As an eye doctor, diagnosing a red eye can be challenging. Are we dealing with an infection, allergy, inflammation, or dryness?

A common question we get is, “Doc, my eyes are red, burning, itchy, and tearing. Is this dry eye or from allergies?” The short answer is it could be one, both, or neither. We'll outline various ways these conditions present clinically and the treatments for them.

The hallmark symptom of allergy – meaning if you have this symptom you almost definitely have the condition – is itching. Red, watery, ITCHY eyes are almost invariably due to an allergen, whether environmental or medicinal. It is one of the most common ocular conditions that we, as eye doctors, treat -- especially when plants are filling the air with pollen as they bloom in the Spring and then die off in the Fall.

The itching occurs because an immune cell called a mast cell releases histamine, causing the itching sensation. It can be quite unbearable for the sufferer, causing them to rub their eyes constantly, which actually increases the amount of histamine in the eye, leading to worsening of the symptoms.

Treatments may include:

• Over-the-counter or prescription allergy drops (mostly anti-histamines or mast cell stabilizers).
• Topical steroids (to get the inflammation under control).
• Cool compresses applied to the eye.

Patients sometimes need to take drops every day to keep their symptoms under control.

Dry eye can have many of the same symptoms as allergic eye disease, with the eye being red and possibly watery ("My eyes are tearing--how could it be dry eyes?"). The main exceptions are that people with dry eyes tend to complain more of burning and a foreign body sensation - like there is sand or gravel in the eye - rather than of itchiness.

Dry eye is a multi-faceted disease with many different causes and treatments. Treatment ranges from simple re-wetting eye drops to long-term medications (both topical and oral), as well as non-medicinal treatments such as eyelid heating treatments.

So how do we determine the difference? The first question I ask patients who complain of red, watery, uncomfortable eyes is, “What is your MAIN symptom? Itching or burning?” The answer will likely direct which course of treatment we take, and as those treatments sometimes overlap, you may have a component of both dry eye and allergy.

That is important to distinguish because many of the treatments we use for allergies - like antihistamine eye drops - can sometimes make the dryness worse. Neither of these conditions is 100% curable (except maybe for allergy, where if you remove the allergen, you obviously won’t get symptoms!). We have many tools in our treatment arsenal to keep the symptoms at bay.

Unfortunately, dry eye and allergy aren’t the only two things that can cause your eye to have the multiple symptoms of red, watery, itchy, burning eyes. There are other problems, such as blepharitis, that can produce a similar appearance, as well as bacterial and viral infections.

So before embarking on a particular therapy, it is wise to have a good exam to help you get on the right track for improving your symptoms.

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.

Oftentimes, contact lens wearers will skimp on their lens care because some of the solutions are costly and it seems like a good way to save some hard-earned cash. But this is not a good idea.

Cutting corners can result in infections or irritations, and after one or two copays to your eye doctor's office, you probably will have spent more than what you saved in a year by cutting corners--plus you have to deal with your discomfort and inability to wear your contact lenses while you are being treated.

The reasons you clean your contacts are to give increased lens comfort, prolong lens oxygen permeability, and to protect your eyes from infection. The reason you have to disinfect your contact lenses is - as nasty as it may sound - that your eyeball and eyelids are covered in essential bacteria that are kept in check by your body’s immune system. When you remove your contact lens at night it is covered in these essential bacteria. If you don't kill them overnight, the bacteria will grow unchecked and then, instead of inserting a freshly cleaned lens, you are inserting a lens covered in more bacteria than your eye is used to and you end up getting an infection.

Let’s talk about the most widely used type of solution - the multipurpose solution. While this is often the most incorrectly used solution, multipurpose solution is a very safe and effective disinfection method when used properly.

Many multipurpose solutions advertise themselves as “No Rub.” Just put it in the case and you are done. This is OK to do, but a quick rub with the no-rub solution in the palm of your hand and the opposite hand’s middle or ring finger provide an even better cleaning option. Just the slight roughness of your fingerprint adds a light scrubbing effect that helps improve the removal of surface debris, protein, and mucous better than just letting the lens soak overnight. This rubbing of the lens is especially important for women to remove any cosmetics that are rarely removed by just soaking alone. These few seconds of extra cleaning will make your lenses stay more comfortable during their wearing cycle, and will help to keep the pores of the lenses open, allowing more oxygen to contact your cornea.

Many name brands and store/warehouse brands of multipurpose solutions exist. All are FDA approved to do the same thing: clean/disinfect/rinse/store your contact lenses. You can't really mess them up unless you try. Remove the lenses, lightly rub them with the multipurpose solution, place your lens into a CLEAN and DRY lens case, and cover the lens with solution to disinfect it. Then let it sit for the number of hours recommended by the manufacturer, generally between 4 to 8 hours, or overnight. Remove the lenses in the morning, rinse with the same multipurpose solution and rinse the lens case out and leave it open to air dry in an area away from your sink and toilet to prevent airborne contaminants from getting into your case as it dries.

The biggest misuse of the multipurpose solution is not changing your case’s solution nightly and just adding more solution to the case each night. We call this “topping off the case.” This is NOT safe because it will lose disinfection power since the old/used solution was busy killing the bacteria and organisms from the night before. Just adding a little fresh solution will eventually allow for the bacteria to take over and you may be adding more bacteria into your eyes than if you never disinfected the lenses to begin with.

Multipurpose solution companies will often give you a new case when you buy bigger bottles of solution. You should start using the new case with the new bottle of solution. Don't just stash the case away. There are fungi and other organisms that can grow in very old lens cases--so USE the new case and don't keep it for when you break the old one.

There are many different multipurpose solutions on the market. They aren't cheap and it is tempting to purchase “what is on sale” to save a few dollars. If it does the same thing as the expensive one, then why bother spending the extra, right? But remember, your contacts are like little sponges that soak up your lens solution. The lens companies don't care if brand A’s solution is compatible with brand B’s or C’s. Mixing solutions with the same lens is also a bad idea because mixing them can cause a chemical reaction if solutions are not compatible.   Another reason to stick with one brand of soluion is that, over time, you can develop a sensitivity to that one particular brand of solution. If you are using the same brand regularly and start having issues your doctor may recommend a solution change to another company that you haven't tried and this may potentially solve your problem. But if you have used several different ones in the few weeks prior to your visit, it makes it much harder to determine the cause of your irritation.

The generic/store brands are usually fine products but a grocery store or discount chain doesn’t have a factory that makes their solution for them--they purchase it from a larger supplier. These third-party suppliers can alter their recipe for their multipurpose lens solutiosn and you as the consumer would never know. You could just start finding your contacts are not as comfortable as they used to be and it is actually the unknown generic solution change that is bothering you. Brand name companies like Bausch and Lomb, AMO, and Alcon will rarely make product changes without making consumers aware that they've reformulated the product--so if something changes with the reformulated product you have a better chance of knowing it than with a generic solution manufacturer.

Finally, there is a product called saline solution. Saline is extremely inexpensive, generally half to a third the price of multipurpose solutions. This is a product made by many different companies and was the first lens solution ever used. Saline solution was initially used in a heat disinfection system where the lenses were boiled nightly. The boiling of the lens provided the disinfection, not the saline solution. The solution was to just to prevent the lens from drying out while you cooked it. You should NEVER use saline solution as a replacement for multipurpose solution. Saline solution is NOT a disinfectant for your lenses. It doesn’t contain an agent that will prevent bacteria and organisms from growing in the case overnight. However, it’s totally acceptable if you want to rinse your lenses in the morning with saline prior to inserting them after they were disinfected with your multipurpose solution.

Oftentimes, a practitioner will recommend a certain type of solution to help with things like dryness, environmental allergies, or allergies to specific solutions. I always recommend checking with your practitioner before making any changes to your lens care solution or lens care routine. The best advice for saving money on your preferred solution is buy extra when it is on sale, buy in bulk, and buy what is most comfortable in a multipurpose solution for you. Then stick with it and use it correctly for many years of happy lens wear.

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.

Cataracts are part of the natural aging process. Everyone gets them to one degree or another if they live long enough. Cataracts, as they progress, create increasing difficulty with the normal activities of living. The symptoms vary from one person to another. Some people have more difficulty with their distance vision, some with reading. People may report difficulty with glare, or foggy, blurry, or hazy vision.

Doctors have noticed an increase in requests for second opinions because patients are sometimes told they have cataracts and they HAVE to have surgery--even though the patient has no visual complaints. Just having a cataract is not a reason to have cataract surgery.

According to the American Academy of Ophthalmology, "The decision to recommend cataract surgery should be based on consideration of the following factors: visual acuity, visual impairment, and potential for functional benefits." Therefore, the presence of a cataract is not enough to recommend surgery. There needs to be some degree of visual impairment that is altering the ability to perform your normal activities of daily living. There also needs to be some reasonable expectation that removing the cataract is going to improve vision.

As an example, we'll use a patient with advanced macular degeneration who has significant visual impairment. If she has just a mild cataract, then removing that cataract is unlikely to alleviate the visual impairment. You therefore need to have both things - a visual impairment that interferes with your normal daily activities AND a reasonable expectation that removing a cataract is going to help improve vision to a significant degree.

There are some instances where a dense cataract might need to be removed even though the above criteria are not being met. One example is when a cataract gets so bad that it starts causing glaucoma. Another instance would be if the cataract interferes with treating a retinal problem because the retina cannot be well visualized if the cataract is severely hampering the view of the retina. Those conditions are VERY rare in the U.S.

Most people who need cataract surgery are aware they have a visual impairment and that impairment is altering their normal daily activities. There are times, however, when we recommend cataract surgery because there is a visual impairment but the patient is not aware of just how bad their vision is. For example, the legal driving requirement in New Jersey is 20/50 or better in at least one eye. So we do occasionally see a patient who think he sees fine but when tested his vision is worse than 20/50 and he is still driving. In that case we would recommend cataract surgery (assuming the cataract is the problem) even though the patient does not think he has an impairment.

If you have been told you need cataract surgery but feel you are not having any significant visual problem, you should consider getting a second opinion.

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.

Just like adults, children need to have their eyes examined. This need begins at birth and continues through adulthood.

Following are common recommendations for when a child needs to be screened, and what is looked for at each stage.

A child’s first eye exam should be done either right at or shortly after birth. This is especially true for children who were born prematurely and have a very low birth weight and may need to be given oxygen. This is mainly done to screen for a disease of the retina called retinopathy of prematurity (ROP), in which the retina does not develop properly as a result of the child receiving high levels of oxygen. Although rarer today due to the levels being monitored more closely, it is still a concern for premature babies.

The next time an eye exam is in order is around 6 months. At this stage, your pediatric eye doctor will check your child’s basic visual abilities by making them look at lights, respond to colors, and be able to follow a moving object.

Your child’s ocular alignment will also be measured to ensure that he or she does not have strabismus, a constant inward or outward turning of one or both eyes. Parents are encouraged to look for these symptoms at home because swift intervention with surgery to align the eyes at this stage is crucial for their ocular and visual development.

It is also imperative for parents and medical professionals to be on the lookout for retinoblastoma, a rare cancer of the eye that more commonly affects young children than adults. At home, this might show up in a photo taken with a flash, where the reflection in the pupil is white rather than red. Other symptoms can include eye pain, eyes not moving in the same direction, pupils always being wide open, and irises of different colors. While these symptoms can be caused by other things, having a doctor check them immediately is important because early treatment can save your child’s sight, but advanced cases can lead to vision loss and possibly death if the cancer spreads.

After the 6-month exam, I usually recommend another exam around age 5, then yearly afterward. There are several reasons for this gap. First, any parent with a 2- to 4-year-old knows that it’s difficult for them sit still for anything, let alone an eye exam. Trying to examine this young of a patient can be frustrating for the doctor, the parent, and the child. Nobody wins. By age 5, children are typically able to respond to questions and can (usually) concentrate on the task at hand. If necessary at this stage, their eyes will be measured for a prescription for glasses and checked for amblyopia, commonly known as a “lazy eye”. Detected early enough, amblyopia can be treated properly under close observation by the eye doctor.

The recommendations listed above are solely one doctor’s opinion of when children should have eye exams. The various medical bodies in pediatrics, ophthalmology, and optometry have different guidelines regarding exam frequency, but agree that while it is not essential that a healthy child’s eyes be examined every year, those with a personal or family history of inheritable eye disease should be followed more closely.

Article contributed by Dr. Jonathan Gerard

NOTE: Many eye doctors commonly like to have another exam around age 3, in order to make sure a pre-schooler's vision is developing correctly. Please go by what your trusted eye doctor advises and is comfortable with.

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.

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 invest in 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.

Lyme disease is an infection that is caused by a spirochete (a type of microorganism) called Borrelia burgdorferi, and more rarely by Borrelia mayonii. It is transmitted to humans by the bite of a deer tick.

The disease has a strong geographical incidence, being highly concentrated in the Northeastern United States and also in Minnesota and Wisconsin.  However, the tick's habitat has been spreading rapidly, and it is always a good idea to be cautious and consult medical help if you think you might have been bitten by a tick that could possibly be infected.

Lyme disease was first recognized in the area of Lyme, Connecticut, in 1975. It can start with a characteristic “bull’s eye” rash, in which there is a central spot that is surrounded by clear skin that is then ringed by an expanding rash. It can also appear just as an expanding rash.

This rash usually starts within days of the tick bite. Eye problems can occur along with this rash in the first phase of the disease. This includes red eyes that can look like full-blown pink eye, along with eyelid swelling. It also can produce iritis or uveitis, which include sensitivity to light and inflammation inside the eye.

The second phase of the disease usually starts within a few weeks of the tick bite and this occurs because the spirochete gets into the blood stream. This stage often has rashes starting away from the original bite site. It can also produce joint pain, weakness, and inflammation in several organs including the heart, spleen, liver and kidneys.  

There are also several ways the second phase can affect your eyes. It can cause inflammation in your cornea (keratitis), retina (retinitis), optic nerve (optic neuritis), uvea (uveitis), the jelly-like vitreous (vitritis) that fills the back of the eye, and the muscles that move your eye around (orbital myositis). It can also affect the eye if it causes problems with the nerve that controls your eyelid muscles so that your eye will not close properly (Bell’s palsy).

There is a third phase of the disease that is caused by long-term persistent infection.  This phase can create multiple neurologic problems and can appear very similar to the presentation of Multiple Sclerosis (MS). The eyes can show any of the same signs as phase two, but the most common presentation is persistent keratitis. Keratitis symptoms are an inflamed cornea, often accompanied by significant pain, light sensitivity, a gritty feeling, and sight impairment.

The diagnosis is made through observation of the presenting symptoms, location in an area where there are significant numbers of the disease-carrying ticks, and a blood test that can confirm the diagnosis.  

The symptoms and signs of Lyme disease can mimic many other problems, so it is important to keep Lyme disease in mind if you are having multiple problems involving different organs and you know or have any suspicion that you may have had a tick bite while you were in areas where the disease is prevalent.

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 care medical field has an unusual split between two different types of insurance for covering eye issues: health insurance and vision insurance. Not all patients have both.

In most cases, your health insurance is used to cover medical and surgical eye problems but not routine exams or the cost of contacts or glasses. Those things are often covered by separate vision insurance.

Why the difference? Originally, health insurance was created to take care of health “problems” and wasn’t designed to cover “routine,” “screening,” or “wellness” exams.

Since health insurance wasn’t going to cover “routine” eye exams, the vision insurance industry arose to help insure/cover those routine exams as well as the costs of glasses and/or contacts if they were needed.

That dichotomy now often causes great confusion when you make an appointment at your eye doctor. When making your appointment, the office is going to need to know which insurance, if you have both, you are going to be using for this particular visit.

Why does the office need to know in advance which insurance you are using?

The main reason is that the rules and sometimes the providers are different for each insurance plan. The vision plans often require the office to check on your availability for coverage and get pre-authorization for the visit BEFORE you get to the office. There are also differences in which providers within an office are in network for the insurance. For example, in some practices the optometrists might be in all the vision plans but the ophthalmologists might not participate in those plans. If you make an appointment with one of the ophthalmologists and tell the office you are using your health insurance, you can’t change your mind the day of the appointment and use your vision insurance instead.

There are also differences in what the insurance will cover as a reason for the exam.  Vision insurance typically covers ONLY routine exams. Those are exams for which you are coming in specifically to get your vision, glasses and/or contact lens prescription checked and get an overall eye health screening.  That means you CAN’T have a medical complaint about your eyes that you want the doctor to deal with. Eyes itchy? Need to use your medical/health insurance.  Dry eyes? Need to use your medical/health insurance.  Have a cataract? Glaucoma? Macular Degeneration? Need to use your medical/health insurance.

Why not just use your medical insurance all the time? That’s mostly because if you have no complaint at all your medical insurance won’t cover that visit (and “my vision is a little blurry” usually won’t cut it).  There is one other issue and that is the refraction.

A refraction is when we check to see if you need a new eyeglass or contact lens prescription. For the most part, health insurance won’t cover the fee for the refraction, which is a procedure that is separate from your eye health exam. Your vision insurance will cover the refraction but not the exam if you are having a medical problem.

Here’s the real kicker. Your health insurance will cover your medical eye problems and your vision insurance will cover your refraction, BUT you can’t use both insurances at the same visit. It has to be one or the other.  (Ridiculous right? I didn’t make the rules, just trying to abide by them.)

So, what are your choices if you have both a vision plan and health insurance? If you have a problem, you need to use your health insurance. If you want to have your eyes refracted so you can get new glasses at the same time you can either pay out of pocket for the refraction OR you can come back in for a second visit, using your vision plan to get a refraction and eye health screening exam so that the refraction gets covered. (Again - I didn’t invent these rules--I am just trying to help you navigate them.) If you don’t want to make two visits, then use your health insurance (with the appropriate complaint) and pay for the refraction and just use your vision insurance to help pay for the actual contacts or glasses you are going to buy.

If you have a question, it’s best to ask when you call the office to inquire about an appointment.

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 is a common misconception that any adverse reaction to a drug is an allergy. That is definitely not the case.

Reporting to your doctors that you have an allergy to a medication when what you really had was a side effect could potentially create a substantial alteration to your medical care in the future. And this could mean a physician might avoid using a drug that could possibly save your life because of the fear of an allergic reaction.

An anaphylactic allergic reaction generally produces a very specific set of symptoms, including difficulty breathing due to constriction of windpipe, swelling of your tongue, and/or a rash and hives that break out over your body. While an allergic reaction can present in other ways, these are the most frequent reactions that occur when you have a true allergy to something.

If that is not the type of reaction you had then it probably isn’t an allergy. If you are uncertain if your reaction to a medication is an allergy or not, testing by an allergist may be able to tell you if your reaction was a true allergy or a side effect.

It is not always just the patient who can misdiagnose a side effect as an allergy. Sometimes it is the doctor or the dentist who tells the patient, “You must be allergic.” This is a quick and easy explanation, but it is not always the correct one.

In optimal medicine, there are not always a lot of “lifesaving” incidences, but there are several drugs that are the preferred treatment for certain conditions and if you report an allergy to these drugs it may make your doctor use a much less effective drug.

Here are some specific examples of when a false report of an allergy may lead to less effective treatment or even failure to offer life-saving treatment.

Epinephrine

The most common potential “lifesaving” drug for which patients report an allergy to is Epinephrine.

The story usually goes something like this: “I was having a dental procedure and soon after the dentist injected my mouth with a local anesthetic of lidocaine with epinephrine my heart started racing and pounding out of my chest and I almost passed out.” This hypothetical patient may come to the conclusion--or the dentist may mention--that the patient is allergic to epinephrine. That reaction is almost never an allergy but a side effect that occurs when a substantial dose of the lidocaine and the epinephrine gets into the blood stream and stimulates the heart.

The mouth and gums are very vascular, and it is easy to have some of that injection end up in the bloodstream, but that reaction is not an allergy and should not be reported as such.

Epinephrine is used to treat severe (anaphylactic) allergic reactions and not using it if you were to ever have a severe allergic reaction could lead to some very bad outcomes. This is not to say you can’t be allergic to epinephrine. You can, but it is extremely rare. If there is any doubt you should be tested by an allergist before you ever record yourself in a medical setting as being “allergic” to epinephrine.

Cortisone/Steroids

Cortisone is a highly effective drug to treat many conditions. Again, it is unlikely but not impossible to be allergic to it.

We all have naturally occurring cortisol circulating in our bodies and cortisone is a very similar molecule but not exactly the same. Cortisone also can have a wide range of side effects depending on where and how it is administered

Some of the common side effects of cortisone, which have been mislabeled as an allergy, are: increased blood sugar, insomnia, mood swings, nausea, and weight gain. These are all known side effects of the drug and not allergies. Cortisone side effects are associated with only certain routes of administration and are often dose dependent.

Why is this important in terms of your eye care? We often use cortisone derivatives, like Prednisolone, to fight inflammation that may occur in your eye, particularly after any ocular surgery. If you report that you are allergic to cortisone when you really only experienced a side effect, we are going to have to use a less-effective medication to deal with your eye inflammation.

As I mentioned above, most side effects are dose dependent and the dose you got in a pill may have caused a side effect you’d rather not have again but the dose in an eye drop is significantly less and highly unlikely to give you the side effect you got with a pill taken orally.

Antibiotics

People often report they are allergic to antibiotics when they really experienced a side effect.

The most common side effect with oral antibiotics is some type of gastrointestinal disturbance, like nausea, or diarrhea. If that was what you had and just prefer not to get that again you still shouldn’t report it as an allergy. If you do, then the drug can’t be used as an eye drop or ointment that might be the best treatment for your condition.

An antibiotic eye drop/ointment is very unlikely to produce the same gastrointestinal trouble that the same antibiotic gave you when given as a pill. You don’t want to take away the most effective treatment for your problem because you mislabeled a side effect as an allergy.

Sedatives/Anesthesia

With sedatives and anesthesia, the issue is often how a person felt either during or after a procedure.

Common comments are “it took me too long to wake up” (side effect not an allergy); “the sedative I got in my IV burned when it went in” (side effect not an allergy); “I was sleepy all day” (side effect not an allergy); “I was nauseous after the procedure” (could be an allergy, but much more likely to be a side effect).

Why are these important? We can make you much more comfortable for a local anesthesia procedure if we can use some sedation. Using sedation may be better for you and the doctor performing the surgery because you are much less likely to move during the surgery if you are resting comfortably.

If you ever have an untoward reaction to a medication it is worth your time and effort to really probe into the issue to figure out if what you had was really an allergy or just a side effect.  Your life may depend on it.

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.

Motherhood...the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has proven that there is a transference of emotion and programming from birth and infancy between a mother and her child--a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind?

The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now the baby's world is no longer just one person--its mother--but also includes third parties, thereby increasing social skills and interaction.

Interestingly, if a mother is blind, it does not adversely affect the child’s development. A study published in the Proceedings of the Royal Society B showed no deficit in the baby's advancement. The sheer fact that the infant looks into the mother’s eyes helps with connectedness and emotional grounding.

Looking into mom’s eyes and face teaches facial recognition and expressions of emotions and is primarily how the child learns in the first few months of life. Additionally, infants tend to show a preference to viewing faces with open eyes rather than closed eyes, thus stressing the importance of the mother or caregiver’s gaze.

Some health benefits to gazing into the mother’s eyes is a lower incidence of autism, or spectrum disorders, and better social skills, higher learning capacity, and emotional groundedness.

The beauty of a mother’s gaze is that the child can feel the emotions of love, security, safety, and overall well-being by connecting with her through eye-to-eye contact. This sets the stage for the future development of social skills, visual recognition of people, and readiness for social interaction in the world.

A big thank you to science and mothers for proving what we already know--that the values in life can be taught to a child “through a mother's eyes,” setting the course for proper interaction for life skills and relationships.

References:

1. Kate Yandell, Proceedings of the Royal Society B ,04/10/2013.

2. Maxson J.McDowell, Biological Theory, MIT Press, 05/04/2011.

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.

No this is not a late-night personal injury lawyer infomercial.

This is a recommendation that you have your LASIK records available, for your own good, later in life.

There are 2 million cataract surgeries done yearly in the U.S. and the odds are, if you live long enough, you will eventually need cataract surgery, too.

What does this have to do with LASIK surgery? 

When doctors perform cataract surgery they remove the cataract, which is the lens of your eye that has become cloudy.  And they replace that lens with an artificial lens called an Intraocular Lens implant (IOL).

The IOL needs to have a strength to it to match your eye so that things are in focus without the need for strong prescription eyeglasses.

Currently, we determine what strength the IOL needs to be by using formulas that mostly depend on the measurements of the curvature of the cornea and the length of the eye.

Those formulas work best when the cornea is its natural shape -- i.e., not previously altered in shape from LASIK.

If you plug the “new” post-LASIK corneal shape into the formulas, the IOL strength that comes out is often significantly off the strength you really need to see well.

This is where having your records becomes important.

Knowing what your eyeglass prescription and corneal shape were BEFORE you had LASIK greatly improves our formula’s ability to predict the correct implant strength.

In most states there is a limit to how long a doctor needs to keep your records after your last visit, so everyone who has had LASIK surgery should get a copy of your pre- and post-LASIK records NOW before they no longer exist.

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 Background

Over the last several years, research has indicated a strong correlation between the presence of Obstructive Sleep Apnea (OSA) and glaucoma. Information from some of these pivotal studies is presented below.

Did you know

• Glaucoma affects over 60 million people worldwide and almost 3 million people in the U.S.
• There are many people who have glaucoma but have not yet had it diagnosed.
• Glaucoma is a leading cause of blindness in the United States. 
• If glaucoma is not detected and goes untreated, it can result in peripheral vision loss and irreversible blindness.

• Sleep apnea is a condition that obstructs breathing during sleep.
• It affects 100 million people around the globe and around 25 million people in the U.S.
• A blocked airway can cause loud snoring, gasping, or choking because breathing stops for up to two minutes.
• Poor sleep due to sleep apnea results in morning headaches and chronic daytime sleepiness.

The Studies

In January 2016, a meta-analysis by Liu et. al., reviewed studies that collectively encompassed 2,288,701 individuals over six studies. Review of the data showed that if an individual has OSA there is an increased risk of glaucoma that ranged anywhere from 21% to 450% depending on the study.

Later in 2016, a study by Shinmei et al. measured the intraocular pressure in subjects with OSA while they slept and had episodes of apnea. Somewhat surprisingly, they found that when the subjects were demonstrating apnea during sleep, their eye pressures were actually lower than when the events were not happening.

This does not mean there is no correlation between sleep apnea and glaucoma - it just means that an increase in intraocular pressure is not the causal reason for this link. It is much more likely that the correlation is caused by a decrease in the oxygenation level (which happens when you stop breathing) in and around the optic nerve.

In September of 2016, Chaitanya et al. produced an exhaustive review of all the studies done to date regarding a connection between obstructive sleep apnea and glaucoma and came to a similar conclusion. The risk for glaucoma in someone with sleep apnea could be as high as 10 times normal. They also concluded that the mechanism of that increased risk is most likely hypoxia – or oxygen deficiency - to the optic nerve.

A more recent study showed that even when factors such as age, gender, and disease are taken into account, there was up to a 40% greater chance of developing glaucoma when obstructive sleep apnea is present.

The Conclusion

There seems to be a definite correlation between having obstructive sleep apnea and a significantly increased risk of getting glaucoma. That risk could be as high as 10 times the normal rate.

It's highly recommended that if you have been diagnosed with obstructive sleep apnea that you have have a comprehensive eye exam in order to detect your potential risk for glaucoma.

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.

There are many options available to adults and children for corrective lenses (glasses and contacts) when engaged in physical activities.

Here is a look at the different modalities and the pros and cons of each:

Prescription Sports Goggles (e.g., Rec Specs)

The main benefits of goggles while playing sports are vision stability and eye protection. When playing fast-moving sports--like basketball, soccer, and rugby--elbows, wrists, and heads fly around at high speed, increasing the risk of eye injury. The eyes and eye sockets can be protected when covered by shatter-proof lenses. Additionally, there is no worry over having a contact lens pop out of the eye, which can be a debilitating experience for some people. The main drawback to goggles is that they can be cumbersome, decrease peripheral vision, and fog up. Additionally, very high prescriptions might not be available due to frame limitations. On the whole, this is a very good option for many people. One additional advantage to sports goggles is that they can often be made with Transitions lenses, providing automatic sun protection in bright light.

Contact Lenses

For many people, the best visual option is contact lenses, particularly soft contact lenses. The main benefits include no decrease in visual field, no fogging of lenses, and no unsightly, heavy glasses. But where sports goggles shine, contact lenses fall short--there is a higher risk of injury, the possibility of less stable vision (especially when wearing multifocal or astigmatic lenses), and the potential of a lens falling out during activities. Gas permeable (hard) lenses are not recommended for sports.

Wearing Nothing

For those whose prescriptions are not so high as to prevent proper functioning without correction, wearing no correction whatsoever is a fine choice. I’m often asked by parents whether their child absolutely needs to wear correction when they are playing sports. It really depends on how high the prescription is and the activity in which the child is engaged. If someone can see well enough to perform the goals without being hindered, not wearing any correction is perfectly fine.

There are plenty of options available for athletes. Visit your eye doctor to see what the best option is for your particular needs.

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.

Hydroxychloroquine (Plaquenil) was originally used to treat malaria and is now commonly used to treat rheumatological and dermatological diseases. It is frequently used for rheumatoid arthritis (RA) and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause.

One of the most significant side effects of the drug is its possibility of causing eye problems resulting in blurred or decreased vision. The most common issue is damage to the retina. It can impair color vision or damage the retinal cells, particularly in the area right around the central vision.

In your retina, the area that you use to look straight at an object is called the fovea. The fovea is the area that provides you with the most definition when looking at an object. The area just around the fovea is called the macula and it has the ability to see objects with slightly less definition than the fovea but significantly better than the rest of your retina, which accounts for your peripheral vision. The most common place for hydroxychloroquine to cause a problem is in a ring of the macula surrounding the fovea.

The reason it is important to detect any of these changes as early as possible is because in many instances the changes are not reversible even if you come off the medication.

The risk of this happening is highly correlated with the cumulative dose of the drug you have received. So, the higher the dose and the longer you have been on it the higher your risk.

The current recommendation is a daily dose that does not exceed 6.5 mg/kg/day (that is milligrams per kilograms per day).  There are approximately 2.2 pounds in a kilogram.  The pills come in 200 mg tablets.  Most people who are on this drug are on either 200 mg once a day or 200 mg twice a day. The safety break point comes at around 135 pounds. People weighing more than that will stay within the safety guidelines (not more than 6.5mg/kg/day) at 400mg per day, but people under 135 pounds should probably only be taking 200 mg per day.

Other risk factors for hydroxychloroquine retinal toxicity include kidney or liver disease and obesity. Obesity is a risk factor because the drug does not penetrate fat tissue so there is more of the drug in your lean body mass (including your retina and its supporting cells called the retinal pigment epithelium). What that means in real terms is that if you take two people who each weigh 140 pounds and put them both on 400 mg a day and one person is 4-foot 11 and the other is 5-foot 9, the 4-foot 11 inch person is at greater risk for side effects because the shorter person has more of their body weight in fat tissue. Since the hydroxychloroquine can’t penetrate the fat tissue, there is a higher concentration of it in sensitive tissues like the retina.  People with kidney and liver problems have a tougher time eliminating the drug from their system so they are at higher risk because the body is going to retain more of the drug for a longer period of time.

The recommendation is to have a baseline eye exam with dilation and a visual field test before or soon after starting the drug. A repeat of that exam should occur every year if there is no evidence of toxicity.  

The actual incidence of retinal toxicity from hydroxychloroquine is difficult to pin down because there is usually a long time between being started on the drug and the start of any identifiable retinal toxicity. The overall rate of probable retinal toxicity is in the range of 1 of every 200 people treated. The rate is much lower than that in the first 7 years of treatment but gets to about 5 times higher after 7 years of treatment. Some of that data is old now and there is much greater awareness currently about keeping people below that 6.5 mg/kg/day dosage level.

I have been in practice for over 25 years and have seen “probable” retinal toxicity from hydroxychloroquine a total of 5 times and only once in the last 10 years--when people have been more careful about keeping the dosage in the right range.

The drug can be very effective in its treatment of RA and Lupus and the likelihood of serious vision problems is small and can potentially be avoided with the correct dosing and monitoring of the eyes. Other drugs in the treatment for RA or lupus may have more frequent or serious side effects then hydroxychloroquine--so it would be wise to consider it a viable treatment option and not easily dismiss it because of the risk of what amounts to a fairly infrequent eye issue.

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 Centers for Disease Control estimates that around 2.8 million people in the United States suffer from a traumatic brain injury (TBI) every year, and vision can be affected.  Concussions are a type of TBI.

The rate of childhood TBI visits to the emergency department more than doubled between 2001 and 2009, making children more likely than any other group to go to the ER with concussion symptoms.

It was once assumed that the hallmark of a concussion was a loss of consciousness. More recent evidence, however, does not support that. In fact, the majority of people diagnosed with a concussion do not experience any loss of consciousness. The most common immediate symptoms are amnesia and confusion.

There also are multiple visual symptoms that can occur with a concussion, either initially or during the recovery phase.

Visual symptoms after a concussion include:

• Blurred vision.

• Difficulty reading.

• Double vision.

• Light sensitivity.

• Headaches accompanying visual tasks.

• Loss of peripheral vision.

Most people with visual complaints after a concussion have 20/20 distance visual acuity, so more specific testing of near acuity, convergence amplitudes, ocular motility, and peripheral vision must be done.

In a study done at the Minds Matter Concussion Program at the Children's Hospital of Philadelphia, patients with a concussion diagnosis underwent extensive vision testing, which assessed symptoms, visual acuity, eye alignment, near point of convergence, vergence amplitude and facility, accommodative amplitude and facility, and saccadic eye movement speed and accuracy.

A total of 72 children (mean age 14.6 years) were examined, and 49 (68%) of those were found to have one or more vision symptoms after concussion. The most common problems were convergence insufficiency (47.2%); accommodative insufficiency (33.3%); saccadic dysfunction (30.5%); and accommodative infacility (11.1%). The investigators also found that 64% of the children with convergence insufficiency also had an accommodative disorder.

Difficulties with accommodation and convergence make it very hard to read for any length of time, with blurring and fatigue and then loss of concentration occurring after a fairly short period of reading time.

For the majority of people suffering a mild to moderate TBI, most of these symptoms resolve in one to three weeks but in some they can persist much longer.

If your visual symptoms after a concussion persist past three weeks, a visit with an eye care specialist is recommended. There may be several options to help improve the symptoms with either prescription eyeglasses or prisms to assist the two eyes to focus together.

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 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 much numbing, 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 types of anesthesia 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, an anesthetist will usually 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.

In honor of St. Patrick’s Day and the “wearin’ of the green,” we thought it would be fun and fitting to share some interesting facts about green…eyes!

#1

Green is the rarest eye color. If your sparklers are truly green, you are something of a unicorn… only about 2% of the world’s population sport this hue. 

#2

Green-eyed people can be found all around the globe. There is a Chinese village, Liqian, where a high percentage of the population sports green eyes and lighter hair.

#3

There isn’t any actual green pigment in a green eye. Melanin, a natural pigment that helps determine our skin, hair, and eye color, is found in all eyes. Brown eyes have quite a lot and blue eyes have relatively little. Green eyes are also low on melanin, but in addition they contain lipochrome, a yellowish, fat-soluble pigment. Lipochrome is also found in things like butter, eggs, and corn. So a little melanin, some lipochrome, and a cool light dispersing scattering called the Tyndall Effect combine to produce those rare green eyes!

#4

At least 16 genes contribute to eye color. You might have been taught in biology class that two brown-eyed parents can have only brown-eyed children, but it’s more complicated than that.

#5

Green eyes are popular in cultural references. Here are some famous characters with green eyes:

·         Jane Eyre—that plucky governess living in a “haunted” mansion, from the book Jane Eyre

·         Rapunzel—another courageous hero in Tangled

·         Scarlet O’Hara—feisty protagonist in Gone with the Wind

·         Scar—the scheming uncle in The Lion King

·         Mary Jane Watson, Catwoman, Batgirl—green eyes are popular in the world of comics

·         Sara Crewe—brave little girl from A Little Princess

·         Harry Potter – from the Harry Potter book series by J.K. Rowling

#6

In a large survey performed by All About Vision, green was voted the most attractive eye color, with over 20% of the 66,000 respondents choosing this hue.

#7

More women than men have green eyes. Scientists aren’t sure why this is, but it suggests there is an underlying gender-related factor that causes this difference.

#8

Animals can also sport green eyes.  Green eyes occur in dogs, snakes, frogs, birds, monkeys, multiple members of the cat family, and many other animals.

#9

People with green eyes are more likely to have certain health issues. Green eyes are more prone to melanoma of the uvea, a type of eye cancer, than are dark eyes. The same is true for macular degeneration. If you have green eyes, protect those beautiful peepers with a quality pair of sunglasses to lower your chances for these diseases!

A common question asked during the eye exam is, “When is the puff coming?”  

Patients are referring to air-puff or non-contact tonometry. Tonometry is the procedure used to measure eye pressure, and this is important for diagnosing and monitoring glaucoma.

In non-contact tonometry, a puff of air is used to measure the pressure inside the eye.  The benefit of this test is there is no actual contact with the eye, but the air puff is sometimes very startling for patients. Some people hate that test and it isn’t the most accurate way to measure your eye pressure.

Some doctors don’t even use the air-puff test. Instead, they place a yellow drop that consists of a numbing medicine and then shine a blue light on the eye. This is done in front of the slit lamp and a small tip gently touches the eye to measure the eye pressure. This procedure is called Goldmann tonometry and is considered the gold standard for measuring eye pressure.  

Another method for checking eye pressure is the Tonopen. This is a portable, hand-held instrument that is useful when patients can’t sit in front of the slit lamp to have their eye pressure checked. The Tonopen also requires a numbing drop to be placed in the eye, and the tip gently touches the eye.

A common question related to tonometry is “what normal eye pressure?”

Normal eye pressure ranges from 10-21 mm Hg. Eye pressure doesn't have any relationship to blood pressure. Many times, people are surprised that their eye pressure is high, but they have normal blood pressure. In general, there is no diet or exercise that will significantly affect eye pressure. It is therefore important to have your eye pressure checked regularly because there are usually no symptoms of high eye pressure until it has affected your vision.

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.

Have you ever seen a temporary black spot in your vision? How about jagged white lines? Something that looks like heat waves shimmering in your peripheral vision?

If you have, you may have been experiencing what is known as an ocular migraine. Ocular migraines occur when blood vessels spasm in the visual center of the brain (the occipital lobe) or the retina.

These optical migraines can take on several different symptoms, but they typically last only from a few minutes to an hour. They can take on either positive or negative visual symptoms, meaning they can produce what looks like a black blocked-out area in your vision (negative symptom), or they can produce visual symptoms that you see but know aren’t really there, like heat waves or jagged white lines that look almost like lightning streaks (positive symptoms).

Some people do get a headache after the visual symptoms but most do not. They get the visual symptoms, which resolve on their own in under an hour, and then generally just feel slightly out of sorts after the episode but don’t get a significant headache. The majority of episodes last about 20 minutes but can go on for an hour. The hallmark of this problem is that once the visual phenomenon resolves the vision returns completely back to normal with no residual change or defect.

If you have this happen for the first time it can be scary and it is a good idea to have a thorough eye exam by your eye doctor soon after the episode to be sure there is nothing else causing the problem.

Many people who get ocular migraines tend to have them occur in clusters. They can have three or four episodes within a week and then may not have another one for several months or even years.

There are some characteristics that raise your risk for ocular migraines. The biggest one is a personal history of having migraine headaches. Having a family history of migraines also raises your risk, as does a history of motion sickness.

Although the symptoms can cause a great deal of anxiety, especially on the first occurrence, ocular migraines rarely cause any long-term problems and almost never require treatment as long as they are not accompanied by significant headaches.

So if symptoms like this suddenly occur in your vision, try to remain calm, pull over if you are driving, and wait for them to go away. If they persist for longer than an hour, you should seek immediate medical attention.

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.

Eye doctors typically pride themselves on being able to improve someone’s vision through glasses or contact lens prescriptions. Whether it’s a first-time glasses wearer, or someone having either a small or large change in their prescription, we like to aim for that goal of 20/20 vision.

Despite our best efforts, however, correcting vision to 20/20 is not always a positive outcome for the patient. Whether someone will be able to tolerate their new prescription is based on something called neuroplasticity, which is what allows our brains to adapt to changes in our vision.

You or someone you know may have had this happen: Your vision was blurry, so you went to the eye doctor. The doctor gave you a new prescription, but after you received your new glasses, things seem “off.”

Common complaints are that the prescription feels too strong (or even too clear!) or that the wearer feels dizzy or faint. This is especially true with older patients who have had large changes in their prescriptions, since neuroplasticity decreases with age. It is also more likely to happen when the new prescription has a change in the strength or the angle of astigmatism correction. Conversely, this happens less often in children, since their brains have a high amount of plasticity.

Quite often, giving the brain enough time to adapt to the new vision will decrease these symptoms.

Whenever a patient has a large change in prescription, I tell them that they should wear the glasses full time for at least one week. This is true for both large changes in prescription strength, as well as changing lens modality, e.g., single vision to progressives.

Despite the patient’s best efforts, though, sometimes allowing time to adapt to the new vision isn’t enough, and the prescription needs to be adjusted. Even when someone sees 20/20 on the eye chart with their new glasses, if they are uncomfortable in them even after trying to adjust for a week then we sometimes have to make a compromise and move the script back closer to their previous script so that there is less change and they can more easily adapt.

In conclusion, adapting to a new prescription can sometimes be frustrating. It does not mean there is anything wrong with you if you have difficulty adjusting to large changes in a prescription. With a little patience and understanding about how your brain adapts to these kinds of changes, your likelihood of success will be that much higher.

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.

For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy.

In a trabeculectomy, the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of the eye and then get resorbed by the blood vessels in the conjunctiva (the mucous membrane that covers the white part of the eye).

This surgery often resulted in a large decrease in the Intraocular Pressure (IOP). Reducing the IOP is the goal of glaucoma surgery because multiple studies show that if you can reduce the pressure the progression of glaucoma slows.

The problem with trabeculectomy is that although it frequently lowers the pressure, it also has a fairly high complication and/or failure rate. This led to some reluctance to perform the procedure unless the glaucoma was severe, or the pressure was very high. As a result of those issues there has been a search during the last 40 years for something that had a lower complication rate and could be more easily deployed earlier in the disease process.

Enter Minimally Invasive Glaucoma Surgery, or MIGS.  There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. They are utilized much earlier in the disease process and when combined with cataract surgery they can be used to not only help control the pressure over the long term but can often even reduce the burden of eye drops afterward.

The biggest advantage to MIGS over the trabeculectomy is that when used in conjunction with cataract surgery, MIGS can lower the eye pressure (although not as much as the trabeculectomy) but often with no higher rate of complications as there is with cataract surgery alone.

The lower complication rate is mainly because the MIGS procedures do not create a full-thickness hole in the wall of the eye.  Most of them involve putting in some form of stent inside the eye. The stent lets the intraocular fluid get out of the eye more efficiently through its normal internal drain called the trabecular meshwork, rather than having to flow to the outside of the eye as with a trabeculectomy.

A stent is not the only way to lower the pressure along with cataract surgery. There is also a laser treatment you can do from the inside of the eye that slows the amount of fluid the eye makes, which also results in a lower pressure. It is called Endocyclophotocoagulation (ECP). Think of a partially clogged drain in a sink with constantly running water. If you don’t want the sink to overflow (or the pressure in the eye to get too high) you either try to unclog the drain (stent) or you turn down the faucet (ECP).

MIGS has been a great development over the last several years, enabling the surgeon to intervene at a much earlier stage of glaucoma and with a significantly lower complication rate than the more invasive trabeculectomy.

At this point I utilize one of the MIGS procedures in almost all patients who need their cataracts removed and are on one or more glaucoma medications. Even if the glaucoma is fairly well controlled at the time, the MIGS procedure gives us the opportunity to try and get a glaucoma patient off their eye drops, which is both a decreased burden of treatment and lets us keep the eye drops in reserve should the pressure start to increase again later in life.

If you have glaucoma and a cataract you should definitely discuss this with your doctor to see if a MIGS procedure along with your cataract surgery could be the right choice for you.

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