Eyedolatry: November 2011

Synergeyes Duette Update

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Will Wearing Glasses Make Your Vision Worse?

A question for the ages. As an optometrist, I answer a lot of questions about vision and ocular health every day, but this particular question pops up more frequently than I would have suspected. The simplest answer is this: if your glasses are the correct prescription, wearing them will in NO way hurt your vision. To be more thorough with this answer though, we actually need to break it down into several common scenarios:

1) My glasses prescription is correct, but it seems like my vision is worse than before when I take them off.

I hear this often from patients that are new glasses or contact lens wearers. If the glasses prescription truly hasn't changed, then vision without glasses looks worse than the patient remembered because they had never previously had crisp and clear 20/20 vision to compare to their own vision. If your world looks blurry all the time, that becomes your normal. Once you get used to 20/20 vision in your new glasses, that same amount of blur looks just terrible because now you know what you are missing!

2) I wear over the counter reading glasses, and I just keep having to get stronger and stronger powers. Have I made my vision worse with the wrong reader?

For those individuals over age 40 that suffer from presbyopia (see this post for more details), reading glasses become a way of life. Because over the counter readers are readily available, many patients will pick a pair in the store based on what feels most comfortable, without seeing a doctor first to verify the necessary Rx. The good news is that wearing readers will not hurt your vision even if you select the wrong power. They can give you headaches if the prescription is too strong or too weak, but this is really the only side effect. And rest assured, even though it feels like you are getting more and more dependent on your reading glasses, it is because your visual system is gradually declining at near due to normal aging changes (none of us are immune!) and not because of the readers. My patients are also often concerned that they selected too strong a power in reading glasses (the powers typically span from +1.00 to +3.00), but a stronger pair will only give you greater magnification and force you to hold things closer if it is stronger than you really need. No permanent harm done, but you will get used to a certain level of magnification if you use a particular power for a while.

Vera Bradley specializes in colorful OTC readers. I also recommend Steinmart for a good selection. Just remember, the quality of OTC readers is not the same as you will get with prescription glasses. There's a reason many people call them "cheaters"-- in the correct power, they are just good enough to get you by!

3) Every year my child's glasses prescription is getting stronger. Is wearing glasses making his vision worse?

This question is the only one where we can get into a scientific debate. Myopia can progress quite rapidly in children, and a number of factors influence this progression. Being near-sighted is a function of the curvature and length of your eye, which in turn is influenced by both genetics and environment. Numerous studies have shown a correlational relationship between amount of time doing near work (like reading) and the presence of myopia. Whether myopic children tend to read more because it is easier for them than distance activities, or if they are myopic because of doing so much reading is under constant debate. There is a school of thought however that near strain, or the strain on the eyes' focusing system when performing a task at near, can induce myopia in an effort to relieve that strain. An overview of these theories can be found in Myopia and Nearwork by Rosenfield and Gilmartin. As optometrists, we try to counteract this progression of myopia from near strain by:

Prescribing the lowest possible prescription to attain 20/20 vision, and thus limiting the amount of near strain when reading with glasses.
Prescribing bifocals or progressives for children when needed to ensure that their distance prescription does not adversely affect their reading facility.
Studies have shown that certain contact lenses such as rigid gas permeable lenses or orthokeratology (where the patient sleeps in rigid contact lenses that act like a retainer to change their prescription overnight) can help slow the myopic progression in some cases. For more information (though it is quite technical), try this article:
http://www.revoptom.com/continuing_education/tabviewtest/lessonid/106321/

This rigid gas permeable (or hard) contact lens has a special design that flattens the cornea overnight, leaving a myope with clear distance vision the next day. This technique is best for myopes -4.00 in prescription or less.

In coming posts I plan to explore the current options for treating myopic progression in children in more detail, so stay tuned!

One more important point to this question: if your glasses are the wrong prescription or incorrectly made, they can cause symptoms like eye strain, headaches, double vision, and of course blur. These symptoms will not have lasting damage when the problem with your glasses is fixed, so if you notice any of these issues, you should have your doctor check your prescription.

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Trending Now: Winter 2011-12 Eyewear

glasses fashion 9:55 PM

It's that time of year again. That's right, flexible spending account season, as it's known in the healthcare industry. Most flex spending accounts expire on December 31st, so for many people who wear glasses this is the perfect time of year to make your purchase! Due to the high demand of the season, expect your local doctor's office or frames retailer to be running discounts or sales, making this a great time to also get a good deal.

For the holiday season, bold designs and colors continue to dominate the eyewear industry. Here are some of my best-sellers!

ROBERT MARC: Branded as the eyewear line of choice for the stars, the quality of these frames is hard to beat. This year's line features several styles in a colored tortoise pattern. The red tortoise (below) and their olive green "jungle tortoise" are two of my favorites. The only drawback on these frames is the pricetag, but the fit and design are truly impeccable.

TIFFANY'S: The company's newly launched eyewear line features their classic robin's egg blue color scheme, as well as familiar accents in silver such as the heart locket and key motifs. This frame line has been very popular at my office because the brand is so distinctive. People can recognize that shade of blue from across the room.

PRODESIGN: If you want bold color, no one does it better than Danish based Prodesign. I find their frame shapes are very angular, but for those people with oval or round shaped faces they are a perfect fit.

CLEAR PLASTICS: I've mentioned it before, but if you are a risk taker, clear zyl frames are a huge trend right now. Yes, they are hard to wear. But people will notice them. One of my good friends recently purchased a pair and they get stopped all the time by people asking where they got their glasses.

Fendi 123

COLOR: Well, since it is my blog, I might as well post my newest pair of glasses. If you are going to have just one pair of glasses, then I would recommend something universal like brown or metallic. But if you are going to have several pair, then get a bold color! Purple, red, and green are the most flattering to most, but every year it seems the color palate expands to more vibrant options.

Coach Lucille

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5 Reasons to NEVER Overwear Your Contact Lenses

CLARE 9:24 PM

How often do you throw away your contact lenses? It is amazing the responses you can get on this simple question. As an optometrist, I have had patients that have been wearing their same trial pair of contact lenses they were dispensed at an exam 2 years ago. Most people aren't that daring, but it is not uncommon to have people wearing lenses for months longer than FDA guidelines recommend. And most patients are very defensive about just how often they are throwing their lenses away. Why do I recommend following FDA guidelines for proper contact lens disposal? Here are 5 very real complications that I treat on a regular basis that are a result of improper contact lens wear.

1) CORNEAL NEOVASCULARIZATION

New blood vessel growth is not a good thing when it means opacification of what should be clear tissue! Picture via optometric.com

Neovascularization means the growth of new blood vessels, which in itself doesn't sound so bad, right? Well in the case of your cornea, it can have potentially devastating results. The cornea is the clear dome of tissue where your contact lens sits, and the clarity is essential to your clear vision. As a clear tissue, the cornea must receive the majority of its oxygen from the atmosphere. When a contact lens sits on top of the cornea, this atmospheric oxygen must travel through the contact lens to supply the corneal tissue. As a contact lens ages, the amount of oxygen to the eye gradually decreases until it reaches an unsafe level (which coincides with the FDA required disposal time, be that monthly or bi-weekly, or daily). What happens if you continue to wear the lens past the time that it is supplying adequate oxygen? Well the cornea has to get oxygen somehow, so it grows it's own blood vessels. With time and repeated insult, your cornea could end up looking like this:

A cornea with significant scarring and neovascularization

Treatment = Change to more oxygen permeable contact lenses or daily wear. If severe enough, contact lens wear may have to be discontinued permanently.

2) GIANT PAPILLARY CONJUNCTIVITIS

GPC: a nasty allergic response to your contact lenses

GPC is one of the most common acute conditions I see from contact lens overwear. What will you notice? Increased discomfort with your contact lenses, and even worse irritation when the contact lenses are off. Many of my patients complain of excessive movement with their contact lenses (that has just recently occurred). The large bumps pictured under the eyelid are papillae, which are an acute allergic inflammation that the body mounts against any protein build-up on the surface of the contact lens.

Treatment = No contact lens wear for 1-2 weeks, prescribed eye drops (typically a steroid if advanced or antihistamine drops if mild)

3) CONTACT LENS ACUTE RED EYE

Acute red eye, usually after sleeping in contact lenses is classic for CLARE

Commonly abbreviated as CLARE, this acute onset red eye is also a side effect of poor oxygen levels to the cornea. Remember that the cornea receives most of its oxygen from the atmosphere, so when you sleep and your eyelids close, you are depriving your cornea of oxygen to some degree. Now put a contact lens on the cornea, and those levels go dramatically down. This is why most doctors NEVER recommend sleeping in lenses as the ideal form of contact lens wear, and when you do sleep in your contact lenses you need to be prescribed a special contact lens made for extra oxygen delivery. If you have CLARE, you will wake up with red, irritated, watery eyes. Best thing to do is take those contact lenses out and throw them away!

Treatment = No contact lens wear for around 1 week. Drops prescribed as needed

4) BACTERIAL ULCER

A Bacterial Ulcer: definitely something you do NOT want

If the picture isn't enough to sway you, let me just emphasize the fact that you do NOT want a corneal ulcer. They are painful. They are really nasty looking. They cause permanent scarring. They can take a very long time to heal up. Did I mention they are VERY painful? Corneal ulcers come in all shapes and sizes, and most are smaller and located more towards the periphery. When I do see a large central ulcer, that means immediate referral to a corneal specialist. If your ulcer is anywhere near your pupil (where light passes through to allow you to see), then you are going to have a permanent scar obstructing your line of sight! Where do these ulcers come from? Like most of the problems we've discussed, a lack of oxygen is a trigger. When the cornea is deprived of oxygen the integrity of the tissue is weakened. Bacteria on your contact lenses can then penetrate the cornea and result in the ulcer.

Treatment = No contact lens wear for several weeks (or indefinitely depending on the severity). Frequent antibiotic use (typically every hour round the clock in severe cases).

5) YOU ONLY GET ONE CORNEA PER EYE. FOREVER.

I frequently tell my patients who are overwearing contact lenses that their cornea has to last them to age 100. You don't want to be depriving it of oxygen in your teens or twenties! Here's another question that I have heard doctors pose: "would you sleep in the same pair of undewear for months at a time without washing it?" Your contact lenses are very prone to accumulating bacteria, so it is very important to properly clean them and throw them away at the end of their lifespan to ensure you aren't depriving your eye of the oxygen it needs.

Take home points:

If you have a red eye, remove your contact lenses and see your doctor. Most of these conditions require a high powered microscope to properly diagnose.
How much money are you really saving by overwearing contact lenses when you take into account that if you get a contact lens complication, the office visits and cost of medicated eye drops is very high? Not to mention the fact that you will be causing permanent damage to the health of your eyes.
If you wear contact lenses, you need a pair of glasses. No exceptions. If you can't see to drive legally without contact lenses, you MUST have back-up glasses. I don't care how old they are. They just need to be good enough for you to use in case you have a complication where you have to be out of contact lenses.

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