Specialty contact lenses

Keratoconus is an eye condition where the cornea thins and bulges into a cone-like shape.   This causes distorted, blurry vision which cannot be corrected with spectacle glasses.   Rigid contact lenses are the only way to correct this astigmatism.   Good news!   There are designs that are customized to your eye.   It can take more visits to obtain the right lens, but it’s worth the extra time!

Will this keep growing?

A growth of pink, fleshy tissue on the conjunctiva (the white clear tissue around the iris) is called a pterygium.   It can look scary, but it usually isn’t cancerous. The growth might spread slowly during your life or stop after a certain point. In extreme cases, it can cover your pupil and cause vision problems.  It can cause annoying symptoms. You might feel like you having something in your eye.  When it gets red and irritated, it can be treated with anti-inflammatory eye drops.  Surgical treatment is uncomfortable, but effective.   Though sometimes, it can grow back.

Does an Eye Freckle Mean Cancer?

Not necessarily!    An eye freckle is called a nevus.   It is a common, colored growth, similar to a freckle on your skin.  You can have a nevus in the front of your eye, around the iris, or under the retina at the back of the eye. A nevus under the retina is called a choroidal nevus.  An eye nevus is usually harmless. However, it needs to be monitored because, like a skin freckle, it could possibly develop into cancer of the eye.

I Want to Get Rid of My Glasses!

With more public appearances, I would like to look my best and get rid of my glasses!    I found out that I’m an ideal candidate for Lasik.  I was worried about my corneal thickness, but everything was OK!     I am seriously considering Lasik, as it would really improve both my vision and my quality of life.    Stay tuned!

Dry Macular Degeneration

Dry macular degeneration is a common eye disorder among people over 65. It causes blurred vision, due to disruption of the pigmented layers in your macula.   The macula is the part of the retina responsible for your central vision.

Prevention and early detection may delay vision loss due to dry macular degeneration.  I recommend getting enough Lutein into your daily diet.   I take Macuhealth every day, since I have a family history of macular degeneration.

MacuHealth: Fight Blindness, Reduce Glare and Eye Strain

MacuHealth® with LMZ3 is a nutritional supplement that helps enhance vision by restoring important pigments found in the eye. Within the macula, there is an important and naturally occurring protective substance known as macular pigment, which is made of three nutrients: lutein, zeaxanthin and meso-zeaxanthin. MacuHealth is the only supplement containing all three of these crucial carotenoids in the recommended dosage.

“Something in my Eye”

White blood cells can penetrate into the corneal tissue as part of the body’s inflammatory response to the presence of bacterial toxins.

A corneal ulcer is an epithelial defect with underlying inflammation and involves much more pain, redness, and vision loss. An ulcer is more serious and requires immediate, aggressive treatment with antibiotics taken every hour.

Infiltrates usually resolve with anti-inflammatory drops. Contact lens wear must be discontinued!

Blood vessels on the Eye

Corneal pannus is the growth of blood vessels onto the cornea.   A common cause of corneal pannus is contact lens wear, particularly if the contacts aren’t fitted properly.  In that case the contacts should be refitted, or perhaps discontinued. Sometimes pannus is a result of past infection such as herpes simplex. Sometimes corneal pannus is not easily treated and cannot be reversed.

Crud on the Eyelids!

If you have blepharitis, which results in sore, red eyelids, with crusty debris, Demodex mite infestation could be the cause!   The incidence of Demodex infestation increases with age, occurring in 84 percent of the population at age 60 and in 100 percent of the population older than 70 years of ageOne way to prevent Demodex infestation is good eyelid hygiene.  I recommend Ocusoft scrubs with Hypochlor spray.

A Surfer’s Eye

A pterygium is an elevated, wedged-shaped bump on the whites of the eye.   It can grow onto the cornea.  Though it’s commonly called “surfer’s eye,” you definitely don’t have to be a surfer to get a pterygium.   But being at a higher elevation with more UV exposure increases your risk for getting it.   Most pterygium are benign, but they can cause discomfort and blurry vision.

 

 

A Huge Floater!

Posterior Vitreous Detachment (PVD) is common and occurs when the vitreous gel that fills the eye separates from the retina.    Symptoms include floaters and flashes in your vision.  In this photo, the patient had cataract surgery, so the floater is more visible.

Symptoms usually subside over several weeks.   Rarely, a PVD can develop into something more serious, like a  retinal detachment or epiretinal membrane.
 

Cheap and Convenient is a Disaster Waiting to Happen

from The Los Alamos Daily Post

Online shopping has truly revolutionized the way we purchase things. Indeed, many of us prefer online shopping to in-store shopping. Now, coming to a theater near you, the first online eye exam that gives you a prescription! This is where the lure of “cheap and convenient” is a disaster waiting to happen.

Recently, I had a patient come in for an eye examination with no vision changes or complaints. I dilated the eyes for a full view of the retina and found retinal holes with underlying fluid. Prompt treatment by a retinal surgeon prevented severe vision loss. Many eye diseases have no symptoms, but early intervention can prevent permanent eye damage and blindness. Contact lenses can compromise the health of your eyes and should not be worn without yearly evaluation.

Many conditions, such as hypertension, diabetes, and autoimmune diseases, first show up in the eye. Evaluation of eye health takes time and care via physical examination. Online questionnaires, Skype interactions, automated instruments, and Iphone apps alone are inadequate.

For quality eyewear, you need an experienced optician who can take several measurements, customize glasses to your visual needs and lifestyle, verify their accuracy, and troubleshoot any problems. Vistakon, the maker of Oasys contact lenses, just announced their “unilateral pricing agreement” where you will receive the same pricing through all online companies, 1-800-contacts, and at our office. At Los Alamos Family Eyecare, our goal is to give you the best vision possible and take care of your eye health. We don’t want you to “go online” when it comes to your eyes!

Epithelial Ingrowth

Epithelial ingrowth is the presence of corneal epithelium in an area where it does not belong. After LASIK, epithelial ingrowth can occur in the interface between the flap and the stromal bed of the patient’s cornea.   If the ingrowth is peripheral and not vision threatening, it can just be monitored.   

OCT in Scleral Lens Fitting

I use my optical coherence tomographer (OCT) for evaluating complex contact lenses, such as sclerals.  It is important that there is enough space between the cornea and the contact lens.

TABLE 1 Applications for Anterior Segment OCT in a Specialty Contact Lens Practice
Evaluating pachymetry and corneal edema
Measuring soft and GP lens thickness—centrally and peripherally
Examining lens edges for flaws and causes of discomfort
Measuring posterior tear film thickness in scleral lenses
Assessing points of lens bearing to determine the need for design modification

Scleral lens compression

Scleral impingement

A scleral lens that is fit too tightly in the periphery can result in vascular blanching.  To remedy this situation, flatten the midperipheral curves to loosen the fit.

Same lens with flattened peripheral curves.

Corneal Edema After Cataract Surgery

This is a common complication of cataract surgery, which usually resolves after 1 week.  Those who have more advanced cataracts pre-existing corneal disease are more likely to have corneal edema.   The primary treatment is typically steroid drops and hyperosmotic agents such as Muro 128 (a hypertonic saline agent) which pulls the edema fluid out of the cornea.  In most cases, the visual prognosis is good.

A Corneal Scratch

Did you scratch your cornea?   The cornea is one of the most sensitive parts of your body, so even a very small corneal abrasion can be uncomfortable.  In addition to pain and feeling that something is in your eye, other symptoms include redness, tearing, light sensitivity, headache, blurry or decreased vision, eye twitching, a dull ache and rarely, nausea.

A bandage contact lens and antibiotics are very effective in healing corneal scratches.

 

Inflamed Caruncle

The lacrimal caruncle is the small nodule at the inner corner of the eye. It is made of skin covering sebaceous and sweat glands.  Sometimes it can get inflamed and swollen.   Artificial tears and steroids usually resolve the problem.

Neovascular Membrane

Did you know that bleeding underneath your retina can cause devastating vision loss?  Choroidal neovascular membranes are new blood vessels that grow beneath the retina in an area called the choroid.   These membranes are associated with many serious eye diseases, most commonly wet age-related macular degeneration. CNVM are also found in patients with histoplasmosis, eye injury, and myopic macular degeneration.

When Contacts Cause Bumps in the Eye

Giant papillary conjunctivitis is a common complication of contact lens wear.   This condition requires anti-inflammatory and/or anti-histamine eye drops.  Contact lens wear should be temporarily discontinued.  Daily disposable contact lenses are recommended.

The inner eyelids usually return to normal appearance following the resolution of giant papillary conjunctivitis.  However, sometimes, there can be permanent, small, white, capped scars of the giant papillary bumps.

Can We Eat Our Way to a Healthy Macula?

by Damon Dierker, OD, FAAO

You are what you eat — we’ve heard it since we were children. Not surprisingly, what we eat today is simply not as nutritious as a generation or two ago. Industrial farming techniques have caused many of our foods, especially fruits and vegetables, to be deficient in nutrients.1 Simply put, our diet lacks the necessary nutrients for our bodies to fight the constant barrage of inflammation and stress that we encounter on a daily basis.

READ MORE:

Glaucoma: the Importance of Early Intervention

According to the Glaucoma Research Foundation, an estimated 2.2 million individuals in the United States have glaucoma.   More than half of those who have glaucoma are unaware because there are NO SYMPTOMS, especially in the early stages.  Studies show that the risk of blindness related to glaucoma 20 years after diagnosis has decreased by 50% due to early intervention and consistent treatment.  Annual eye examinations with advanced technology, we can treat glaucoma early and prevent complications such as vision impairment, loss of peripheral vision, and blindness.

Meibomianitis

Meibomian refers to a particular type of gland in the eyelids. There are about 25 to 40 meibomian glands in the upper eyelid and 20 to 30 in the lower eyelid. The function of these glands is to secrete oils, which help keep the tears from evaporating too quickly.

Meibomian gland dysfunction is blockage or some other abnormality of the meibomian glands so they don’t secrete enough oil into the tears. Because the tears then evaporate too quickly, MGD is a leading cause of dry eye syndrome. It also is associated with an eyelid problem called blepharitis.

Central Retinal Vein Occlsion

The retina is nourished by blood flow, which provides nutrients and oxygen that nerve cells need. When there is a blockage in the veins into the retina, retinal vein occlusion may occur.  Central retinal vein occlusion (CRVO) is a blockage of the main vein in the retina. Blockage of the small veins in the retina is called branch retinal vein occlusion. The blockage causes the walls of the vein to leak blood and excess fluid into the retina. When this fluid collects in the macula (the area of the retina responsible for central vision), vision becomes blurry.

Referral for a complete physical, with blood work and cardiovascular evaluation.   Referral to the retinal specialist.   If there is underlying leakage and fluid, treatment can be effective.

Corneal Pannus

Corneal pannus is the growth of fine blood vessels onto the clear corneal surface. The treatment depends on the cause. For instance, a common cause of corneal pannus is a poorly fit contact lens.   Also, pannus can occur if the contact lens does not allow enough oxygen to the eye.  Contact lens may need to be temporarily or permanently discontinued.   Sometimes a pannus may represent an old or current infection that is dangerous to vision such as can be caused by herpes simplex.

Episcleritis

Episcleritis is a self-limited inflammation that does not cause lasting damage.  Most patients with episcleritis may not require any treatment.   Either Prednisolone Acetate 1.0% or Fluorometholone .1% 1 drop 3x/day can be prescribed.  Cold compresses can also help relieve the discomfort.

Blepharitis

If you are diagnosed with chronic blepharitis, an ongoing regimen of eyelid hygiene is recommended.   We often prescribe over-the-counter lid scrubs such as Ocusoft.   Eyelid hygiene is the cornerstone of treatment for most cases of blepharitis.

Besides a program of eyelid hygiene, supplemental treatment with topical and oral medicine can be helpful.

We also recommend nutritional supplementation with omega-3 fatty acids, such as flaxseed oil, to aid healthy function of meibomian glands that provide essential lubrication for eye and eyelid comfort.

 

Subconjunctival Hemorrhage

A subconjunctival hemorrhage occurs when a tiny blood vessel breaks under the conjunctiva.  A subconjunctival hemorrhage often occurs without any injury to your eye. Even a strong sneeze or cough can cause a blood vessel to break in the eye. You don’t need to treat it.  A subconjunctival hemorrhage is usually a harmless condition that disappears within two weeks.   You should stay away from aspirin, and use cold packs to reduce inflammation.

2016-12-12_15-54-06

Bad Eye Burn

Chemical alkali burns of the cornea, are the most severe and painful.   Treatment requires medical intervention, sometimes surgery, acutely and in the long term, for maximal visual rehabilitation.  Common goals of management include:   (1) removing the offending agent, (2) promoting ocular surface healing, (3) eliminating inflammation, (4) preventing infection, and (5) controlling intraocular pressure.

Immediate copious irrigation remains the single most important therapy for treating chemical injuries.

The above patient is being treated with Prokera (Bio-Tissue) brand device, which is a sutureless, amniotic membrane that has been proven to be invaluable in the treatment of chemical injuries.    2016-12-07_16-14-59

Confluent Drusen in Macular Degeneration

Small, yellowish deposits known as drusen, can have discrete or indistinct margins.    Macular degeneration can be classified according to the number and size of drusen, amount of geographic atrophy, and pigmentary changes.    This patient has dry macular degeneration, which is being carefully monitored with photos, as well as daily Lutein supplements.