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.
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Saturday May 26, 2007 - 11:17am (CDT) Edit | Delete | Permanent Link | 0 Comments
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

and

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.
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Saturday May 26, 2007 - 11:16am (CDT) Edit | Delete | Permanent Link | 0 Comments
ORTHO-K
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.
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Saturday May 26, 2007 - 11:15am (CDT) Edit | Delete | Permanent Link | 0 Comments
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...
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Saturday May 26, 2007 - 11:14am (CDT) Edit | Delete | Permanent Link | 0 Comments
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...

Comments

  1. Diabetic retinopathy can be treated with a laser to seal off leaking blood vessels and inhibit the growth of new vessels. Called laser photocoagulation, this treatment is painless and takes only a few minutes.

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  2. yes. i refer for this frequently

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  3. is there any way to treat/prevent/lessen latent hyperopia? I was recently diagnosed and would like to know what I can do to prevent it from getting worse and to alleviate the symptoms of it (eyestrain, eye fatigue, headache, blurriness, etc.)

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  4. well, you cant really "prevent it from getting worse". presbyopia will eventually force all latency to become manifest. its just a matter of time. the kicker is...how much time, and what is the quality of vision and symptomology (headaches, eyestrain, etc) in the interim? there is no magic formula, every doc does it differently. you just have to find the right balance of symptoms. generally more plus power = more blur but less headaches, fatigue & eyestrain. less plus power = less blur but more headaches, fatigue & eyestrain. you & your OD just have to find the max plus you can "stand" blur-wise in order to minimize the other symptoms. sometimes this takes multiple visits & multiple Rx's, and sometimes when you finally "find" the "right" Rx it only works for a short time before it needs to be changed again. there's really no way around it.

    one good suggestion is to possibly try soft, disposable contact lenses b/c contacts are cheap & easy to change Rx's on. that way you can "try" new Rx's out before "committing" to a big supply, and if it doesn't last very long a change is easy & cheap to make.

    good luck! its not an easy road sometimes.

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  5. Hi! Could you give me updated information about the Accelerated Orthokeratology treatment?

    I've been wearing my AOK lenses for the past 5 years (beginning summer 2005?). My -600 (left eye) and -400 (right eye) vision was readjusted to: -100 (left) and 20/20 (right) vision.

    I remember only going to the doctor two times, initially to get the pictures taken of my eye, then a checkup ~2 week later.

    Since that time, my vision has worsened though. Within 2 years, my vision has worsened to: -3.00 (Left) and -1.50 (Right). Due to the decreased vision, I have started wearing soft contacts: Acuvue Advanced for Astigmatism.

    My questions:

    1) Are there supposed to be several checkups/ several times new lenses are made, to ensure you've got the perfect AOK lenses to wear?

    2) Is it normal for my vision to worsen by this much?

    3) If I stopped wearing my AOK lenses, would my vision be -9.00 (left) and -5.50 (right)

    4) Is it healthy for me to even be wearing contacts 24/7??? (the AOK lenses at night, soft lenses in the daytime?)

    I should be talking to my practitioner first, but I would like to get another professional's opinion as well!

    Thanks, I hope I get to hear from you!

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  6. 1) you're still wearing the same pair of AOK lenses from 2005? they warp, you know. they usually only last about 2 yrs if worn every night. thats probably the problem right there...losing effectiveness b/c of warpage.

    2) probably not

    3) probably not

    4) depends on who you ask. I say probably, as long as the daily ones are silicone. although wearing WARPEDAOK lenses probably isn't great

    you probably need to get a new orthokeratologist, STOP wearing AOK for say 6 weeks and re-assess. I be you're not -9.00. I bet your right AOK lens is warped & providing minimal correction

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  7. Thanks so much for your input!!!!!!!!! I didn't expect such a fast/thorough reply :)

    1) I can't remember the exact year of when I got the pair of AOK lenses, but I know it was quite a few years ago.... I'd say roughly 2005 or 2006! I was not aware that they would warp!! I will go back to my practitioner.. but I wonder how much it'll cost. o.o

    I've thought about getting assessed/receive LASIK surgery-......... but the mere idea of it terrifies me. I have researched personal experiences and watched the procedures, but still.... 0____0 Can people get this surgery done, while they're unconscious? lol

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  8. hi, I'm 13. I'm becoming Hyperopia. I sit at the back of science class. I usually can see what's on overhead but I should make my eyes bigger and smaller to see the word. I spent a lot of hours on computer in summer. It sounds kinda normal but i think my eyes became worse. I do have glasses. I know I did a mistake and from now on, I don't use computer more than 1 or 2 hours perday. I reall need my eyes. Please tell me how to make my eyes see far objects better; or give me an exercise to prevent my eyes to become worse and start healing. Thank you

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  9. thats not hyperopia, thats myopia or nearsightedness. computer use does not generally CAUSE myopia progression, so limiting your computer use to "1-2 hrs" will not help. there is no "exercise" that prevents myopia progression. its genetic.

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  10. Im 100% sure its not genetic. My family(both mom and dad) and their aprents do not use glasses a lot and their eyes are fine. It started since summer and since i started using computer a lot.
    At least, do you know any way to help my eyes get better?

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  11. well sorry but you're 100% incorrect. it is genetic, regardless of who in your family does or does not wear glasses. recessive genes, carriers, incomplete dominance, etc etc. and no...no way to "get better"

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  12. Hello Doctor,

    yesterday my opthamologist diagnosed that i have latent hyperopia and i should wear glasses. I am already wearing a small cylindrical glasses. I work at least 7-8 hours on computers. Do you suggest I should wear combination of cylindrical and spherical glasses(0.5) for latent hyperopia problem. Please help
    Shradha

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  13. well, I really can't make a suggestion for you in this case because that's not really enough information.

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  14. Dear Princeidoc,

    I have recently started wearing ortho k lenses, my prescription, left right, is 4.25 and 5. After a week of wearing these lenses I noticed that I've been getting ghosting in both eyes but more so in my left eye, this occurs both day and night, but worse at night. Is this normal? is this permanent? if I stop wearing these lenses, how long will it take for it to return to its original prescription or corneal shape, and will the ghosting be gone? I am having second thoughts about ortho k.

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  15. I won't do over -5.00 for this reason, even tho many of my colleagues say ortho-k "can be" done up to -10.00(!) diopters. -5.00 is my limit and I don't even like doing those. I'll try to talk them out of it. I really prefer to only do the ones under -4.25, and so I like to catch them early. But I refuse to do over -5.00.

    yes, this is all par for the course in a -5.00 ortho-k patient. -5.00 is really too much to get it all most of the time. most of them end up being a residual -0.50 or so even at max effect (hence the ghosting). it's just not ideal for people who want to see really clearly.

    if you stop wearing the lenses, in theory you'll be back to 90% of your old Rx in about 3 days and 100% in about 3 weeks. give or take. and yes, you'll be just like you were before...no ghosting (unless you had ghosting in your old Rx...)

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  16. thank you for quick reply !

    I hope you don't mind me asking further questions, if I were to continue wearing these lenses until it stabilizes, would I still experience these ghost images? (At the moment, if I were to look at a word, lets say "ortho k", I would see a whole ghost image of that word under it. Also, how long would it take for my eyes to stabilize with good vision with these lenses?

    I read on a health forum about ortho k, and a few patients who used these lenses said they experienced double vision and ghosting after discontinuation of lens wear (even after two and a half years), do you know what could have happened here? (these patients wore their lenses for over 6 years)

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  17. If you're early into ortho-k (less than 3 weeks) then the ghosting could get better. If you're over a month in, then it is what it is and it is not getting any better. There could be many factors (lens placement, etc) but in your case its probably bc you're -5.00.

    No, no one has ghosting from ortho-k "two years" after discontinuing. That does not happen. Those patients are confused on the source of their ghosting. That does not happen. There are zero permanent or even semipermanent effects of ortho-k after 30 days, no matter what you read from some unhappy patient elsewhere

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    Replies
    1. I am not sure if I want to continue using these lenses, can I get your opinion? what do you think? Am I a good candidate or not, do you recommend me to continue using these lenses?

      Also, in the past year my prescription went up by 1.25 in my right eye and 0.75 in my left eye, other years, it has went up by 0.25, do you know what may have caused this to happen? (I'm turning 17 in a month, and like a moderately active life)

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  18. My eye doctor told me that you can wear these contacts for as long as you want, is this true? and if so it is safe? Another point she pointed out was that how I will see in the end is the same as how I see through the Ortho-k lenses, is this also true?

    I know I've asked many questions, and I continue to do so because I find your anwsers very helpful, much appreciation.

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  19. Yes they are safe for long term wear

    It is debatable whether "in the end" you will see like you do thru the lenses. Too many factors.

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  20. Thank you for the information. It has been a really helpful read

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