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Optometrists providing Wichita and surrounding areas with designer frames, contact lenses, incredible customer service, and unmatched eye care for over 35 years.
What Is It?
Dry Eye Syndrome is a condition in which there are insufficient tears to lubricate and nourish the eyes. Either there are not enough tears or the tears are of poor quality. Common, often chronic, particularly in older adults, and may cause chronic redness to the white part of the eyes.
Who Gets It?
§ Older Individuals- Tear production decreases with age
§ Female- Due to hormonal changes, use of oral contraceptives and menopause
§ Side Effects of Medications- Antihistamine, Decongestants, Blood Pressure medications, Diuretics and Antidepressants
§ Medical Conditions-Rheumatoid Arthritis, Diabetes, Lupus, Thyroid conditions, Stroke Patients, Fibromyalgia
§ Environment- Smoke, wind, dust, debris in work conditions, dry climates
§ Dehydration- Too much caffeine, not enough water
§ Failure to blink when performing near task (tablets, phones, e-readers, computers)
§ Contact lens wear or Lasik surgery
Is it a Serious Condition?
In most cases, Dry Eye is not a serious condition. However, in moderate to severe cases it may make a person more susceptible to bacterial and viral infections of the eye. Some of these infections can cause scarring of the cornea and long term visual decline. In addition, Dry Eye can affect vision by general blurriness and visual distortion. Depending on one’s profession, this may or may not be serious. For such professions that rely on vision to make life or death decisions, namely soldiers, firefighters, policemen and women, EMTs, trauma nurses, and surgeons of all types, dry eye is a very serious complication. If these professionals can’t see clearly, they can’t perform their jobs to the best of their ability. Other patients with even mild to moderate Dry Eye may have every aspect of their lives affected in terms of their ability to work, use a computer, read, take a test, or ride comfortably in a car or plane. Comfortable, clear vision is a tremendous factor in today’s fast paced visually demanding world.
Treatments
Adding Tears to the Tear Film- Ask your doctor as not all tear supplements are made the same in terms of viscosity, preservatives and healing properties.
Conserving Tears -Keeping the tears in the eye longer.
Punctual Occlusion- block some not all tears from draining out of the eye
Increasing Tear Production
Glaucoma
January is Glaucoma Awareness Month, so we want to focus on this disease process and the best ways to diagnose, prevent, and treat it. Glaucoma is a multi-factorial, complex eye disease with its primary characteristics being damage to the Optic Nerve and subsequent visual field loss. Vision loss occurs when the intraocular pressure is too high for the specific individual and therefore damages the optic nerve. This damage cannot be reversed. With glaucoma, side vision is affected first. It may be either gradual or rapid and vision loss may go unnoticed by the individual. Over time, if glaucoma is not treated, central vision (reading, recognizing faces, etc.) can be decreased and lost.
Those at risk for developing glaucoma include those with a family history of the disease, African Americans over the age of 40, and everyone over 60 years of age, especially Mexican Americans. In addition, those who have a poor diet, are lacking in exercise, are overweight and smokers are also at risk. According to the National Eye Institute, more than four million people in the United States have glaucoma. Unfortunately, nearly half of those with glaucoma are not even aware that they have it.¹
Since glaucoma has no symptoms (except in rare cases), and if nearly half of four million people in the U.S. are not aware that they have glaucoma, it would seem to highlight the importance of regular eye exams. Most comprehensive eye exams will include measurement of intraocular pressure, analysis of your visual field, and assessment of the optic nerve. If you have findings that indicate a suspicion of glaucoma or have one or more risk factors for glaucoma, further testing may be warranted. Such special tests may include Optical Coherence Tomography (OCT), Pachymetry, and assessment of the proper drainage of fluid out of your eyes.
Optical Coherence Tomography is like an “MRI” for the eyes and will allow your doctor to assess the Optic Nerve down to the cellular level. An OCT will show the health of you Ganglion Cell layer as well as the Retinal Nerve Fiber layer and allow for monitoring of changes to this tissue over time. Pachymetry measures the thickness of your cornea and the measurement of fluid drainage can be affected by growing cataracts and cause an increase in intraocular pressure. If your doctor deems your cataract to be causing this increase, laser treatment to decrease the pressure or even cataract surgery may be warranted. At this point in time, all glaucoma treatment is focused on decreasing the pressure in your eyes. This can be done with drops, laser, or conventional surgery.
(1) National Institutes of Health, National Eye Institutes, News Brief: Look to the Future: Get an Exam to Save Your Vision From Glaucoma.
Below is an article that recently ran in the online version of The Wall Street Journal. This is a testament to why we do many of our most in-depth tests.
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As an ophthalmologist, David Ingvoldstad sees much more about his patients' health than just their eyes. Thanks to the clues the eyes provide, he regularly alerts patients to possible autoimmune diseases like rheumatoid arthritis and lupus, monitors progression of their diabetes and once even suspected—correctly, as it turned out—that a patient had a brain tumor on the basis of the pattern of her vision changes.
Because the body's systems are interconnected, changes in the eye can reflect those in the vascular, nervous and immune system, among others. And because the eyes are see-through in a way other organs aren't, they offer a unique glimpse into the body. Blood vessels, nerves and tissue can all be viewed directly through the eye with specialized equipment.
With regular monitoring, eye doctors can be the first to spot certain medical conditions and can usher patients for further evaluation, potentially leading to earlier diagnosis and treatment. Clots in the tiny blood vessels of the retina can signal a risk for stroke, for example, and thickened blood-vessel walls along with narrowing of the vessels can signal high blood pressure. In some cases, examining the eye can help confirm some of the diagnoses or help differentiate disorders from each other.
"There's no question the eye has always been the window to the body," says Emily Chew, deputy director of the epidemiology division at the National Eye Institute. She adds, "Anybody with any visual changes…should be seeing someone right away."
Scientists are working to advance their knowledge of what the eye can reveal about diseases. For instance, researchers are studying how dark spots on the back of the eye known as CHRPE, or congenital hypertrophy of the retinal pigment epithelium, are associated with certain forms of colon cancer, and how dementia-related changes are signaled in the eye, such as how the eye reacts to light. Other scientists, like Dr. Chew, are studying how to keep the eye healthier for longer, which could be good for the health of the eye as well as the rest of the body.
Companies are building enhanced technology that allow for better viewing of the eye. Scotland-based Optos, for example, created a machine that allows for better screening of the periphery of the retina. The machines can now be found in doctors' offices and research clinics. Instead of the typical 30-degree view of the eye, it offers a 200-degree view. Being able to see more of the periphery could mean earlier or more accurate diagnosis of various diseases and may also be coupled with intervention tools to improve treatment. Optos is currently funding a study of the use of retinal imaging to diagnose heart disease, according to Anne Marie Cairns, head of its clinical development.
The eye's job is to deliver vision by converting incoming light information into messages that the brain can understand. But problems in vision can indicate a problem outside of the eye itself.
One critical structure in the eye is the retina, which allows us to experience vision. It is made of brain tissue and contains many blood vessels. Changes in vessels in other parts of the body are reflected in the retina as well, sometimes more noticeably or sooner than elsewhere in the body.
The eyes can help predict stroke risk, particularly important to people with heart disease and other stroke risk factors. That is because blood clots in the arteries of the neck and head that might lead to stroke are often visible as retinal emboli, or clots, in the tiny blood vessels of the eye, according to the National Eye Institute.
The immune system's interaction with the eyes can be telling, too, yielding information about autoimmune diseases or infections in the rest of the body. Sometimes eye symptoms may appear before others, like joint pain, in patients.
For instance, inflammation in the optic nerve can signal problems in an otherwise healthy, young person. Along with decreased vision and sometimes pain, it can suggest multiple sclerosis. If the optic disc, a portion of the optic nerve, is swollen, and the patient has symmetrical decreased field of vision, such as a decreased right visual field in both eyes, they may need an evaluation for a brain tumor—a rare circumstance.
If immune cells like white blood cells are seen floating in the vitreous of the eye, it could signal a local eye infection or one that is spread throughout the body.
Diabetes is one disease that can cause major changes in the eye. In diabetic retinopathy, a common cause of blindness, blood vessels hemorrhage and leak blood and fluid. When blood vessels don't function properly, they can potentially cause eye tissue to be deprived of oxygen and to die, leaving permanent vision damage.
Also, in diabetic patients additional blood vessels may grow in the eye, anchoring themselves into the sticky gel known as the vitreous, which fills a cavity near the retina. This condition can cause further problems if the retina tears when it tries to separate from the vitreous—a common occurrence as people age—but is tangled by growth of new blood vessels.
Usually diabetic patients who come in for eye exams already know they have the disease, and the primary purpose of an eye exam is to make sure they don't have diabetic retinopathy or, if they did have it, that the condition hasn't progressed, say eye doctors like Dr. Ingvoldstad, a private practitioner at Midwest Eye Care in Omaha, Neb. But once in a while there is a patient who has noticed vision changes but didn't realize he or she had diabetes until alerted during an eye exam that there were signs of the eye disease that is consistent with the condition, he says.
The American Academy of Ophthalmology recommends eye examinations whenever individuals notice any vision changes or injury. Adults with no symptoms or known risk factors for eye disease should get a base line exam by age 40 and return every two to four years for evaluations until their mid-50s. From 55 to 64, the AAO recommends exams every one to three years, and every one to two years for those 65 and older.
With August being Children’s Eye Health and Safety month we would like to focus on common visual deficiencies, how a child’s eyes work to read and important safety tips for your child’s eyes.
The three main refractive errors are nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Nearsighted children see well up close, but not far away and may “fool” a lot of educators and parents as they typically do quite well in school. Farsighted children can see great far away, but may struggle to focus to read for long periods of time with decreased comprehension. Astigmatism causes varying levels of blur because the cornea (the clear front part of the eye), or the lens inside the eye is “out-of-round”. All three of these conditions can be corrected in most children with prescription glasses.
The eyes also need to accommodate or focus on a near target adequately and be able to maintain that focus while reading. The lens inside of the eye has to “change” its shape or accommodate on the page of a book in coordination with the muscles in the eye and proper signals from the brain. In some cases, reading glasses are an appropriate treatment for accommodation deficiencies.
The eyes also need to “point-in” or converge to read the words on a page. Even if your child sees 20/20, if their eyes under-converge or over-converge, they will struggle to read. Under or over-converging causes words on a page to variably go in and out of focus. If your child over-converges, reading glasses may alleviate this problem. In some instances of under-convergence, glasses are not warranted but rather visual therapy, a form of physical therapy for the eyes, is needed to fix the problem.
The only way to be certain that your child is seeing to the best of their ability is to schedule a routine eye examination. During the exam the optometrist will test your child’s visual function to determine the steps necessary to correct any vision issues and maximize their performance in the classroom, on the sports field and to navigate the complex digital world we live in.
Steps also need to be taken to insure the safety of your children’s eyes. Throughout the summer, families spend a lot of time together at the lake and pool. While these activities give us a chance to cool down they also put us in direct contact with the elements, including sun and wind exposure. Recent studies have shown that ultraviolet (U.V.) light contributes to cataract formation, as well as, a contributing factor in Age Related Macular Degeneration. These studies also show that U.V. light has more of an effect on children than adults. One of the best things you can do, from a health standpoint, for your child is to get them a good pair of sunglasses that blocks 100% of the UVA and UVB light and get them in the habit of wearing them. And as always, contact lenses should never be worn while swimming in pools, lakes and oceans as toxicity and microbial contamination rates are high.
In observance of Women’s Eye Health and Safety month in April, we would like to shed some light on two common eye diseases that affect females. Age-Related Macular Degeneration (A.M.D.) and Chronic Dry Eye Syndrome affect females at a higher rate than males and increases in frequency with age.
A.M.D. is the leading cause of blindness in the United States. Current estimates in the U.S. show that eight million Americans have intermediate stage A.M.D. Even more alarming is the fact that 1.3 million will progress to neovascular (wet) A.M.D. within the next five years. How do you know if you are at risk? We know that the primary risk factors for developing AMD are: age, genetic disposition or genetics, smoking and low macular pigment. We cannot change our age or genetics and overall smoking is decreasing in the US. Recent evidence is showing an ability for us to modify our macular pigments to decrease our risk of A.M.D.
Secondary risk factors of A.M.D. include: female gender, light colored skin and eyes, high body index (overweight), unprotected exposure to the sun and poor diet. We have been told for years that diet and exercise are good for us and sun exposure is bad. Interestingly, people of Equatorial descent such as African, South American and Indonesian have low incidences of A.M.D. On the other hand, individuals of European, Scandinavian, Russian ad American descent have a much higher incidence of A.M.D. The common link here is pigmentation, in particular, darker pigmented individuals have more macular pigment, likely as a protective measure against the sun.
Affecting more than 15 million people in the United States, A.M.D. is the leading cause of blindness in adults 55 and older. A.M.D. comes in two main forms: dry A.M.D. and wet A.M.D. Recent studies have shown promise in preventative measures using vitamin supplementation, specifically Zeaxanthin and Lutein, which serve to protect the macula.
Our office has incorporated a vitamin called EyePromise® Restore that contains both Zeaxanthin and Lutein and is showing good results to boost a person’s macular pigment. Increasing your macular pigment density has shown to protect against the progression of the degenerating process of A.M.D. We track macular pigments in our office with an instrument called Quantify® by Zeavision. This allows us to monitor how effective vitamin supplementation is working.
For wet A.M.D., there have also been great strides in care. Wet A.M.D. occurs when there is enough damage to the macula allowing new blood vessels to grow into this area. These new blood vessels tend to be leaky in comparison to regular blood vessels and leak blood into the macula. This blood can subsequently cause scarring and poor vision. New treatments are aimed at preventing these new blood vessels from leaking blood and thus preventing scarring of the macula and preserving visual function.
Dry Eye Syndrome also affects females and its prevalence goes up with age. Dry eye is very common, and under diagnosed, and often self treated. Common symptoms include: “stinging, burning, scratchy sensation in eyes and stringy mucus in or around the eyes, increased irritation with smoke or wind, eye fatigue after short periods of reading, sensitivity to light, difficulty wearing contact lenses, excessive tearing, and blurred vision often worsening at the end of the day or after focusing for a prolonged period.” [1]
As you can see from the symptoms list, Dry Eye ranges from slightly annoying to severely affecting ones quality of life. Treatments are aimed at replacing the three components of the tear film using lubricating drops, gels, ointments as well as prescription emulsions like Restasis®. A lot more emphasis recently has been on nutrition in the area of omega-3-fatty-acids through diet or vitamin supplementation.
April is also women’s eye safety month and most folks head outdoors to enjoy free time with their family activities. This is also the time where more people are working outside either full-time or on the weekend around the house and in the yard. It has been well documented that ultraviolet rays can have a negative impact on the skin in terms of skin cancer and especially the skin around the eyes and nose. Sunglasses, larger in size than your small trendy dress glasses, will serve to protect the skin around the eyes.
Sunglasses should have a high quality ultraviolet filter inside the lens and not as a thin film on the front of the glasses as this can be scratched off and lose its effectiveness. Ultraviolet filters in sunglasses serve to protect the lens inside your eyes from cataract development as well as keep harmful rays off the macular preventing further damage or development of A.M.D. Polarized sunglasses also block light that is reflected off of water making your vision for boating, fishing and poolside activities more visually comfortable.
Unfortunately, this is also the time of year where eye care professionals see more cases of eye trauma from construction workers, lawn/garden/tree workers and the weekend gardener. Protective eyewear prevents a vast, majority of these injuries; however, we urge special care with weed eaters, edgers, saws and the like. Good quality safety or a wrapped sunglass, like Oakley or Maui Jim, comes in handy to most lawn activities as well as golf and tennis. Enjoy the summer and be safe!
[1] Mayo Clinic