Tuesday, November 19, 2013
It's rare. REALLY rare. If your eye is red/blurry/painful and you wear contacts most or all of the time...it is UNlikely that you have or will ever have a corneal abrasion. And if you go to a doctor with those symptoms and they diagnose "corneal abrasion" and you are a HEAVY contact lens wearer, you should be skeptical of that diagnosis. People who have abrasions remember exactly when and how it happened. They got hit with a branch while mowing or their dog scratched them while wrestling or something. They can pinpiont the exact moment their eye started hurting. But if you're sleeping in contacts and you wake up with a painful eye, that's not an abrasion. It can't be! A contact lens is a barrier - it protects you from being "scratched". I always joke that diagnosing "corneal abrasion" in a chronic contact lens wearer is like telling someone they skinned their knee under their knee pads. It pretty much can't be done. If you wear contacts and your eye hurts and is red, it is VERY LIKELY that it is a CONTACT LENS RELATED problem (inflammation or infection from wearing contacts). Not "pink eye" and not "corneal abrasion".
Tuesday, November 5, 2013
Yahoo Sports Article about Ortho-k The non-contacts, non-LASIK solution for Jameis Winston's squinting problem There were two questions that a national audience was asking after Jameis Winston kept Florida State's national championship bid on track on Saturday. "How is this freshman so good?" And … "What is he squinting at?" The 19-year-old redshirt freshman quarterback led the third-ranked Seminoles to a 41-14 blowout of No. 7 Miami to boost the team's BCS title aspirations and his own Heisman Trophy credentials. As he did so, he unwittingly spawned a series of GIFs and Twitter comments, with a country-wide audience immediately picking up on his habit for squinting towards the sidelines in between each play. Given that Winston appeared to be straining to see the play calls from the Seminoles sideline, it seemed extraordinary that he could effectively identify receivers downfield as the team yet again topped 40 points in collecting its eighth straight victory. FSU head coach Jimbo Fisher cleared up the confusion in his Monday press conference. "[Winston] has contacts but he doesn't like wearing them," Fisher said. "He has a very minimal prescription, I guess. It is just at night he has a hard time with the lights sometimes. He sees; he's fine. [The squint] is just the way he looks over there." Florida State officials have thoroughly evaluated Winston's eyesight and have no concerns about his ability to read the action on the field, even at night. Considering how he has stepped into the shoes of E.J. Manuel (a first-round pick of the Buffalo Bills) and spearheaded the Seminoles' superb season so far, that is little surprise. Interestingly, Winston does wear his contacts during baseball season, when he pitches and plays right field for FSU. "It is a different game," Fisher said. "The contacts … they get knocked out, they get loose. Sometimes he [wears them], sometimes he doesn't in baseball, I guess. In football he doesn't like it, but it has never been a factor." Winston appeared to put the subject to rest late in the day Monday when Orsillo Vision Care and Optical in Tallahassee, Fla., posted a photo of the quarterback on its Facebook page after he was fitted for Ortho-K lenses.
Tuesday, October 29, 2013
In 2009 I blogged about Treating EKC with Betadine. At the time it was an interesting topic because there was basically no way to treat viral keratitis at all. I didn't use it very often, however, because patients just complained too much about the stinging and burning of the betadine, even after lavage (washing it out). Basically the treatment was so painful for some that it kind of turned me off from using it. Now, however, I am treating viral EKC ("epidemic kerato-conjunctivitis" or viral "pink eye") with ZIRGAN. Zirgan is ophthalmic gancyclovir (anti-viral), designed and marketed for the treatment of HSV (herpes simplex virus) keratitis, and it has quickly become the gold standard. It absolutely works, and is infinitely better at treating HSV than it's predecessor Viroptic. I read a blurb in an ophthalmology trade publication about possibly treating EKC with Zirgan as an "off-label" use and I tried it on a few patients with resounding success. It absolutely works for this, and so now I do it routinely. The big problem is that it is expensive! a 5 gram tube (because it's a "gel" in a tube, not a bottle of liquid) still runs between $225-275 last time I called around. That's pretty high for a benign condition that is self-resolving, but I tell patients that they have to weigh how miserable they are vs how much they are willing to spend. It's not dangerous to not-treat EKC...it's only REALLY ANNOYING.
Wednesday, October 2, 2013
The #1 reason for a contact lens-wearing patient to have a red, painful, light-sensitive eye is not "pink eye", not "corneal ulcer", and not "corneal abrasion". It's infiltrative keratitis, or an INFLAMMATORY event (not infectious, which is why some practitioners choose to call this a "sterile ulcer"...I don't like that term b/c I think the word "ulcer" implies microbial keratitis) that causes a collection of white blood cells in the cornea, or a visible white spot. It causes pain, blur, light sensitivity and redness, most often after SLEEPING in contacts, even contacts that are FDA approved for extended wear. If you sleep in your contacts and you wake up with a painful, red eye, it's probably infiltrative keratitis. I always think it's funny that patients and doctors both will diagnose these as "corneal abrasion". How did it get abraded!!?? You can't "scratch" an eye that has a contact lens on it. Infiltrative keratitis is not dangerous. It's only painful and annoying. Most of them go away on their own in a few days if the lens is removed, HOWEVER...you still need to come in for an exam. Why? Because unfortunately the symptoms of infiltrative keratitis (redess, pain, light sensitivity, blur) ARE THE EXACT SAME SYMPTOMS AS A MUCH, MUCH MORE SERIOUS CONDITION: microbial keratitis. Only by LOOKING at your cornea will I be able to tell if you have the "no big deal" infiltrative keratitis or the "VERY BIG DEAL" microbial keratitis. No amount of describing your symptoms to me over the phone will allow me to differentiate. So if you sleep in contacts, even if I told you that was ok, and you wake up with a painful, red eye...you have to come in. If you have IK I'm just going to Rx you a steroid-antibiotic combo and you'll be over it soon. Maybe this would be a good time to switch to dailies like Alcon's DT1? In 13 years of practice I have yet to have a dailies wearer who had a significant problem...
Thursday, September 26, 2013
One of the provisions of the Affordable Health Care Act (aka Obamacare) is that it taxes medical devices. Well the FDA absolutely defines contact lenses as "medical devices", so I presume this means contact lenses will be taxed. So...consumer cost for contact lenses is going up what? Approx 8.25%? Optometrists and opticals will have to start collecting, documenting and paying this "sales tax" on the sale of contacts. Fun times.
Wednesday, September 11, 2013
We purchased one. It's awesome. Patients love it and staff loves it. We got the new "Daytona" version
Tuesday, July 23, 2013
I am so often asked in the exam room and on the net what I recommend and what are my "favorite" products to use/prescribe. So every now and then I post them! Here are the "winners" of the 2013 Prince Choice Awards: 1) BEST DAILY DISPOSABLE CONTACT LENS: hands down it's Alcon Dailies Total 1. Possibly the most comfortable contact lens ever, excellent optics, excellent safety, excellent compliance. It's 1 knock is cost. 2) BEST TWO WEEK CONTACT LENS: Acuvue Oasys. 3) BEST MONTHLY CONTACT LENS: Alcon Air Optix Aqua, with Night & Day a close second. 4) BEST OVERALL CONTACT LENS: Alcon Dailies Total 1. 5) BEST TORIC CONTACT LENS: Alcon Air Optix for Astigmatism. I have literally never used a better, more stable toric lens in 13 years of practice. This lens rocks. 6) BEST CONTACT LENS SOLUTION: Clear Care. Absolutely cleans the best, hypoallergenic. It's 1 knock is that you must actually follow the directions. 7) BEST PRESCRIPTION ANTIHISTAMINE EYE DROP: Lastacaft. Works immediately, very long duration. 8) BEST OTC ANTIHISTAMINE: ketoifen fumarate, found as the active ingredient in Zaditor, Alaway, Zyrtec and others. 9) BEST OTC ARTIFICIAL TEAR: Systane Ultra. 10) BEST PRESCRIPTION ANTI-INFLAMMATORY: Lotemax (for surface inflammation). 10 is probably enough for now haha...so there you have them! Winners of the 2013 PRINCE CHOICE AWARDS!