Eye Know - Valley Eye Care Blog

Healthy Vision Month

5/1/2018

The National Institutes of Health's National Eye Institute has named May 2018 as National Healthy Vision Month. It's not Christmas or the NBA Playoffs but, as an eye care provider, I am excited about it. I love any reason to talk about eye care and share information with my patients that can help them improve their vision and eye health. Follow the link to learn more about how you can take care of your eyes so they can take care of you.

nei.nih.gov/hvm/healthy_eyes

The Future's So Bright: Viewing the Solar Eclipse

4/13/2017

This summer, many residents of the Continental United States will have the opportunity to see something that hasn't happened to American observers since June 8, 1918. On August 21, 2017, a total solar eclipse will be seen by many along its designated path, which includes southern Idaho. For those hoping to observe this interesting and inspiring event, planning and safety are vital.

While sunglasses provide protection from ultraviolet radiation for normal outdoor activities, they do not provide adequate protection from the potent ultraviolet and infrared radiation to which eclipse observers will be exposed so the important consideration about viewing this unique and transitory celestial event is eye protection. Even as the Sun's visible light is dimmed by the eclipse, observers may unknowingly expose themselves to harmful UV and IR radiation. Observers who have the right protection will be able to view the event without any damage to their eyes. Those who don't know how to view it properly will be at high risk for permanent vision loss.

Commercially available solar eclipse glasses can be purchased from many stores and online retailers. You can identify these products by looking for a particular code. When viewing the eclipse, use only eyewear that is ISO certified for solar eclipse viewing, which will have the code ISO 12312-2 (or the longer version, which reads ISO 12312-2:2015). These products are very inexpensive and can be purchased as singles and also in multi-packs so you can make sure that friends and family members watching the eclipse with you have the proper protection. In this case, the old saying that "an ounce of prevention is worth a pound of cure" applies, though instead of an ounce, we may say "a dollar" while also noting that solar retinopathy is associated with permanent eye damage and vision loss for which there is no cure at any cost.

Enjoy the eclipse, but enjoy it safely. Protect yourself and your family with the right safety eyewear so you'll all be able to see the eclipse, but more importantly, so that you'll be able to see everything that comes after it for the rest of your life. For more information on the eclipse, the following links are recommended:

https://eclipse.gsfc.nasa.gov/SEhelp/safety2.html.

https://www.timeanddate.com/eclipse/in/usa/idaho-falls

https://www.greatamericaneclipse.com

Eye Pods - Laundry Detergent and Eye Injuries in Children

2/3/2017

A recent research letter published by ophthalmologists in the Journal of the American Medical Association reports a significant increase in serious eye injuries from exposure to highly-concentrated detergents in the increasingly popular laundry detergent pods made by various companies.1

Chemical injuries from these potent detergents can cause permanent eye-related complications including loss of vision. The researchers note that young children are at especially high risk of exposure to these products because the pods are brightly-colored and have the appearance of candy.1 Exposure can occur when they are mishandled because the pod casings are easily ruptured, perforated or dissolved.

A total of 12 cases of detergent pod-related injuries were reported in 2012 but the numbers have increased over time, with a total of 480 cases reported in 2015, the last year analyzed by the researchers. This increase corresponds with increased sales and use of laundry detergent pods.1

As always, an ounce of prevention is worth a pound of cure. Put your laundry detergents out of reach of small children, just as you would do with any other harmful chemicals, and educate older toddlers and other children in your care that these products can be harmful. If a child in your care gets these or other harmful chemicals in his eyes, a rapid response is critical since damage can occur very rapidly. Flush the affected eye(s) with a steady stream of clean water for at least 10-15 minutes. While flushing the eye, hold the eyelid open and avoid allowing the run off to go into the other eye or be inhaled or ingested by the child. Do not allow the child to rub the eyes before or after flushing and make sure any residual detergent on the child's hands is washed off. Next, take your child, without delay, to an eye care professional for examination of the eyes, additional flushing and subsequent management of complications.

1. Haring RS, Sheffield ID, Frattaroli S. Detergent pod-related eye injuries among preschool-aged children. JAMA Ophthalmol. Published online February 2, 2017. doi:10.1001/jamaophthalmol.2016.5694. Accessed February 3, 2017.

The Price of "Beauty"

1/17/2017

The Price of "Beauty"

In our day, the word "beauty" has come to connote a certain type of physical appearance, presentation or set of characteristics defined largely by those who work in fashion, cosmetics or the entertainment industry.

Merriam-Webster defines beauty as "the quality or aggregate of qualities in a person or thing that gives pleasure to the senses or pleasurably exalts the mind or spirit." It lists loveliness as a synonym. It does not speak of cost-intensive regimens which negatively impact the very thing one is trying to beautify. The concept of beauty, by any definition, makes no provision for self-mutilation or regret.

One of the latest trends in so-called beauty is eyelash enhancement done either by adhering false lashes to one's natural lashes or by the application of various products to promote lash growth.

While I am no more nor less likely to observe such trends in everyday life than any other male, I do encounter them more frequently and know more about them than the average guy because I am an eye doctor.

If you are interested in eyelash extensions, you should know that they will diminish the health and appearance of your natural lashes at least temporarily (7-8 weeks or more). To be fair, I have seen some lash extensions that have temporarily produced the desired results and were well tolerated. However, I have also seen patients who have presented with thinned, truncated lashes after cessation of extensions or between applications, as well as some who have reacted poorly to the products used in applying and removing the extensions. The results have not been what anyone would consider beautiful. In addition to my clinical observations, many have taken to the internet to share their negative experiences, making particular mention of the poor condition of their natural lashes after wearing extensions. The old adage often used to moderate the disappointment of a bad haircut is applicable here - "It'll grow back."

For some who feel they must have longer, thicker, darker lashes, eye doctors can prescribe Latisse, the only medication that is FDA approved for the novel treatment of hypotrichosis. It produces longer, thicker, darker lashes by promoting lash growth. The results are impressive but are also temporary and there are potential side effects. These do not present significant risks to the patient and even those which are of a cosmetic nature are minimized or eliminated with patient education and proper use. I have had many patients use Latisse who have been pleased with the results though others, after their initial inquiry, have elected not to use Latisse because of the cost.

Many cosmetics companies offer other products that claim to promote lash growth. While these are likely more cost-effective than Latisse and possibly extensions, I could not speak with any certainty about their results nor their ingredients. Most products from reputable companies list the ingredients, though there is not a great deal of scientific information available about how they work. In my experience, I have not seen any complications from their use, though without more time and information, I cannot really comment on any particular product. Your best course with these products are online reviews and friends or consultants you trust.

What I can say with certainty is that the health of your eyelashes and eyebrows, as well as highly-specialized glands within the eyelids play an important role in maintaining eye health and good vision. Remember that certain chemicals and non-sterile products used around the eye may get into the eye and cause irritation, build-up on contact lenses or even cause eye infections. Furthermore, the application of certain products may affect the function of glands within the eyelids that produce part of the tear film which, when properly composed, keeps the surface of the eye healthy and functional. Problems with the tear film can cause acute or chronic redness and irritation (which does not look beautiful).

My advice is be happy with what you have and do what you can to keep yourself and your eyes healthy because nothing looks as good as that. Adequate hydration, nutrition and rest are always good ideas. When using cosmetics around the eyes, use good products and use them appropriately. Don't share eye makeup or applicators with others due to risk of infection. Avoid using heavy eyeliner along the bottom lid as doing so clogs the glands at the lid margin and alters and pollutes the tear film. Always remove your makeup before you go to bed to prevent clogged pores and sebaceous cysts and remember what my wife learned about makeup after being a teenage female in the 80s - less is more! Keep things simple, safe and healthy and you'll be looking great and seeing well.

Contact Lens-Related Corneal Infections

8/19/2016

This link from a CDC report reinforces what we all know about contact lenses, which are a great option for vision correction, but they must be worn properly.

Contact Lens-Related Corneal Infections - United States, 2005-2015

One of the many reasons that prescriptive authority must be part of contact lens wear is so eye doctors can provide patient education to combat at-risk wear habits. Many patients wonder why they must be seen yearly if they feel that their prescription hasn't changed. While many are often surprised to find that visual acuity has declined gradually since their last exam and are excited about seeing better with an updated prescription, some really do not have any significant changes in their vision at certain times in their lives, but most contact lens wearers do admit to habits of over-wear, laziness in maintaining their lenses and so on, thus requiring regular monitoring and education to reduce the risk of complications, some of which can cause permanent vision loss.

Some complications present acutely, others are more gradual but a very high percentage are preventable with education and proper adherence to safe wear, replacement and maintenance recommendations. This study sites a significant percentage of cases reported as preventable, but I feel it is likely much higher. I do occasionally see complications from contact lens abuse (or rather self-abuse via careless contact lens wear), though I am pleased to report that the number of cases seen in my practice has decreased steadily over time. Very few cases involve patients that I have seen regularly where repeated instruction regarding safe lens wear habits has taken effect.

In addition to education, other dialogue during exams can lead to changes in the brand or replacement modality of contact lenses to not only improve vision but also provide reduced risk, improved comfort and overall quality of life. Very rarely do I see cases that do not involve a improper wear. I tell patients that their relationship with their contacts is like any other relationship; if they do the right thing every day and take care of their lenses properly, their lenses will take care of them. Conversely, if they get lazy, take their lenses for granted or abuse them, they will live to regret it. So do the right thing every day.

Bad Allergies Happen to Good People

4/19/2016

Just when we think that Winter is over and we can enjoy the great outdoors, Mother Nature reminds some of us that Spring is not without its own issues. As the grass grows, trees bud and flowers bloom, this otherwise glorious season can be quite unpleasant for those who suffer seasonal allergies.

Allergy symptoms can include sinus congestion, headaches, runny nose, sore throat and red, itchy eyes. For those who have asthma, it can cause an exacerbation of breathing difficulties. These symptoms can also have in impact on our overall quality-of-life and productivity because they can interfere with our ability to get good sleep and perform well at work.

It is important for allergy sufferers to recognize that there are many management options for their combination of symptoms. The first, though sometimes most challenging step is to eliminate exposure to the allergen(s). In reality, this is not always practical so limiting exposure is the next best thing. This may include closing your windows during peak pollen times and using HEPA filters in your home's heating/cooling system and vacuum, keeping household surfaces clean and dust-free and showering after yard work or other outdoor activities. Once you experience symptoms, therapeutic options may include over-the-counter and prescription drugs in the form of oral medications, nasal sprays and eye drops.

With regard to eye-related allergy symptoms, there are several good oral and topical over-the-counter products but also many products (mostly topical) which can do more harm than good. I often tell patients who present with various levels of ocular surface disease and who have been using OTC redness-relief or allergy eye drops, that they would have been better off using no drops at all. Ocular surface dryness, rebound redness and pupil dilation are common side effects of certain OTC eye drops. If you are not sure what to use, ask your eye doctor. We want you to get it right. Also keep your eye doctor in mind if you feel that your condition requires a prescription medication.

Contact lens wearers who struggle to maintain clean contact lenses during allergy season may benefit from an antihistamine/mast cell stabilizer eye drop as well as a new cleaning regimen or even a different brand of contact lenses during allergy season. Allergy expression can often lead to an alteration of the tear film and subsequently, rapid build up on contact lenses. Many allergy patients like the option of a daily disposable contact lens so they always have a clean lens.

So enjoy the weather, work in the yard, go for that walk or play outside with the kids. Don't let seasonal allergies ruin your enjoyment of the outdoors. Good options are available to help you manage the symptoms of seasonal allergies.

Does My Child Need Glasses?

2/26/2016

Parents often ask me whether eye doctors can tell if a patient has real vision problems or if he or she is just trying to get glasses they don't really need. The answer is yes. I do occasionally see young patients who feign poor vision because they want to get glasses and making the distinction between those who actually need glasses and those who simply want glasses is pretty straight-forward.

Creating false complaints for the purpose of obtaining a certain reward is called malingering. Malingering may be done for the purposes of avoiding work or punishment or for gaining a desired outcome such as drugs, money, insurance benefits or even glasses (though false complaints about visual dysfunction to obtain glasses do not rank with the more serious abuses of the healthcare system).

The doctor's approach is never to discredit a patient. Rather, the approach is to make an accurate assessment of the patients' health and function. Malingering must be a diagnosis of exclusion, meaning a physician cannot determine that a patient is making false claims unless he or she has determined by thorough examination, that there is no basis for anything related to the patient's complaints. It is never a matter of guessing about a patient's motives.

If you are not sure what to do, err on the side of caution and have your child tested by an eye care professional. Vision screenings are great and the efforts of volunteers, school nurses and even pediatricians or other providers are commendable but even so, such screenings yield false positives and false negatives and are not equivalent to an examination by an eye care professional.

In cases where focusing problems in children can lead to permanent vision problems (a condition called amblyopia), intervention is essential and the sooner the better. Eye doctors use many different tests to determine visual function and measure focusing problems before making any diagnosis or prescribing corrective lenses. Though I do see the occasional malingering patient, most young patients come in because they have legitimate complaints about their vision and require corrective lenses or other treatment. And while their malingering peers may be disappointed when no glasses are prescribed, those who really need them generally appreciate the improvement in vision and upon follow-up, they and their parents have favorable reports citing improved performance in academics or sports, being less clumsy, cessation of headache symptoms and so forth.

Of all the things you are required do for your child, making a clinical diagnosis about his or her vision is not a call you have to make. Leave that to the eye doctor.

Latest, Greatest

2/3/2016

Throughout my career, I've enjoyed great support from contact lens manufacturers and representatives. In many cases, I've been granted special access to new products as they've emerged. Some have been great, others have been disappointing and others still have given mixed results but remain in our lineup because, although they may not be right for everyone, they provide great results for certain patients. I have never believed that one approach is right for every contact lens patient. That's why I have one of the largest diagnostic contact lens inventories in the valley.

Sometimes a new product is just new but doesn't really offer anything better or even different from what is already available in the marketplace.  We've just received our fitting set of ACUVUE Brand Oasys 1-Day with HydraLuxe from Vistakon. In this case (literally), I feel that this is not just a new product. Having tried them myself for over the past couple of weeks, I feel that these lenses offer something very special. Unprecedented comfort. They are easy to handle and the initial comfort, as well as end-of-day comfort is unlike anything I've tried before. If you have dry eyes (welcome to southeastern Idaho) or if you've had other difficulties wearing contacts, you may do very well with this product. Lenses have a wide range of spherical powers ranging from -0.50 to -12.00 diopters and +0.50 to +8.00 diopters.

The ACUVUE Oasys 1-Day with HydraLuxe are for daily disposable wear which means you get a fresh lens every day. Daily disposable lenses are very convenient for regular wearers but can also be a great option for patients who wear contacts part-time, for recreational use or for special occasions in which contacts may be preferred over glasses.

I am excited about this product and expect many of our patients to have a very positive response to it.

New Year, New Benefits: Eye Care and Insurance

1/15/2016

Many eye doctors occupy space in two distinct realms. This does not mean dual citizenship or superhero origins. Rather, it means that eye doctors can participate in insurance plans that cover routine vision care and plans which cover medical eye care.

For many, the start of a new year also means changes in insurance benefits. Consumers naturally want to use their benefits in a manner that is most advantageous but doing so can be challenging and confusing. Some plans renew at the beginning of the calendar year while others go year-to-date from the previous date of service for certain benefits. Some plans allow for out-of-network care but some of those have reduced benefits or a separate deductible. Many consumers are unsure about the difference between vision plans vs. insurance for medical eye care and which plan may be used for their eye care needs.

Routine vision care benefits are those for which you pay an add-on fee in addition to your medical insurance premium for benefits not covered under your medical plan such as annual eye exams where your eyes and vision are evaluated and corrective lenses are prescribed. Vision plans also have hardware benefits for new frames, eyeglass lenses or contact lenses.

Medical insurance covers visits to the eye doctor for problems such as eye injuries, eye infections, visual disturbances not related to glasses or contacts and for medical conditions that affect they eyes like dry eyes, ocular allergies, cataracts, diabetic eye disease, glaucoma, retinal defects and so forth.

Many people do not seek care for medical eye problems because they mistakenly think that they need a vision plan to see the eye doctor. However, if the problem has a medical basis then the regular health plan will cover medical care for eyes, just as it would for any other health problem anywhere else on or in the body.

The world can be a confusing place. The approach to your care at Valley Eye Care is simple and the fees for eye care are the same for equivalent services whether patients are self-pay or insured. And remember, if you have health insurance, medical eye care is covered even if you do not have a separate vision plan. For care that is not covered by insurance or where insurance benefits are not applicable, Valley Eye Care's fees are very competitive. If you have questions about your eyes and how to best meet your eye care needs or the needs of your loved ones, give us a call at (208) 522-2839. The affiliate Optical staff is well-versed in helping patients learn about the provisions and limitations of their insurance plan(s) prior to receiving any services and other considerations detected during an examination may also help ensure that third-party coverage is used appropriately.

Keeping it Simple: Eye Care in a Corporate Setting

12/18/2015

When I was a student at Idaho State University, I was fortunate to work as an optician in an optical center that was part of a national chain. I gained a lot of experience in customer service and optics and was mentored by a great optometrist and friend. Since then, I have always worked and been comfortable in that type of eye care setting, which I think has many benefits for both patients and providers.

Since graduating from the Pennsylvania College of Optometry, I have had the opportunity to work with other great doctors and opticians in different settings. Working relationships, locations, business arrangements and branding have evolved over time and these changes have sometimes been confusing to friends and patients. Many have asked recently about my new practice but the most recent change I've made only involved a new logo and name (Valley Eye Care). The constant is that I have been practicing at the Sam's Club Optical in Idaho Falls for 11 years now and I still enjoy it very much.

I like being a problem-solver so my business model in this setting is based on doing all I can to make getting excellent eye care convenient, efficient and cost-effective for patients. The Optical staff is very friendly and helpful and they work to provide me support in patient care as well as work directly with patients in the sale of glasses and contact lenses. This division of labor, along with other aspects of this setting, allow me to spend more time talking with patients, performing eye exams, prescribing corrective lenses for vision-related issues and providing eye care for medical conditions, rather than in sales or performing other operational and administrative tasks.

There are many great optometrists in our area and each provider and different type of practice model helps to meet the demands of patients in our area. There are also several great ophthalmologists in our fair city and I enjoy working with them in cases where I need to refer a patient for LASIK surgery, cataract surgery, retinal surgery and so forth. I have been working in the field of eye care in one form or another - optician, optometry student/intern/optometric physician - for 19 years now. I guess that means I like what I do. I also love the simplicity of being an independent optometrist in a corporate practice location. For me, keeping things simple is important - not necessarily because it make some things seem easier, but because keeping things simple means being able to give proper attention to the most important things.

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