A friendly gentlemen came in to see me today with a very angry eye and reported that he had been working on his son’s car earlier in the week and his eye has been red and scratchy every since.  As I was preparing to drill out the large hunk of rusted metal (left), it dawned on me, October is Eye Injury Prevention Month!

Statistically speaking, over 2.5 million Americans will experience an eye injury this year.  Some injuries are simply unavoidable or arise from falls or motor vehicle accidents, most injuries occur due to negligence and a lack of proper protective eye wear.

It is a common misperception that all eye injuries occur “on the job.”  In reality, about 45% of eye injuries actually occur at home and (I’m sorry guys) men have much higher risk for eye injuries than women.

Common places/tasks for Eye Injury

• Yardwork

  Mowing the lawn or being outside while others are mowing.  This is doubly true for power edging or using gas or electric powered trimmers.  Rocks, organic debris, and dirt can be picked up and propelled with dangerous speed by all of these machines and tools.

• Workshop

  As a carpenter I can assure you, the force with which a power tool expels projectiles can be simply staggering (picture right is a deep corneal laceration from  metal lathe work).  Think about the work that needs to be accomplished and which tools you will be utilizing and plan accordingly.  Also consider what chemicals/stains/sprays/fumes your eyes may come in contact with.

• Working on the car

  There’s more at risk here than just a bruised knuckle.  Working on and especially under a car is a major source of metallic foreign bodies.  Additionally, arcs, sparks, and battery acid can be blinding.  Keep protective goggles in your garage and vehicle and wear them for any and all repairs.

• Housework

  If you actually read the ingredients of most household cleaners, you may be surprised.  Make sure these dangerous chemicals, cleaners, and disinfectants are used in a well-ventilated area and with proper eye protection.  Chemical splashes from some of these hazardous cleaners can cause permanent burns and vision loss.

In order to combat these potentially blinding situations, we strongly recommend that all households have at least one pair of ANSI-approved safety glasses to use for these tasks to reduce the chance of eye injury.  In order for glasses to be marketed for safety purposes the lens and/or frame must bear the required marking of ANSI Z87 or preferably Z87+ (the ‘+’ denotes high impact resistance).  Protective eyewear of this kind is readily available at all hardware stores or purchased from your local eye doctor.  It is important that safety glasses fit close to the face with minimal gaps for optimum protection against chemical splashes.  Click here for additional information on safety eye wear.

If a chemical splash does occur, rinse the eye with copious amounts of luke-warm tap water for 15 minutes.  That may seem like a long time but this is imperative.  The sooner this gets done the better, as this will dilute and neutralize the caustic compounds.  Then seek treatment from your local eye care provider.

The cornea is extremely sensitive and has more nerve endings than any other tissue in the body.  Anyone who’s had an eye injury can tell you; they hurt… A LOT!

Accidents happen, but Ben Franklin said it best, “an ounce of prevention is worth a pound of cure.”

We hope you have enjoyed this quick talk on eye injury prevention.  If you have any additional questions or think of a topic for future discussion; drop me a line at [email protected].

Wear your safety glasses and take care of those eyeballs!

Contact Lenses in Pediatrics

As eye care professionals, it is difficult to count the number of times this scenario has played out in our exam rooms.

A child presents for their back to school eye exam with a parent in tow.  The exam is uneventful, the prescription is checked, the eye health is thoroughly evaluated, and after all testing is completed and the findings are conveyed to the parent or caregiver, the real crux of the visit finally reveals itself… someone brings up contact lenses.

Suddenly, what was a cordial visit gets a bit more heated.

Parent:  “You are WAY too young! I didn’t get them until I was in highschool!”

Child: “But my friend Billy got them two years ago!”

Parent:  “Maybe if you could keep your room clean, your mother and I would consider it!”

Child: “But I don’t like wearing glasses, especially under my baseball helmet!”

Parent:  “It isn’t safe at your age, we’ll talk about it next year when you’re 13.”

This usually continues rapid fire for 15 to 20 seconds until, exasperated after having made their cases, both parent and child turn in anticipation toward me to cast the deciding vote…

“In reality, you are both right,” I will undoubtedly say.

Let’s look at this rationale in two ways, first by looking at an actual study on the matter and secondly by looking at contact lenses in pediatrics from a real world view point.

The Contact Lenses in Pediatrics or CLIP Study

This study sought to answer the age old question of when is it appropriate (i.e. safe) for children to begin wearing contact lenses?  This large study enrolled 84 children from the ages of 8 to 12 along with 85 teens from the ages of 13 to 17 and all participants were brand new to contact lens wear.  The demographics of the participants in this study were reflective of the general US population in terms of gender and race.  All participants where properly trained, fit with the same brand of contacts for continuity, and then followed at one week, one month, and 3 month intervals, when problems from new contact lens wear are the highest.  The follow up visits looked for problems like reduced vision, trouble with putting in and taking out contacts, proper fitting of the contact, and checking the health of the ocular surface with a microscope for signs of inflammation or infection.

When all the data was tabulated, there was no statistical difference in the safety or ability of contact lens wearers in either of the two groups.  To put it another way, if proper contact lens training and fitting was performed by the doctors and staff, then 8 year old children wore contact lenses as safely and successfully as 17 year old teens!

Not only that, another arm of the CLIP study looked at the child’s perceived “quality of life.”  This survey showed a remarkable 24% improvement in children’s perception of contacts compared to glasses.  The largest areas of contact lens preference came in the categories of overall appearance, improved vision, more comfortable activities (sports), and reported self esteem.  In other words, all the things that adults love about wearing contacts… children and teens did as well!!

In Reality

Although the studies clearly show that children and young adults of a wide age range can wear contact lenses safely and enjoyed doing so, it certainly doesn’t mean that all children and young adults should wear contacts.  The Fairness to Contact Lens Consumer Act (FCLCA) was signed into law in 2003 (way back when congress actually passed legislation), and declared contact lenses as “medical devices,” and for good reason!!  Any eye care professional has a slew of horror stories and will willingly tell you that rarely does a day go by without a contact lens wearer presenting to the office for some problem directly related to contact lens over-wear and abuse.

Not surprisingly, severe complications from contact lens wear are a significant contributor to avoidable and preventable blindness in the US.  Therefore, far more than any age requirement for contact lenses, it is imperative that there be a responsibility and maturity requirement and especially when you are dealing with the eyes of a child.

When the parents feel that a child has demonstrated the responsibility level required do all the things necessary for proper and safe contact lens wear; no overnight wear, proper care and cleaning, on time replacement, etc. The studies clearly show that with proper training and doctor skill, contact lens wear in children and young adults is a safe, appropriate, and patient appreciated alternative to spectacles.

Thank you as always for stopping by Eye to the Future; we hope you have enjoyed this discussion.  Please feel free to email any questions or topics for future discussion to [email protected].

Take care of those eyeballs and we’ll see you next time!

CLIP Study

With school back in full swing, Precision Family Eye Care and the Eye to the Future blog want to take a moment this week to impress upon all parents the importance of getting routine vision exams for all school age children.

School and Pediatrician screenings are simply not adequate, and unlike adults, children can’t articulate their vision problems because they don’t understand that the way they see the world isn’t “normal.”  Uncorrected prescription (like nearsighted, farsighted, and astigmatism) as well as eye alignment and focusing problems, and even ocular diseases can all inhibit the ability of your child to use their eyes properly.  This leads to disrupted vision and potentially vision threatening conditions being simply overlooked or even causing learning problems and leading to a diagnosis of LD (Learning Disorders), ADHD or even dyslexia.

The learning environment today is flush with visual tasks: smart boards, iPads, digital learning, computer work, homework, test taking, etc.  It shouldn’t surprise us then, that learning experts estimate that roughly 80% of all learning is dependent upon the sense of sight and unfortunately, at least 25% of school aged children have a visual impairment that may prevent a child from reaching their full academic potential.

Please make sure that your child has the proper tools for academic success this year by scheduling a comprehensive exam with your eye doctor today!

As is often the case, most of the ideas for this blog come from actual questions asked by patients.  On Eye to the Future today we will be answering one of these questions I received just last week, “How do animals see in the dark?”

GREAT QUESTION!

How exactly does my dog and cat run scot-free through a dark room but I stub my toes and step painfully on toys?

The answer: it’s all in the design of the eye.

Thanks for stopping by, next week on Eye to the Future we will be discussing… kidding of course.

To answer this question fully, there are actually three major anatomical differences between the human eye and animal eyes capable of great night vision.

Rods versus Cones

As most are aware, the retina is the covering of the inside of the eyeball.  Although this thin tissue is only about 3 human hairs thick, it is essentially the ‘film in the camera’ and is responsible for sensing the light that enters the eye and transmits that signal back to the brain where it is processed.  The actual cells that sense the light are called photoreceptors and there are two main types: rods and cones.  Although they both are important in seeing, they do so very, very differently.

Cones are responsible for color vision and high acuity vision however these cells only function in bright light.  Rod cells, by contrast, are much less sensitive to colors and fine details but are able to detect light and function in much lower light situations.

In humans, 90% of our cones cells are located in the central part of our vision which allows us vivid, clear, and colorful central vision, but general poor vision under scotopic (dark) conditions because of a lack of rods in our central vision (graph at right).  By contrast, nocturnal animals have retinas composed mostly or even entirely of rods cells, especially in their central vision.  This affords nocturnal animals great night vision; however, their lack of cone photoreceptors leaves these animals with little to no color vision and an overall decrease in clarity compared to humans.

Bigger is Better

Since nocturnal animals cannot benefit from the crisp vision that cone cells allow, they require a much larger image to focus on their retinas.  The easiest way to accomplish this is with a larger eye and larger eye structures (like a stronger focusing cornea and lens as well as a larger pupil to let in more light).  The human eye is about 24 mm (about 1 inch) in diameter.  The eyes of nocturnal animals are substantially larger even through the animal itself can be much, much smaller.  The owl is a perfect example of this since it has an eye that is about the size of a human eye but gives enough visual information to allow the owl to be a successful night bird of prey.  However if we are talking size, the most dramatic example and clear winner of the “Biggest Eye on the Planet” award goes to the giant squid which is able to visualize prey in the pitch black of the ocean’s depths with an eye that’s the size of a dinner plate!!

Tapedum Lucidum

Although larger eyes and specialized retinal cells are certainly useful, nocturnal animals have one final trick up their sleeves to help with night vision.  The retina in all animals is a clear, see through tissue.  The reason for this is because the rod and cone cells that actually sense the light are at the back of the retina, so the layers above need to be clear to let light get through.  Now in a human eye, once the light goes through the retina it hits the retinal pigmented epithelium or RPE.  This thin layer of cells is highly pigmented and absorbs excess light that gets through the retina to reduce glare/scattered light and improve overall clarity of vision.

However, many nocturnal animals like deer, raccoons, cows, horses, and even dogs and cats, have developed a specialized RPE behind the retina called the Tapedum Lucidum that does the exact opposite.  Instead of being highly pigmented to absorb the light that the retina does not collect, the Tapedum Lucidum is a highly reflective tissue, like a mirror, that actually bounces the light back through the retina for a second chance to be detected.  This adaptation effectively doubles the chance that even very low amounts of light will be detected by the retina.  Reflections off of this tin foil like Tapedum Lucidum is also what causes the brilliant white reflections from the eyes of nocturnal creatures, like a deer in headlights or even a photo of the family pet.

We hope you have enjoyed this long answer to a short question.  Next time on Eye to the Future, we will be discussing polarized lens.  How they work, how they’re made, and why they are so, so useful for clarity and vision.

I’ll leave you with a picture of our sweet boy, Remy, taking a rest from reeking havoc and showing off his Tapedum Lucidums.

See you next time on Eye to the Future.

On occasion, there are landmark studies regarding the eyes that everyone should know about.  Today on Eye to the Future we will be discussing two such studies, by far the largest and most important studies on preventing the progression of the aging condition Macular Degeneration.  (For those not interested in the science, the results and take home points are summarized at the bottom of this post.)

Age Related Macular Degeneration (ARMD or simply AMD) is the leading cause of new blindness in the United States for individuals over 65 years old.  This condition is not a new problem, however, for many decades the mechanism for why this damage occurred was unknown and treatment options for this condition were woefully limited and relatively ineffective.  Thankfully, in the last decade and a half, some genius innovations in treatment, as well as some landmark studies on prevention, have given individuals afflicted with this blinding disease a fighting chance at retaining vision throughout their lives.

Macular Degeneration can be classified into two categories Dry and Wet (for an in-depth discussion on the difference between the two, please view our website for a thorough discussion).  Dry Macular Degeneration (above) always comes first and by itself can cause vision loss, however, more often it is the 10-15% of patients that convert to the Wet form (with its associated bleeding and scarring) that suffer severe permanent damage.  Therefore, researchers set out to look for ways at preventing or at least slowing down the conversion to this more aggressively blinding Wet form (right).  The research culminated in the Age Related Eye Disease Study (AREDS) that was first published in October of 2001, and overnight, changed the way eye care practitioners approached macular degeneration.

AREDS 

It had been hinted at in smaller previous studies that antioxidants as well as the trace element Zinc appeared to be helpful for macular degeneration patients.  As a direct result, many patients starting taking high doses of these vitamins and minerals without any set dosing amounts, schedules, or any singular study that ensured this practice was even effective… or safe for that matter!!  It became clear that a definitive study was needed and the National Eye Institute, one of the government’s Institutes of Health, brought onboard a decorated panel of eye doctors, biochemists, and nutritionists who came together and concocted the follow mixture of supplements.

Vitamins

o   Beta-Carotene (15mg) which is converted in the body to Vitamin A

o   Vitamin C (500 mg)

o   Vitamin E (400 IU)

Trace Minerals

o   Zinc (80 mg), which was shown to be effective in earlier studies

o   Copper (2 mg) to prevent anemia while taking high doses of Zinc.

Over 3500 patients with various amounts of Macular Degeneration took this supplement for a minimum of 5 years.  Once all the data was tabulated, the most encouraging results were for the patients who needed it most with intermediate to advanced Macular Degeneration.  The results for patients in this category are outlined below.

Once it was shown that this nutritional supplement formula of both vitamins and trace minerals decreased advanced Macular Degeneration by 25% and vision loss by nearly 20%, many different nutraceutical companies began reproducing the AREDS Formula with brand names that you have likely heard of or have seen in stores like I-Caps™, PreserVision™, Ocuvite™, et al.

AREDS 2

Not long after the AREDS was published, the researchers behind the AREDS study went back to work on an even larger more detailed study using the information gleaned from the first study.  The results of the AREDS 2 were just released in 2013.  This improved study adjusted two of the past components of the AREDS formula and also added a third.

1. Beta-Carotene:  Very high doses of Beta-Carotene/Vitamin A supplements have been linked to an increased risk of Lung Cancer in current or former smokers.  Since smoking in-and-of-itself is already a significant risk factor for developing Macular Degeneration, beta-carotene was removed completely for safety reasons and replaced with two other carotenoids: Lutein (10 mg) and Zeaxanthin (2 mg) which were deemed a safer and equally effective substitute for Vitamin A.
2. Zinc:  It was suspected that high dosages of Zinc are linked to digestive problems.  Reducing Zinc (to 25mg)  showed the same benefit as the AREDS formula, but removing Zinc from the formula completely was detrimental.
3. Omega 3 fatty acids (fish oils):  These compounds are a known anti-inflammatory and antioxidant.  Researchers added this compound to the AREDS formula in hopes of additional reduction in risk, however, Omega 3’s were shown to have no effect on Macular Degeneration progression.

AREDS 1 and AREDS 2: Take Home Points

• Any patient with confirmed macular degeneration will benefit from eye specific supplements, but these supplements are most helpful for patients with moderate to advanced Macular Degeneration.
• These supplements should be taken IN ADDITION to any multivitamins, not as a substitute (9 out 10 patients in the AREDS 2 study were also taking a concurrent multivitamin).  If only one supplement is desired, there are formulations of these supplements that combine the AREDS formula with a multivitamin for simplification.
• The original AREDS formula is fine for many, if not most patients.
• Any smoker or former smoker should avoid beta-carotene supplements completely and use only the AREDS 2 formula with Lutein and Zeaxanthin instead.
• Omega 3 fatty acids (fish oils) although wonderful for the body and the eyes, did not have a meaningful impact on Macular Degeneration.
• These studies ONLY found benefit for patients with diagnosed Macular Degeneration.  These supplements are not designed, and should not be taken for “routine” eye health or even for patients with a family history of Macular Degeneration.

We hope you found this discussion interesting.  As always, if you have any questions or have ideas for future topics feel free to contact us and ask.  We love questions!

Eye to the Future next week will be a fun one… but I’ll let it be a surprise.

Well, it’s back to school time and that means it’s also time for some germs to be spread and flus to be caught.  This time on Eye to the Future we will be talking about the eye’s contribution to the germ problem with Pink Eye.  The term Pink Eye gets batted around quite a bit in most people’s lexicon.  The problem with this term is that is really doesn’t describe what the problem really is or how a patient’s irritated eye should be monitor/treated or if that patient has the possibility of spreading their eye condition to others.  Therefore, let’s dispel some myths and define some terms.

Conjunctivitis, commonly referred to as Pink Eye, is the technical (but nonspecific term) for any inflammation or infection of the conjunctiva.  The conjunctiva is a thin, clear, slippery tissue that covers the white of the eye and inside of the eyelids.  This tissue is the first line of defense and acts as an overseer against any viruses, microbes, or irritants that get into the eye.  When the conjunctiva senses that the environment on the front of the eye is not healthy or a potential for infection exists, it calls in reinforcements from the rest of the immune system for help and makes the eye look red or pink.  It is important to note that this reaction happens not only against infections, but in ALL instances of eye irritation.

Therefore, a red or pink eye does not mean that you have Pink Eye, or even a conjunctivitis for that matter, it just means that the eye is unhappy for some reason.

If the diagnosis is in fact conjunctivitis, there are three different types of conjunctivitis: allergic, bacterial, or viral conjunctivitis.  Pink Eye is widely considered to be ONLY the viral type.

–        Allergic conjunctivitis is an extremely common occurrence especially around here in the Ohio River Valley.  As the name implies, this is an allergic reaction that happens due to pollen, dust, dander, contact lenses or chemicals (like soaps or makeup).  Commonly this condition presents in both eyes with watering, itching, and a “soggy” eye appearance.  Treatment here is to quell the inflammation and this is accomplished best with prescription eye drops.  Since there is an environmental cause, this conjunctivitis is not contagious.

–        Bacterial conjunctivitis is actually rather uncommon.  True bacterial infections of the conjunctiva present with a sudden swollen, very red eye along with a heavy mucus discharge.  Antibiotics are often given as treatment for conjunctivitis even though a bacterial infection is rarely the cause.  This form can be contagious when a mucous discharge is still present.

–        Viral Conjunctivitis.  Now, here is the true Pink Eye.  Most conjunctivitis is viral in nature and these infections are spread through direct contact.  The worst of these is the adenovirus which quickly spreads through workplaces, households, and schools.  The adenovirus has a latent period of 7-14 days from initial contact with the virus to the start of eye symptoms developing.  Symptoms include redness, watering, itching, and tenderness of the preauricular lymph nodes (the ones just in front of your ear).  Symptoms start in one eye and often spread to the other eye in 3-5 days and failure to seek treatment could result in scarring of the cornea and the possibility of permanently decreased vision.  Treatment for most viral conjunctivitis involve prescription antiviral eye drops and/or in office treatment.  It is EXTREMELY important with ALL viral conjunctivitis to wash your hands frequently and to stay away from work or school until symptoms improve.

We hope this has shed some light on a common but commonly confusing condition.  It is important to reiterate, that a red eye does not necessary mean Pink Eye or even conjunctivitis.  For any red eye it is important to seek treatment from your eye doctor to get a proper diagnosis and treatment regimen to keep your fellow students, coworkers, and family members safe if the condition is contagious.

Finally… if we are discussing Pink Eye and Myths we should tactfully address one final item.  For the record, performing a certain bodily function on a certain bedding item, while childishly humorous, most certainly DOES NOT spread Pink Eye.

Stay tuned for the next installment of Eye to the Future where we delve into a landmark study on Macular Degeneration that everyone should be aware of: the AREDS (Age Related Eye Disease Study) and how it can prevent blindness.