January Is Glaucoma Awareness Month

Glaucoma is one of most misunderstood eye diseases that eye doctors treat. Most people have heard of glaucoma and know they don’t want to have it, but I’ve found that most of my patients aren’t really sure how it damages vision or how it gets treated. 2.7 million people in the United States have glaucoma and it is the second leading cause of blindness.

Certain types of glaucoma are painless, which gives the disease the dubious distinction of being called “the sneak thief of vision”. It is a disease that damages the optic nerve in the eye causing progressive loss of peripheral vision, and by the time someone notices that they have lost portions of their visual field it is too late, and that visual loss is irreversible. One of the variables that causes the optic nerve to sustain damage is elevated intraocular pressure. If the pressure in the eye is extremely high, the eye will be painful, but the majority of patients only have moderately elevated pressure and will not know it is high until it is detected on a routine eye exam. Factors that increase the risk of developing glaucoma include being African American, having a family history, hypothyroidism, being over 60, and previous eye trauma. Typically, the initial treatment modality is using eye drops that lower the intraocular pressure,  but more advanced or complicated cases may need laser or surgery.

A disease such as glaucoma is a perfect example of why everyone needs routine eye care, even if they have 20/20 vision, since evaluation of the optic nerve, peripheral vision, and eye pressure measurements in the office are key to preventing devastating and permanent vision loss. 

How To Combat M.A.D.E. (Mask Associated Dry Eye)

Aside from staying home with minimal to no contact with the outside world, face masks, hand washing, and social distancing remain the key ways to slow and prevent the transmission of COVID-19. The most common complaint I hear from my patients relating to their eyes and the usage of masks has been foggy glasses, but an interesting study recently published by C.O.R.E. (Center For Ocular Research and Education) found an increase in dry eye and ocular irritation in people who wear masks for long periods of time. The reason for this has to do with the mechanics of mask wearing. When a mask is worn, especially when it is worn loosely, air flow from our breath is directed upwards towards our eyes and has the potential to cause the tear film to evaporate and cause dry eyes. This upwards flow of exhaled air  is also what causes glasses to fog. 

So what do we do? The first thing is to make sure your mask fits really well over your nose. Patients have asked me how I function wearing a mask all day vis-a-vis the fogging and I show them that when I have my mask on I wear it high on my nose with the wire on top sealed in such a way that air is not constantly escaping from the top. Other ways to seal the mask are by using a cool adhesive called Nerdwax or actually taping the mask on top. If your eyes feel dry, use a high quality artificial tear 3-4 times a day and make sure you remember to blink!  Lastly, the use of digital devices also contributes to dry eyes so make sure you are taking breaks during the workday.

Makeup Tips For Contact Lens Wearers

cosmetic products

This month’s post was originally going to discuss eye makeup tips for everyone, whether you wear contacts or not, but an interesting patient encounter last week prompted me to address contact lens wearers first. A young woman came in for her yearly eye exam and contact lens renewal complaining that a few hours after putting her contacts in her eyes the lenses became foggy and she had trouble seeing. She was wearing a two week lens, meaning she takes it out every night and cleans it and puts in a fresh lens every two weeks. This kind of contact lens usage can lead to a condition called GPC (giant papillary conjunctivitis) where one becomes sensitive/allergic to the proteins that build up on the lens over time. At first I thought this is what she had but when I looked at her contacts under the biomicroscope I immediately saw that her contacts were coated with bronze shimmery deposits that looked nothing like anything found in nature and everything like someone took blobs of makeup and threw them on her contact lenses. This prompted a conversation about her makeup habits, which actually were not bad except that when the problem would not go away she decided to put her makeup on first and then put the contact lens in. Bad move, it only made things worse. Next month we will talk more about makeup and eyes but here are some quick tips specifically about contacts and makeup.

  1. Contacts first, makeup second, and wash your hands first!
  2. Using primer on your lids prevents eye shadow from creeping into your eyes and onto your contacts, I like the one by Urban Decay.  
  3. Do not use eyeliner on your waterline – it will clog every oil gland you own and cause dry eye as well as migrating onto your contacts. 
  4. Use high quality eyeliner – I love Urban Decay 24/7, NYX waterproof retractable eye liner and Marc Jacobs Highliner gel eye crayon – they stay put without sliding around.  
  5. At the end of the day remove contacts first then remove your eye makeup.
  6. Daily disposable contacts will help prevent sensitivity to accidental buildup of anything on your lenses, whether it be makeup or proteins, this is the safest and healthiest way to successfully wear contact lenses.  

New Contact Lenses Prevent Sight From Worsening!

asphalt road between trees

When I was eight, my eye doctor prescribed glasses for me to see the blackboard. The truth was, my vision was so bad I should have worn glasses all the time, but my mother told me that wearing glasses would make my vision worse so I walked around in a blurry haze for ten years until I got my first pair of contact lenses. When my own daughter needed glasses at the age of six (bad genetics from her dad) I made sure she wore them all the time so she would not miss out on seeing the beautiful details in the world around her the way I did (love you mom). One thing that concerned me however was how quickly her prescription changed, sometimes every six months. Back then the idea of slowing the progression of nearsightedness was not even in its infancy and according to the conventional wisdom of the time I had her wear bifocals. Fast forward almost twenty years and controlling the progression of nearsightedness is now a reality. 

There are a couple of options out there such as Ortho K (wearing hard lenses overnight to reshape the cornea), atropine eye drops, and soft multifocal lenses with specific parameters to help blur certain parts of the vision and attenuate others. Although these modalities are FDA approved, they are not necessary FDA approved for myopia (nearsightedness) control. A few days ago CooperVision announced that they came out with a daily disposable soft multifocal lens called MiSight  which is specifically approved by the FDA for myopia control. This is a very exciting addition to our arsenal of myopia control tactics and one that I believe will be embraced by both parents and eye care professionals alike due to its ease of use and availability. As soon as I get more information on the accessibility of the lens I will post a little more on how the technology works and who would be a good candidate for this treatment.

Don’t Blame The French Fries!

bowl of french fries

Last month a story came out of England about a teenager who went blind from eating only junk food. I found this very interesting and bookmarked the article so I could blog about it when I had the time. Well oopsie, September passed by in a blur and the email I had saved with the link to the article got buried in my inbox until yesterday when in a frantic attempt to organize my life by starting with my work emails I encountered the article I had saved. After doing a little research on the story I was glad I waited to share the information because the initial story that most of the media outlets shared left out certain details that misrepresented the real lesson to be learned from this young man’s tragic vision loss.

The basic story is that a teenager in the UK whose diet consisted of Pringles, white bread, french fries and occasionally some ham lost his eyesight to a condition called nutritional optic neuropathy which like it sounds, develops due to the lack of the proper nutrients that the eyes need in order to function. Many of the articles used this story as a cautionary tale, admonishing junk food eaters and parents of picky eaters that this is what could happen if you don’t eat a healthy diet. Turns out the young man who went blind was not a “picky eater” but rather , he had an eating disorder called ARFID (Avoidant Restrictive Food Intake Disorder) which led to various nutritional illnesses. The media however jumped on the bandwagon of the evils of junk food and fad diets instead of using the story as an opportunity to bring awareness to the importance of detecting mental health disorders in children and teenagers. Does poor nutrition due to a diet limited to french fries lead to blindness? Absolutely that can happen, but this story was way more complex than simply blaming Pringles and fries.