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 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.

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.

So you’re going about your day and notice a slight twinge when you blink. It starts off as a mild awareness, then proceeds to a painful feeling with every blink. You look in the mirror to see what could be causing it, and there you see a small red bump forming.

You decide to wait to see what happens and one of three things occurs. It might get bigger, redder, and more painful; it might shrink and goaway; or it might stay put, but it is no longer painful or growing in size. Let’s dive into one of the most common eye conditions we treat: hordeola (commonly known as “styes”) and chalazia.

Hordeola (or singular hordeolum), are infectious abscesses of the glands that line the eyelids. Bacteria that are naturally occurring on the eyelids and eyelashes can make their way into the gland and form what is essentially a pimple in the eyelid. If it goes untreated, hordeola can (rarely) lead to spreading of the infection throughout the eyelid (preseptal cellulitis) or even start to invade the orbit of the eye (orbital cellulitis).  At that point, infection can spread to the brain and even be life-threatening and require hospitalization. Thankfully, it rarely gets to this point.

Treatment can consist of warm compresses, ointments, and oral antibiotics to kill the infection. Just like a pimple, it is not always necessary to be on antibiotics.  It’s actually the warm compresses that do the most good.  If you can get the gunk that is clogging the gland opening to thin out it will often just drain on its own without antibiotics.  Sometimes, however, if the warm compresses alone aren’t working, and an antibiotic might be necessary.  Don’t buy the over-the-counter ointment called “Stye.” It is not going to make it any better and could further clog the glands.

Chalazia (or chalazion singular) often start off as hordeola, but over time they become sterile, meaning non-infectious. Once the infection has cleared out, what is left behind is often what amounts to a marble-like lump in the eyelid. These are often more difficult to treat, as they no longer respond to antibiotics. If small enough, people can just leave them alone and see if they go away on their own. Larger ones, however, can be rather unsightly. If a chalazion no longer responds to warm compresses or ointments, we might treat it with steroid injection to shrink it, or it can be surgically removed.

We see these lumps and bumps on almost a daily basis in practice. Usually, they are very simple to treat and go away quickly.

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.

Itching, burning, watering, red, irritated, tired eyes... what is a person to do? These symptoms are classic signs of Dry Eye Syndrome (DES), which affects millions of adults and children.

What causes this?  Dry eye syndrome can be brought on by many factors: aging, geographical location, lid hygiene, contact lens wear, medications, dehydration, etc. The lacrimal gland in the eye that produces tears, in a person over forty years old, starts slowly losing function. Females with hormonal changes have a higher incidence of DES (dry eye syndrome). Dry, arid climates or areas with high allergy rates tend to have higher incidences of DES as well. Another major cause is increased screentime--when we stare at a computer screen or phone, our blink reflex slows way down. A normal eye blinks 17,000 times per day, usually producing enough tears to be symptom free, if not contenting with other factors.  But blink rates go way down while using screens.

Blepharities, a condition of the eyelids, can cause a dandruff-like situation for the eye, exacerbating a dry eye condition. Contact lenses can add to DES, so make sure you are in high oxygen contact lens material if you suffer from DES. Certain medications such as antihistamines, cholesterol and blood pressure meds, hormonal and birth control medications, can also cause symptoms of a dry eye. Check with your pharmacist if you are not sure if your medication could be contributing to the problem.

And finally, overall dehydration can cause DES. Some studies show we need 1/2 our body weight in ounces of water per day. For example, if you weigh 150 lbs, you need approximately 75 ounces of water per day to be fully hydrated. If you are not at that level, it could affect your eyes.

Treatment for DES is varied, but the main treatment is a tear supplement to replace the evaporated tears. These come in the form of topical ophthalmic artificial tears. Oral agents that can help are Omega 3 supplements such as fish oil or flax seed oil pills. They supplement the function of meibomian glands located at the lid margin. Ophthalmic gels used at night, as well as humidifiers, can help keep your eyes moisturized. Simply blinking hard more often can cause the lacrimal gland to produce more tears automatically.

For stubborn dry eyes, retaining tears on the eye can be aided by punctal plugs. They act like a stopper for a sink, and they are painless and can be inserted by your eye care practitioner in the office. Moisture chamber goggles can also be used in severe cases to hydrate the eyes with their body’s own natural humidity. This may sound far out but it gets the job done.

Being aware of the symptoms and treatments for dry eye syndrome can prevent frustration and allow your eyes to work more smoothly and efficiently in your daily routine. If your eyes feel dry as the Sahara or they water too much, know that help is on the way through proven techniques and products. You do not need to suffer needlessly in the case of Dry Eye Syndrome anymore. Make an appointment to talk with your eye doctor about the best treatments for 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.

What Is Intraoperative Aberrometry?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

"What are these weird floating things I started seeing?"

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

• Are nearsighted.
• Are aphakic (absence of the lens of the eye).
• Have past trauma to the eye.
• Have had inflammation in the eye.

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

• Sudden increase in number of floaters that are persistent and don't resolve.
• Increase in flashes.
• A shadow covering your side vision, or a decrease in vision.

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment. Only about 15 percent of people with PVD develop a retinal tear.

If left untreated, approximately 40 percent of people with a symptomatic retinal tear will progress into a retinal detachment – and a retinal detachment needs prompt treatment to prevent vision loss.

Generally, most people become accustomed to the floaters in their eyes.

Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed. And for most people, the risk of surgery is greater than the nuisance that the floaters present.

Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable. However, this is not a recognized standard treatment and it is not widely practiced.

In general, the usual recommendation for floaters and PVD is observation by an eye care specialist.

Article contributed by Jane Pan M.D.

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

There are many opinions on the topic of texting and driving. The goal of this blog post is to explore the effects on vision during texting.

So, from a visual perspective, why does texting make you more likely to crash? The problem lies in distraction from driving. For example, it takes a fast texter approximately 20 seconds to read and reply to a text. At 55 mph on the highway, a driver glances away from the road for approximately one-third of a mile. When the driver is focusing on their screen, this essentially gives the driver tunnel vision, causing the visual system to essentially use peripheral vision for driving. Your central vision is used to detect depth perception, detail, and colors such as red or green. So when texting, your depth perception, or 3-D vision, is altered and if cars are stopped ahead or closing in rapidly, it's not as easily detected. Colors, such as red brake lights or traffic signals, are not as easily noticed.

Next time you encounter situations with texting and driving, know that the visual system was designed to perform advanced visual perception while using central vision. This includes detail vision, depth perception, and color vision....all of which are placed on hold while texting and driving.

For more information on texting and driving see:

www.itcanwait.com

US Dept. of Transportation

www.AAA.com

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.

Despite requests that patients bring their current glasses to their office visit, many show up without them.

Sometimes it’s an oversight: “I was rushing to get here and forgot them”; “I left them in the car”; “I picked up my wife’s glasses instead of mine by mistake.” Doctors have heard them all.

Sometimes it is unavoidable: “I lost them”; “They were stolen”; “I ran them over with the car”; “I left them on the roof of the car and drove away and now they are gone.”

Frequently, however, it’s intentional. There is a perception by some people that if they don’t like their current glasses or feel like they are not working well for them that they are better off having their eye doctor start from scratch. “Why would I want the doctor to utilize a pair of glasses I’m not happy with as a basis or starting point for my next pair of glasses?”

But bringing your glasses to an appointment is important.

There are two main reasons for eye care professionals to know what your last pair of glasses were.

The first is to see what type of glasses they are and how you see out of them. Are they just distance? Just reading? A bifocal? A trifocal? A progressive?

Even if you feel they aren’t working for you, it is essential for doctors to know the type of lens you had previously. It is also important to know how you see out of them and what the previous prescription was. This can help eye care professionals determine a new prescription that will work better for you.

The second reason doctors like to know what was in your last pair of glasses is that the majority of people who wear eyeglasses have some degree of astigmatism in their eyeglass prescription.

A significant change in either the amount or axis of the astigmatism correction from one pair of glasses to the next is often not tolerated well, especially in adults. If there is too much change from the previous prescription, many people experience a pulling sensation in their eyes when they wear the new glasses. It can cause symptoms of eye strain, headaches, and distortion, making flat objects like a table look like they are slanted.

Many of the problems that occur when we try to give someone a new eyeglass prescription could be avoided if doctors knew the last prescription and how you did with it.

Anytime you are going to the eye doctor, it is essential to bring your most current pair of glasses with you to the exam--whether you love them or hate them!

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.

Did you know that having one's eyes tested can reveal symptoms of ADHD (Attention Deficit Hyperactivity Disorder)? ADHD is a set of symptoms that includes trouble with focus, overactivity, and behavioral control. It is estimated that one in five people has some sort of ADHD.

ADHD is a condition that has multiple symptoms and it can affect any age, though commonly it affects children. There is difficulty with visual processing, which includes doubling letters, reversing letters, and jumping words and lines of print.

Eye examinations are a crucial part of the diagnosis of ADHD. Proper visual function can be assessed through a thorough eye exam. During the exam, visual complaints, focusing, and processing can be assessed to rule out ADHD.

When glasses are prescribed for an patient with ADHD, prescribing the correct type of lens is vital. Many patients benefit from an anti-glare/anti-reflective or AR treatment on their lenses. This cuts unnecessary light from entering the eye, making visual processing easier.

In some cases, it is discovered that the person has a non-ocular visual processing problem. This simply means that their eyes have little or nothing to do with the symptoms of ADHD. This gives valuable information to the health care provider that is managing the patient and suggests more non-ocular testing for a compete diagnosis.

ADHD is very common, and the great news is that there are multiple treatment options. Many resources for help are available on the Internet and through health care channels.

Having an eye exam should be one of the first items on the checklist if you are suspicious about ADHD because valuable information on visual processing can be gained.

For more resources see these websites:

National Institute of Mental Health, www.nimh.nih.gov/

ADHD.com

American Optometric Association, AOA.org

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 the 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 was 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 eventual, 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 during those events 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.

The Conclusion

There seems to be a definite correlation of 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.

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

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

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

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

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

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

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

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

Will reading glasses make your eyes worse? The short answer is "No."

Although we don’t know the exact mechanism by which humans lose the ability to focus up close as we age (a process called presbyopia), the fact remains that it happens to almost all of us.

The leading theory of how this occurs is that the lenses in our eyes get stiffer and thicker as we age--one of the muscles in the eye that contracts to change the shape of the lens does so less and less effectively because the lens itself gets less pliable.

The process of changing the focus of the lens from far away objects to up-close objects is called accommodation. If you have normal distance vision without glasses, then your eye's natural focus spot is far off in the distance. In order to focus on an object close to you, the lens in your eye has to alter its shape. The ability of your lens to do that is at its best when you are born and it slowly gets less and less pliable as the years go on. You have such a tremendous ability to accommodate when you are young that the slow loss of this ability is not perceptible, until you reach about the age of 45.

At around 45 the lens has lost so much accommodative ability that you start to have difficulty focusing on near objects. The impact usually starts when you notice that in order to look at anything small up close, you start holding it further away. Even though this decreasing ability to focus up close has been slowly getting worse since the day you were born, many people feel like the problem has occurred very suddenly. We have many people who come into the office around age 45 telling us “all of a sudden” they can’t read. What has probably been happening is they have just very slowly been adapting by holding things farther away until one day “their arms are too short” and then they can’t read easily.

That is where reading glasses come in. Some people just buy over-the-counter readers, which can work fine for them, but if you haven’t had an exam in some time it is much wiser to get your eyes checked first to make sure the normal aging process is the only problem. Once it is confirmed through a medical eye exam that there are no other issues, reading glasses are usually prescribed. Contact lenses are also an option at this point.

At the beginning, a low-powered reading glass is used. As time goes on, the lens in your eye continues to stiffen and your ability to focus up close continues to get worse. The result of that is that your reading glass prescription gets stronger, usually at a clip of about one step every 2 to 3 years.

IT IS NOT USING THE READING GLASSES THAT ARE MAKING YOU WORSE. TIME IS THE CULPRIT.

The decrease in reading ability is going to continue to get worse as you get older whether you wear the reading glasses or not. Trying to avoid wearing glasses and struggling along without them is not going to stop the march of time. You really can’t preserve your reading ability by not wearing them--you are just needlessly making things harder on yourself.

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.

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.

A patients with advanced macular degeneration 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.

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.”

Need a  chuckle or a groan?  Here you go...

1. Did you hear about the guy who just found out he was color blind?  It hit him right out of the purple!

2. What happened to the lab tech when he fell into the grinder?  He made a spectacle of himself.

3. Why is our staff so amazing?  They were all bright pupils!

4. Why did the smartphone have to wear glasses?  It lost all of its contacts.

5. What did one pupil say to the other?  I’m dilated to meet you.

6. What do you call a potato wearing glasses?  A Spec-Tater!

7. What do you call an optician living on an Alaskan island?  An optical Aleutian.

8. What was the innocent lens’s excuse to the policeman?  "I’ve been framed, officer!"

9. Where is the eye located?  Between the H and the J.

10. Where does bad light end up?  In Prism!

You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying out-of-pocket for certain features.

Where did this come from? Why should you have to pay out-of-pocket for cataract surgery? Shouldn’t your health insurance just cover it?

In trying to answer these questions, you will first need a little history of both cataract and refractive surgery, which corrects errors of refraction such as nearsightedness, farsightedness, and astigmatism.

Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.

Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.

The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable, enabling them to fit through tiny incisions of around 3 millimeters.

Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.

Medicare and most other insurance do not cover refractive surgery (LASIK, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by non-surgical means, such as glasses and/or contact lenses.

Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.

The merging of cataract and refractive surgeries is why there are now options to not only get your cataract removed, but also to correct your astigmatism (irregular shape to cornea) and/or presbyopia (the inability to see well up close that hits nearly everyone in their 40’s).

This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.

Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.

If you want to address your astigmatism and/or presbyopia at the time of cataract surgery in order to be less dependent on wearing glasses after surgery, then paying for those components is going to be an out-of-pocket payment for you.

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 2019 National Coffee Drinking Trends report showed that 64 percent of people who participated in the survey said they had drunk coffee the previous day, which is interpreted as daily consumption. This was up from 57 percent in 2016, said the report. 

Even though the U.S. population is drinking more coffee than ever, the nation still only ranked 25th overall in per capita consumption. The people of Finland average 3 times as much coffee consumption as people in the U.S.

So what does all this caffeine intake do to our eyes?

The research is rather sparse and the results are mixed.

Here are some major eye topics that have been investigated:

Glaucoma

One study, published in the journal Investigative Ophthalmology and Visual Science, showed that coffee consumption of more than 3 cups per day compared to abstinence from coffee drinking led to an increased risk for a specific type of Glaucoma called Pseudoexfoliation Glaucoma.

Another analysis of several existing studies by Li,M et al demonstrated a tendency to have an increase in eye pressure with caffeine ingestion only for people who were already diagnosed with Glaucoma or Ocular Hypertension, but no effect on people without the disease. A separate study, published by Dove Press, done with the administration of eye drops containing caffeine to 5 volunteers with either Glaucoma or Ocular Hypertension showed that there was no change in the eye pressure with the drops administered 3 times a day over the course of a week.

Summing up the available studies in terms of Glaucoma, the evidence points to maybe a slight increase in Glaucoma risk for people who consume 3 or more cups of coffee a day.

Retinal Disease

A study done at Cornell University showed that an ingredient in coffee called chlorogenic acid (CLA), which is 8 times more concentrated in coffee than caffeine, is a strong antioxidant that may be helpful in warding off degenerative retinal disease like Age Related Macular Degeneration.

The study was done in mice and showed that their retinas did not show oxidative damage when treated with nitric oxide, which creates oxidative stress and free radicals, if they were pretreated with CLA.

Dry Eyes

A study published in the journal Ophthalmology looked at the effect caffeine intake had on the volume of tears on the surface of the eye. In the study, subjects were given capsules with either placebo or caffeine and then had their tear meniscus height measured. The results showed that there was increased tear meniscus height in the participants who were given the caffeine capsules compared to placebo. Increased tear production, which occurred with caffeine, may indicate that coffee consumption might have a beneficial effect on Dry Eye symptoms.

Eyelid Twitching

For years eye doctors have been taught that one of the primary triggers for a feeling of twitching in your eyelid has been too much caffeine ingestion (along with stress, lack of sleep and dry eyes). I have been unable to find anything substantial in the literature to support this teaching. Therefore, I’m going to have to leave this one as maybe, maybe not.

The End Result

Overall, the evidence for the pros and cons of coffee consumption and its effects on your eyes appear to be rather neutral. There are one or two issues that may increase your risk for glaucoma but it also may decrease your risk of macular degeneration or dry eyes.

Since there is no overwhelming positive or negative data, our recommendation is--and this holds for most things--enjoy your coffee in moderation.

Related links

• Study: Coffee is good for your eyes
• Study links caffeinated coffee to vision loss
• Effect of caffeine on intraocular pressure
• Effect of caffeine in patients with primary open angle glaucoma
• Drinking coffee prevents eye damage
• Caffeine increases tear volume

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.

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.