RETINOPATHY, LATENT HYPEROPIA, ORTHO-K
- DIABETIC RETINOPATHY
- I frequently have patients who are diabetic with fluctuating vision and visual complaints. Something to remember about diabetes as far as your eyes and vision are concerned:
1) Diabetic retinopathy is the #1 cause of permanent blindness in adults in the U.S. For this reason every diabetic needs an annual dilated eye examination to rule out or follow retinopathy. At our office we digitally photodocument all retinas of all diabetics.
2) Both diabetes and the medications for it can affect your vision and your Rx. Any large change in your blood sugar levels can change your prescription. This is a common source of frustration for patients. One of the better solutions in my opinion to try and lessen this effect is the use of PROGRESSIVE glasses or "line-less bifocals".
3) Any "new" floaters in a known diabetic warrants another dilated eye examination. New floaters could mean the onset or progression of retinopathy.
- LATENT HYPEROPIA
- Latent hyperopia is a fairly common refractive problem that eye care professionals deal with quite frequently. Technically it involves an amount of "farsightedness" that is not "manifest". To elaborate a little, when a person has a vision evaluation there are really 2 things at play as far as their refractive state or glasses Rx is concerned (for the sake of this discussion, we are not including eye health issues, binocular vision issues, contact lenses and other parts of an eye examination). The 2 factions of determining your glasses Rx are:
1) the glasses Rx that your eye actually exists as
2) the Rx that you see well through or prefer (this is the "manifest" Rx)
One would assume those would be the same, but oftentimes they are not. Very frequently a person "likes to look through" a glasses Rx that is different from (sometimes vastly different from) the Rx that their eye "really is". For practical purposes and in my opinion, usually the difference between the "real" Rx and the "manifest" Rx is what I call "latency". (As an aside, sometimes we are only able to diagnose latency by pharmaceutically paralyzing the focusing muscle...a procedure known as "cycloplegia"). This is one of the reasons why in the age of computers we still have to ask a patient "which lens is better?". By that point in the exam we usually already know what the Rx "really" is, but we still have to ask the patient which lens they "like".
In the case of hyperopes or farsighted people this can become very difficult. Most hyperopes (especially uncorrected ones) continually "focus" or accommodate to literally change their Rx by the second or on-the-fly. This is useful because there is a "range" of Rx's that most hyperopes see well through, but sometimes becomes problematic for patients if they have a large amount of hyperopia or if they are losing their ability to focus. A lot of hyperopes don't even know they are farsighted until they start losing the ability to accommodate, and their "latent" hyperopia becomes "manifest", or rather...they have always been farsighted but now its "coming out" because they are losing their ability to focus.
Consequently farsighted people sometimes have a lot of trouble with frequently-changing Rx's and getting used to new Rx's. Frequently the vision through a new glasses Rx is not IMMEDIATELY clear to the patient.
Patients sometimes have a hard time understanding how we eye care professionals would ever want to Rx something that is not immediately clear to the patient, but in some cases it is in the patient's best interest to do so. We are usually trying to avoid other, BIGGER problems than just a symptom of "blur". Some of those "other problems" could include: strabismus (eye turn), headaches, eyestrain, and more.
I guess the point of this lengthy diatribe is to try and have some faith in your eye doctor or eye care professional. If they tell you "you'll get used to your new glasses", then at least give it a try, even if you don't think the vision is as clear or as comfortable as you think it should be upon first putting on your new pair of glasses. Don't assume that it's "supposed to be" immediately clear.
- Orthokeratology, AKA "ortho-k" is a low cost, safe, completely reversible non-surgical alternative to LASIK. Even children can have this procedure done, its that safe and reliable. Using precision custom computer-designed and lathed shaping lenses, your cornea is gently molded while you sleep, similar to the way some people wear a "retainer" at night to keep their teeth aligned. The result is clear unaided vision during waking hours. It might be ideal for very active people who are bothered by wearing glasses and contacts, but do not want the expense or risk of LASIK. Imagine swimming without your glasses or contacts. Imagine never again getting dust or debris under your contacts or having your glasses get foggy or slipping down your nose. Imagine riding your motorcycle or driving a convertible car, or even using your air conditioner in your vehicle without drying your contacts out. Imagine not having to shop for or buy prescription glasses, prescription sunglasses or disposable contact lenses, all without surgery. It is not a gimmick, and it is available right now. Additionally, it is the only known refractive procedure that is thought to possibly slow myopia progression in children (multpile studies on this and a new article in the "Case Reports" section of the May 2007 Contact Lens Spectrum magazine...not yet linkable). Attempts to slow myopia progression with ortho-k is called "myopia control".
So Why not just have LASIK? Top *10* reasons:
1) Ortho-k has no age restriction. It can be performed on patients of all ages, including children. Laser surgery can only be performed on patients 18 and older.
2) There is no post-operative pain or inflammation, or risk of post-operative infection with ortho-k, and therefore no need for weeks of prescription pre and post-operative medications like steroids and antibiotics.
3) It is easy to modify your shaping lenses should there be an increase in nearsightedness after beginning the treatment. Laser surgery would require another surgical procedure (called an "enhancement"), with another post-operative recovery period.
4) There are no problems with the healing of the "flap" like there are in LASIK. No risk of folds, debris under the flap, or more importantly complications such as "DLK" or "epithelial ingrowth".
5) Ortho-k is usually about 1/2 the cost of LASIK.
6) Ortho-k is reversible should you not be satisfied with the results, or if you would like to have LASIK later. Laser surgery and the side effects from it are not reversible.
7) Ortho-k can be done even if your prescription has been increasing. Laser refractive surgery should only be done if your prescription has been stable for at least one year (and some even recommend 3 years).
8) Ortho-k has been shown to possibly slow or stop myopia progression in children. LASIK is not FDA approved for use in children, and has not been shown to slow progression of myopia.
9) In LASIK, corneal nerves are severed, which sometimes causes Dry Eye Syndrome. This is not possible with ortho-k.
10) Otho-k is safer (less risk) and has less side effects than LASIK.
Quick FAQ about Ortho-k:
1) "Is it permanent?" No. The effects are temporary and there will be a need to wear the shaping lenses on a nightly basis in order to maintain good vision during the day.
2) "Is it safe?" Yes. Safer than LASIK, and as safe or safer than regular contact lens wear.
3) "I read an article on the internet that said ortho-k was bad for my eyes, and even causes blindness! Is that true?" No. Those types of articles are written about traditional (old) ortho-k. Ortho-k is "accelerated ortho-k", and is totally new and different and completely safe. The FDA even allows children to have the procedure done, so according to the FDA, ortho-k is definitely safer than any laser refractive procedure.
4) "My old eye doctor said that orthokeratology is "fringe" eyecare and LASIK is much better. Is that true?" No. Many eye doctors don't fully understand how accelerated orthokeratology is different from traditional (old) orthokeratology.
6) "Does it hurt?" No. The lenses are very comfortable.
7) "Can I use this procedure to get my pilot's license or into the military/FBI/police academy/etc?" Yes most of the time, depending on your Rx and the specific visual requirements.
8) "Does ortho-k cause scarring of my eye?" No. Ortho-k does not permanently change your eye in any way. It is important to point out that every surgical procedure (LASIK, PRK, etc) causes some amount of permanent corneal scarring. Orthokeratology is the only refractive procedure that does not scar your cornea (because it is the only non-surgical refractive procedure).
9) Ortho-k works best on nearsighted prescriptions from -1.00 to -6.00. People with -10.00 cannot really have ortho-k done. Plus (+) prescriptions and reading prescriptions are not awesome candidates, either.
- PEDIATRICS AND CONTACT LENSES
- One of the most frequent questions we get asked at our office is "how young can a person be to get contact lenses?" The answer is...it is completely variable from child to child and from condition to condition.
Barring a medically-necessary contact lens for for infants and toddlers due to congenital cataracts or excessive anisometriopa (large difference in Rx between the eyes), the following are some suggestions to see if your child is ready:
1) The child must "want" it: parents who think contact lenses would be "easier" or cheaper because the child is frequently losing or breaking glasses are in for a big surprise. Insertion, removal and care of contacts can be fairly difficult to learn. Contacts are not a commodity, they are a medical device. The biggest & quickest failures are when the parents want contacts for the child, but the child himself or herself does not have a desire to wear them. Contact lenses pose just as many problems as they solve.
2) The child must be responsible: the wear and care of contacts requires a pretty significant amount of responsibility.
3) The child must be patient: children who quickly get frustrated are not good candidates.
4) The child must be dexteritous: children who have poor fine motor skills are usually unsuccessful.
As soon as your child meets all of those criteria, he or she might be ready to try! Be patient with them, they're not going to quickly learn how to insert & remove them. In my anecdotal experience, girls are usually ready about age 10 or so, boys about age 14. The reasons boys are ready a little later is b/c boys usually care less about their appearance, and boys generally have not ever used eyeliner or mascera, so they have no experience with anything being close to their eyes...
- BE A GOOD PATIENT
- This applies to patients going to any doctor, not just the eye doctor. So many patients get frustrated with the care they receive, and some of that frustration is definitely warranted. Lots of doctors are overworked and overbooked.
But you can help receive the best care possible by helping the doctor and his/her medical staff:
1) Answer questions as accurately as possible and be honest: when the doctor or the staff asks you a question about your health, answer it. Remember that the doctor is bound by patient/doctor confidentiality and HIPPAA regulations. Don't only tell the doctor what you think is pertinent to the situation. For example, often patients fail to list any medications on their form, but when asked directly they admit they are taking multiple medications. They just didn't think the "eye doctor" needed to know if they were taking birth control or high blood pressure medications, etc so they didn't list those. The doctor definitely needs to know, or he/she wouldn't have asked.
2) Along with answering questions accurately is trying to avoid being vague. A good example of this occurs nearly every day in our office: when asked when their last eye exam was, many patients answer "oh...quite awhile ago!" or "before we moved here." Those are not really very good answers to that question. What the doctor wants is an actual time estimate like 1 year ago or 5 years ago or 1995. A ballpark estimate is fine, but you can't answer "before we moved here". You have to assume the doctor doesn't know when you moved here.
3) Know your own medical history: If you had surgery, know approximately when it was and what it was for. If you have had cancer, tell the doctor about it. If you have had trauma, make sure they know.
4) Know your medications: This is probably the most important one. Either know your medications by memory or carry a list.
5) Have a complaint or list of complaints. Know why you are there and what you want from the exam, and tell the doctor these things.
6) And lastly, be patient and nice: Doctors generally don't really enjoy seeing really grumpy or demanding patients. You may be in a hurry or be upset b/c you had to wait a long time before you were seen, but being short and unpleasant doesn't make it better. It just makes the doctor want to get you out as soon as possible, which may not be in the best interest of either of you. Remember that doctors are human and make mistakes and can have bad days and be grumpy themselves...