So you had RK (Radial Keratotomy) eye surgery in the 80’s…

Before the days of LASIK vision correction, Radial keratotomy (RK) was the miracle surgery that allowed the blind to see without glasses.  Unfortunately, there were no data that tested the long-term results of RK.  Many patient had great vision after the surgery, but their eyes slowly worsened year after year.  RK is no longer performed because results are unpredictable and LASIK allows for much safer and precise correction.

Some RK patients see fine without glasses, several decades after the surgery, but many require glasses.  There is a small percent of patients that cannot even see with glasses and experience drastic changes to their vision throughout each day.  This is due to the high degree of corneal irregularity from post-RK scars.

The only way to treat corneal irregularity is to cover it with a scleral lens.  A scleral contact lens contains saline that fills in the gaps covering the cornea and restores a smooth surface to the eye surface.  These special lenses are as comfortable as soft contact lenses and provide clearer vision than glasses or any other type of contact lens.

Schedule your contact lens evaluation today to see the difference a Scleral lens could make in your vision!

So you’ve been diagnosed with Ocular Graft vs. Host Disease (GVHD) …

Hematologic stem cell transplantation is commonly used to repair the immune system following high intensity radiation treatment.  Simply put, a donor gives healthy blood to somebody with a weakened immune system to jump start their immunity and prevent them from becoming sick.

It is common for the new blood cells (the graft) to view the recipient (the host) tissue as foreign.  This results in tissue damage, often targeting the tear glands of the eyes.  This is termed Ocular Graft versus Host Disease (GVHD).  Damaged tear glands tend to stop working well, if at all, and result in a severely dry eye surface.  This dryness is painful, debilitating, and may cause permanent vision loss if not treated quickly.

The solution?  Scleral contact lenses.  These lenses restore the ability to live a day without worrying whether or not your eye irritation will keep you in bed all day.

Schedule a Scleral contact lens evaluation today to get started and get dry eye relief! Suburban Eye Care: (734) 525-8170

Have astigmatism? Wear contacts? This lens is better than yours.

For most people with astigmatism, the contact lens options have been notoriously lousy since the dawn of time.  The vision is blurry, the contacts are uncomfortable, and they dry out after only 6 hours of wearing.  Those wearers without astigmatism have enjoyed great advancements in lenses that prevent dryness and itching, but those suffering from astigmatism have been left off the comfort train for quite some time.. until now.

Bausch and Laumb and Acuvue both released new daily disposable lenses this month that offer superior comfort and crisp vision.  Doctors and patients alike have waited for a new technology like this to come along for decades and it’s finally here.  The Oasys 1-day (Acuvue) and Biotrue for astigmatism (B&L) will be the solution for many patients dissatisfaction with previously tried contact lenses.

Schedule your contact lens evaluation today and try out the new lenses for a week.  It will change the way you see!  Suburban Eye Care: (734) 525-8170

So your child is becoming nearsighted.. what are your options?

Myopia, also called near-sightedness, develops during childhood and continues to worsen until adulthood.  There is no way to cure myopia, but there are several methods of limiting the amount of myopia a child will ultimately develop.  Why does this matter you may ask?  Myopia is caused by the eyeball growing longer.  When the eyeball grows longer, it increases the risk of several eye diseases including retinal detachment, glaucoma, and cataracts.

The exact mechanism that triggers myopia to progressively worsen is still unknown, but there are several known methods to slow down myopia in children.  Much of the literature indicates that excessive near tasks such as reading for hours on end or staring at a tablet may play a role in worsening myopia.  There is also a genetic component, so if one or more parents are nearsighted, children are at a higher risk of become nearsighted as well.

One of the easiest ways to prevent nearsightedness is encouraging outdoor activities instead of indoor activities.  Research has yet to pinpoint a reason, but the natural light from the sun may have an effect on slowing myopia.

Treatment Options

As far as treatments, orthokeratology (Ortho-K) is by far the most effective method of treatment to slow the eyes from getting worse and becoming more nearsighted.  In ortho-k, contact lenses are used only while sleeping and removed in the morning.  The lenses reshape the front of the eye, similar to LASIK, to allow for clear vision during the day.  The younger a child starts ortho-k treatment, the better their results will be.

The earlier treatment is started, the less nearsighted they will be as an adult.

If orthokeratology is not an ideal option, soft multifocal contact lenses are the next best treatment.  These lenses are also shown to slow down the formation of nearsightedness, and are wore throughout the day and removed at night.  They are available in monthly reusables or daily disposables, which are preferred especially for children.

Bifocal glasses are the least effective at myopia control, but are still better than single vision glasses and contact lenses.

 

If a child is expected to have high myopia, it is always best to intervene with treatment early in the form of overnight contact lenses, multifocal contact lenses, and bifocal glasses.  The earlier treatment is started in a child’s life, the less nearsighted they will be as an adult.

Quit crying over dry eye. New dry eye treatments have arrived!

For those who have never experienced chronic dry eye, it’s difficult to understand how uncomfortable the condition can be.  Dryness can cause a myriad of symptoms such as redness, itchiness, grittiness, blurry vision, and watery eyes.  Alongside the discomfort, people constantly have to explain to coworkers and family why they appear to be crying when dryness is the culprit for the tears.

Watery eyes

This may seem counter-intuitive that dry eye causes tears to run down the cheeks, but it’s actually a reflex of the eye called “reflex tearing.”  These reflex tears are made quickly by the tear glands in a last-ditch effort to keep the surface of the eye from drying out completely and preventing damage to the front of the eye.  This type of tear lacks the normal oil component and is made of mainly salt and water.  The high salt content is the reason tears running down the cheeks causes puffy eyelids.

There are several treatment methods for dry eye depending on severity and type.  The two type of dryness are tear deficient and evaporative.  The only way to diagnose which type is causing dryness is testing with a dry eye specialist.  The TearLab instrument is used by many specialists to assess the severity of dryness and track improvement throughout treatment.

Tear deficient dryness

Tear deficient dryness is caused by the tear glands not producing enough liquid or water.  Hydration is critical in this type of dryness.  If the body does not have enough extra water to spare, the tear glands will turn off.  Many medications will also slow down the tear glands and result in dryness.  Hormone fluctuations caused by birth control and menopause also have strong impacts on the tear glands which is why women suffer from dryness more often than men.

In order to treat this tear deficiency, more tears must be added.  The prescription eye drops Restasis and Xiidra (just released in 2016) are powerful medications that result in more natural tears.  In some cases, these medications alone are not enough to solve the problem alone and further treatment is required.

Scleral contact lenses are great for treating this type of dryness and also offer the benefit of clear vision without glasses.

Evaporative Dry Eye

The majority of dry eye falls into the category of evaporative dry eye.  This type of dryness usually requires a more involved treatment than just using eye drops.  The treatment targets the oil glands of the eyes called Meibomian glands, making them work better and more efficiently.  If the Meibomian glands are not functioning properly by secreting oil over the surface of the eye, the watery tears will evaporate quickly causing dryness.  The treatment plan is determined by the optometrist and will usually consist of a combination of the following:

• Fish oil supplements
• Warm compresses
• Lid scrubs
• Medications
• Regenerative biologic eye drops (New)
• In-office dry eye therapy sessions – MiBoFlo ThermoFlo (New)

Dry eye cannot be resolved instantly and may require months to completely change the physiology of the tear glands themselves.  Once treatment begins, most dry eye patients do experience great relief within the first few weeks.

Schedule a Dry Eye Consultation with one of our specialists today and experience the relief!  Call us at (734) 525-8170 or http://Suburbaneyecare.com

So you’ve been diagnosed with Keratoconus? What now?

What is Keratoconus?

Keratoconus is a disease of the eye that begins very mild in the early decades of life and eventually requires special treatment in order to maintain vision.  The disease is caused by the failure of collagen (the hard glue of the body) in the cornea to maintain its strength.  As the cornea weakens, a small area of the cornea bulges forward, producing a dome or cone shape on the front of the cornea (hence the name “kerato-conus”; or cone of the cornea).  Along with genetics that can lead to a weak cornea, another associated risk factor is eye rubbing, often due to allergies.  Avoiding rubbing the eyes, preventing children from rubbing their eyes, and using anti-allergy eye drops are all steps that may lower risk of developing keratoconus.

What are the treatment options?

There are several treatment options for keratoconus, depending on the severity:

Mild Keratoconus

Glasses

Glasses are a poor treatment option for keratoconus and will not provide clear vision.  A contact lens is almost always necessary for usable vision and is a much better option than glasses alone.  A backup pair of glasses should be kept for times that contact lenses may not be worn due to health risks such as corneal ulcer, infection, or even lost lenses.

Soft Contact Lenses (Custom made)

Younger patients are able to achieve good vision with a custom made soft contact lens.  In my office, we use a soft lens that is replaced every 3 months.  The lens is made specifically for each patient’s eye and is usually very comfortable.

Corneal Cross-Linking

In April 2016, the FDA approved the first corneal cross-linking system in the United States.  Corneal cross-linking is a procedure used to strengthen the cornea and slow the progression of early keratoconus.  Ultra Violet light (UV-A) and Riboflavin (Vitamin B2) eye drops are used for the treatment, which is an outpatient procedure that generally lasts less than an hour.  The procedure is not meant to improve keratoconus or cure it, but merely stabilize it.  A contact lens will still be necessary to maintain vision.

Moderate Keratoconus

As the condition worsen, soft contact lenses will no longer be successful.  A “hard contact lens” or RGP (Rigid gas permeable) lens is the next line of treatment.  There are several different designs of RGP lenses that may be used:

Traditional RGP Lens

These lenses are small and rest directly on the cornea.  They are the traditional method of correcting early-moderate keratoconus.

Scleral Contact Lens

This lens is made of the same material as an RGP, but is larger in diameter.  Instead of setting on cornea, the lens rests on the sclera (white of eye).  This is the preferred method of correcting moderate to moderate to severe keratoconus because it does not scar the cornea as much as traditional RGP lenses.  They also may provide better comfort and vision than other types of contact lenses.  Read more at my post about scleral lenses.

A backup pair of contacts is strongly recommended if vision is dependent on the contact lenses.  These lenses can often take up to 1-3 weeks to order and receive, which can be devastating if relying on only one set of lenses that broke or have been lost.

Severe Keratoconus

Late stage keratoconus is detrimental to quality of life unless treated.  Once scleral contact lenses no longer improve vision, cornea transplant is often the only option to increase sight.  This stage of the disease is usually reached during the later decades of life and varies greatly between patients.

OrthoK, preventing nearsightedness one night at a time

Have you considered wearing contact lenses at night instead of during the day?  This is a great solution for many children and adults that require contact lenses or glasses to see the world clearly.  This new technology is known as Orthokeratology or OrthoK for short.

OrthoK lenses are a great option for kids if both parents are nearsighted.  This special lens has the ability to slow the growth of the eye, which in turn minimizes the power of the glasses or contact lens prescription during adulthood.

Advantages of OrthoK Contact Lenses:

• No contact lenses during day – OrthoK lenses are worn while sleeping only
• Prevents high prescriptions in kids – Important if parents are both severely nearsighted
• Less dryness due to contact lens wear – no drying of contact lens during daytime
• No worrying about kids losing contact lenses at school
• Lower risk of eye diseases such as glaucoma and retinal detachment

How do these special contact lenses work?

The lenses apply a small amount of pressure to the front of the eye to lightly flatten the cornea surface.  When the correct amount of pressure is applied overnight, it provides clear vision throughout the day without the need for glasses or traditional contact lenses.

Who are the best candidates for OrthoK?

Children who have highly nearsighted parents will more than likely also be strongly nearsighted.  If kids (Ages 8-18) are already suffering form nearsightedness, their condition will only worsen over time.  If intervention is taken at a young age, the child will not become as nearsighted, and will also be at a lower risk of glaucoma and retinal detachment throughout adulthood.  Children with a high likelihood of nearsightedness are the best candidates for OrthoKeratology lenses.

Discuss OrthoK lenses with your family Optometrist and see if they are right for your child.

Technology update – Scleral contact lenses

Scleral lenses are the newest contact lens technology offering sharp vision along with outstanding comfort.  They are often used to treat potentially blinding eye conditions such as keratoconus, but are also a terrific alternative to normal contact lenses if dryness or comfort has been an issue in the past while wearing lenses.

What’s different about scleral lenses from normal soft contact lenses?

The name “scleral” refers to the size of the contact lens.  Instead of the lens resting on the cornea like a soft contact lens, the lens is designed larger than the cornea, allowing it to rest on the sclera (the white of the eye).  The advantage of using the sclera as a resting place instead of the cornea is what provides the improved comfort.  The sclera has few nerve receptors compared to the dense nerve network of the cornea.  Less nerve receptors being irritated by a contact lens generally means better all day comfort while wearing lenses.

The most common conditions that are treated with scleral contact lenses:

• Moderate to Severe dry eye
  • The lenses are inserted differently than a typical soft contact lens.  Before applying the lens to the eye, the bowl of the lens is filled with saline.  This provides hydration to the eye throughout the day without worrying about drying out mid-day.

• Keratoconus
  • Keratoconus is a condition of the eye that causes blurred vision, even with prescription glasses. A scleral contact lens is required to improve vision in the moderate and severe stages of keratoconus.  Traditionally, hard lenses (rigid gas permeable lenses) have been used, but they may cause scarring that can be avoided with scleral contact lenses.

• Post-LASIK eyes / Post-RK eyes / Irregular corneas
  • Many people who had refractive surgery (LASIK / PRK / RK) in the 80’s and 90’s complain about dry eyes. Scleral lenses are a great option for anyone with dryness or vision distortion after refractive surgery.  The saline in the lens fills in the irregularities from the scar tissue on the cornea and also hydrates the surface of the eye to prevent dryness.

• Graft versus Host Disease
  • Graft versus host disease (GVHD) causes an attack on the tear glands of the eye, causing severe dryness that results in extreme pain and potential blindness.  The scleral lens is used to provide constant hydration to the eye throughout the entire day.

Ask your optometrist today if you’re a candidate for scleral contact lenses!

Multifocal Contact Lenses — ditch those reading glasses

You’ve turned 40 and can’t see the texts on your cell phone anymore. What happens next?

You have two choices – bifocal glasses OR multifocal contact lenses

Most contact lens wearers can continue to wear contacts throughout their life with a simple switch in type of contact lens. Generally, after age 40, most people begin to struggle seeing up close.  Multifocal contacts offer the ability to see far away AND at near.

Tried them in the past with poor results? The technology has improved significantly from lenses that were available even two years ago and we now have over a 90% success rate with our new multifocals.

• Advantages of Multifocal Contact Lenses:
  • No more reading glasses – The goal is to eliminate the need for reading glasses 90% of the time
  • Great for active lifestyles – Bifocal glasses can get in the way of an active lifestyle
  • Can wear non-prescription sunglasses – Wear sunglasses bought at the convenience store and see clear
  • Can wear safety eye protection over them

How do they work?

Multifocal contact lenses have two prescription powers in them. One for distance vision and another for near.  The lenses use the normal change of our pupil size to focus the different powers at the appropriate times.  Generally, the reading power is concentrated in the center of the lens.

Focusing on objects at a near reading distance should make the pupil constrict and appear smaller.  This focuses the near power on the retina and allows clear vision for both distance and near through one contact lens.

Ask your optometrist if multifocal contact lenses are a good choice for your eyes!
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Published by Dr. Brett Arnold

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