Archive for the ‘Patient Education’ Category

January is officially Glaucoma Awareness Month. Educating ourselves on what glaucoma is and how it affects vision is the first step in preventing vision loss or blindness. This is because glaucoma does its damage in a slow and gradual manor often without showing signs or symptoms until permanent damage has already occurred. That is why routine vision exams are critical in catching this “silent sight killer.”

What is Glaucoma? Glaucoma is a group of diseases that damage the optic nerve at the back of the eye. This is the part of the eye that transmits image signals to the brain. The most common form is called primary open angle glaucoma, in which the pressure in the eye increases and the fluids inside the eye do not drain properly. All other forms arise from this increase in pressure.

There is no cure for glaucoma but early detection and proper medication can slow or prevent vision loss. Because there are virtually no symptoms in its most common form, an annual eye exam is needed to detect the warning signs early on.

My friend and occasional collaborator, Jessica Barnett asked me a question on Twitter the other day: “Random thought.. Do you have any blogs about the dangers of wearing contacts for too long/way too long?”

My first thought was, “Oh, man. She must be in big trouble.” Most people don’t think about the possible harm contacts can do until they have red, angry, painful eyes. It turns out that, no, she just has a lot of friends who push their contacts WAY past their limits. And she wanted some info to share with them.

First, let’s clarify a bit of terminology. When patients do not follow the recommendations regarding their contact lenses, they usually refer to it as “wearing contacts for too long.” Sometimes they say they just “over-wear” contacts. What doctors call it is “contact lens abuse.” Because, like almost anything, contacts can be used properly to provide safe, clear, and comfortable vision, or they can be used in a way that causes unnecessary risk.

When people abuse their contacts proteins, oils, bacteria, and allergens build up on the surface of the lenses. These are then in constant contact (get it? 8)) with the sensitive lining of your eyeball and eyelids. If you do not take your contacts out, or you wear them longer than you are supposed to, you limit the ability of your eyes to clean and recover. This increases the likelihood of a problem that can range from something mildly annoying to something permanently blinding  - like acanthamoeba.

So what is the worst that can happen? Check out this video to illustrate “the worst week of my life.”

Or this quieter patient saying  that it felt like ” my eye was going to burst out of my face”

Most contact lens complications are certainly not this bad. Most commonly, people first develop dry, red eyes as a result of the eyes not getting enough oxygen, the lenses not fitting correctly, or as a reaction to components of the contact lens cleaning solution. You do not want to let these initial problems develop into an infection or a corneal ulcer as described in the videos above. As a general rule, if you experience any pain, redness, watery eyes, sensitivity to light, or the feeling that something is in your eye or stuck on the contact take out the contacts and schedule a visit with the eye doctor that prescribed your lenses.

Here are some things you can do to reduce the chances of problems with contacts:

1. Throw away your contacts as recommended.
2. Do not sleep in your contacts unless specifically allowed by your doctor.
3. NEVER use tap water when cleaning lenses.
4. Wash your hands before handling contacts.
5. Ignore the “no rub” label. Clean your contacts as instructed.
6. Never reuse contact lens solution.
7. Keep your contact lens case clean and replace it regularly.
8. Own an up-to-date pair of back-up glasses to give your eyes a break.

For months, I’ve been reading, writing, and speaking about the Nintendo 3DS, all without actually seeing or using it. I was finally able to change that yesterday. After helping put the kids to bed, I slipped off to Best Buy and purchased a shiny black 3DS. I brought it home and Cristina and I spent a few hours setting it up and using it. We’ve had a Nintendo DS at Bright Eyes for years that we use as a reward activity during vision therapy, so it was immediately very familiar.

3D Effects

One of the biggest selling points of the 3DS is that the user does not need to wear special glasses to see the 3D effects. This is called autostereoscopic 3D and is definitely where 3D technology is going. It works surprisingly well, considering the small screen. You do have hold the screen flat relative to your head. If you angle the screen, you will either see double or lose the 3D effect.  The 3D does work from positions other than dead-center. This means that, while not ideal, it is possible for more than one person to see the 3D effect at one time.

I was particularly interested to see how well the “3D volume” slider worked. This allows users to adjust the amount of 3D shown to suit their tastes and the particular game. It works amazingly, seamlessly well. I was able to adjust the 3D anywhere from none, to just-noticeable, to full with just a flick of my thumb.

Augmented reality

One of the most intriguing aspects of the 3DS is its use of AR (augmented reality) as part of the game. This allows the viewer to play the game within the room or area that they are really in. (See picture to the right).  Not only is this extremely fun, there are some potential visual benefits to this. If the game is getting further away, it is more likely that the user will hold the game further away and look further away, potentially reducing some strain on the eyes. (I should note that I don’t have any research on this, but it occurred to me while playing.)

3DS vs. DS

One of the biggest visual concerns with 2D game systems such as the original Nintendo DS is that children tend to hold the screens incredibly close – as close as 3 or 4 inches. A person of any age should not hold a book or game closer than their Harmon Distance (or the distance from the knuckle to the elbow). With the 3DS, the 3D effect is better when the game is held a foot or so away from the eyes, so this will naturally encourage users to stay within their Harmon distance.

Safety

Much has been made, appropriately, of the potential adverse effects of using 3D technology, due to the differences of 3DS and real-life 3D.  Nintendo’s official warning of “vision damage” occurring for those six and under has gotten a lot of attention. While I haven’t seen any proof of this, I think it is reasonable because a person has to pretty visual sophisticated to use the 3DS. So I do recommend keeping it away from the young kids. They should be building with blocks and playing outside anyway,

For the older kids and adults (like Justin, on the left) who use the 3DS, eyestrain is possible. Already, I’ve talked to patients who have experienced headaches, nausea, and blurred vision from the 3DS. I’m happy to report that after an hour neither Cristina nor I experienced any of these symptoms. However, we routinely do activities during vision therapy that require visual skill and flexibility. For that reason we are much more accustomed to the visual demands required by the 3DS.

The #1 thing to remember: moderation. Take frequent breaks, even if you feel OK. Use the 20/20/20 Rule – Every 20 minutes, look away from the screen at something 20 feet away for at least 20 seconds. Even Nintendo recommends that players take a 10 minute break every hour.

If you or your children do experience symptoms, or don’t see the 3D even with the 3D on “full” be sure to get a through eye exam to look for vision or eye coordination problems. And remember that eye exams are recommended at age six months, three years, and before kindergarten.

For more on potential health effects of the Nintendo 3DS, see my interview with PCWorld. See also the American Optometric Association’s press release on the subject

Overall

In summary, the Nintendo 3DS easy to use and fun. The 3D effects are effective and being glasses-free is very nice. The augmented reality really works well. When used in moderation for the appropriate ages, I do not see any harm. If you do have concerns, schedule an appointment at Bright Eyes either on our webpage or calling 813-792-0637.

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

This is a guest post by Dr. Hilla Abel, the Cheftometrist.

Most people would agree that vision is a precious sense, and maybe even one that we tend to take for granted. While serious eye diseases like macular degeneration and diabetic eye disease are on the rise, the good news is that science is helping us understand what we can do to protect our eyes as much as possible. One key strategy is eating well. Check out these tips to learn what foods are good for the eyes…

1. Eat plenty of colorful veggies and fruit. Choose a wide variety of vegetables and fruit to get in your eye-healthy antioxidants, like vitamins C and E, and get your fiber in too. Selecting produce like berries, red bell peppers, sweet potatoes, and broccoli helps insure that you get the spectrum of plant nutrients in your diet.

Steamed Kale by Laurel Fan

2. Along with all your colorful veggies and fruit, pay special attention to include lots of leafy greens. Dark leafy greens like spinach and kale are high in lutein, which protects against macular degeneration and cataracts. When you eat lutein, it is literally sent to the macula and lens of the eye to protect these structures from light damage and oxidative damage. Lutein is really important for eye health!

3. Try to avoid white sugar and white flour as much as possible. White sugar and white flour contribute to a high glycemic-index diet, which has been shown to increase risk of macular degeneration and diabetes (which can lead to diabetic eye disease). Instead of eating so-called refined (i.e. processed) foods, choose the real deal: whole grains like brown rice, oats, and quinoa for your carbohydrates, and high-fiber foods like beans and vegetables.

4. Choose healthy fats. Our bodies need some fat from the diet, and it’s important for the fat that we consume to be of good quality. Omega-3 fatty acids have been proven to protect against macular degeneration and are used to treat dry eyes. Try to regularly incorporate omega-3-rich foods like salmon, anchovies, sardines, and flax seeds in your diet. And while you’re increasing your consumption of omega-3′s and other good fats, be sure to also decrease your consumption of the poor quality fats found in processed foods.

5. Go exotic! A number of foods which have been known to be healthy according to ancient medical traditions have turned out to be scientifically beneficial. Turmeric is the yellow spice found in curries and has been shown to have antioxidant and anti-inflammatory benefits; early studies suggest that turmeric may have a role in preventing or treating eye diseases like cataracts, macular degeneration, diabetic eye disease, and glaucoma. Green tea, of Chinese origin, packs in an incredible amount antioxidants, fights inflammation, and protects against sun damage. Chinese tradition has also taught us that goji berries (also known as wolfberies) are good for the eyes. Now, modern science has proven that goji berries are high in zeaxanthin, which protects the macula and lens along with lutein.

As you can see, eye-healthy eating is sensible, with many delicious foods working to protect your eyes. In addition to eating right, other eye-healthy strategies are wearing sunglasses, exercising regularly, not smoking, and getting regular eye exams. Your eyes are worth it!

A note for those of you with medical conditions… If you have any specific medical conditions that may relate to food, be sure to speak with your doctor before making changes in your diet. For example, people taking warfarin (Coumadin) should speak to their doctors before increasing their consumption of leafy green vegetables.

Dr. Hilla Abel is a practicing optometrist and a certified natural foods chef. For more eye-healthy recipes & tidbits, visit her blog at www.morethancarrots.com and follower her on Twitter at @Cheftometrist.

Macular degeneration is a leading cause blindness.  It is a disease that is usually diagnosed in those over 55, affects both eyes and is slowly progressive. Macular degeneration is also known as ARMD (Age Related Macular Degeneration).

Macular degeneration can cause significant loss of central vision, but will not cause complete blindness as it does not affect the side, or peripheral, vision.

Thus, ARMD affects only central vision and may cause blurriness, distortion and non-moving black/grey spots in our vision.  Legal blindness is possible.

The macula is a small area of the retina.  It measures about 1.5 mm x 1.5 mm and gives us our central vision, including reading, our best color vision and is the only place sensitive enough to give us “20/20″ vision.  When we stare at something small, we are moving our eyes so that the image of interest falls on our macula.

The two forms are differentiated by the presence of abnormal blood vessels underneath the retina.  The abnormal blood vessels are called neovascularization.

The dry form does not have neovascularization and is usually more slowly progressive than its counterpart.  Most patients have the dry form, but it is possible for the “dry” to become “wet.”

Both forms involve degeneration of the different layers of the macula.

There are lots and lots of vitamins claiming to be good for macular degeneration, but only one formulation has ever been proven to have an effect.  An NIH based study concluded that the so-called AREDS formula of vitamin reduced the risk of severe vision due to wet ARMD by 25% in those patients.  Only those patients that were of medium to high risk derived any benefit.

Patients with dry macular degeneration or patients with low risk ARMD do not have any reason for taking the vitamins.

Supplements such as lutein, omega 3 fatty acids, Beta-carotene, etc. have never been truly proven to be effective and are presently under study by NIH.  This study, the AREDS 2 Study, will be concluding in a few years.

Symptoms of ARMD include blurry vision, distortion and dark/grey spots in your central vision.  The dark/grey spots correspond to areas of the macula that have significant degeneration and are called “scotomas.”  Scotomas are basically small blind spots.

For those of you already diagnosed, self-monitoring of your vision may be helpful by use of an Amsler grid.  This is an inexpensive, yet sensitive method, for tracking any changes.

Treatments are available for the wet form of the disease and include laser treatment, Photodynamic Therapy (PDT) and intravitreal injections of anti-VEGF medications.  The earlier a problem is diagnosed, the better the outcome.  Currently, anti-VEGF medications are a common way to treat wet ARMD.

There are presently no treatments for dry ARMD.

In general, if you experience any sudden, persistent, changes in your vision, including distortion, please inform your eye doctor.

Any changes in your vision should be reported to your doctor.  If a retina problem is suspected, a thorough, dilated exam of your pupils will allow the best view of the retina.

Further testing may be warranted to confirm the diagnosis.

It isn’t necessary to see a retina specialist, but more important that you be examined.  If needed, your eye doctor may refer you to a specialist.

Randall V. Wong, M.D. is a retina specialist practicing in Virginia.  Get the latest health info on diabetic retinopathy and macular degeneration.

To help educate patients and parents about visual problems and treatments, we have been giving out online references for the last few years. Well, I was looking at it the other day while handing it to a patient and I was shocked at how out of date it was! I am happy to report that the amount of information on children’s vision and vision therapy has absolutely EXPLODED on line.

I hope that you find the references below useful in learning about vision and finding others with similar questions and experiences. And, of course, do not hesitate to Ask Dr. Nate. You may also want to share your experience online via one of the below, or email me at doc@brighteyestampa.com.

I am intentionally leaving in the full links so that if you want to print and share this information with a friend or a family member you can do so without having to Google or Bing any of them.

Also, understand that this is not a comprehensive list. I have not included every possible online resource – the list would be too long! If I have left any out that you think should belong, please let me know!

See well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

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Welcome to 2010, everyone!  I hope you are enjoying the start of a brand-new decade.

Readers of this blog know that it is a Bright Eyes News tradition to create an eye related Top Ten List of New Years Resolutions. For 2008, wrote about resolutions for eye health. For 2009, I wrote about resolutions for children’s vision.

Thinking back to 2009, I’ve talked to a number of patients who had lost – or were about to lose – their jobs.  It was an economically challenging year for many.  So I thought this year I would take this issue head-on and make a list for people who want to save money on eyecare. But, as a doctor, it wouldn’t be appropriate to just say, “Skip your exams, squint instead of updating your glasses, and wear your contacts until your eyes fall out.” First, it isn’t sound advice. Second, many of these actually cost more money in the long run.

So here is a list of New Years Resolutions to Save Money on Eyecare (Without Sacrificing Quality). I hope that you find it helpful.

1) Maintain a regular schedule for eye exams.

Many people feel that they are saving money by skipping their recommended eye exams.  Did you know that eye exams are primarily about eye health, not just clarity of sight?  There are some blinding conditions with no symptoms that can only be detected with a thorough eye exam. If caught early, they can often be treated early with much simpler treatments. This can save hundreds or thousands of dollars of complicated treatment, including ocular surgery. This doesn’t even factor in the lost income and quality of life that can come from the loss of vision.

2) Get the exam that you pay for.

This may seem very obvious, but you should be sure that you are getting a complete and thorough eye exam. After all, if you are paying for something, you should get it.  Sometimes people are reluctant to have their pupils dilated during an exam, but if they don’t, the doctor cannot look for signs of disease in the back of the eye. Find out if there is a charge to come back and finish the exam at a later date. If you bring your child to eye doctor because you have concerns that vision may be affecting school performance, ask beforehand what type of tests are included.  Not all vision plans will cover this specialized testing, so you should find out how much it costs.

3) Utilize InfantSEE.

As with all health issues, prevention is more cost effective than treatment. This is particularly true for infants. An eye early eye exam can detect potential problems such as extreme nearsightedness and farsightedness as well as strabismus and amblyopia. To assist in this, the American Optometric Association created the public health initiative called InfantSEE. Optometrists who participate in the program will provide one visual and eye health exam to infants between six and twelve months old at no charge.

4) Understand your Vision Plan, Medical Insurance, Flex and HSAs.

Some medical plans have coverage for eye exams. Some plans specifically cover medical problems such as eye infections and glaucoma. Other plans are specifically for vision and will have coverage for a vision exam, glasses, or contacts, but not medical visits. If you or your employer pays for these benefits, use them wisely. Find out what the annual benefits are. Ask the doctor’s staff to help you maximize your benefits. For example, you are getting both glasses and contact lenses and your plan only covers one of these, you may save more money applying the benefits to the glasses.  Also know that you cannot ask that the vision plan be billed on a different date than you actually received the service.  However, you CAN use your Flex and HSA accounts for eyecare and optical purchases.

5) Select your eyewear carefully.

When you are picking out eyewear, try on the styles and brands that you like. But keep in mind the purpose of each pair of glasses you buy. You might love the Tiffany & Co. frames with crystals, but if you work or play hard, it might make more sense to get some less expensive frames that are built to be durable. Costa Del Mar sunglasses are durable, but if you are prone to losing them(or dropping them in the gulf!) spend a extra few dollars on a glasses strap. And when shopping  around, be sure you compare apples to apples. A discount store or online retailer may be cheaper,  but consider material quality and customer service when making your choice.  Will your optical service remake lenses in the case of an error?  What happens if the coating flakes off within a few months?

6) Get the right lens materials and coatings.

Find out what the doctor or optician recommends for lens options, but don’t just assume that more expensive is better. Some lens options are worth a little extra: Crizal Alize or VisoXC will improve the clarity of your lenses, reduce glare, and resist scratches.  Some fabulously high-tech lens materials are essential for someone with a very high prescription but may be a waste of money if you have a low prescription. We always recommend UV protection for all general purpose glasses, but if you only use glasses for reading indoors, then it may not be needed. I encourage you to get glasses that meet your needs, but that doesn’t mean that every pair has to have all the bells and whistles. If the optical staff do not explain your options to your satisfaction – ask. They may be able to help you save money when they understand how the glasses are to be used.

7) Try multipurpose lenses.

Do you own just one pair of shoes? Not likely, because most people have different shoes for different purposes. Your eyes also have different needs and no one single pair of glasses will meet all those needs.  But you don’t need to own a baker’s dozen pairs of glasses either. If you have a different prescription for reading and distance (like most people over 45), save money with just one pair of bifocals or progressives. In Florida, it is best to have a dedicated pair of prescription sunglasses.  But eyewear with clip-on sunglasses or Transitions (that darken in the sun) are a cost-effective and protect your eyes from UV and bright sun.

Make use of your warranties.

If you are spending hard-earned money on glasses, you expect them to work well for you. Always inquire about what warranty is included in your purchase. At Bright Eyes, all of our eyewear frames come with a 2 year, unconditional breakage warranty. If you get premium scratch coating, it also includes 2 year scratch warranty. See if your optical offers similar coverage and if they do, make use of it.

9) Learn about your contacts.

Talking to your optometrist about your contact lens options.  Monthly lenses may be a cost-saving option for full-time wearers;  daily lenses are a good deal for occasional contact wearers, especially when you factor in the solution costs.  RGP (hard) contacts frequently outperform their soft counterparts and can be up to half as expensive.

10) Consider alternative financing options.

Many offices, including ours, accept Care Credit, a health care credit card with options for 6-months interest-free financing.  This is helpful for more expensive treatments not covered by insurances, such as Corneal Reshaping (orthokeratology), an method of providing glasses- free vision, or vision therapy, which allows people to overcome visual challenges to live life up to their potential.  Even eyeglasses and eye exams qualify for Care Credit purchases. Ask about Care Credit or similar programs at your doctor’s office.

I hope that this has been helpful in ensuring that you get best eyecare possible! Happy New Year!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.
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Yes, it is that time again. Cold and flu season and that often means “pink eye” AKA conjunctivitis. Here is a little video I found on You Tube about Pink Eye:

If you have a red, irritated eye, don’t wear your contacts. Call the office to schedule an appointment to make sure it isn’t something more serious.

Be Well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Retinoblastoma can be devastating, even fatal. This is an amazing story about one very brave boy, Jake Olson.

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.