Contact Lens wearers of the world, meet one of the greatest enemies of successful contact lens wear:  

Giant Papillary Conjunctivitis or GPC.

“My contact lenses wear out REALLY fast, I am constantly changing them!”

“I just can’t wear the contacts very long, they’re always moving on my eye.”

“I’m getting this weird stringy, white goop when I wear my contacts.”

What is Giant Papillary Conjunctivitis?

Giant Papillary Conjunctivitis, or GPC as it is commonly known, is an inflammatory condition involving the conjunctiva of the human eye.

The conjunctiva is the thin slippy tissue that covers the front of the eyes as well as the inside of the eyelid.  The hallmark of this condition are small (and sometimes GIANT!) bumps called papillae that form on the underside of the upper eyelid.

This is very chronic condition and can range from mild, to moderate (such as our patient pictured left), to very, VERY severe (If you are squeamish, DO NOT CLICK!).

Holy Crap!  What Causes These Bumps?

At its core, GPC is an allergic condition and occurs almost exclusively in contact lens wearers (90 plus percent).  It can also rear its ugly head with patients (like myself) who have very severe allergies – and in the Ohio River Valley, there are lots of us!

“It is estimated that up to 35% of extended wear contact lens wearers with develop symptomatic Giant Papillary Conjunctivitis.”

With contact lens wearers every individual is different.  These bumps frequently form with certain types or brands of contact lenses, from the chemicals in contact lens cleaning solutions, or from overwear/abuse of contact lenses.

This is essentially a mechanical problem.

The brain is physiologically wired to blink the eyes every 10-12 seconds.  Every time a blink occurs the underside of the lid rubs against the contact lens.  Deposits, chemicals, and/or allergens on the contact lenses will begin to irritate the conjunctiva of the upper eyelid.  With each blink these inflamed papillae begin to form, multiply, and expand making the symptoms worse and worse.

Why do these “bumps” cause me problems?

Think of these papillae bumps like the grit on sandpaper.

1. With each blink, these ‘sandpapery’ bumps rub, push and pull the lens around making it uncomfortable to wear.
2. The bumps also poorly wet the lens making deposits form quicker.  This results in the need to change your contacts far more frequently.
3. Finally, the areas between the bumps allow mucus to form leading to an irritating, stringy, and often blurring mucus that coats the eye.

Not to mention that as the papillae bumps multiply and grow, the rubbing on the contact lenses increases making the symptoms worse and the bumps bigger – a death spiral for contact lens wear.

What do we do about it!

Well, the problem here is that when the papillae are mild, the symptoms usually get shrugged off or put up with for months or even years.

Once the symptoms are bad enough that the contact wearer come in because the contacts “aren’t working”, the Giant Papillary Conjunctivitis is usually quite ‘ground in,’ severe and chronic.

If this condition IS caught early, a simple change to Daily Disposable lenses is usually sufficient.  Daily Disposable lenses are replaced every day which means there is no time for deposits or allergens to attach to the lenses.  Additionally, there is no solutions needed for Daily Disposable lenses which removes a lot of cleaners and chemicals that contribute to the papillae bumps.

For severe problems unfortunately, there is NO simple solution and the treatment usually consists of several steps.

1. First step is discontinuing ALL contact lens wear.  It doesn’t matter what lens we put on your eye at this point, it’s going to get manhandled by those BIG bumps!
2. Since this is an inherent inflammatory reaction, we will start you on steroid eye drops for a period of weeks to months.  Since this is a chronic condition, it often takes a long time to reduce these bumps to a level acceptable for comfortable contact lens wear.
3. Once the Giant Papillary Conjunctivitis is under control, we will fit you will Daily Disposable lenses to keep this from happening again.

Other treatment options for this condition included discontinuing contact lenses all together or exploring the possibility of a surgical solution to refractive error through LASIK surgery.

If you are a contact lens wearer and have noticed these symptoms in your eyes.  Please consider scheduling an evaluation with your eye care provided.  With Giant Papillary Conjunctivitis, an ounce of prevention is worth a pound of cure.

If you have any questions about this topic or any others, please contact me at drwolf@precisionfamilyeyecare.com

Take care of those eyeballs!

•  Nick Wolf, OD

Histoplasmosis is something that most people living in the Ohio River Valley (aka the”Histo-Belt”) have probably heard about.

If not and you live the Ohio or Mississippi River Valleys, the CDC estimates there is up to a 90% chance that you have been exposed.  Given that Histoplasmosis can have severe complications to multiple organ systems, including the eyes, it’s something we think you should know more about.

Here we will look to demystify Histoplasmosis and explain:

• What is it
• How infection occurs
• What symptoms it causes
• How common is it
• Who gets it
• Why Histoplasmosis can cause blindness
• How this condition is treated

What is Histoplasmosis?

Histoplasmosis actually starts as an infection caused by the fungus Histoplasma capsulatum.  This fungus is naturally found in the droppings of birds and bats and resides in the soil.  The spores of this fungus are often disturbed by construction or farming of contaminated soil and become airborne.  Exposure to Histoplasmosis occurs from inhaling the airborne spores into the lungs which becomes the primary infection site.

Acute Histoplasmosis infection in the lungs usually begins 3 to 14 days after the primary exposure and the symptoms include:

• Fever
• Chills
• Chest Pain
• Coughing
• Muscle Aches

The severity of the initial symptoms are extremely variable.  The vast majority of Histoplasmosis infections are either symptom free or simply get written off as a mild case of the flu.  Mild to moderate cases pass without note because the body is usually able to recover within a few days to a week.  In certain cases however, like infants, the elderly, or the immunocompromised, the primary infection can be deadly and needs prompt treatment with antifungal medication.

Since the acute infection from Histoplasmosis is in the lungs, it is very common to have some evidence of a past infection, even if that infection was mild and non-diagnosed.  Many times these findings are only uncovered years later with routine imaging through X-ray or CT scans (as seen right).

Who Gets Infected with Histoplasmosis

Any one, of any age, race, gender, or ethnicity is at risk for exposure and infection from the Histoplasmosis fungus.  Those of us that reside in the Histo-Belt (Ohio and Mississippi River Valleys) are at a particularly high risk.

The CDC estimates that exposure to these fungal spores in this region reaches endemic levels of as high as 90% exposure.

People at particularly high risk of infection include those in construction, aggriculture, roofing, and those who have grown up around birds or on a farm.

This is an Eye Doctor Blog, Right?

Yes, yes, I didn’t forget the eyes.

While the lungs are the primary infection site for Histoplasmosis, a unknown but small percentage of patients exposed to Histoplasmosis will also develop an infection in choroid layer of their eye (vascularized layer behind the retina: healthy retina pictured at Left).

Just like the lung infection, the initial eye infection usually resolved without any treatment or knowledge that the infection occurred.  The initial infection does, however, leave a very characteristic pattern of damage.

This pattern is something that eye doctors in this area see very, very often and is called the Histoplasmosis Triad.

The Ocular Histoplasmosis Triad

As the name implies, there are three distinct changes that are commonly seen in patient with a history of Histoplasmosis exposure/infection.

1. Peripapillary atrophy or scarring around the optic nerve that leaves the back of the eye and transfer visual information to the brain (Black arrows)

2. Punched our peripheral scars around the outside of the retina called “Histo Spots” (White arrow)

3. Scarring of the choroid in the Macula (center part of vision where you see 20/20, Yellow arrows)

While the first two Histoplasmosis changes are benign and do not progress or threaten vision.  Scarring in the macula can be a sight threatening condition.

The risk here is NOT of infection or a reactivation of the fungus, although that is possible.  The problem here is that for an unknown reason and often times decades after the initial infection, the scarred areas at the center of vision tend to develop and grow new blood vessels.  These new blood vessels cause leaking and bleeding in this very sensitive area and require immediate treatment.  These new blood vessels develop in a similar way to Wet Macular Degeneration which was discussed in another post.

There are several forms of treatment for these blood vessel nets, I’d encourage anyone wanting to know more about the treatment to visit Bennett and Bloom Eye Center’s excellent page on this topic.

Dr. Wolf!  First you made me scared of Cats… now I’m scared of Birds…

The take home message about Histoplasmosis is that in the Ohio River Valley, exposure and sub-clinical infection is EXTREMELY common.

Most of the time, even if some ocular changes are found, there is little to no risk of progression or blindness.

What IS critical; is that if areas of scarring from Histoplasmosis are present in the center part of vision, they should be thoroughly investigated, tested, and monitored closely.

Most importantly, with Histoplasmosis so common around here, this is just yet another reason to get yearly eye exams.

Take care of those eyeballs!

–  Nick Wolf, OD

Additional Resources

National Eye Institute website on Histoplasmosis

Mayo Clinic website on Histoplasmosis

CDC website on Histoplasmosis

Everyone has heard the term “Lazy Eye” but in reality this is not be the best term.

In actuality, it is most often not the eye that is the problem but rather the eye’s connections to the brain and the brains ability to use the eye that is really the issue.

This condition, called Amblyopia occurs in 4-5% of otherwise healthy children and is the main reason that the doctors at Precision Family Eye Care strongly recommend all children receive routine eye care to identify and treat this condition early.  Here’s why…

Amyblopia or “Lazy Eye”

As eluded to, amblyopia is most often not a disease of the eye itself, the eye is usually perfectly healthy.  However even with the correct glasses prescription in place, the eye does not see things normally and is termed “lazy”.

How can that be??  

Well, when a child is born there is no vision in the womb, therefore there is very little vision at birth.  Like walking, talking, and crawling, vision is learned.  It is only after an infant starts examining the world around it that firm hard wiring begins.

The eyes are obviously in the front, but they are a camera, nothing more.  What actually “sees” is the occipital lobe at the back of the brain.  The pictures from the eyes are sent via the optic nerve to the Lateral Geniculate Body (LGN) in brain for processing.  After that, the processed signal is sent by optic radiations called the Meyer’s Loops to the Primary Visual Cortex of the occipital lobe which actually interprets the picture (diagram right).

Because this complex pathway requires active stimulus or pictures from the eyes to form, this process can be disrupted if there is not a normal picture coming from each eye. This process of abnormal visual development can occur in one or both eyes and for a number of reasons.  The most common reasons for Amblyopia are high or asymmetric eye prescriptions and strabismus (eye turns).

If found early, treatment and training is available to help build this nerve network; if not, the vision reduction is permanent.

Types of Amblyopia

Refractive Amblyopia

Refractive amblyopia occurs when there is a large or very unequal refractive error (glasses prescription) present at birth. Even though the eyes are healthy, if one or both eyes are unable to send a clear image to the brain, the brain will not connect to the eyes properly.  One of the most common scenarios is when one eye is normal (little or no glasses prescription required) and the other eye is born very farsighted. In this scenario, a child will see clearly with both eyes open and rarely complain of problems because their brain is only paying attention to “the good eye.”

Pediatric Strabmismus (Eye Turn) Amblyopia

Strabismus is a condition that occurs when the eyes aren’t properly aligned with one another from birth.  This results in one eye turning in, out, up or down with respect to the other eye. When the eyes are not working together properly, the brain is getting two different pictures from the eyes.  This leads to double vision which the brain does not like.  As a result, the brain will then decide to pick only one eye to develop properly and the input from the other turned eye will be ignored.

Without the input from that eye to develop the needed connections to the brain explained above, the turned eye will have permanently reduced vision if not properly diagnosed and treated.  Eye turns can be quite obvious, however, amblyopia can occur from even mild eye misalignment that often goes unnoticed by parents and teachers.

Both of these types of Amblyopia often result in only one eye being affected and both often go unnoticed without a proper eye exam due to one eye developing properly and the child not understanding that only seeing out of one eye isn’t “normal.”

Treatment of Amblyopia

Regardless of the cause, is important to identify and treat amblyopia as early in life as possible.

If the development of one or both eyes is stunted, it is not only possible, but probable, that vision will be improved with treatment.  The treatment of amblyopia is directed to improve vision by strengthening the brain’s connections to the weaker amblyopic eye. This can be done with a combination of full time glasses, wearing an eye patch, or sometimes eye drops.  As the brain pays more attention to the amblyopic eye, the essential connections between the eye and the brain can be improved, resulting in better vision for that eye.

The key to treatment is timing!!

Children posses amazing neuroplasticity or the ability to rework connections within the brain.  Just like everything else though, humans get stuck in our ways over time, and our brains are no different.  The visual pathway continues developing from birth through age 7 – 8.  If treatment is given before this time, the prognosis of vision improvement is very good.  After age 8 however, amblyopia may be resistant to treatment as the visual pathway has already completely developed.

The take home message here is that “Lazy Eye “or Amblopia is more of a brain problem than an eye problem.  However, this is very treatable, but requires a proper early diagnosis.

Therefore, all children should receive an eye exam by age 3 and then every year as they go through school ages to ensure them the best chance at a lifetime of healthy eyes and excellent vision.

As always, feel free to contact us with any questions or ideas for future topics.

Nick Wolf, OD

For more information on Amblyopia, vision development in children, and binocular vision problems please visit our website pages or visit the National Eye Institute’s excellent page about this condition.

Contact Lenses for more than Vision

As optometrists, we fit contact lenses daily.  While new contact lens materials and designs have greatly increased the comfort and vision of our contact lens patients, we couldn’t help but wonder if contact lenses had additional diagnostic potential…

With that backdrop, some recent announcements and advancements in contact lens technology has got us very, very excited.  Several different companies are now looking at ways of incorporating recent technological breakthroughs into contact lenses for the purposes of disease monitoring.

Today on Eye to the Future, we will delve into two contact lenses of the future.

Google/Alcon’s Blood Sugar Monitoring Lens

The first, and one you might have heard about, is a recent paring between Google and Alcon (eye care branch of the drug company Novartis).

While I personally cannot wait for a self driving car, the geniuses over a Google have equally excited our profession with their recent announcement to use their expertise to develop a contact lens that monitors blood sugar for diabetic patients.

This contact lens (pictured at left) would contain micro sensors to measure the blood sugar levels in the tears as well as a radio antenna thinner than a human hair.  The data is then transmitted from the antenna to a smart phone app to allow the continuous monitoring of blood sugar.

With the epidemic of diabetes in this country, this non-invasive contact lens of the future could revolutionize the way patients monitor their blood glucose levels.  In addition to the easy of measurements and lack of finger sticks, this information would be enormously helpful for primary care doctors and endocrinologists in developing specific treatments plans depending on how blood sugar levels change throughout the day.

The Triggerfish by Sensimed

Everyone who’s been to the eye doctor knows the dreaded “Puff of Air” but what that test is actually measuring is the pressure inside your eye.

The Swiss company Sensimed has developed a wearable tech heavy contact lens called the Triggerfish.  This contact lens of the future (right) was designed for the sole purpose of continuously measuring eye pressure over a 24 hour period.

Eye pressure, or intraocular pressure (IOP), is an important factor in the diagnosis of Glaucoma and even more important in determining the effectiveness of a Glaucoma treatment.  The problem with eye pressure is that it fluctuates quite a bit throughout the day, as much as 50% or more in glaucoma patients.

IOP tends to be lowest in the afternoon or early evening when many people get eye exams.  This can give us a false sense of security that the eye pressure is “normal”.  Even worse, the IOP also tends to be highest when we can’t record it, usually the very early morning hours when most of us are just waking up or enjoying our morning cup of coffee.

Having a graph of the high and low points with this non-invasive testing would allow eye doctors the ability to choose specific treatments that are most effective when the eye pressure tends to be highest.

The Triggerfish is worn in one eye (1).  A wireless antenna (2) is positioned around the eye to collect the data from the contact lens.  Then a set of wires (3) sends data from the antenna to a recording device worn by the patient (4).

The patient is fit with the contact lens and antenna in office and simply wears this device as well as a monitoring pack for 24 hours before returning to the doctor where the data is downloaded and analyzed.  This is very similar to heart monitors often used by primary care doctors and cardiologists to record a patients cardiac measurements outside the office setting.

This lens is currently going through studies in the US to determine its safety and effectiveness, but is already in full use overseas.

For additional information on the Triggerfish diagnostic contact lens, please visit the Sensimed website.

We hope you have enjoyed this little overview of the some contact lenses of the future.  If you have any questions, as always, please contact us and ask.

–  Nick Wolf, OD

What are Floaters?

The technical term for these visual phenomena are called Muscae Volitantes which is Latin for “Flying Flies.”  No one refers to them that way though, they are simply called floaters.  Commonly floaters are noticed as specks, strands, or ‘ameba-like’ see through forms that drift through the vision from time to time.  They will often move as the eye moves and appear to change shape as they float about.

The first important thing to know is that floaters come from, and form in, the jelly of the eye called the Vitreous (right).  Floaters can form at any age and can range from mild to severe.

The jelly inside the eye is quite thick and gel-like as a child but over our lifetime it breaks down and liquefies.  As the jelly liquefies, it gets sticky and clumps begin forming.

These floaters are suspended within the jelly of the eye and with eye movement they become “shook up” and drift about similar to snow floating inside a snow globe.  As these clumps pass through the center part of vision you will see the shadows of them.

Floaters tend to more visible against a flat background, like a bright blue sky or a freshly painted wall.  Additionally, floaters are more pronounced in bright environments because bright lights make the pupil smaller which casts a more visible shadow from the floater onto the retina.

Below is a fun and quite educational video explaining floaters (as well as another commonly described and really cool “eye quirk” called the Blue Field Entoptic Phenomenon… that’s so cool it deserves a blog post of it’s own).

Should I get checked if I see Floaters?

While hugely annoying, floaters in general are a normal and mostly benign condition.  It is important to note however, that any new or changing presentation of floaters should be examined for a potential eye problem.

As anyone who’s gotten a corneal abrasion can attest to, the surface of the eye is highly enervated and sensitive.  By contrast, there are no nociceptors (or cells that sense pain) inside your eye.  Therefore, if you develop a problem on the inside of your eye like a tear in the retina, a bleed, or an infection, you will feel no pain; your only symptoms will be an increase in the floaters you see.

Additionally, floaters in conjunction with bright flashes or arcs of light in the side vision, is cause for concern and should be checked.  Flashes of light come from traction of the jelly on the retina and could lead to a problem.

One Floater to ALWAYS get checked

One specific type of floater that should always be investigated is something called a Posterior Vitreous Detachment (or PVD for short).  PVDs occur as the liquefying jelly in our eye begins to collapse in on itself and peels away from the lining inside the eye, called the retina.

This process is a near guarantee with age, occurring in about 50% of humans at age 55, up to 86% by 90.  When the vitreous, or eye jelly, pops off its attachment to nerve in the back of the eye, it leaves a very large, very annoying circular floater right in the center of vision.  This floater is referred to as a Weiss Ring (pictured left).

The problem here is not the floater itself.  Instead, as jelly peels away from the retina, it will often tug on the retina and has to potential to cause retinal tears in up to 10% of patients with an acute PVD.

Is there a treatment for Floaters?

The vast majority of the time floaters are a normal, albeit irritating, condition.  Since these little buggers are actual inhabitants inside the eye, there is no simple treatment to remove them.

One option is something called a vitrectomy, where a retinal surgeon removes the jelly of the eye and replaces that jelly with saline.  This is a significant operating room type surgery with lots of potential complications and therefore is rarely performed for floaters alone.

A newer treatment option that has surfaced in the last decade is to use a high powered laser to essentially “blow up” the floaters.  While a novel approach, putting this much laser energy into an eye has the potential for very serious complications making this a very questionable approach.

What we do have going for us is that over time the brain will learn to “see” floaters less and less and gravity will also take it’s toll and floaters will sink out of vision.

Bottom line, the best treatment for floaters: try to ignore them.

We hope this discussion has answered some of the questions you had about Floaters.  If you think of any other questions, feel free to let me know!

Take care of those eyeballs!

–  Nick Wolf, OD

For additional reading material on Floaters, please visit the Mayo Clinic’s excellent page.

Kamra corneal inlay by AcuFocus, Inc.

Some things in life are annoying and unavoidable, reading glasses certainly fall into that category…

Up to this point, there really has not been a surefire, surgical way to fix the near problems associated with presbyopia or the “Curse of the 40s.”

Conductive Keratoplasty (pictured left) was a procedure that was done in the past by making thermal burns in a circular pattern on the cornea… this was pretty much a resounding failure and this procedure is rarely performed anymore.

Another option was and still is LASIK.  Near vision with LASIK is achieved by surgically inducing monovision, where one eye is corrected for distance and the other for up close.  Think of it like the 21st century version of the monocle and is commonly done with contact lenses.  This is an effective correction option but tends to become less useful for near vision over time.

The best surgical option currently available is doing cataract surgery and putting in a lens that can actually focus for distance AND up close.  Cataract surgery without a actual cataract is considered a cosmetic, out-of-pocket cost by insurance companies.  With the add on cost of a couple of these high tech lenses, the price tag quickly becomes cost prohibitive to many individuals.

Introducing Corneal Inlays

Corneal inlays are small pieces of plastic that are installed inside a pocket in the cornea.  The pocket is created with the same laser that is also used to make the “flap” during LASIK surgery.  The inlay is slid into the pocket, positioned correctly, and then the pocket seals itself.

There are several cornea inlays used for presbyopic correction overseas and in Canada and a couple are slugging through the FDA approval process in the US.

The one most likely to be available to bifocal wearing Americans in the near future is the Kamra inlay by AcuFocus, INC.

The Kamra corneal inlay (shown above) is about 1/5 of the size of a contact lens and is implanted into only one eye.  This plastic inlay has one central hole and over 8,000 tiny holes in the plastic to allow nutrients to flow through.

This device works by using the pinhole effect.  Not to get too far into the weeds here, but if you every played with a pinhole camera as a child, or are familiar with photography, you know that making a smaller opening (or f-stop) on a camera increases the depth of focus.  The Kamra corneal inlay only allows light to pass through a very small 1.6mm central hole and not through the normal pupil size which ranges from 3-7 mm.  This greatly increases the available ranges that the human eye can focus on, particular with reading and computer tasks.

Since this device is positioned over the pupil, it is invisible to the naked eye.  The video below shows several different patients with the kamra corneal inlay.  It also does not effect the distance vision but allows for some additional vision for near tasks without reading glasses or bifocals.  Unlike the other surgical options discussed above, this inlay can also be removed if treatment is not effective.

https://www.youtube.com/watch?v=GKECqj0JiDQ

This product is still in the investigatory stage and will likely not be available to patients (outside of research centers) until 2016 or later.  For more information please visit the AcuFocus, Inc website about the Kamra corneal inlay.

We hope you have enjoyed this walk-through of a new technology you may be offered in the future and we will continue to keep you informed of any new or interesting advancements as we keep an Eye to the Future.

Take care of those eyeballs!

– Nick Wolf, OD

“I see tiny men with hats” aka Charles Bonnet Syndrome

Severe vision loss and blindness in the United States is an unfortunate reality.  Conditions like macular degeneration and diabetic eye disease are often the culprits.  When blindness does occur, a significant number of patients will inexplicably begin seeing brilliant, colorful, vivid, and reoccurring visual hallucinations all while being otherwise perfectly sane.  This bizarre and often unsettling condition is referred to as Charles Bonnet (“bō-NAY”) Syndrome.

Who Was Charles Bonnet?

Charles Bonnet was a Swiss philosopher who, in 1760, first described this phenomenon that would later bear his name.  Bonnet’s grandfather was nearly blind in both eyes from cataracts (long before surgical repair was possible).  Even with the visual impairment, his grandfather often described “seeing” complex scenes, people, animals, and even buildings and landscapes.  Although Bonnet was quick to understand the link between blindness and visual hallucinations, Charles Bonnet Syndrome was not officially recognized as a defined psychological condition until 1983.

How is “vision” still possible with blindness?

The visual hallucinations seen with Charles Bonnet Syndrome are obviously not real but simply phantom visions.  The brain desperately wants to continue using the eyes for visual stimulus.  However when eye disease robs the brain of that ability… the brain essentially… makes stuff up!  The process is quite similar to phantom limb syndrome where sensations, pain, or tingling are often noted in a previously amputated limb that is no longer there.

What do sufferers commonly see?

Visual hallucinations from Charles Bonnet Syndrome are quite varied but most often involve patterns, animals, people, or scenes and commonly fit into the individual’s actual surroundings.  One characteristic of Charles Bonnet visions is that they are commonly “Lilliputian” hallucinations meaning everything and everyone look much smaller than they would normally appear.  This trait of Charles Bonnet hallucinations results in individuals commonly seeing small pixie-like figures of varying colors and appearances.

These hallucinations usually occur during down time and not while the patient is active.  Additionally, these hallucinations are visual only and do not involve interaction, smell, sound, taste, nor touch and usually are actually quite soothing and non-threatening when they occur.

This.  Is.  Normal.

Yes, visual hallucinations from Charles Bonnet Syndrome are in fact normal and occurs in otherwise completely mentally healthy individuals.  Suffers realize that these visions and images they are seeing are not real.  Actual statistics for Charles Bonnet Syndrome are quite difficult to fully assess.  This is not surprising as individuals who experience these hallucinations are hesitant to discuss them with friends, family, or doctors for fear of stigma or being labeled as mental insane.  It is estimated by most researchers to be extremely common affecting anywhere from 14-40% of individuals with recent blindness.

There is also no treatment for Charles Bonnet Syndrome.  These visions occur off and on for the first 12-18 months after blindness but usually become less and less frequent over time.  The most important treatment is to educated patients that although this condition can be unsettling, it is a normal neurological response to recent blindness and not a sign of mental illness.

Feel free to follow up with any questions or comments and thank you, as always, for tuning into Eye to the Future!

• Nick Wolf, OD

For more information on Charles Bonnet Syndrome and/or talking about this condition with blind family members please visit the Royal National Institutes of Blind Peoples’ excellent page about this condition.

Glaucoma Awareness Month – Q & A

Glaucoma is a condition that most everyone has heard of, but quite a bit of confusion still exists.

Since January is Glaucoma Awareness Month, we will be doing a Q&A style post giving some simple facts and debunking some myths about Glaucoma.

If there’s a question I missed feel free to ask.  For a far more in-depth discussion on Glaucoma, please visit our glaucoma webpage or the National Eye Institute’s page about Glaucoma.

What is Glaucoma?

Glaucoma is a disease where the internal pressure of the eye causes irreversible damage to the optic nerve that leaves the back of the eye and carries the visual signal to the brain.

How common is Glaucoma?

It is estimated that Glaucoma afflicts about 2.5-3 million Americans… the scary part is; only half of them know they have it!

Does family history play a role?

Absolutely!  In the Barbados Eye Study, having Glaucoma in your nuclear family (parents and siblings) increased your risk of developing Glaucoma to as high as 20%.  Furthermore, African or Hispanic ancestory also increases the risk 4 fold.

But I don’t feel eye pressure problems?

Unlike high blood pressure which makes you feel funny when elevated, high eye pressure is rarely ever felt unless it gets very, VERY high.  This means you have no idea that your own eye pressure is higher or lower than normal without testing.

My eye pressures are always normal at the eye doctor, so I don’t have Glaucoma?

Not so fast.  The Baltimore Eye Study sought to answer this question, looking at hundreds of new patients with Glaucoma and looking for trends.  In that study, 55% of newly diagnosed Glaucoma patients had normal eye pressure at their first visit and 16% had normal eye pressures throughout the whole study!  So no, just because your eye pressure is at a “normal” level doesn’t mean you are safe from this eye disease.

I have been told I have high eye pressures, which must mean I DO have Glaucoma?

No, as well.   Many people fall into the category called “ocular hypertensive,” meaning the eye pressure is slightly increased compared to what is considered normal but no active damage is occurring to the optic nerve.  A study called the Ocular Hypertensive Treatment Study (OHTS) looked at the risk involved with elevated eye pressure.  While high eye pressure is surely a risk factor for Glaucoma, that study found that only 10% of ocular hypertensive patients developed glaucoma damage after 7 years of no treatment.

Therefore, if your pressures are elevated it is important to monitor closely and treat if necessary, but not all individuals with high eye pressures need treatment.

Well if eye pressure doesn’t tell you if I have Glaucoma, what does?

Not a simple question.  Diagnosis of Glaucoma is like putting a puzzle together, and your eye pressure is only one piece.  In order to fully rule out Glaucoma, some additional information is needed to evaluation your optic nerve health, eye drainage, and peripheral vision among other things.  This information is collected with simple, painless in office testing.

How does Glaucoma affect vision?

Glaucoma vision loss is devious.  Unlike other eye diseases that cause loss of central vision, Glaucoma causes side vision loss.  Peripheral vision loss from Glaucoma is impossible to perceive early in the disease.  By the time enough side vision has eroded to become obvious to the patient, you have lost up to 90% of your vision and the disease has reached irreversible end stage with limited treatment options.

That coupled with the lack of actual symptoms from eye pressure has led to Glaucoma being called the “Sneaky Thief of Sight.”

Can it cause Blindness?

Unfortunately yes.  Glaucoma is the third leading cause of new blindness in the United States and the second leading cause of blindness worldwide.

I have Glaucoma, what is MY risk of blindness?

A study was once performed where glaucoma was diagnosed and simply followed, not treated.  In that study, 29% of those individuals reached blind, end stage disease in 10 years.  However, with early diagnosis, proper treatment, and comprehensive monitoring, the risk goes down to only 6% over 15 years.

How is Glaucoma Treated?

While eye pressure alone is not a sure sign that Glaucoma is present or absent, study after study has shown that lowering eye pressure prevents further vision loss.  Therefore, the main treatment for Glaucoma is to lower the eye pressure through the use of prescription eye drops or some surgeries in advanced cases.

Since Glaucoma is such a silent disease.  The key to keeping this condition in check is routine, preventative care.  If you have any risk factors for Glaucoma outline on our website, it is highly advised to receive at least a yearly Comprehensive Ocular Health Exam.

As always, please email with additional questions and take care of those eyeballs!

–    Nick Wolf, OD

The technology of contact lenses has come a long, long way in the past 10 years, solving most of the problems that people associate with these medical devices.

“Contacts lenses irritate my eyes”… Done!… more natural and wettable materials to improve comfort!

“I can’t wear contacts because of my astigmatism”… yes you can with new toric technology!

“But I’m over 40 and need to wear reading glasses with my contact lenses”… well, let me tell you about Bifocal Contact Lenses…

Bifocals contact lenses aren’t necessarily new to the contact lens market.  The first bifocal contact lenses came out about 20 years ago; however, it was so darn bad that it turned off a lot of patients (and doctors) to the potential of these designs.  As manufacturing techniques and technology have improved, this class of contacts has reaped the rewards.  Bifocal contact lenses these days are stunning, giving patients clear distance and reading vision with an 85-90% success rate.

How do Bifocal Contact Lenses Work

The key to bifocal contact lenses is in the design.  These lenses are bifocals in the name only and work nothing like a pair of bifocal glasses.  Bifocal glasses have different zones within each lens with very different prescriptions for clear vision from distance to near.  You simply need to direct your eyes through that section of the lens for clear vision at that whatever distance you want to see.  Since a contact lens is so small and always sits at the same place on the cornea, it is not feasibility for the lens to move around enough to look through different areas.

Instead, if you look at these lenses under a microscope they have concentric rings just like the rings on a dart board.  Each ring of a bifocal contact lens is designed to focus for a different place: distance, intermediate or computer, and reading (see right).  All the vision from all distances is focused by the contact onto the retina in the back of the eye and the retina sends that information to the brain.

What the brain receives is a garbled, distorted mess, but the supercomputer sitting between our ears is able to filter out the distances that it’s not interested in.  This results in you being able to read a menu one moment and then check the score of a ball game on a television the next.  This process sounds quite convoluted but it actually works surprisingly well!

Additionally, there are multiple parameters we can change and adjust to fine tune the vision through these contacts based on how they work for the patient in real life situations.

Keys to Success with Bifocal Contact Lenses

There is no panacea, or cure all, for the “Curse of the 40’s” but Bifocal Contact Lenses are a large step in that direction.  The keys to success with these lenses are realistic expectations and patience.  Since the brain has never used lenses like this before, it takes 2-4 weeks of daily wear for the brain to understand how these lenses ‘work.’  During that time it is common to notice some distortion and blurring but most of that goes away over time.

If you are new to Bifocal Contact Lenses there has never been a better time to try out this technology.

Schedule an appointment with you eye care specialist today!

–  Nick Wolf, OD