Tips for Healthy Eyes in 2013

Well, we’re not all dead, so it looks like we’ll have to endure another year.  2012 gave us many things to remember, although I can’t really remember any of them right now.  With that in mind, let’s look forward to 2013 and the best ways to keep your eyes healthy in the year to come.

1.  Vitamins A, C, and E (the antioxidants) are good for your eyes.  Vitamin Q, however, is not.  NEVER take vitamin Q.

2.  Despite popular knowledge, wearing someone else’s glasses will not cause your vision to deteriorate.  Although wearing them might turn you into that person.

3.  Avoid staring into the sun.  This can cause damage to the eye known as solar maculopathy.  That being said, this damage generally only occurs after prolonged viewing of the sun; if you just want to glance at it, that’s fine.  The sun is pretty.

4.  Flashes of light or an increase in floaters in your vision may signal a retinal detachment, which requires prompt detection and treatment.  These symptoms may also be caused by attending a rave; if you hear a thumping bass beat, you probably don’t have a retinal detachment.

5.  Double vision, or diplopia, is a bad thing.  If ever you should see double, get yourself to an eye doctor immediately.  You may have an aneurysm.  You may also have a drink in your hand; if you have a drink in your hand, the diplopia is probably not as urgent, although you should get to an eye doctor soon anyway, just in case.  Put the drink down first though.

6.  Call your mother; she wants to hear from you.  This has nothing to do with eyes, but it’s just good advice in general.

7.  When your optometrist offers to dilate your pupils, go along with it.  Yes, your near vision will be blown to smithereens for a couple hours.  Yes, the sun will seem so bright that it’s as if the star around which our little planet revolves has a personal vendetta against you.  Yes, your eyes will look as though you just indulged in an illicit mind-altering substance.  However, with dilation, your optometrist can detect not only ocular abnormalities, but many, many other systemic diseases that may have as yet gone undiagnosed by your primary care physician.

Even Mario hates being dilated.

Even Mario hates being dilated.

8.  If your eyes burn, they’re probably dry – use artificial tears.  If your eyes water, they’re probably dry – use artificial tears.  If your eyes feel “tired,” they’re probably dry – use artificial tears.  If artificial tears, they’re probably artificial tears, use artificial tears.

9.  Take your contact lenses out of your eyes.  Unless you’re not wearing contact lenses.  Overwearing your contact lenses can lead to the following:  vision-threatening eye infections, corneal neovascularization, giant papillary conjunctivitis, corneal edema, and jelly bumps.  Yes, jelly bumps.  You may ask, “What are jelly bumps?”  Wear your contacts for too long, and you’ll find out.

10.  If you’re staring at a computer screen right now, take a break!  Every 20 minutes look away from the screen for 20 seconds.  Computer vision syndrome exists and is becoming an epidemic; you can avoid it entirely by just looking away. Go ahead, look away.  You’re not looking away.

Look away.

Do it.

You’re not going to miss anything.

I promise.

Really, at this point I’m just trying to be facetious.

Have you looked away yet?

So those are 10 tips for protecting your eyes for the new year.  2013 looks like it’s shaping up to be a good one, and I think we owe it to ourselves to make it count since we survived 12/21/12.  Be happy, be safe, and I’ll see you at the party after we all survive 13/21/13.

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Re:

In answer to my last post regarding writing letters, I have prepared the following as a response to the sample patient letter I composed.  Fellow optometrists, I encourage you to have a stack of these handy so that you’re prepared when a patient hands you the previously typed letter.  I do accept monetary donations.

Dear [patient name],

I appreciate your forethought in preparing the letter you have given me, which outlines your concerns about your eyes.  It takes a person with a large amount of [intelligence, kindness, good looks] to come up with such a well-worded document.  Anyway, let’s talk about your eyes.

You may take this as an indication of your age, but I recommend a [bifocal, trifocal, prosthetic eye].  I know this kind of thing is not good for your vanity, but I’m an optometrist, not Tim Gunn.  We have many different choices in spectacle frames, however, and I’m sure you can find something that makes you look [distinguished, flirty, other adjective]; that is, until your glasses inevitably get [lost, broken, eaten by the dog or vice versa].  In which case it’s probably a good idea to go ahead and buy a second pair as well.  Hey, seeing well and looking good ain’t cheap.

All health-related aspects regarding your eyes look good, although your ocular surface looks a little dry; I recommend [Restasis, artificial tears, looking up when it rains].  Your eyes don’t feel dry, you say?  They actually water all the time and are the exact opposite of dry?  Well, believe it or not, it’s possible that your eyes water because they are dry – this is a common occurence in people with dry eye syndrome; basically the tears your eyes are producing are [not of good quality, not coating your eye properly, crocodile tears].

I did not see any signs of serious ocular diseases such as glaucoma or macular degeneration, although you do you have very early cataracts forming.  Not to worry, as these are generally very slowly progressive and at worst will only cause you to have trouble with [reading, glare, thinking your spouse is attractive (kind of like nature’s beer goggles)].  When the time is right and you feel like your vision is no longer acceptable to the point that you can no longer perform everyday tasks, then we can talk about referring you to the local ophthalmologist’s [office, clinic, van] for cataract extraction.

Oh, I can see as you’re reading this that you have to hold the paper pretty far out from your face; either you are presbyopic or the paper just smells really bad.  If it’s the former, the bifocals I prescribed earlier will help; if it’s the latter, it’s probably because our paper is made from [recycled products, card stock, Soylent Green] kind of like those old Weekly Readers from grade school.  Remember those?  God did those things reek.

In summary, you should be good to go until your next annual eye exam, and I do mean annual, rather than the decade-long gap since the last time you were here.  Speaking of which, you should probably dispose of the trial pair of contact lenses that we gave you at that last visit; they’re probably a little [protein-deposited, worn out, nah nevermind they’re fine].  Call me if you need anything, otherwise I’ll SEE you then!  Haha, eye doctor humor!

Sincerely,

[Doctor’s name]

Aaaaaaaand scene!

To all of you optometrists out there who read this, see if you can get me an honorary Fellowship in the Academy for this great service I have provided you; writing case reports is so overdone.  And besides, what good does yet another case report do?  Either it reinforces previously known treatment protocol or it presents such a rare variation that no one will ever see such a thing again.  (What you’ve just witnessed is me justifying the fact that I’m writing on a blog rather than writing case reports.)

Like any doctor-patient relationship, communication is key.  And nothing communicates how much you care about your patient like a letter typed by a stranger on the internet.  So until next time, keep it real.

Trail of Tears

Are all artificial tears created equal?

This is a question that I imagine many people must ask themselves when they walk down the eyecare aisle at Wal-Mart, or Target, or Jewell-Osco, or Costco (I actually don’t know if Costco has an eyecare aisle, but if they do I like to picture 10-gallon drums of Opti-Free).  I admit, until recently, I couldn’t recall the last time I had ventured down the eyecare aisle; as an eye doctor, I benefit from freebies at work.  But now that I’ve taken the time to wander down that aisle flanked by multicolored boxes of artificial tears and contact lens solutions, I can understand why people feel a little overwhelmed.  It’s a veritable Rainbow of Uncertainty.

It’s a similar experience to those times when the wife tells me to buy her some shampoo; all the bottles look the same to me, so I pick the cheapest one.  Honey, I’m sorry you ended up looking like James Carville.

Did that say “Pantene” or “Paint Thinner?”

So when your eyes are feeling dry and you just want a little relief, how do you pick which artificial tears to use if they all look the same and promise the same things?  Maybe you heard Ben Stein say on TV that Clear Eyes will help.  Or maybe you have a co-worker who swears by Systane.  Or perhaps you read an article online about a woman who poisoned her boyfriend with Visine.  Stay away from Visine.

Luckily for you, you have me.  I’ll admit, I don’t have a strong opinion on a lot of things, but boy-howdy do I have one when it comes to artificial tears.  Stop laughing at me.

First and foremost, I’m a big proponent of looking at ingredients.  Whether I’m buying artificial tears or artficial sweetner, I want to know what’s going in my body.  With eyedrops, the active ingredient you’re mostly likely going to see is the lubricant itself, such as glycerin, polyethylene glycol,  or carboxymethylcellulose.  You may also see a preservative, such as polyquaternium or benzalkonium chloride, listed.  Preservatives can be sort of a mixed bag; they’re good in that they keep bacteria from contaminating the bottle, but they may also be responsible for causing ocular toxicity if used too much, thus defeating the whole purpose of an artificial tear in the first place.  For this reason, I generally prefer a preservative-free drop, such as Theratears, for those times when frequent dosing is necessary.

Exciting stuff, right?

YES THAT IS EXCITING

Another thing to consider, after ingredients, is the specific application of different types of artificial tear.  Some claim to be better for certain types of dry eye, some are better for night time, some give you X-ray vision.  You don’t want to buy the wrong drop at the wrong time.  That is, if you were to pick up some Genteal ocular ointment and put that stuff in while you’re at work, have fun looking at life like it’s a dream sequence for the next 15 minutes – you might as well smear vaseline on your face.  So be careful about the indications on certain products; if there’s a moon and stars on the box, it’s probably not indicated for high noon.

“Okay almighty optometrist,” I can hear you saying to your monitor, “so which artificial tears do you recommend, specifically?”

Well, for your everyday run-of-the-mill mild dryness, I use a lot of Systane Ultra and OptiveSystane Gel and Blink Gel are both good if you like a thicker drop.  For dosing more than four times a day, I use Theratears.  If overnight lubrication is needed, an ointment like Genteal is great.  I try to stay away from Clear Eyes and Visine if possible (and it’s usually possible).

Now you know, and knowing is half the battle.  “What’s the other half of the battle?” you ask?  I…I’m not really sure.  G.I. Joe only ever gave me 50% of the formula for winning the battle.  Let’s say the other half involves artificial tears.  Aaaaaaand we have closure.

The End.

The Syndrome You Don’t Know You Have

I recently had the ill fate of diagnosing my mother with DES.  It’s a disease that many people in the United States have, but many are completely oblivious to it. I would venture to guess that some of you reading this right now may even have it. Unfortunately, it’s diseases like DES, the insidious ones that creep up on us, that can eventually cause the most damage.  It’s not an easy disease to treat and usually, once treatment is begun, it must continue indefinitely.  It can be quite the life-altering experience.

Unlike more well-known chronic and debilitating diseases, DES has no strong support foundation; that is, no telethons, no celebrity backing, no 5K charity events.  People afflicted are forced to suffer in silence and often even family support is hard to come by.  These are the reasons I’ve decided to try to raise public awareness of DES.  It’s far too important a subject to be swept under the rug.  Plus, there are dust bunnies under there.

So, how do you know if you have DES?  What are the symptoms?  Who is at risk?  What can you do about it?  When is a door not a door?

For starters, EVERYONE is at risk of developing DES at some point in their lives.  The initial symptoms can vary, but most commonly this syndrome begins with blurry vision.  Many people will visit their optometrist because they think their glasses or contact lens prescription has changed; that’s a reasonable assumption.  However, these same people may become perplexed whenever their doctor tells them that the prescription is the same.  That’s when the questions start.

“But if my prescription is the same, why has my vision deteriorated?”

Once again, this is a reasonable question.  This is usually the point when the optometrist will examine the health of the patient’s eyes and ask questions to dig deeper into the symptoms.  Along with the worsening vision, the eyes may have started burning recently, or there may seem to be a film over them, or they may be coated in crusty matter in the morning.  The symptoms can be almost endless, but most often the most noticeable one is the blurred vision.

And it’s at this point that the doctor might diagnose DES.

The patient’s world comes tumbling down around them.  “Why me?” is a common question I hear.  As a doctor, this is the time for some hand-holding, as it can be a very sensitive time for the patient.  The good news is that treatment is available.

Not only is treatment available, but it comes in many forms, from pulse-dosing of steroid eye drops to collagen implants within the drainage ducts of the eyes.  If you suffer from DES, there is certainly no shortage of options for therapy.

Most importantly, if you are diagnosed with Dry Eye Syndrome, know that it is a chronic issue that requires ongoing monitoring and managment.  There is no easy fix.  But I’m here for you, and I am going to try with everything I have to organize a charity 5K run.

Oh, and the answer is “when it is ajar.”