices at the beginning of this century. It was the first time we were able to see anatomy and pathology inside the eye on a microscopic level without the use of any radiation.

It has been a great addition to our examination techniques and allowed us to see many causes of vision loss at a level of detail we never had before.

The two biggest uses for OCT in optical health are diagnosing diseases of the retina, particularly the area of central vision called the macula, and for diseases of the optic nerve, the most common of which is glaucoma.

For retinal disease it has been extremely helpful for macular problems such as macular degeneration (the leading cause of blindness in the U.S.), diabetic retinopathy, retinal vascular occlusions, and retinal swelling from inflammation.

The OCT allows us to see the individual cellular levels of the retina and helps in diagnosing the exact level where the pathology is occurring. If you look into the eye at the retina and see some bleeding in the macula it is difficult to judge where that blood exists without this machine. Is it superficial in the retina and coming from the retinal circulation or is it deep in and coming from the choroidal circulation under the retina?

The difference between those two locations can have a significant impact on what disease is causing the problem and what the proper treatment is. The OCT is also helpful in following the effect of treatment. If you are treating a bleeding or swelling problem in the retina, the OCT can track the degree of improvement with a level of detail that could never be matched by the human eye.

For glaucoma and other problems with the optic nerve, the OCT can precisely measure the thickness of the nerve tissue as it passes through the optic nerve. The hallmark of glaucoma is progressive loss of nerve fibers in the optic nerve.  Being able to measure the nerve thickness down to the micron level assists in both diagnosing and watching for progression of any optic nerve disease.

Fundus Photography

A picture is worth 1,000 words...

Fundus photography is just that, a regular picture of the inside of your eye. The pictures highlight the appearance of the macula and the optic nerve and record it for prosperity.

As eye doctors we make notes in the medical record of what we see when we look in the eye. The wording of anything that looks abnormal with the retina or optic nerve does vary somewhat from doctor to doctor. One of things we record is something called the cup to disk ratio (C:D) of the optic nerve. We express that ratio as a percentage. Normal is about 30% or .3. The range of normal is very wide and some “normal” eyes have a .1 cup and others can have a .7.

In glaucoma those percentages get larger over time as the person loses nerve tissue. So, if you were born with a .3 cup but in your 60’s you were found to have a .5 cup that would be a strong indicator that you might have glaucoma.  However, if you were born with a .5 cup and at 60 you still have a .5 cup then you don’t have glaucoma.  When you look at someone at 60 with a .5 cup it’s hard to be sure if this is normal for that person or did they progress from a .3 cup to a .5 cup.  If only I had a picture …  

Pictures of the back of the eye really do tell the story better than words. I can describe what the C:D looks like to me but a different doctor may describe it differently. Doctors are usually fairly consistent in their estimate of the C:D when it is the same doctor watching that C:D over time. When a different doctor estimates the C:D that consistency is just not there. My .4 C:D may be my partner’s .5. But you can’t argue with the picture.  

The same thing occurs with retinal bleeding. Rating the amount of bleeding as mild, moderate, or severe is somewhat helpful but there is a broad range of “mild” or “moderate”. When comparing two pictures taken at two different points of time it is much easier to decide if something is really getting better or worse.

We also use fundus photography to keep an eye on small tumors, called choroidal nevi, that can develop in the eye. These are increased areas of pigmentation under the retina in an area called the choroid. Most eye doctors explain these pigmented spots as “freckles in the eye.”  Most choroidal nevi are small and fairly flat. They can, however, sometimes grow larger and rarely turn into a melanoma in the eye. Serial photographs are very helpful in watching the lesions for growth.

These three tests - visual field, OCT, and fundus photography - make up the core of our testing. There are many other tests that can be performed along with your eye exam but these three we described here probably make up about 80% of the tests you may encounter, depending on your eyes.

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 light of the holiday season, here are our top 10 eye care jokes.

1) What do you call a blind deer?No Eye Deer!

2) What do you call a blind deer with no legs?Still No Eye Deer!

3) Why do eye doctors live long lives?Because they dilate!

4) Why did the blind man fall into the well?He couldn’t see that well.

5) Why shouldn’t you put avocados on your eyes?Because you might get guac-coma!

6) What did the right eye say to the left eye?"Between you and me, something smells."

7) A man goes to his eye doctor and tells the receptionist he’s seeing spots. The receptionist asks if he’s ever seen a doctor.The man replies, “No, just spots.”

8) How many eye doctors does it take to screw in a light bulb?One … or two

9) Unbeknownst to her, a woman was kicked out of peripheral vision club.She didn’t see that one coming!

10) What do you call a blind dinosaur?A do-you-think-he-saurus

Bonus: What do you call a blind dinosaur’s dog?A do-you-think-he-saurus rex!

Article contributed by Dr. Jonathan Gerard