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Solar Eclipse Eye Safety by Dr. Hedman

solar eclispe

Unless you’ve been living under a rock, you’re aware of the upcoming solar eclipse on August 21, 2017.  The total eclipse will darken skies all the way from Oregon to South Carolina, along a stretch of land about 70 miles wide.  People who attend the big event are in for an unforgettable experience; a solar eclipse is a spectacular astronomical event.  There is a great deal of interest in watching eclipses, and many people are predicted to flock to its path to experience it.  Approximately 12 million people live within the narrow band of totality, and approximately 25 million reside with a day’s drive of it.  If you are one of those people who plan to experience this phenomenon, it’s important to be prepared to protect your eyes!

Looking directly at the sun, even when it is partially covered by the moon, can cause serious eye damage or even blindness.  Solar retinopathy occurs when harmful radiation from the sun reaches the eye and is concentrated by the lens onto the retina. This burns the retina and destroys the cells that enable you to see.  There is no treatment for solar retinopathy and recovery can take 3-6 months. Loss of central vision can even be permanent.

Anyone planning to view to total solar eclipse this summer should get a pair of solar viewing glasses.  These protective lenses make it possible for observers to look directly at the sun and should be worn so that no direct radiation from the sun can reach the eye.  According to NASA, three manufacturers have certified that their eclipse glasses and hand-held solar viewers meet the ISO 12312-2 international standard for such products: Rainbow Symphony, American Paper Optics, and Thousand Oaks Optical.  Make sure you purchase viewing glasses from one of those companies.  Sunglasses CANNOT be used in place of solar viewing glasses. Other materials that are unsafe and should never be used for solar viewing include: black developed color film, exposed film negatives, photographic neutral-density filters, food wrappers, polarizing filters, smoked glasses, CDs or DVDs,  and “space blankets”.

Enjoy the eclipse next month, but make sure you protect your sight!

#eyesafety #solareclipse

Telemedicine—and specifically Online Eye Exams by Dr. Piatt

online eye exam

Why I’m excited:

Having gone on medical mission trips to under-served groups, with significantly less access to eye care, I’m thrilled when technology comes out that can improve their quality of life by improving their vision.  On our trip to Guatemala, we were in a small village and there was a mother who was so incredibly far sighted, after fitting her with glasses, she looked down at her baby’s face and had the biggest smile.  I don’t think she had ever seen her child clearly.  It’s always a very moving and rewarding experience to fit people with glasses who have never worn them before.

The idea of having an online eye exam is amazing because even in third world nations, most people at least know someone with a smart phone or computer access.  If an area was able to do online eye exams, a group working with the Lion’s Club or other organizations, could go down with the specific glasses for this group of people.  Normally you’re bringing down hundreds of glasses, doing the exam there and hoping you happen to have a fit in your collection of frames that you brought, often times, just giving the best option even if it’s not perfect.  You could be more specific in what you bring.  You could also just mail them with their names attached.

Why I’m concerned:

The concerns I have so far, is that I’m not sure who’s regulating the online eye exam industry.  They don’t claim to be an eye exam, so they haven’t registered through the FDA.  Therefore, it isn’t FDA approved.  It’s not approved by the state.  Who’s testing the technology and ensuring patient safety?  They’re claiming not to be a replacement for an eye exam, and yet call it an online eye exam.  The attorney general doesn’t look into them unless there have been concerns reported to them.  An autorefraction isn’t the same thing as a refraction and a retinal or external eye photo isn’t the same thing as a comprehensive eye exam.

So although I love that we could be bringing SOMETHING to an underserved population that doesn’t have access to anything better, is this something I would recommend to American citizens who do have access to something better?  Increased access to an inferior exam isn’t progress.  It isn’t a step in the right direction for Americans.  It isn’t (at this time) equal to the care you would receive seeing an eye doctor in person.

Case Studies

Off the top of my head, I’m thinking of a couple case studies that could have slipped through the cracks.  Two individuals had similar experiences in our office; one was a long term patient who came for annual eye exams.  She was healthy with glasses, had no other complaints besides wanting to update her frames and make sure her eyes were healthy.  When she came in her eye pressures were incredibly high and this was not normal for her.  She had never measured that high.  She ended up having narrow angle glaucoma, was ultimately referred for surgical intervention and is currently using glaucoma drops.  Had she not come in for her annual eye exam, she likely would have progressed to some vision loss before she realized there was a problem.  It was easily caught and taken care of and at this time has no measurable visual field loss from her glaucoma.

A similar problem occurred with a new patient who came in our door.  He was complaining of a vision change and wanted to update his glasses.  His pressures were the highest I’d ever seen.  He also was referred out for surgical intervention and his sight was saved because of a regular eye exam.  You cannot check intraocular pressure online.

A very different case study involved a twelve year old boy who presented for a regular eye exam.  He had no complaints about his vision, headaches, or general eye comfort.  His sibling wore glasses and his parents wanted his eyes checked.  He could see 20/20.  His intraocular pressure was great.  During the health exam, a flame shaped hemorrhage was observed on his optic nerve head in his retina.  In an adult if you saw that you would think glaucoma (likely normal tension glaucoma), but in a kid that’s pretty unlikely.  I referred him out because it didn’t look normal and ultimately he was found to have elevated cerebral spinal fluid pressure.  That can cause optic neuritis and damage the optic nerve.  In the exam it wasn’t swollen at all.  It was caught early enough that it was addressed before his vision was ever affected.

Conclusion:

I think telemedicine can be utilized very effectively.  I would enjoy using it especially if it’s a patient I already have a relationship with. I don’t believe it’s a replacement for a full eye exam, but I think it could be utilized for some office visits.  Allergic conjunctivitis, for example: you’re out mowing the lawn and your eye gets incredibly swollen with an acute reaction.  If you’re able to send a picture to your doctor, you’re able to dialog through a series of questions and answers and then an antihistamine or whatever remedy is most appropriate could be called in.  I also think it could be life changing in a third world application.

It’s an exciting world.  I’m eager to see what technological advances are around the corner. What I do not want to see happen is a patient hurt because they trust in technology that is unregulated by anything other than a business desire to make money off of the convenience that an online “exam” provides with no recourse when things go wrong.

#telemedicine #onlineexams #eyehealth

Cataract Drops by Dr. Winkel

The Future is Coming

 

Within 5-10 years, scientists will hopefully create and design a non-surgical treatment for cataracts.

In 2015, exciting research was published in the journal, Nature, paving the way for the possibility of eyedrops to reduce cataracts in humans.

Dr. Kang Zhang, Professor of Ophthalmology and Chief of Ophthalmic genetics at University of California was one of many researchers responsible for the published research on the success of the drug, lanosterol reducing the cloudiness caused by cataract in dogs.

Genetics was the base for deciding to test lanosterol. Scientists studied the genes of 3 children who had significant hereditary cataracts.  They identified a genetic mutation that interfered with the production of lanosterol, a steroid which occurs naturally in the body.

The university researchers first tested the new drug in lab cultures, then in the cataract lenses of rabbits, and finally on 7 dogs from 3 different breeds who were suffering from adult-onset cataracts.

cataract 

Photo Credit LING ZHAO ET. AL./NATURE

What isn’t known from the dog participants is if there is subjective improvement in vision. They can’t tell us which is better, #1 or #2. The opacity is reduced, but if the lens does not have enough structure to aim light rays correctly, vision may not be distinct.

 

Research needs to be completed to formulate a safe, non-toxic, formula of lanosterol for testing in humans.

In 2015, The Ophthalmic Genetics and Visual Function Branch of the National Eye Institute’s, J. Fielding Hejtmancik emphasized the potential of the new eye drops in future eye care use for humans.

Companies are being formed to continue development and testing in various areas of eyedrops for cataract prevention.

We will keep our eyes peeled for future successes.

 

 

Cataracts by Dr. Hedman

cataract

A cataract is a cloudiness that develops in the clear lens of the eye.  The lens is a crystalline structure that sits just behind your pupil (the black circle in the center of your eye).  Its purpose is to focus light on the retina so you can see clearly.    Like grey hair, cataracts are an inevitable part of ageing that affect different people at different ages.  The risk of cataract increases as you get older.  By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

Other risk factors for developing cataracts include:

  • Certain diseases (for example, diabetes).
  • Personal behavior (smoking, alcohol use.)
  • Ultraviolet radiation. Studies show an increased chance of cataract formation with unprotected exposure to ultraviolet (UV) radiation
  • Drugs. Certain medications, such as corticosteroids, are associated with cataract development
  • Having other eye conditions, such as long-term uveitis
  • Following an eye injury or an eye surgery

 

Rarely, cataracts are present at birth or develop shortly after. They may be inherited or develop due to an infection (such as rubella) in the mother during pregnancy. While there are no clinically proven approaches to preventing cataracts, simple preventive strategies include:

  • Reducing exposure to sunlight through UV-blocking lenses
  • Stopping smoking
  • Increasing antioxidant vitamin consumption by eating more leafy green vegetables or taking nutritional supplements

 

In age-related cataracts, changes in vision can be very gradual.  Signs and symptoms of a cataract may include:

  • Blurred or hazy vision
  • Reduced intensity of colors
  • Needing more light to see well
  • Increased sensitivity to glare from lights, particularly when driving at night
  • Increased difficulty seeing at night
  • More frequent changes in your glasses prescription

 

Some people may not initially recognize the visual changes. However, as cataracts worsen, vision symptoms increase.

When a cataract progresses to the point that it affects a person’s ability to do normal everyday tasks, surgery may be needed. Cataract surgery involves removing the lens of the eye and replacing it with an artificial lens. The artificial lens requires no care and can significantly improve vision. Cataract surgery is considered one the safest surgeries today and is the most common surgery among Americans over age 65.  At this time, surgery is the only treatment available for cataracts.  However, please see Dr. Winkel’s blog this month to learn about research currently being done on alternative treatments.

 

Contact Lens Care by Dr. Winkel

ulceration

May is Healthy Vision Month, so today I want to discuss proper care and use of contact lenses.

Mistreating your contact lenses may lead to devastating loss of vision. I have observed this many times over my years of practice.

Unfortunately, in 1 week, I treated 2 individuals that had improperly cared for or did not wear their lenses as dictated by guidelines. Each had severe ulceration of one of their corneas.

Ulceration is due to infection of the cornea from bacteria, virus, or fungus.  It looks like fluffy, white or yellowish cloudiness on the cornea. This will leave a scar, always.  If small, and closer to the white part of the eye, vision may not be reduced.  However, if close to the pupil and/or large, vision will likely be impaired.

During the infection phase, it is painful, causing extreme redness of the white part of the eye, severe light sensitivity, much tearing of the eyes. Difficult to impossible to perform typical activities like work or school, etc.

Don’t think waiting and putting in any drops from the medicine cabinet will make it go away.  Call your eye care professional for early treatment.  This will improve the chances of saving your vision.

The Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report (MMWR), published August 18, 2016 indicated 1 in 4 events of corneal damage to contact lens wearers occurred because patients weren’t caring for lenses properly, wore them too long, or while they slept.

Further research indicated that an unbelievable 99 percent of surveyed contact lens wearers reported at least one unsafe hygiene behavior.

According to the report, the top 5 worst behaviors are:

  1. Sleeping or napping in contact lenses (87.1 percent)
  2. Showering (84.9 percent) or swimming (61 percent) in contact lenses
  3. Extending the recommended replacement frequency of cases (82.3 percent), or lenses (49.9 percent)
  4. Topping off disinfecting solution (55.1 percent)
  5. Rinsing lenses with tap water (35.5 percent)

 

If you have questions about proper lens use and care, please call the office. We will be pleased to assist you.

#contactlenses #healthyvisionmonth #ulceration

Digital Eye Strain by Dr. Hedman

digital picture

We live in a digital world. Between TVs, tablets and computers, smartphones and even gaming systems, the average person spends hours every day on digital devices. Many individuals experience eye discomfort and vision problems when viewing electronic screens for extended periods. This is called Digital Eye Strain, or Computer Vision Syndrome and it’s becoming a widespread problem as people spend more and more time each day looking at their electronic devices. Digital eyestrain leads to dry eyes and puts strain on the muscles that help the eye focus. When viewing digital devices, the eyes are looking at a pixelated image that is rapidly alternating or flickering multiple times per second. It is much harder for the visual system to maintain a sharp or consistent focus on an electronic image compared to a hard image. Although computer vision syndrome causes discomfort, it doesn’t typically cause vision loss or any permanent damage to your eyes.

According to the American Optometric Association, the most common symptoms associated with Digital Eye Strain are:

  • eyestrain
  • headaches
  • blurred vision
  • dry eyes- including burning, stinging, gritty sensation and even watery eyes
  • neck and shoulder pain

These symptoms may be caused by:

  • poor lighting
  • glare on a digital screen
  • improper viewing distances
  • poor seating posture
  • uncorrected vision problems
  • a combination of these factors

The suggestions below can help alleviate some digital eye strain symptoms:

  • Don’t take a vision problem to work. Even if you don’t need glasses for driving, reading or other activities, you still may have a minor vision problem that is aggravated by computer use. You may need a mild glasses prescription to reduce vision stress on the job. It’s a good idea for computer users to get a thorough eye exam every year.
  • Make sure your glasses meet the demands of your job. If you wear glasses for distance vision, reading or both, they may not provide the most efficient vision for viewing your computer screen, which is about 20 to 30 inches from your eyes. Tell your optometrist about your job tasks, and measure your on-the-job sight distances. You may benefit from one of the new lens designs made specifically for computer work.
  • Minimize discomfort from blue light and glare. Blue light from LED and fluorescent lighting as well as monitors, tablets and mobile devices can negatively affect your vision. There are numerous eyeglass lenses now available to selectively block out the high-energy blue light that contributes to the fatigue and strain placed on the eye’s focusing system. For people who spend significant hours on a computer or other digital device, these lenses may provide some relief and comfort. Minimize glare on your computer screen by using a glare reduction filter, repositioning your screen, or using drapes, shades or blinds. Also, keep your screen clean; dirt and fingerprints increase glare and reduce clarity.
  • Adjust your work area and computer for your comfort. Place your computer screen 20 to 30 inches from your eyes. The top of teh screen should be slightly below horizontal eye level. Tilt the top of the screen away from you at a 10-to 20-degree angle.
  • Take breaks throughout the day. After working on your computer for an extended period of time, do anything in which your eyes don’t have to focus on something up close. To maintain comfortable vision while using digital devices, it is important to use the 20/20/20 rule. For every 20 minutes of digital device use, look away for 20 seconds focusing on something 20 feet away. 
  • Use artificial tears or lubricant drips to help relieve symptoms of dryness. When staring at a digital device, the eye does not blink as frequently, and this causes faster disruption and evaporation of the tear film that protects the ocular surface. When the surface of the eye begins to dry, irritation is felt, such as burning and stinging. Ask for eye care professional what drop they feel would work best for you.

 

Eye Protection by Dr. Piatt

shattered glassesPicture yourself riding your bike on a beautiful sunny day in the Tri-Cities along the Sacagawea trail with your fiance. You’re having a lot of fun and you’re competitive, so you’re moving fast. Suddenly, without warning, your boyfriend stops in front of you and you run into his back tire. You fly over the handle, clear him and his bike, and land on your side and head, bouncing to an ungentle stop. Sound a bit extreme? Well, this is exactly what happened to one of our employees last year… and she MARRIED the guy!

She not only suffered from a significant concussion (shameless plug for Dr. Hedman’s blog this month), but she also was wearing her sunglasses at the time. Everyone knows they need sunglasses with 100% UV protection, but most people don’t even think about whether their lenses are shatter resistant.

Although all non-laminated lenses must pass the ANSI standards (American National Standards Institute), which is to drop a 5/8 inch steel ball weighing approximately 0.56 ounce from a height on 50 inches upon the horizontal upper surface of the lens for dress wear, (industrial wear is even more strigent). The lens materials that are best for shatter resistance are polycarbonate lenses and trivex lenses. Polycarbonate lenses are not as optically clear of a meaterial and they’re easy to scratch. WE highly recommend trivex lenses if clarity  is important to you. However, if you need high velocity protection, that is typically made in polyccarbonate. Look for a marking on the lenses or the frame that has a variation starting with Z87, or if you need high velocity safety frame, look for Z87+. A quick demonstration of the difference between safety lenses and non safety lenses is available on a video.

Check it out: https://www.youtubcom/watch?v=jtqavYTI2p0e.

If you’re doing an activity where a safety frame is necessary, they’re available in several frame manufacturers. We carry Wiley X in our Pasco location and some of our Oakley frames are also safety rated. (If you want tot know abut the advantages of different sunglass tints for your different hobbies check out Laura Winkel’s blog this month.)

Be safe and keep your eyes healthy, not only from UV, but also from injury!bike crash

#eyeinjury #safetyglasses #concussion #WileyX #Oakley

Chemical Eye Injuries by Dr. Piatt

jalapeno with gloves

In Appreciation of Workplace Eye Wellness Month, I wanted to talk about chemical injuries at work. One of the common misconceptions that floats about out there is that acids in the eye are worse than alkaline burns. Don’t get me wrong, acid in the eye is an emergency and needs to be addressed right away, but alkaline burns tend to be more devastating to vision , and more likely to cause permanent blindness.

Accidents with chemicals can happen to anyone, but if you make sure you stay aware of the dangers of the chemicals you are working around, you can prevent a lot of incidents. Think of it this way, a strange dog may look as friendly as can be, but you are still going to take precautions that minimize the chance that you get bitten. Treat chemicals with that same level of respect.

You don’t have to be a chemist to be exposed to chemicals. Almost any workplace environment has access to powerfully destructive chemical agents in the form of cleaning solutions. Using proper protective devices, such as cleaning gloves and goggles is the surest way of preventing a burn, but even the most careful of us can have an accident.

If an accident does occur, it is instinctive to start flushing your eyes with water. That’s a good thing, follow that instinct! That being said, one of the most common mistakes made in these incidents is that a person does not flush their eyes out long enough. That standard is to flush your eyes after a chemical incident for a full 15-20 minutes. It’s best to flush with a sterile saline solution, but if that’s not something you have on hand, running tap water is much better than nothing. At a hospital your eyes would be flushed and tested with litmus paper until they are at neutral. If you happen to have litmus paper in your first aid kit, that is what it is for.

After flushing the eyes, go to an Emergency Room. Make sure to bring them the following information if you have access to it:

  1. The time and place of the injury.
  2. The name of the chemical and if possible the ingredients list. Bring the bottle the chemical came in if possible. Although the doctor can look it up through poison control, this step saves valuable time.

Oddly enough, a common place to get a chemical burn is when working with food. Imagine you’re working in a restaurant or for a caterer cutting chili peppers and didn’t think to wear gloves. You can wash your hands repeatedly with soap and water and still be able to taste the spice on your hands. If you’re one of the unlucky few that touches their eyes after cutting jalapenos, you know how painful that can be. Keep in mind that capsaicin, the active component of chili peppers that gives them their heat, is also used to give pepper spray its punch. If you cut peppers without gloves on, be sure to soak your fingers/hands in oil or milk. Even if you’ve already gotten the pepper in your eye, soak your hands first because it’s easy to get more pepper in your eye without cleaning your hands properly. Next, soak a paper towel in milk and dab it to your eye, if some milk runs into your eye, it may help your discomfort.  If there’s no abrasion on your cornea, you shouldn’t have to worry about causing an infection. The goal is to break down any oils on your eyelid.

Chemical burns in the eye are bad enough that I’ve never heard of anyone getting the same type twice. It’s something you’re careful not to repeat! Even better is being careful enough to not have to learn the lesson the hard way.

Good eye helath everyone!

Kendal Piatt, OD

#chemicaleyeburn #eyesafety