Are there contact lenses for dry-eye patients?
There are a number of options – not just contact lenses but a number of treatments that can improve a dry-eyed person’s ability to wear contact lenses. They need a more hydrated lens, which makes daily disposable lenses an excellent option. Any surface deposit, you get a clean, healthy lens on the eye every day. So they tend to do much better. Other soft lens materials that improve wearability or decrease symptoms when contact is in the eye also need the right solutions. These are made to work with particular lens materials. Ten years ago all solutions worked with all types of soft lenses. Now only certain types of work with certain lenses.
If we’re in the right lens material and they’re fit properly and you’re using the correct solution some people benefit from treatments to improve the baseline level of tears. We can use tear plugs, which effectively block the tear drain (in-office procedure, no pain, takes 5 minutes) and provides an increased lake level so the contact lens rides on a deeper level of tears and thus causes fewer symptoms of dryness.
How do I know if I am a good candidate for Lasik?
That’s the most common question we’re asked. The key with laser surgery is matching your goals with what the laser can correct. You should think in terms of functional goals. Maybe you’d like to water ski without contacts, follow the ball while playing golf without your contacts or glasses, read without your glasses. Can we accomplish that with laser-vision correction? It’s functional surgery. It’s not cosmetic. It’s a really great procedure with a very low risk of complications.
The best way to tell if you are a candidate is first to have your comprehensive eye-health vision exam. That tells us 70 percent of what we need to know if you’re a candidate for refractive surgery.
If you wear contacts your prescription is a good place to start. Are you within range of what we can correct? Generally, that’s about 1-11 units for laser surgery and up to 5 units for astigmatism. We can correct certain levels of nearsightedness and farsightedness, and 80-85 percent of people will fall into those categories. You have to be within that range and stable, not changing.
If after a discussion with your Cool Springs or Donelson Eyecare doctor everything looks good for your candidacy then we have you back for the remaining 30 percent of necessary pre-surgical tests. Those tests can determine definitively how safe it is for you to have surgery. We’ll put you on the right medications preoperatively and set up your surgery with the right surgeon and right technique for you.
Not all surgeons and methods are alike. There are 15 or so who do it in Middle Tennessee, but about four who provide the best outcome. How do you know? Come to us and we’ll tell you who’s best. We want you to have surgery once. The point is to give you improved vision and function without complications.
How do you treat glaucoma?
Glaucoma is a disorder of the optic nerve, so treatment protects the optic nerve. Right now most of our treatments incorporate the use of eye drops to lower pressure on the eye, which puts less stress on the optic nerve and protects it. We marketed eye-pressure checks that most people still equate glaucoma with high pressure, but it’s not even included in the definition of glaucoma anymore. High eye pressure is a risk factor, but in and of itself it’s not glaucoma. Glaucoma is asymptomatic. Have a comprehensive eye-health examination yearly or as prescribed by your doctor. Most of our emphasis besides early treatment is monitoring people who have risk factors and following them closely so they never develop any loss of vision or any visual-function problems. Treatment is first aimed at prevention through exams on a regular basis. If you develop glaucoma it does not mean it’s going to lead to blindness. We treat it with eye drops to prevent further damage and sometimes will incorporate the use of lasers and surgery to manage a particular individual’s glaucoma.
How old does my child need to be to wear contact lenses?
There is no set age. It’s more a question of your child’s maturity. You might be surprised to learn that the success rate with contact lenses with 8-year-olds and above is 80-90 percent. The goal we set with them is for them to be able to put in the contacts and take them out themselves and wear them for the time we set.
Two factors move us toward contacts at an earlier age. One is involved in sports. Contacts are better and safer, typically than glasses. If your child is involved in football, basketball, baseball, tennis, soccer, cheerleading, etc., you should consider contacts.
The second is cosmetics. Perhaps your child already has asked about contacts. Don’t be shy about bringing your child’s concerns to the attention of your Cool Springs or Donelson Eyecare doctor.
Daily disposable lenses work great for children. They can be part-time or full time. They eliminate the need to take care of solutions and cases, and we have more contamination from those than the lenses themselves. So they’re very convenient for patients and parents.
I am thinking about Laser surgery. What are some of the side effects I should be aware of?
The Laser is a very safe procedure. In fact, it’s the safest. You’ll see the risk involves blindness, but it’s an infinitesimally small risk. The laser is also very effective but not 100-percent perfect. There is a great chance we can reduce your prescription, but not a 100-percent chance you’ll walk out and never have to wear glasses again. There’s an 85-percent chance that – with the best surgeons in town – you’ll be able to see without glasses and contacts. You might still have some astigmatism, near or far; you might still need to wear glasses or contacts. The laser can be repeated. We wait 3-6 months, and we can enhance or provide a second surgery. Glare and halos are two more common side effects. But we see those less and less with custom eye surgery. There are fewer problems with nighttime vision. The more common side effect is dryness. Everybody’s eyes are dryer after laser, but it gets better. There are a number of therapies before surgery to minimize the chance of dryness after. There’s nearly no discomfort through the post-operative course.
I hate the aftereffects of dilation. Why is it necessary and do I have options?
Yes, you have options. The reason we dilate pupils is so we can see inside the eye better. Historically we needed to do that so we had a good view of the retina. We’ve had Optomap since 2002, though, and it allows for a digital retinal image taken through a normal-sized pupil without drops. Optomap allows us to see the full extent of the retina, and you get to review that with us on a flat-panel monitor so you can see what we see.
There are cases where dilation is necessary, such as peripheral cataracts and certain retinal problems where we need more of a 3-D view. Routine dilation in a general comprehensive eye exam is not necessary. Unfortunately, when we do have to dilate, the drops that make the pupil bigger freeze the focusing system. Lights are brighter because the pupil is bigger and we can’t focus, especially up close. Those drops last longer in brown-eyed patients than blue-eyed patients.
As always it’s best to talk to your doctor about whether Optomap is suitable for you, but in most cases it is.
I have diabetes but my vision seems clear. Do I need to have my eyes examined or should I wait until I have a change in vision?
You need to have your eyes checked annually at a minimum if you have been diagnosed with diabetes. The changes that can cause a loss of vision with diabetes mostly have to do with swelling of the macula, and that’s not often perceived by the patient. You should check your swelling or any other changes in the blood vessels due to diabetes.
There are many early treatments with medicine or laser to reduce fluids and preserve vision. If we examine a patient who has a loss of vision because of diabetes and fluid we can only stabilize it. Early diagnosis is critical to maintaining your vision.
The best thing patients can do to protect their vision is to keep their blood glucose under good control with their endocrinologist or regular physician. HbA1c is a measure of your average sugar over the preceding three months. That number is between 5 and 12, and there’s less progression of eye trouble when that number is less than 7.
I have heard about contact lenses that can be fitted to allow me to see without glasses. Do they work?
There are gas permeable lenses that we can fit in a certain manner to reduce a person’s prescription such that they can function without their glasses in many cases. Think about orthodontics for your teeth. Braces reform the dental structure to allow teeth to be straight. Certain types of lenses on an overnight basis work as a sort of retainer. You take them off in the morning and you can function without your glasses for the next 24-72 hours. Many people like the flexibility of going to bed with contact lenses and waking up not having to wear glasses.
There are a limited number of practitioners who work with gas permeable lenses and understand them well enough to do that. We are one of them. Gas permeable lenses are a less expensive way to function without glasses or Lasik surgery.
I have problems with my vision on the computer. What options are there to make it easier?
Most people who do a lot of computer work have eye strain. Keep your eyes well lubricated. Break every 30 minutes. Try not to stare. Blink.
Soft progressive contact lenses give a good field of vision. Another thing that really works well is computer lenses and glasses. Computer lenses are designed to give a large field of view and give focus or aim at the right distance for computer use while also allowing someone to read at close distance. Over-the-counter reading glasses are best designed when someone has equal trouble in both eyes. You can read with these but you have to move really close to see the computer screen. Computer lenses allow you to do both. They give you a reflection-free surface.
Sometimes we’re asked what kind of lighting can lessen eye strain. Incandescent lights work better than fluorescent lights because they have less glare. They’re best placed over your shoulder rather than shining straight down on your screen because that will cause fewer reflections.
I see floaters. Should I be concerned?
A floater is a term for a change in the fluid inside the eye. Two-thirds of your eye is made of a fluid-like a gel called the vitreous. Over time that gel becomes a little runnier, and when it moves and becomes more fluid some fibers stick together and cast a shadow on the back of the eye. They’re a nuisance but they don’t steal our vision. Over time because the fluid is moving around, they eventually will move out of the way. They tend to be a lot more visible against a blue sky or white background.
The floaters that are more of a concern are showers of floaters accompanied by flashing lights. The fluid sits next to the retina, and if it pulls on the retina it can cause a retinal detachment. So any new floater that you notice should be checked out to make sure the retina is not at high risk.
Is there such a thing as bifocal contact lenses?
Yes, and now they’re much better and generally very easy to adjust to. They’re available in soft and gas permeable, and for most people, they provide reasonably good vision for far away, computer and near so as to minimize the need to wear reading glasses. You can’t throw away your glasses, but for active people who want options, the progressive contact lenses are a good thing to consider.
You’ll hear us refer to them as “progressive” lenses. Try them. The technology has improved greatly.
My eyes are dry. What options are there to make life easier and my eyes less dry and more comfortable?
Dry eyes are one of the most common problems that we face for patients of all ages, in particular as we mature and more likely in women.
Eyes become drier and can cause mild irritation, and sometimes that can develop into significant problems.
What we’ve learned in the last few years is that dry eyes are not just a product of less moisture but also are characterized by a chronic inflammatory problem. When we treat them we think in terms of lubrication and reducing swelling on the surface of the eye.
The most common treatment is drops. Restasis is the only drop that actually increases the production of tears. It can be very effective, as can other drops.
You also can incorporate nutritional elements. Omega-3 fatty acids are very helpful in lubricating the eye.
What can make dry eyes worse? This might surprise you, but sleeping under ceiling fans could contribute to dry eyes. So can dry conditions, contact lenses, and certainly some medications.
My eyes itch during allergy season. What do you recommend to help them?
There are some very good prescription drops and some good over-the-counter ones. They can really take care of the itch. Some are once or twice a day during even the acute phase of allergy. Sometimes go past antihistamine. Use steroid eye drops to minimize the burning and watery red feeling that are associated with allergic eye problems.
Systemic antihistamines do a good job of treating nasal and upper respiratory discomfort, but usually, they do not have enough penetration into the ocular surface to help with an intense itch. If your eyes are really itchy, come see us.
It’s particularly important for kids. Some eye doctors believe untreated itchy eyes which lead to intense rubbing can lead to a weakening of the cornea. That can lead to keratoconus. There’s a higher rate of allergic eye complaints in people who have misshapen corneas.
My friend’s eyes always look red. What eye conditions can cause this?
Irritation is the number one contributor to red eyes. Red eyes are the dilation of the blood vessels to leak out anything irritating the tissue. Some examples are allergies, viral infections, bacterial infections, toxic fumes, perfumes, chemicals, chlorine in the water. There are a couple of other things we think of when we think about chronically red eyes. Dry eyes are a major cause of chronic red eyes. Tears become thinner and there’s not enough lubrication so the body tries to assist. Unfortunately, it leads to dilated blood vessels. Visine constricts the blood vessels and thus contributes to dryness.
Another common condition with red eyes is related to rosacea, an inflammatory condition on the cheeks, forehead, and chin. The same glands that get irritated on our skin are at the base of the eyelashes. They can cause chronic irritation and inflammation in the eyes. They can give people red eyes or reddened eyelid appearance.
Certain other eye drops can cause irritation or over time will make a person’s eyes red. Any red eye, acute or chronic, should be evaluated by your eye doctor.
My son and daughter are really into sports. What can I do to help them play their best when it comes to vision?
People acknowledge that vision is important in any sport, but they overlook how our visual system can limit our play if it’s not working to its best.
At the fundamental level, make sure your prescription is corrected and basic muscle-balance and eye-health issues are addressed. The next level is what type of vision correction is best. Certain contact lenses are better for sports. Athletes have a higher level of correction needed. Astigmatism that someone else might not address might be something an athlete should have corrected. Athletes also need to consider whether they should have sports glasses or goggles, the right tinting, peripheral vision, safety protection, what can fit under a helmet, etc. They need someone who can connect the athletic needs with their eye needs.
The third level to help the athlete is to take the vision they have, their static sports vision, and give them exercises that through repetition can improve their baseline. We can improve peripheral awareness, motor skills, dynamic visual-motor acuity. Can you be moving and jumping and still recognize a ball with letters on it, pick out the letters? That requires an enhanced visual system.
At Cool Springs EyeCare we understand that the athlete’s eyes work uniquely within a given sport. We can provide exercises and/or the right level of correction to help them excel.
One of my parents has macular degeneration. Should I be taking vitamins to prevent it?
If you don’t have macular degeneration the true data says you don’t need to be taking vitamins. The AREDS study proved that if you already have developed macular degeneration you may benefit from a formulation of nutraceuticals that’s high in zinc. Now, family history … the longer we live our macula undergoes changes that result in blurred central vision.
There are some factors to monitor to reduce that risk.
- Stop smoking. If you don’t smoke, don’t start.
- Keep your blood pressure, particular your lipids, in a good range. The macula is supplied by a hugely active hemodynamic area. It’s especially prone to blood pressure or arthloscerotic diseases affecting it.
- Wear sunglasses. UV cumulative light seems to break down the macula tissue.
Blue eyes can increase your risk of macular degeneration. African-Americans, Latinos and darker pigmentations are at lesser risk of developing it. There seems to be some evidence, this is only hypothetical and anecdotal, that higher levels of Omega-3 fatty acids may turn off a gene that causes the macula to be susceptible. Higher levels of antioxidants despite not being proven to be helpful may over a longer period of time prevent some macular degeneration.
So dietary oily fish, 2-3 servings, and green leafy veggies like mom always told you to eat – broccoli, spinach, greens – are the best things to pursue. There’s no truth that carrots make your eyes or vision better or prevent macular degeneration.
What are the advantages of better quality frames?
They last longer, have a better warranty, stay in shape on your face better and look better, won’t break down, and hold the lens better. If they’re left in the car the materials will tend not to warp as much.
In a lot of cases, more time and effort is spent on the comfort and look of the frame. It’s usually better to invest more in the frame and the lenses if you want something to last and provide a more comfortable vision when you have the lens on. Higher-end frames sometimes are better for fashion but may not be better quality. You’re paying for the fashion. It’s worth it to invest more to a certain level. But when you get above $500 you’re probably paying just for the name or the fashion. That’s OK because maybe that’s what you want.
What are the signs or symptoms of glaucoma?
Typically there are no symptoms with glaucoma. It’s an optic-nerve problem. The optic nerve transmits all of the visual information to the brain.
Historically we convinced people that high eye pressure meant glaucoma. The reality is a lot of people have glaucoma without high eye pressure. It’s not even part of the definition of glaucoma anymore. Only 5 percent or fewer of patients have a high enough eye pressure that they’ll have pain or symptoms attributable to glaucoma.
Some of the signs or symptoms are changes to the optic nerve, small losses of side vision, or higher eye pressure that might cause damage to the optic nerve.
The most important thing to do is to have your annual eye exam. Family history is a risk factor. So is diabetes. We generally start to say around age 40 your risk starts to go up by about a ½ percent a year. Glaucoma can happen at any age, but typically it takes time to develop. We’re more likely to be treating it in patients who are older than 40.
Most people should not go blind or lose significant vision with glaucoma. If it’s caught or diagnosed early you usually can maintain good vision just with eyedrops. Sometimes we might encourage laser or other surgery to get the eye pressure to a low enough level that the optic nerve won’t be damaged.
It’s essential to be diagnosed as early as possible. Newer technologies allow us to tell who has a few suspicious findings from who is truly developing glaucoma.
In the early days, it was diagnosed when a person said they couldn’t see well. Now it’s long before a patient has had any loss of vision or any problems.
What is new in cataract surgery detection and care?
For 15 years now cataract surgery has been performed with no shots, no patch, and no pain.
The two newest advancements are the size of the incision and the type of implant.
The incisions now are virtually microscopic. One area doctor is making a 1.8-millimeter incision. Smaller incisions mean quicker healing time and less chance for infection.
We always put an implant in when we remove a cloudy human lens. Before the standard implant was very good for distance vision but you needed reading glasses. Now we use a “progressive” implant, a multifocal interocular lens. For many of our patients, this lens will provide not only clearer vision but will minimize the need to wear glasses at all.
What should be included in a comprehensive eye examination?
Three main areas are covered: eye health, muscle balance and function, and the refractive state of your eye.
We will examine the front, back, and middle of the eye, the internal structures, looking for cataracts, glaucoma, changes in the retina, problems with the cornea. The absence of vision problems does not mean that you don’t need an eye exam.
We’ll check your muscle balance and function with a battery of tests. How do your eyes focus, align, the transition from near to far and far to near? We’ll also check your depth perception and color vision.
The refractive state refers to whether you’re nearsighted or farsighted.
One of the neatest advances is the ability to do a very comprehensive exam without needing to use eye drops. We can check eye pressure without that familiar air puff and we can scan your retina without dilation and its aftereffects.
What should I do to protect my eyes from developing macular degeneration?
The macula is the most sensitive part of the retina that provides our straight-ahead or central vision. Over time it starts to wear out and break down. In some patients, it breaks down at an earlier point and you can lose straight-ahead vision. That’s called macular degeneration.
There are preventable things we know you can do to minimize your chances of macular degeneration. Don’t develop diabetes. If you do have diabetes, keep it in check. Stop smoking. Control your blood pressure. Wear good ultraviolet sunglasses outside. Those cumulative effects can hurt your central vision.
There are reports that some nutrients, such as lutein and Omega-3 fatty acids, can minimize the risk of macular degeneration, but those reports have not been confirmed. There are vitamins for people with macular degeneration that can slow the process. They’re not shown to be of benefit to those who don’t have it.
Otherwise, research is ongoing. A family history of macular degeneration suggests you may be at higher risk, as are those with lighter-colored eyes. For your individual-risk profile consult your Cool Springs or Donelson Eyecare doctor.
What should I look for in high-quality sunglasses?
First and foremost you want to have lenses that protect against UVA and UVB light. The cumulative effect of that light will cause damage to the lens and retina inside the eye and can contribute to dryness and chronic redness on the front of the eye. We’re much more exposed to this in the Southeast. Interestingly you can’t always trust because it’s a brand name that they’re going to protect against UV light. You can always have your glasses tested on a UV analyzer, which we can do here.
Secondly, the quality of the optics really varies in no-power sunglasses. You should be able to put a good pair on and it should not distort the world as you look straight ahead and also as you move the glasses up and down in front of your eyes. Do that trick to make sure the world doesn’t move because there is some power ground into the lenses. That can strain your eyes.
We buy sunglasses for fashion and function. Are they for the beach? Driving? Golfing? Biking? Racing? All of that affects which type works better. Some can be made with a person’s prescription. As with any product you want to know who is standing behind it. Are they made well? You’re paying good money, what are you covered for? The quality of the scratch-resistant surface can vary widely. Some are automatically replaced. The color and degree of tint should be consistent with how you use the sunglasses. Gray or green will provide a more natural view. Brown will change color perception. In general, we don’t recommend blue tint because those are actually allowing higher levels of blue light, which is scattered more, to be transmitted.
What vitamins should I take or supplements should I use to protect my vision?
There are a lot of nutraceuticals out there and a lot of the information regarding them is fact mixed with some snake oil mixed with some good intuition. Separating something marketed vs. something researched is important and where we come in.
A few facts: If you have macular degeneration a study, Age-Related Eye Disease Study (AREDS), has proven that in the majority of cases you can slow the process with higher zinc, copper, betacarotene. However, in that original study, Lutein Zeanthifili was not studied, but it is often included in over-the-counter vitamins. Some good anecdotal information suggests that lutein should be beneficial, but that has not been verified. There’s an ongoing study that we should have data from in 2-5 years that take the AREDS formulation and breaks out some components. Does half the amount of zinc give a lower rate of progression? Adding lutein, Omega-3 fatty acids (fish oils). When we get AREDS 2 we’ll know more about slowing macular degeneration. If you do not have macular degeneration there is no benefit to taking these meds. Certain supplements appear to be healthful for people with dry eyes, including Omega-3s. Flaxseed oil for women is beneficial to improve tear film and hydration of the cornea. We don’t yet know particularly the right level for each individual. That’s customized over time.
We can’t talk about nutrition without saying what you should avoid for healthy eyes. Smoking is No. 1. It increases your chances of macular degeneration, cataracts form, and it decreases your tear film and leads to dryer eyes.
When I see cop shows on TV, I always see them checking a DUI suspect’s eyes. What are they looking for?
One of the signs of higher blood alcohol content that cannot be masked or prevented is nystagmus. This is an oscillating or vibrating movement of the eye that tends to occur in gazing to the right or left. If someone is particularly inebriated he or she may have nystagmus looking straight ahead. You can’t hide involuntary eye movements.
When should I have an eye exam?
Here is what we recommend:
Age Recommended Eye Exam Frequency
Infant Initial Infant See® Exam between 0-1 (Our doctors recommend this free exam to achieve the best vision for your child and for peace of mind for you as a parent)
3 and 5 Comprehensive Exam with Eye Doctor
6-18 Every 1-2 years
19 – 40 Every 2-3 years
41 – 60 Every 1-2 years
61+ Every year
In addition to the above minimum standard protocols, anyone who falls into one of these categories requires at least an annual eye exam to preserve and protect their best vision:
- Contact-lens wearers
- Diabetic patients
- Any ocular condition or suspicious finding requiring follow-up (glaucoma or glaucoma suspect, nevus, cataract, macular degeneration, post Lasik patient, etc.)
Why are some progressive (or no-line) bifocals better than others?
It’s a general category, like when we talk about tennis shoes. Sometimes you might be better off with Nike, or Reebok, or Adidas. Some very low-cost progressive lenses are poor performing, but there are many that are very advanced and offer a lot of visual advantages. In general, better progressives make it so much better to adapt to and function. Almost 98 percent of people who need help with loss of near vision can adapt well to progressive lenses. We use higher-quality technology to make it easier. Higher-quality characteristics are good distance vision without distortion to the sides, a large reading area, and a good-sized middle channel that allows for a good width of focus on the computer. It’s important in any particular part of progressives that you have them sized effectively. If the transition zone from far away to up close is set too far away you don’t get the full benefit of the reading zone. Zeiss technology measures head and eye positions to make sure they’re centered correctly. We have very experienced opticians who understand how to measure and how each progressive works to make them the best fit for your particular visual needs.
Will marijuana prevent glaucoma?
Marijuana is an effective drug at lowering eye pressure. However, it’s not as effective as other commercially available treatments. The systemic side effects of marijuana are much greater than the medicines we use to treat eye pressure. For that reason, those wanting a medical reason to treat glaucoma with marijuana don’t have as much scientific evidence to support them when there are other better alternatives available.
Will wearing glasses make my eyes worse?
No. When we prescribe glasses for a refractive area they’re changing the optics of light so they focus on your retina where the image should. Wearing glasses doesn’t prevent you from becoming more nearsighted nor does it cause more nearsightedness.
Changes to your prescription are caused genetically or occupationally. Some people do a lot of work in close proximity to their computer screens. Glasses and contacts do not make eyes better or worse. Perceptually some people may take their glasses off once they’re used to seeing really clearly, and there’s a reason for that. You’re used to the way you see and you have a redefinition of what great vision is. Your brain sets the bar higher. The same vision you had without glasses isn’t as tolerable now without the glasses.