Thursday, July 2, 2015

Foreign Body in Eye: What to Do (FLUSH!) and What Not To Do (Everything Else)

If you get something in your eye, flush it with saline (if you have it) or tepid water (if you don't have saline). That's it! Simple! If that doesn't work...STOP! Everything else you could try will probably make it worse. Here is a short list of things people often tell me they have tried to remove foreign material from their eye, along with the result I see when they finally get here: credit card (makes a HUGE mess of your corneal epithelium, almost always fails) Q-tip (makes a mess) magnet (this never, ever works. NEVER. can't be good for your eye) heavy eye rubbing (just swells your lids up) someone else's tongue (I can't believe I have to type this, but obviously I do. doesn't work AND promotes bacterial infection) If you cannot see something in your eye, STOP TRYING TO REMOVE IT. We get a few of these every week, usually contact lens wearers who swear there is a "piece of contact lens" stuck in their eye. They try and try and try and dig and dig and dig trying to remove it, even tho they can't see it. IT IS USUALLY NOT THERE. That's why they are unable to remove it. No kidding 9 times out of 10 when a patient thinks there is a contact lens or a piece of one "stuck" in there, it's not there. They're just feeling what we call "foreign body sensation", which means their eye is swollen or inflamed or irritated and it's sending a signal that there's something in there. When they dig and dig and dig, they just compound all of their problems. If you flush and you can't remove the foreign body that you see, or you can't get rid of the foreign body sensation of something you CAN'T see...JUST. STOP. Come in to the eye doc. We can get it out quickly and painlessly and we won't make a big mess of your cornea, or we can confirm that there's nothing in there so you can stop digging and causing more damage! To summarize: FLUSH! That's it! Don't do anything else! Reserve everything else for the optometrist!

Tuesday, June 30, 2015

Contact Lens Abuse and How to Handle It

We all have them: the 15-35 year old patient who literally wears the same pair of disposable contacts w/o removing them for months at a time. Some of them even BRAG about it! "Yeah I've had THIS pair in for 6 months! Hahaha!!!!", like it's cool and funny. Or they announce that they "know when" to change contacts because they "start hurting" and all that. Obviously they're putting their health at risk. Some of them have symptoms: red eyes, dryness, etc, but a lot of them are totally fine. No redness. No pain. Corneas are clear. It's all fine! So what's the problem? An optometrist really has to be careful here. People do not like to be reprimanded, even when they know they're wrong. If you "cut them off", not allowing them to have any trials or buy any boxes, they're just going elsewhere, and probably give you a negative review on Angie's List/Google to boot. Then you've both lost their business and sent your problem patient to some other unsuspecting eye doc. And those patients are much more likely to lie to the next doc because telling the truth about their contact lens habits got them cut off from buying them, so now their vision is even more at risk! No, we must tread lightly. I find that people generally despise being scolded or having scare tactics used on them. It's a turn off. I really believe the best way to handle it is to NICELY and maybe even laughingly say something like "well you know we recommend that for your safety and long term vision you need to be taking the contacts out nightly and changing them regularly...the brand you're wearing is designed for two weeks of daily wear". We're just kind of politely reminding them to do the right thing. I usually jokingly throw in something like "you know - people who smoke 2 packs of cigarettes a day usually feel great! They don't think it's a problem at all until one day someone diagnoses them with lung cancer!" Have any of you patients experienced some optometrist "yelling" at you about the way you wore your contacts? Any of you docs have a method of patient education that you wish to share? Chime in below in the comments section!

Friday, June 26, 2015

Coopervision "MyDay" Silicone Daily Disposables

Coopervision has its answer to Alcon's Dailies Total One and J+J's Acuvue TruEye: http://coopervision.com/our-company/news-center/press-release/coopervision-introduces-myday%E2%84%A2-daily-disposable-lenses CooperVision introduces MyDay™ daily disposable lenses June 06, 2013 MANCHESTER, ENGLAND, 6 June 2013 — Combining its deep understanding of daily disposable wearing habits, practitioner demands and advances in materials science, CooperVision Inc. (NYSE: COO) today unveiled MyDay™ daily disposable lenses at the British Contact Lens Association (BCLA) Clinical Conference & Exhibition. Featuring a unique chemical structure called Smart Silicone™ chemistry, MyDay™ lenses (stenfilcon A) create efficient channels for oxygen delivery to the cornea. With less silicon needed to achieve the desired oxygen permeability levels, the efficient silicone network allows for increased hydrophilic materials. This results in improved lens surface wettability, higher water content and lower hydrogel-like modulus for a softer, more comfortable wearing experience. Consequently, MyDay™ lenses offer practitioners and patients the optimal balance of comfort, handling and breathability for a healthy lens-wearing experience. The lenses are expected to be available in Europe by September 2013, with rollouts in other global markets beginning in 2014. “As the silicone hydrogel daily disposable category has evolved, we’ve been patient in our approach, spending time to develop a lens platform that addresses all critical requirements from the industry and wearers,” said Dennis Murphy, executive vice president, Global Sales and Marketing, CooperVision. He added: “MyDay™ is silicone hydrogel taken to the next level. It’s designed for today’s generation that’s approaching life faster, smarter and more efficiently – people who want to experience all the world has to offer, yet do so effortlessly. MyDay™ promises healthier wear while minimising patient interaction with, and awareness of, the lens.” Clinical research indicates that nine of every 10 patients are satisfied with the comfort of MyDay™ lenses. In a bilateral, randomised, investigator-masked wearer comparison with the current leading daily disposable lens, MyDay™ lenses enjoyed superior performance across all measures: comfort, dryness, handling (by a staggering five-to-one ratio) and overall satisfaction. In addition, after two weeks of daily disposable lens wear, the high oxygen permeability of MyDay™ daily disposables contributed to less eye redness, resulting in whiter looking eyes.” Keith Tempany, practitioner and owner of renowned boutique opticians and contact specialists, ‘Tempany’s’, based in Broadstone, United Kingdom, trialled the lens. He said: “I’ve found MyDay™ to be one-of-a-kind: a daily disposable lens without compromise. MyDay™ lenses with Smart Silicone™ bring oxygen transmission at a greater level than needed for daily wear. The high water content enhances lens movement and contributes to wearer comfort. And the hydrogel-like modulus has superb handling and is gentle against the ocular tissue, allowing effortless transition of existing hydrogel daily disposable wearers. I expect high demand among practices who understand what daily wearers need in an optimised lens.” Mark Harty, European president of CooperVision, said: “We are delighted to be bringing to market a completely new product that forever changes the face of the daily disposable contact lens market. We know that silicone hydrogel is currently the preferred material for daily wearers, yet the lenses available today continue to be perceived by some practitioners and patients as difficult to fit, not easy to handle and uncomfortable at the end of the day. We aim to advance the entire industry with the launch of MyDay™, helping eye care practitioners offer the benefits of silicone hydrogel lenses to even more patients by providing a product with an optimal balance of comfort, handling and breathability for a healthy lens-wearing experience. We’re confident that once patients try MyDay™, they won’t look back.” MyDay™ lenses will be available in sphere powers of -10.00D to +6.00D (in 0.25D steps to -6.00D and 0.50D steps to -10.00D; and in 0.25D steps to +5.00D and 0.50D steps to +6.00D). All lenses have an 8.4mm base curve and 14.2mm diameter, with a 0.08mm centre and 0.07mm edge thickness. An ultraviolet radiation blocker helps protect wearers’ eyes, limiting 75 percent of UVA and 99 percent of UVB rays. About CooperVision CooperVision, a unit of The Cooper Companies, Inc. [NYSE: COO], is one of the world’s leading manufacturers of soft contact lenses. Dedicated to continually bringing a fresh perspective to the contact lens experience for practitioners and patients, CooperVision specialises in lenses for astigmatism, presbyopia, and ocular dryness. The company routinely collaborates with eye-care professionals in the research and development of relevant products. CooperVision manufactures a full array of monthly and daily disposable contact lenses featuring advanced materials and optics. For more information, visit www.coopervision.com. Contact lenses are medical devices and can only be prescribed and dispensed by a licensed eye care professional.

Wednesday, June 17, 2015

Online Glasses and More 1-800-CONTACTS Talk

So last night I got a few replies to some of my blog posts about contact lens sales and 1-800-CONTACTS: "Um no. You shysters got slammed by the FTC for your anti-competitive practices and withholding your "patient's" contact lens prescriptions - which you already got busted for in the 70's with eyeglass prescriptions. Can't blame 1-800-contacts for that now can you?" and "Yet another OD in support of anti-competitveness and price fixing." So let's address some of this. Yes, OD's got in trouble in the 70's and 80's for withholding glasses and contact Rx's, and rightfully so. How does that make it ok for 1-800-CONTACTS to fill box orders with passive verification in 2015? Or battle the contact lens manufacturers in state court over unilateral pricing? Come on. I already said we don't even try to make money on the box sales anymore. Did you miss that? I'll tell you something else we have never done here: withhold an Rx for anything. I am not disputing that some OD's have done this, but we never have. Let me tell you about online glasses: they suck. I'm serious. I mean it's probably fair for you young, low-prescription single-vision wearers out there who happen to fit in an average sized frame, and many of my patients have done this. I willingly and freely offer those patients the written Rx *WITH* the PD so they can do just that. But a bunch of them (even the easy Rx's!) come back complaining, and when we take measurements on the glasses they turn out to be some seriously shoddy work. Some of them are really bad. The worst are the progressives. Virtually none of them are right. Some of them are *close*, but MOST of them have been pretty darned terrible. That's because you can't "ballpark" an optical center/seg height measurement on a progressive. The only way it works is when the patient is sitting in front of a real person who knows what they're doing and has the right instrumentation and experience to choose the right brand/design for the precise vision needs of that individual person. And when it's not exactly right the patient has major problems. Not to mention the lenses are almost always cut way, WAY too big for the frame (a common newbie mistake). A too-large lens will never pop out, which is one reason why they do this. It's also the fastest way to make a pair of glasses, and should we be surprised that the online guys are in a big hurry? Or are that they are probably newbies? But a too-large lens will break a metal frame way before it's time, and seriously distort a plastic frame in a way that eventually makes the edge show and look *terrible*. How long is the warranty for? Better check up on it. I am not "in support of anti-competitveness (sic)". I just see through 1-800-CONTACTS obvious struggles and resultant state legislative lobbying. The single thing that makes their model work is going away, and I predicted it. I have already said that I don't care where patients get their contacts because we literally do not even try to make a profit on them anymore.

Monday, June 15, 2015

Are We "Spoiling" Patients?

We read all the time that myopia is a worldwide "epidemic", and I'm not disputing this. Something like 80% of Asians are myopic. But some of this IMO is that people are getting spoiled. We eye docs can and do make people see *awesome*. Literally better than 20/20. So much so that most glasses wearers EXPECT 20/20. Some of them are not even happy with 20/20. I'm serious. They wanted better than that. They complain about having normal acuity. They have seen superhuman 20/10 acuity and now that's what they want all the time, at all distances. I mean we OD's kind of brought this on ourselves to some degree. Gone are the days of only the severely vision impaired wearing glasses. Before about the 1920's we couldn't even make astigmatism glasses! So a whole bunch of people out there were walking around with 20/30 acuity and -1.50 uncorrected cylinder. Let me tell you that almost no one with -1.50 astigmatism goes uncorrected nowadays in the US. Almost all of them are wearing glasses or contacts or getting lasik. So what changed? Are we as a culture really having our eyes deteriorate THAT much more than in years past? Studies say we are, but I bet some of it is that people just won't deal with/accept 20/40 vision anymore. People want better, ESPECIALLY if they have experienced better in glasses. Once they've seen 20/15 they will not go back to 20/40. They DEMAND 20/15. And we sell it to them! That's all fine and good... Good for our pocketbooks, I guess. But there are some problems, like: 1) when elderly people who have seen 20/15 for many, many years start having cataracts, dry macular degeneration and other problems that affect their acuity. I have so many 65+ patients who see ok... 20/25 even... But are very, very upset. They want "sharper" than that. 2) parents who demand their children wear glasses when their acuity is really pretty good and their Rx is low. The parents see 20/15 and when someone tells them the child is "only 20/30" they are very, very upset. But do children need to see 20/15 all the time? I mean I don't know. I'm not saying they don't, but I am saying a case could be made that they don't. 100 years ago a 20/30 child was considered totally fine. 3) presbyopes who have seen 20/15 at all distances for their entire life refuse to accept that having "clear, sharp" vision at all distances SIMULTANEOUSLY is absolute fantasy. It's not possible, and a lot of them are in absolute denial. If you're over 45 you will have to give up clarity at some distance for some visual task, no matter how much money you are willing to spend. It's inevitable and it's a compromise and there is no way around it. You will have to tolerate some blur. I'm rambling here but the point is this: I think it's possible that routinely making patients see INCREDIBLE may be creating a culture that absolutely DEMANDS that. So much so that we have a lot of people who are upset with normal 20/20 vision. It's potentially a problem.

Monday, May 25, 2015

Dyslexia Not Linked to Eyesight

So says this study: http://www.bbc.com/news/education-32836733 Dyslexia is not linked to any problems with eyesight, say researchers. Teams from Bristol and Newcastle universities carried out eye tests on more than 5,800 children and did not find any differences in the vision of those with dyslexia. This raises doubts about the value of using coloured overlays or lenses to help dyslexic children with reading. Report co-author Alexandra Creavin said eyesight was "very unlikely" to be the cause of such reading problems. The study draws on a long-term tracking study in the Bristol area, which has followed the health of more than 14,000 children since the 1990s. About 3% of children have severe dyslexia and researchers, using a sample of 5,822 children from this tracking study, carried out detailed eye examinations on dyslexic and non-dyslexic children. 'Perfect vision' They found that those with dyslexia were no more or less likely to have any sight or eye-related problems, such as short or long sightedness, squints or difficulties in focusing. "Some practitioners feel that vision impairments may be associated with dyslexia and should be treated. However, our study results show that the majority of dyslexic children have entirely normal vision on the tests we used," said Cathy Williams, lead author and a paediatric ophthalmologist. Where there were dyslexic children with eye problems, the occurrence was no more likely than for non-dyslexics, the study found. And a large majority of dyslexic children were defined as having "perfect vision". This raised doubts about vision-based forms of assistance, such as using coloured filters to help with reading. This can include putting coloured acetate sheets over a page or wearing tinted lenses. Dr Creavin, from the University of Bristol, said the research showed the need for clearer, evidence-based guidance for parents on what might help. Dr Williams said the study was not looking for other possible causes for dyslexia, but it was the biggest study examining whether there was any link to children's vision. Colour filters John Rack, director of education and policy at Dyslexia Action, said the charity backed the report's findings. "However, not everyone has followed us in following the evidence, and the view that dyslexia is rooted in some problems in vision or visual processing is still widespread. "The confusion comes in part from the fact that a minority of people who are dyslexic do find that text is significantly clearer when viewed through a coloured filter or lens. And some who are not dyslexic experience the same kind of benefit," said Dr Rack. Kate Saunders, chief executive of the British Dyslexia Association, said that "some children and adults report benefits" from using coloured lenses or filters. She said reading tests showed that such coloured filters could help people with dyslexia.

Thursday, April 30, 2015

The "PRACTICE" of Medicine

I am always saying: if you have an eye problem, go to an eye doctor. The jack-of-all trades primary care doctors really don't know what to do with you. Just as another recent example of this, I was just sent a "picture quiz" from one of my medical apps. It detailed the case of an adult who had pain, redness and light sensitivity for weeks, despite using prednisolone (steroid) eyedrops (no word on how he got them, whether some other doc Rx'd those to him or he had them from some previous problem or he bought them OTC in Mexico or what). Here's the picture quiz with the multiple choice answers. The green check shows that I chose the correct answer (click the screenshot for a larger view): The biggest takeaway here is that given that rather obvious history and picture, still only 45% of medical docs made the right call. This is an app that almost all medical doctors and students have because it is specifically designed for MD's, so the vast majority of people taking this quiz are MD's. There are a few DDS's & OD's like me, but not many. This quiz is MOSTLY taken by MD's. So less than half of the respondants got the correct answer. That's pretty scary, especially given that there is really only one thing in medicine with that specific appearance of "dendrites". Nothing else even closely approximates that appearance, certainly not "keratoconjunctivits sicca" (dry eye) or "staphylococcal corneal ulcer" (bacterial infection). THE ONLY condition that causes dendrites like the ones in that picture is herpes simplex. So once again I say: IF YOU HAVE AN EYE PROBLEM, GO TO AN EYE DOCTOR. I kind of wished one of the answers had been "pink eye" because then I bet even less people would have chosen the correct answer. MD's can't stay away from a diagnosis of pink eye, haha. They did put "corneal abrasion" on there which is the other overly-diagnosed eye condition!