Valley Eye Care
Follow Valley Eye Care on Facebook, Instagram or our site blog for eye care updates.
  • Home
  • Eye Care Services
  • Provider Information
  • Location
  • Eye Know - Valley Eye Care Blog

Day In, Day Out: Guidelines for Contact Lens Care

12/10/2015

 
Picture
In the old days, contact lens care was like Potion's Class at Hogwart's - there was heat or UV disinfection, separate enzymatic additives and saline for rinsing off cleaning agents.  For some time now, soft contact lens wearers have enjoyed the simplicity of a single multi-purpose product of one brand or another to store, clean, disinfect and condition their contacts.  Unfortunately, human beings have a way of getting lazy about things that need to be done routinely.  

While there are other considerations and I regularly advise each patient, often giving additional instructions to ensure they avoid complications from contact lens wear, I have outlined here what I would define as the absolute minimum for most contact wearers to maintain and safely wear soft 2-week or monthly replacement contact lenses.  If you are doing more that this, keep it up.  If you fall below the standard set in these recommendations, you should recognize that doing so puts your eyes and vision at risk of serious complications and that doing a little better every day can greatly reduce your risk.    

1. Wash your hands prior to touching your eyes or handling your contacts.

2. Rub your contacts daily (regardless of what the bottle may say).

3. Rinse your case with your sterile multi-purpose solution prior to storing lenses - do not use tap water.

4. Fill your case with fresh solution each time you store your lenses - do not top off or reuse solution.

5. Discard and replace lenses according to the recommended replacement schedule.

6. Replace your case every 2-3 months.

7. Avoid touching the tip of your contact solution bottle due to risk of contamination and infection.

8. Check the solution's expiration date.  Discard solution it if it is expired or has been contaminated.

9. Remove lenses prior to sleep, unless your doctor has prescribed lenses that are approved for overnight wear and has explained the risk/benefit considerations involved with extended wear.

10. Never wear lenses overnight if they have been exposed to any recreational water source (hot tub, pool, outdoor bodies of water and so forth) regardless of their approval status for extended wear.

As I said, there are other things to keep in mind and so if your doctor has given you additional guidelines for safe and comfortable contact lens wear, you should stick to those guidelines.  The recommendations listed above are for soft disposable 2-week or monthly replacement contact lenses that are maintained with multi-purpose contact solution.  If you wear daily disposables, rigid gas permeable contacts or use a different product for maintenance such as a peroxide-based solution for overnight storage and cleaning, make sure that you are using these products appropriately.  If you are not sure, check with your eye doctor.   
  

Eyes on the Road

11/20/2015

 
Picture
If you are planning to travel for the holidays and you wear glasses or contact lenses, make sure you are prepared.  If  you forget to plan and pack for your visual needs, your trip will be much less enjoyable and possibly more hazardous.  Traveling involves unfamiliar areas and traffic patterns and other unknowns such as weather conditions which make clear vision essential to getting there and back safely.  In addition to blurry vision, other travel-related safety and health issues pertain to improper contact lens wear and UV exposure.           

Eyeglass wearers should make sure their glasses are in good working condition.  Most optical shops will adjust and clean your glasses at no charge, regardless of where they were purchased.  If you feel like your vision isn't as good as it could be, you may need to see your eye doctor and update your prescription so you can order new glasses prior to your trip.  Whether you wear glasses or contacts, remember to pack a spare pair of glasses if you have an extra pair.   

Contact lens wearers should make sure that they have an adequate supply of contacts on hand and pack spare lenses, along with a contact lens case and appropriate lens solution.  If you are planning to fly and you intend to keep contact lens solution in your carry-on bag, remember that the bottle cannot exceed a volume of 3.4 ounces.  Contact lens wearers should avoid transferring their solution from the stock bottle to a smaller non-sterile container thereby risking contamination, serious infections and vision problems.  Many brands are available in sizes that are compatible with T.S.A. carry-on restrictions.

Most contact prescriptions have daily disposable options that can be very convenient for traveling and do not require the wearer to pack solution.  I often write contact prescriptions for patients in their preferred 2-week or 1-month replacement brand but also write a prescription for a daily disposable brand in cases where that type of lens may be more convenient for travel or safer for recreational use - especially if the contacts will be worn for various water sports or other activities where the lens will be exposed to a recreational water source.    
If you will be driving or spending much time outdoors, sunglasses can make your experience more enjoyable and provide protection for your eyes.  Make sure your glasses provide UV protection.  Polarized lenses are superior in many ways but they may not be for everyone.  Whether you already have a favorite pair or are shopping for new sunglasses, your optician or your eye doctor can evaluate them and ensure that you have what you need.     


Lastly, if your eye doctor has prescribed a topical eye drop for a medical condition that affects your eyes, don't forget to pack your medication(s).  For chronic conditions like glaucoma, make sure you have enough medication to last and that refills are available so you can use them according to your doctor's directions.  

Have a fun and safe holiday season.  Remember to take care of your eyes so that they can take care of you - including when you travel.  

Keep Your Peppers out of Your Peepers

11/12/2015

 
Picture
A patient I saw recently reminded me of how spicy food can be bad for contact lens wearers.  This doesn't mean can't enjoy Mexican, Thai or other varieties of spicy food if you wear contacts.  It means that if you are making a spicy dish, you could end up with very irritated eyes if you handle your contacts after working with hot peppers. 

Capsaicin is the main heat-rendering molecule associated with jalapenos, serranos, habaneros and other hot peppers.  Capsaicin and similar molecules found in hot peppers can leave a very persistent residue on your hands, especially if you handle the pithy internal ribbing.  These compounds are not very water soluble so even extensive hand washing may not remove all the residue.  Since even small traces of capsaicinoids on your fingers can cause significant eye irritation if you touch your eyes or contacts while capsaicin is present, the best precaution is to wear gloves while handing hot peppers.  It is also important to avoid spreading the potentially irritating residue to other items or utensils.  Thus, gloves should be disposed of as soon as you are done handling the hot peppers.  Glove options include latex, nitrile and vinyl gloves and each type has different considerations regarding allergenicity, presence of powder, size availability, fit, type of cooking task you are performing and cost.  There are many good online resources regarding the pros and cons of each type of glove as well as other recommendations for food safety.  Whatever type you choose, just remember to protect your hands (and eyes) when handling hot peppers.  


Rheumatoid Arthritis and the Eyes

11/5/2015

 
By Bradley L. Rhinehart, O.D. 

Rheumatoid Arthritis (RA) is an auto-immune disease which causes pain, loss of function and progressive joint damage.  Initially, small joints in the hands and feet are affected but RA can spread to other joints and other parts of the body.  Although RA primarily causes musculoskeletal complications, other considerations include mental health and so-called "extra-articular" complications in the nervous system, heart, lungs, digestive tract, kidneys, skin and eyes.1  While there is still much to learn, it is known that RA affects females more frequently than males, and that risk increases with age and with a family history of RA.2 

Important considerations for RA patients include pain management, maintaining normal function and preserving quality of life.  RA should be diagnosed and treated by physicians who specialize in rheumatology and auto-immune diseases.  Extra-articular complications should be managed by appropriate specialty providers.  For example, since both RA and RA treatment can affect the eyes, ocular complications of the disease and risks associated with treatment should be managed by an eye doctor.  

Moderate to severe dry eye is often associated with RA and such patients often require aggressive dry eye treatment to help maintain healthy eyes and good vision.  When RA is properly managed or is in a period of remission, it is easier to control dry eye symptoms.  In addition to dry eye treatment, a detailed health history may reveal other physical symptoms in patients who have RA but have not yet been diagnosed.  When undiagnosed RA is suspected, referrals should be made to a rheumatologist so patients can receive the additional testing and care they need.  

Another aspect of RA management is the risk of retinopathy and vision loss in patients taking a so-called "high-risk medication" like Plaquenil (hydrxoychloroquine).  This medication can be very effective in managing pain and joint stiffness in RA patients as well as in treating complications of other auto-immune diseases like Lupus.  Retinopathy may be avoided or limited when patients are properly monitored.  Providers and patients need to be vigilant since even though retinal complications are rare, the adverse effects are irreversible and can continue to worsen, even after a patient has discontinued the medication.  Ideally, eye doctors may detect changes in the eyes before patients notice any functionally significant vision loss.

Risk factors for retinal complications with hydroxychloroquine pertain to dosage, height, weight and age as well as impaired liver or kidney function and the presence of preexisting retinal disease.3  Current guidelines established in 2011 by the American Academy of Ophthalmology recommend a complete eye examination, automated central visual field testing and one of several methods to evaluate the integrity of the central retina, (for which I usually recommend non-invasive diagnostic laser imaging of the macula), prior to or shortly after beginning treatment.4

Thereafter, patients should have an eye examination yearly.  Other specialized testing does not need to be repeated within the first 5 years unless a patient has additional risk factors.  After 5 years, both the eye examination and the enhanced retinal testing should be repeated yearly since complications are more likely after 5 years, which is usually around the time patients reach a cumulative dose of 1,000 grams.4

As with all medications, it is all about risk vs. benefit.  Hydroxychloroquine provides significant benefits in terms of decreased pain and joint stiffness and improved dexterity, mobility, mood and overall quality of life to many patients.  RA patients should work closely with their primary care and specialty providers, including their eye doctor, to manage the disease and reduce the risk of  potential complications associated with treatment.  Patients should remember that, while retinal complications are rare, monitoring is important because the risk is different for each person and adverse effects can be permanent.  In cases of retinopathy, the eye doctor should report findings to the managing rheumatologist so an appropriate substitution can be prescribed.  Retinal evaluation should then be repeated every 3 months until the condition is stable.3


1 Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular manifestations in rheumatoid arthritis. Mædica. 2010;5.4:286–291. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152850. Accessed October 29, 2015. 

2 Mayo Clinic Staff. Diseases and conditions, rheumatoid arthritis. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/risk-factors/con-20014868. Accessed October 30, 2015.

3 Hansen MS, Schuman SG, Scott IU, ed., Fekrat S, ed., Marmor MF ed.

Ophthalmic pearls: hydroxychloroquine-induced retinal toxicity.  EyeNet June 2011. http://www.aao.org/eyenet/article/hydroxychloroquine-induced-retinal-toxicity?June-2011. Accessed October 29, 2015.

4 Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler, WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118:415–422. http://www.ncbi.nlm.nih.gov/pubmed/21292109. Accessed October 29, 2015.

Understanding Eye and Vison-Related Headaches

10/14/2015

 
Picture
If you are suffering from headaches, this article I wrote may help you determine whether or not they are vision-related.  

To read it, go to: 
http://healthylivingmadesimple.com/catalog/?cid=29#page=44



Eye Know

10/14/2015

 
I am excited to have this platform to share things that I know about eye care and vision with you.  Posts on this blog will feature items of interest to patients of all ages and from all walks of life.  Much of the content will be original and based on my own experience but I will also share information from other sources that I hope will help you enjoy great vision, maintain healthy eyes and enhance your quality of life.

Dr. Rhinehart  
Forward>>
    Schedule an eye exam.

    Author

    This blog features eye-related items of interest written or posted by Dr. Rhinehart. 

    Archives

    May 2018
    April 2017
    February 2017
    January 2017
    August 2016
    April 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015

Site powered by Weebly. Managed by HostGator