Doctor Articles

1. Antioxidants and Free Radicals
2. ASTIGMATISM
3. Binocular Vision
4. CATARACT
5. Color Blindness
6. Dry Eye Syndrome (DES)
7. Eye Exams for Youth
8. Myopia and your Environment
9. Pain Medication for General Use
10. The Profession of Optometry
11. Proper Wear and Care of Contact Lenses

All articles are listed alphabetically.  Scroll down to find a specifice article listed above.

Antioxidants and Free Radicals

Our body's cells need and use oxygen and in the process of this utilization some of the by-products that are created are referred to as free radicals. Theses free radicals can cause damage to normal cells that will in turn be a detriment to our general health. Antioxidants are substances or nutrients in our foods, which act as "free radical scavengers" and hence can prevent or slow the oxidative damage done by the free radicals. Studies have shown health problems such as heart disease, diabetes, cancer, and various ocular conditions are all influenced by oxidative damage. Antioxidants my also enhance our body's immune defense and lower the risk of infection. 

There are several enzyme systems within our body that seek out free radicals and terminate the chain reaction before vital cellular molecules are damaged. Research has proven that certain micronutrients (antioxidants) that our body cannot produce such as vitamin E, vitamin C, beta-carotene, and selenium (a trace metal) also function similar to our body's defense system and interact positively with free radicals. 

There are numerous antioxidants that work in your favor relative to certain detrimental eye conditions. It has been determined that the development of glaucoma (a condition where non-painful pressure increases inside your eye and causes nerve damage) can be stymied by certain antioxidants such as ginkgo biloba, which initially was marketed as a memory aid supplement in the United States. Vitamin A palmitate in combination with manganese and zinc has also been helpful to some people suffering from glaucoma. Studies have proven that the antioxidants lutein, zeaxanthin, and as previously mentioned selenium can delay or possibly prevent the onset of macular degeneration which is another visually threatening condition. For the most part the verdict is still debatable if antioxidants play a roll in curbing the development of cataracts, but studies have shown that they improve tear stability and the health of the conjunctiva.  

While vitamins and supplements may be good for you, you should treat them with the same respect as any other drug you may be taking as too much of them may actually cause unwanted health side affects such as headaches, nausea and diarrhea. Of most importance is to incorporate antioxidants into your diet. Some examples are the following: Beta-carotene is found in apricots, carrots, mango, red peppers, squash, asparagus and sweet potatoes  Vitamin c is found in broccoli, oranges, kiwi, cabbage and turnips  Vitamin E is found in almonds, wheat germ oil, corn oil, soybean oil, mango and turnip greens  Blueberries are among the highest in capacity of antioxidants among all fruits and vegetables  Dark chocolate, green tea, and red wine (in moderation) have antioxidant properties  Lutein can be found in kale, collard greens, swiss chard, and most importantly spinach. 

For more information relative to nutrition recommendation relative to diet and eye health check out the following site: Vision Health Treatment Options & Nutrient Recommendations. 

Astigmatism

Astigmatism is not a serious eye health or vision condition. Like nearsightedness or farsightedness, astigmatism is a refractive error, which defines how images come into focus for visual perception. Nearsighted (myopic) individuals have a clearer focus for close images and those farsighted (hyperopia - more on this topic later) see better for distant objects. Astigmatism causes visual distortion at all distances because objects come into focus at two distinct positions as opposed to only one. Most frequently it is related to the shape of the cornea (the clear membrane on the outer most external surface of the eye) because it is shaped more like a football as opposed to a basketball. Astigmatism can be combined with myopia or hyperopia or simply be an entity by itself. Actually most everyone has a little astigmatism, but the more distance between the two points of focus, the more visual perception is distorted. Significant astigmatism that may be detrimental to vision generally is present in childhood, thus it is important for children to have visual screenings at a young age. Left untreated at youth may result in lifetime of subnormal vison. Astigmatism can easily be corrected for proper focus with spectacles and in most cases even with contact lenses, but unfortunately the condition will not go away and often changes throughout a lifetime simply requiring an adjustment in ones corrective lenses. 

Binocular Vision

Binocular vision is simply perceived vision were both eye are used functionally as one unit. From the Latin basics: bini means double (both eyes) and oculus refers to the eye. There are four main advantages to having two eyes working together as opposed to one. 

#1 Hey, one eye becomes injured or non-functional, you have another one to fall back on! #2 If both eyes are healthy and functional a wider peripheral field of view is perceived. With two eyes a maximum field of view is 200 degrees 120 degrees makes up the binocular field of view and each eye is flanked by another 40 degrees of very peripheral monocular viewing. #3 Having both eyes work in unison, definition of viewed objects is enhanced simply one plus one makes three! #4 Good binocular vision provides stereopsis, which in layman terms means depth perception. This really only applies for the viewing of relatively close objects because the separation of each eye provides a different view of a close object thus a perspective difference of the distance of how far the object is away from you is analyzed by both eyes. The separation of your eyes is not a factor relative to viewing objects much farther than three feet. 

A segment of my visual examination involves the testing of binocularity. As reviewed in the previous post relative to early age examinations to be sure there is not total lack of binocularity such as "lazy eye", I test the ability of your eyes to work together for every exam. Often times there is a slight horizontal or vertical misalignment of the eyes and prism can be added to your prescription to enhance vision. Patients adapt easily to the adjustment of their prescription with the added prism (it does not make your lenses thick) and appreciate the improved binocular focus and visual comfort.

Cataract

A cataract is a condition where the crystalline lens inside your eye becomes cloudy and with progression causes blurred and distorted vision. This internal lens is flexible and before it ages and becomes more rigid has the ability to adjust its shape and enable proper close-up focus when stimulated by the eyes turning in to see at close range. Generally the lens starts to lose its flexibility and focus ability in midlife (40's) and thus the need for reading glasses or bifocals. As you age the lens becomes a totally fixed structure, changes its clear hue causing some perceptual color distortion, and eventually will distort and cause blurred vision which can not be corrected with spectacle lenses. Essentially everyone past the age of 70 has some degree of cataract that affects normal clear vision. Often times your glasses prescription can be adjusted to provide adequate vision relative to the cataract, but eventually the lens will need to be surgically removed from your eye for satisfactory vision, which will require Ophthalmological services. 

I can monitor and provide guidance in regards to your cataract development with yearly comprehensive examinations, adjust your glasses prescription if vision can be enhanced and of course refer you to an Ophthalmologist when surgery is determined to be necessary for proper vision. Cataract removal is one of the most frequent surgical procedures preformed and the success rate for good restored vision is close to 100% when provided by competent surgeons. Typically cataracts develop in both eyes, but not necessarily at the same rate and surgery becomes necessary when the lesser-developed cataract does not provide you with adequate vision. Generally the more advanced cataract is removed first and the lesser-advanced one is removed shortly afterwards. The surgeon replaces the lens/cataract with an artificial implant and remarkably vision is often restored to pre-cataract acuity requiring only the need for reading glasses.

Color Blindness

Color blindness is really a misleading term applied to a condition that affects approximately 10% of males and less than 1% of females. As opposed to "blindness", color deficiency or confusion is more applicable terminology to describe the anomaly. Most people with a color vision defect can see colors, but have confusion with differentiating between red and green those cases are hereditary in nature and will affect both eyes. Much more rare is confusion between blue and yellow and those cases are generally acquired relative to an underlying condition and may affect only one eye. Total color blindness is very rare and often is related to other serious eye problems. 

Picture your eye like a film camera. The front part of your eye, the external cornea and the internal crystalline lens (where cataracts form), bring images to focus on the inside of the back of the eye where special nerve cells on the retinal membrane react to light. These nerve cells include rods and cones that contain specialized pigments that change when the different wavelengths of light strikes them. The cones, which are concentrated in the very center of the retina, are responsible for color vision and contain a mixture of three photosensitive pigments: red, green and blue. Those with a color vision defect have a deficiency or absence of one or more of these pigments, which respond to a specific wavelength of light. The rods are located in the more peripheral retina and contain only one pigment, which reacts the same to all wavelengths of light. The rods are very sensitive to light and allow us to see in dim illumination. When the rods and all types of the cones are not defective and working together, the eye sees all possible colors. It works similar to how a painter can mix just a few colors together and come up with paint of every possible color! 

So what are the consequences of being colorblind? Symptoms vary from person to person depending on the severity of the condition. Some cases may be so mild that that the individual may never experience any difficulty perceiving color in the real world. More commonly people have trouble with certain tasks that involve separating or defining different colors. A colorblind individual would have difficulty interpreting chemical testing kits for swimming pool water, hard water, soil or water pH tests because they rely on evaluating subtle color differences. When grilling a piece of meat, a red deficient individual would have some difficulty determining whether it is raw or well done he may also have confusion whether a woman is wearing lipstick. Green or rip tomatoes may be difficult to separate. Ketchup could look like chocolate syrup! Buying ripe or unripe bananas can be difficult for the color blind. Some food could look disgusting a full plate of spinach could look like a cow pie. 

Color vision deficiencies bother affected children from the earliest years. Coloring can become difficult a child may pick the pink crayon inside of the blue one to color the ocean. Generally "color blind" individuals adapt and do not suffer any serious lifetime detrimental issues. Traffic lights always have the red on top and those with color vision confusion determine which light is lit by the brightness, not the color that stands out one with normal color vision sees. 

Dry Eye Syndrome (DES)

 "Dry eye" is a disease that involves the natural production of tears, the conjunctiva (white of the eye) and the corneal epithelium (surface) of the eye.  Improperly functioning glands along the eyelid margin may also be a factor that affects the condition. Up to 1/3 of the world population may have DES. Older adults and women are more likely to be involved as are those with arthritis, smokers, and contact lens wearers. Medications such as antihistamines, antidepressants, diuretics, and hormone replacement therapy may exacerbate the condition. Living in a dry, dusty and windy climate with low humidity may have an affect plus certain environmental activities such as extended computer use (when blinking is often diminished) can cause the eye to become dry. Cosmetic facial surgery which may not allow the blinks to remain complete can also cause dryness to the eye and simply being inside particularly during the winter months where your house or office is heated with forced dry air may play a factor. 

The most common symptom is a feeling of scratchiness or the sensation that something resembling sand is in the eye. Other common symptoms are stinging and burning sensations to the eye, episodes of excessive tearing because the irritating dryness sensation to your eye stimulates the lacrimal gland to secrete excessive watery tears and the clarity of your vision may also be diminished. 

Dry eye syndrome is an ongoing condition that treatments may not cure, but the annoying symptoms can usually be managed to the point of accepted tolerance. A combination over-the-counter artificial tear and lubricating drop is typically the first approach I suggest and my preference of eye drop is Systane. You don't have to be concerned about using the drops too frequently and generally application of the drops is required on a regular basis up to four times a day to be affective for relief. If the artificial tears do not remedy symptoms, there are also prescription antibiotic drops that stimulate tear production and plugs that may be inserted into the tear duct to aid in keeping the natural tears on the eye. Simple approaches may also aid in comforting dry eyes such as more frequent blinking when engaged in extensive near projects like computer related activities, being sure that your furnace air filter is being replaced as suggested and utilizing a household humidifier that moistens the air. 

Please do not hesitate to call for an appointment if you suspect you may have this condition. When symptoms are present a biomicroscopic examination of the external structures of the eye will often reveal DES and a treatment plan can be generated. Major medical health insurance can be billed for a visit of this nature. Remember your eyes should always feel comfortable and be clear of abnormal redness.

Eye Exams for Youth

Comprehensive eye examinations are an important part of health maintenance for everyone and I think everyone should be entitled to see their environment as clearly as possible, especially children during the developmental years. 

In general parents should consider having their children's eyes examined around the age of 3 or of course sooner if they suspect a vision problem such as the crossing of eyes or simply the inability to see properly. If there is a history of "lazy eye" in your family or someone who simply has to wear "thick glasses", it is probably even more important to have your child's eye examined at a young age. Most schools require proof of an eye exam before a child starts the first grade. I suggest a yearly examination for those youth (school age) that require spectacle correction or I suspect there may be a condition that could advance into the need for glasses. If glasses are not required on their initial exam, a good rule of thumb is every two years to be sure eyes stay healthy and myopia or astigmatism has not developed causing blurred distance vision or general focus difficulty at any distance. 

Vision is linked closely to the learning process and those children who have trouble seeing or interpreting what they see, often fall behind in their reading and comprehension. Often times, children will not complain about their vision because they don't know what good "normal" vision is really like. If your child is falling behind in school and in particular does not like to read, I suggest he have a comprehensive exam which may involve dilation of the eyes to rule out a possible underlying vision or eye health problem.

Myopia and your Environment

There have been theories over the years that too much close-up vision causes myopia. I believe that for adults there is a correlation, but not necessarily for children. When I first started my Optometric career the doctor preceding me in practice would frequently prescribe a bifocal correction to children as a preventative to increased myopia. The assumption was that the child would be looking through the bifocal when viewing close-up objects or reading, thus requiring less accommodation. Accommodation is the thickening of the lens inside the eye so proper focus is unconsciously adjusted for near vision It is precipitated by the turning in of the eyes, the internal contraction of intricate eye muscles and the stimulus for a focused image on the retina. Theory was that excessive accommodation caused stress on the eyeball and it became elongated causing images to become out-of-focus and falling short of the retina. Either children looked over the bifocal (not using it for close vision) or the less accommodation when looking through the bifocal for near vision did not play a factor in youth becoming progressively more myopic because I seldom saw stabilization of myopia when bifocals were prescribed to children. 

For children becoming progressively myopic it is generally a growth trend plus there may be some hereditary considerations I do not think environmental situations play much of a factor. Unnecessary extra accommodation may cause visual stress which can be encountered by patients of all ages who read or view close-up objects at a very close viewing distance for sustained periods of time. I recommend that all patients try to keep at least a 16 inch near viewing distance. I have definitely noted in my 35 years of practice a correlation of increased myopia in adults relative to close sustained long periods of near viewing. The best example would be day-long computer related jobs or college students engaged with long periods of reading. I have noted in my practice that practically everyone in their 20's and 30's who becomes more myopic is engaged in long periods of near focus. Interesting also is that these same individuals who became myopic as adults generally lose some of their myopia in their 40's and 50's. 

A few simple concepts to keep in mind if you have a job requiring prolonged computer use are the following: 1) the closer the monitor, the more stress on you visual system. Try not to have the viewing distance closer than 20 inches. 2) Periodically look up at distance (every 10 minutes for at least 30 seconds) and after an hour, take a 5 minute break. 3) Have your vision checked at least every two years or of course sooner if you note changes in your vision. A specific prescription for near related tasks may be of benefit if you are subject to environmental myopia. Something as simple as OTC reading glasses may be used in conjunction with contact lens wear.  

Pain Medication for General Use

The proper use of pain medication is important for those of all age groups and with some basic understanding can be utilized safely and efficiently for minor discomforts. Within reason it is OK to self medicate and provide over-the-counter medication for children if proper guidelines are followed. Pain medication does not cure the underlying condition, but may provide comfort while it runs its course. If after a few days of over-the-counter pain medication used as directed, you are still in distress, consult the proper medical authority. 

Aspirin: Known as acetylsalicylic acid, it is often used to relieve minor aches and pains, reduce fever and might inflammation. Perhaps the most common use of aspirin now is its affect as an antiplatelet. This action helps protect the blood vessel walls and aspirin is often suggested long-term in low dosages to help prevent heart attacks and strokes. Aspirin is not recommended for children and adolescents because of the risk of Reye's syndrome and in higher dosages may cause stomach discomfort and ringing in the ears for adults. 

Ibuprofen: Like aspirin, it is classified as a nonsteroidal anti-inflammatory drug (NASAID), but may be more affective to relieve symptoms associated with arthritis and general tissue inflammation. It acts as a blood vessel dilator and is affective against fever especially when inflammation is involved. 1200 mg over-the-counter is considered the maximum daily dose for adults, but like aspirin it can cause digestive problems and is not the best choice for children. 

Tylenol: Paracetamol is its active ingredient and is referred to as acetaminophen in North America. It is prescribed mostly for relieving pain and reducing fever relative to allergies, colds, cough and flu symptoms. Tylenol is the best choice for diminishing fever in children. Gastrointestinal side affects are much less compared to the NASAID, but the inflammation fighting affects are less. Paracetamol is metabolized in the liver and used in high doses especially if combined with alcohol may cause irreversible liver failure. 

This brief article provides very general information about the use of over-the-counter pain medication available. Tylenol is also sold as a class of stronger pain relievers containing codeine, but a prescription is necessary.

The Profession of Optometry

The term "optometry" comes from two Greek words: opsis meaning view and metron meaning something used to measure. Yes, that's what I do: measure your vision! And I try to do it as accurately as I can to provide you with the best quality of vision possible with either spectacle lenses or contact lenses. The root word opto is a shortened form of the Greek word ophthalmos, which means: "eye". 

An Optometrist or O.D. (from Greek words meaning oculus doctor) is the primary health care professional for eye related issues and especially trained in prescribing eyeglass and contact lenses prescriptions.  We are qualified and state licensed to examine, diagnose, treat, and manage diseases, injuries and disorders of the visual system, the eye and associated structures as well as identify related systemic conditions affecting the eye. It is also my responsibility as an Optometrist to correspond and refer with other health care professionals (particularly eye surgeons Ophthalmologists) for proper patient care when eye and systemic conditions are diagnosed and beyond my scope of care and treatment. Optometrist counsel patients regarding eye surgery and non-surgical options that best meet their visual needs related to occupations, avocations, and lifestyles. 

The first schools of optometry in the United States were opened in the late 19th century. There are now 20 accredited schools of optometry in the United States and admission is considered extremely competitive. Prior to acceptance to optometry school generally 4 years of under-graduate study are required plus a good score on the Optometry Admission Test. To obtain a Doctor of Optometry degree a student must successfully complete a 4-year postgraduate program. Then prior to practicing the profession an optometrist must pass a national examination plus an examination presented by the state in which he chooses to practice in. All optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of care. 

Given the importance of vision relative to the quality of life, I consider my job rewarding as I often am able to restore or improve a patient's sight.

Proper Wear and Care of Contact Lenses

Practically all contact lenses that are now fit are of the soft disposable/planned replacement type.  I have a few patients that wear the gas permeable version, but most patients prefer the initial comfort of soft lenses and technology has now progressed to the point that most of the previous complicated fits can now utilize a soft lenses. There are also one-day disposable lenses available now and most current lenses allow enough oxygen transfer through the material that they are approved for extended wear. Just because the lenses are approved for extended wear does not necessarily mean that sleeping in the lenses would be appropriate for you. Various versions of bifocal contact lenses are also now available. After an initial fit or yearly contact lens exam all my patients are prescribed a care regimen plus a suggested wearing and lens replacement schedule. Most of the lenses that I fit come in 6-packs and are to be replaced monthly per eye if wearing on a daily basis. 

Over the years I have found that most contact lens wearing complications evolve because of improper patient compliance. Some patients do encounter "dry eyes" and seasonal allergies may complicate the wearing of contacts. The most common non-compliance issues are over-wearing the contacts (too much extended wear) or keeping lenses past the prescribed maximum duration of safe "lens life". Just because the lenses feel OK, does not mean that they have not deteriorated past the point of wearing a lens that is healthy for your eye. 

On the good side of contact lens wearing is the evolution of better disinfection solutions that are used daily in the wearing of contacts. In years past many wearers encountered sensitivity with the preservatives that were formulated in the marketed cold disinfection products, but now most solutions are "user friendly" and I seldom witness a sensitivity reaction. A few years ago some of the combination (storage, rinsing, cleaning and disinfection) solutions were marketed as "no-rub". Studies determined that the mechanical cleaning/rubbing of the solution onto the lens was still necessary for the best cleaning care of the lens. Generic solutions are available, but I prefer patients use one of the products from the major pharmaceutical companies because I think they have better up-to-date formulas and better quality control. Rubbing of the lenses after removal is still important and of course replace your solution daily. It is then not necessary to rub the lenses prior to insertion, but you may want to rinse them. Rinse out your case with warm water after each use and replace frequently. I also suggest that those that are permitted to sleep with their lenses (extended wear) rinse out their eyes upon awakening. Do not remove the lenses in the morning after sleeping with without rinsing your eye out first. To be on the safe side, extended wear of the lenses should not exceed 6 nights in a row for anyone.    

As I have told patients for years, if the lenses feel comfortable, you see well out of each eye while wearing the lenses, and your eyes are not "getting red", in general you are probably doing fine with the wearing of the contacts. And of course in conjunction with those premises, you are wearing the lenses and replacing them as recommended. All contact lenses patients should be seen for an examination yearly to check the external health of their eyes and up-date the optical prescription. Please contact my office if you are having any persistent issues with successfully wearing your contacts relative to any of the above-mentioned guidelines.