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Diabetic Eye Disease Awareness Month

November is Diabetic Eye Disease Awareness Month. Approximately 34.2 million Americans have been diagnosed with diabetes, while around 88 million currently have prediabetes, the condition that occurs just before diabetes. Because this disease affects so many people, I thought I’d take a moment to discuss the ways that it can affect a person’s vision.

What is Diabetes?

Before we discuss the eye conditions that can happen as a result of diabetes, let’s look at the disease itself. Diabetes occurs when there’s too much sugar (glucose) in the blood over time and not enough insulin (the hormone that helps cells process sugar) being made to handle these glucose levels. There are three types of diabetes, type 1, type 2, and gestational.

Type 1 diabetes is hereditary and happens as a result of the body not being able to make insulin on its own. Type 2 diabetes is largely preventable and is caused by high glucose levels and a person’s body no longer making enough insulin. Once there’s not enough insulin to handle the amount of sugar in the blood, glucose levels are hard to control. While type 1 and type 2 diabetes are incurable, gestational diabetes is usually a temporary condition that affects some women during pregnancy.

What is Diabetic Eye Disease?

While diabetic eye disease may sound like one condition, it’s actually a group of conditions that those living with diabetes are particularly susceptible to. All of these can negatively impact a person’s ability to see clearly and can potentially cause blindness. Eye conditions that affect those with diabetes include the following:

  • Diabetic retinopathy- Your retina is the portion of your eye that detects light and sends signals through your optic nerve back to your brain. High blood sugar levels can cause the blood vessels to the retina to leak, damaging the eye over time.
  • Diabetic macular edema- This condition is caused by fluid build-up on and around the retina that causes swelling and blurred vision.
  • Cataracts- Cataracts can happen to anyone, but diabetics are more at risk due to the increased sugar in their blood.
  • Glaucoma- Like cataracts, glaucoma can affect many people, but having diabetes doubles your risk for this condition.


As I said before, diabetes causes an increase of sugar in the bloodstream. This causes damage to blood vessels, which in turn can cause a number of other health problems including diabetic eye disease. Controlling diabetes with medication and diet is the first step to preventing diabetic eye disease.

It’s also extremely important that those living with diabetes or at risk for diabetes have a comprehensive, dilated eye exam at least once a year. While there are very few obvious warning signs of diabetic eye disease, a trained eye care professional can spot and help treat problems before they become more serious.

If you are one of the many people currently living with diabetes, find an eye doctor who will work closely with you to prevent these conditions and keep your eyes healthy for life!

Pre-school Vision

Preschoolers use their vision to guide all their learning experiences. From ages 2 to 5, a child will be fine-tuning the visual abilities gained during infancy and developing new ones.

Stacking building blocks, rolling a ball back and forth, coloring, drawing, using scissors, or assembling toys all improve important visual skills. Preschoolers depend on their vision to learn tasks that will prepare them for school. They are developing the eye-hand-body coordination, fine motor skills and visual perception necessary to learn to read and write.

This is also the time when parents need to be alert for the presence of vision problems such as crossed eyes or lazy eye. Crossed eyes or strabismus involve one or both eyes turning inward or outward. Amblyopia, commonly known as lazy eye, is a lack of clear vision in one eye, which can’t be fully corrected with eyeglasses. In addition, parents should watch their child for an indication of any delays in development. Difficulty recognizing colors, shapes, letters, and numbers can occur if there is a vision problem.

Steps taken during these years to help ensure their vision is developing normally can provide a child with a good head start for school.


School-Age Vision

A child needs many abilities to succeed in school. Good vision is key.It has been estimated that as much as 80% of the learning a child does occur through his or her eyes. Reading, writing, smartboard work, and using computers are among the visual tasks students perform daily. A child’s eyes are constantly in use in the classroom and at play. When his or her vision is not functioning properly, education and participation in sports can suffer.As children progress in school, they face more demands on their visual abilities. The size of print in schoolbooks becomes smaller and the amount of time spent reading and studying increases. When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful, and children will typically:

  • Avoid reading and other near visual work as much as possible.
  • Attempt to do the work anyway, but with a lowered level of comprehension or efficiency.
  • Experience discomfort, fatigue, and a short attention span.
  • Some children with learning difficulties exhibit behaviors of hyperactivity and distractibility. These children are often labeled as having “Attention Deficit
  • Hyperactivity Disorder” (ADHD). However, undetected and untreated vision problems can elicit some of the very same symptoms commonly attributed to ADHD.

Because vision may change frequently during the school years, regular eye and vision care are important. The most common vision problem is nearsightedness or myopia. However, some children have other forms of refractive error like farsightedness and astigmatism. In addition, the existence of eye focusing, eye tracking, and eye coordination problems may affect school and sports performance. Eyeglasses or contact lenses may provide the needed correction for many vision problems. However, a program of vision therapy may also be needed to enhance vision skills.


Vision is more than just the ability to see clearly or having 20/20 eyesight. It is also the ability to understand and respond to what is seen. Basic visual skills include the ability to focus the eyes, use both eyes together as a team, and move them effectively.Other visual perceptual skills include:


– the ability to tell the difference between letters like “b” and “d”


– “picture” in our mind what is happening in a story we are reading


– be able to remember and recall details of what we read

Every child needs to have the following vision skills for effective reading and learning:

  • Visual acuity — the ability to see clearly in the distance for viewing the chalkboard, at an intermediate distance for the computer, and up close for reading a book.
  • Eye Focusing — the ability to quickly and accurately maintain clear vision as the distance from objects change, such as when looking from the smartboard to paper on the desk and back.
  • Eye-tracking — the ability to keep the eyes on target when looking from one object to another, moving the eyes along a printed page, or following a moving object like a thrown ball.
  • Eye teaming — the ability to coordinate and use both eyes together when moving the eyes along a printed page, and to be able to judge distances and see depth.
  • Eye-hand coordination — the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball.
  • Visual perception — the ability to organize images on a printed page into letters, words, and ideas and to understand and remember what is read.

If any of these visual skills are lacking or not functioning properly, a child will have to work harder. This can lead to headaches, fatigue, and other eyestrain problems.

When is a Vision Exam Needed?

Your child should receive an eye examination at least once every two years-more frequently if specific problems or risk factors exist, or if recommended by your eye doctor. Unfortunately, parents and educators often incorrectly assume that if a child passes a school screening, then there is no vision problem. However, many school vision screenings only test for distance visual acuity. A child who can see 20/20 can still have a vision problem. In reality, the vision skills needed for successful reading and learning are much more complex.

Let’s Discuss Donuts

Today we want to talk about glaucoma, so naturally we’re going to talk about donuts!

Now, we know what you’re asking: What does glaucoma have to do with donuts? An excellent question. No, it’s not because donuts are amazing and should be discussed (they of course are, and they should).  The answer lies in the key to glaucoma diagnosis and treatment, which is to protect the optic nerve, and your optic nerve resembles a, you guessed it, glazed donut. With a donut you have the edible part (arguably the best part) and the hole in the middle. Now while the optic nerves in our eyes don’t actually have a hole, they do have a central depression called the “cup”. During every one of our eye exams we measure the healthy optic nerve (edible part of the donut) and estimate the size of the central cup (hole).

Central cupping can vary due to genetics, refractive error (eyeglass prescription), race, and a few other factors. 33% of the average American’s optic nerve is represented by the cup, meaning the average donut hole is a third the size of the donut.  In general, smaller is better, larger is worse.

What is most important is to measure and monitor the size of the cupping (donut hole) over time. If the donut hole is growing and the edible part of the donut is becoming thinner, it is very likely that the patient may be developing glaucoma.

Glaucoma is truly defined as vision loss characterized by loss of healthy optic nerve tissue over time.  We monitor that with an OCT for structure and visual field for function.  There are a number of evidence-based medicine tests which help us monitor patients who are suspicious for developing glaucoma in the hope that we can prevent, or catch, an early transformation from “suspect” to true glaucoma.

So, now that we’ve taught you a thing or two about glaucoma (and simultaneously made you hungry), ask yourself: What size is MY donut? That’s the question we hope comes to mind the next time you drive by a Krispy Kreme, Dunkin, Donelson, or Cool Springs Eyecare!

If you have any questions about glaucoma or want to schedule an appointment to get your donut checked, call Donelson EyeCare today!

Diabetes – Complications with Sugar

Diabetes and eye health are tied together more closely than you may realize! Let us shed some light on this relationship so you know how it can affect you and those close to you. Diabetes is becoming more and more prevalent in the area, as (9%) of Tennesseans are reported to have diabetes. In some areas of the country, that number exceeds (12%). It is an epidemic that is a truly a growing concern in America and other countries.

We can debate the causes (poor diet, lack of exercise, increased high fructose corn syrup, etc.). The reality remains that we must diagnose, treat, and protect patients from diabetic problems. How does this relate to vision health? The answer lies in a disorder known as diabetic eye disease.

There is both good and bad news when it comes to diabetic eye disease. The good news is most diabetic eye problems do not cause pain. None of us like pain. However, when you have a disorder that is asymptomatic (showing zero to few symptoms) it is especially dangerous. It is dangerous because patients do not report any specific problems or symptoms, even blurred vision in many cases. This leads to a number of patients with diabetic eye disease receiving treatment after the disorder has developed. That’s the bad news.

Let’s talk facts.

Diabetes is the number one cause of new cases of blindness among the working population in the United States, and this has been true for many years. The number one cause for loss of vision and diabetes is due to a fluid buildup in the central part of the retina called the macula. This fluid buildup disrupts vision in mild to moderate levels but is often not as perceived by the patients. For that reason, we use high-quality equipment, doctor knowledge, and advanced technology to evaluate the patient’s retina and macula.

(80%) of vision loss and diabetes is caused by this fluid buildup. The best way to imagine this is noting how you see when you are under water in a swimming pool. It is not as clear as when you are above the water level. Ultimately, that type of blurry, foggy, watery vision is what we’re trying to prevent by diagnosing diabetic eye macular edema (fluid). In some cases, the fluid buildup creates a signal to the brain that it needs to send more blood vessels and oxygen to the retina. While this seems like a good idea, ultimately these new blood vessels are very brittle and breakable. They also have an elasticity to them, so they stick to other parts of the inner eye. These new blood vessels (called neovascularization) can lead to severe loss of vision due to large hemorrhages or retinal detachment. Each of these can be devastating complications that, if left untreated, can lead to blindness. Even when treated, many people do not return to their normal pre-event vision level and therefore suffer from vision decreases.

In general, diabetes can affect many areas of the eye from the cornea (dry eyes) and lens (cataracts) to the optic nerves (glaucoma). Despite these other affected areas, diabetes is especially known for its vascular complications due to leakage and new blood vessel formations at the macula or on the retina.

The best way to prevent diabetic complications are:

  1. Make sure you are seeing your general physicianand understand any risk factors you might have for developing diabetes.
  2. Discuss with your physician the right diet – typically low sugar or carbohydrate to minimize the development of diabetes over time.
  3. Have your eyes checked annually – even if youdon’t have any symptoms of changes in vision.

Our mission is to protect, correct, and enhance eye health and vision. Diabetes poses a significant threat to our patients and those in the United States due to complications on the retina. Your annual eye health and vision exam is a high value, low hassle way to provide you with peace of mind and protect your vision for life.

Fall Allergies: Cause, Effect, and Solution

Seasons changing are often something to look forward to. Especially when the chill of winter is conquered by the warmth of spring, and the swelter of summer is subdued by the cool crisp of autumn. One of the downsides of changing seasons, however, is the allergens that come along with them. So, let’s talk the causes, effects, and solutions of seasonal allergies and how they can upset your eyes. The focus of this talk? Fall.


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Let’s kick this conversation off with a quick background of your eyes and why they can get the brunt of allergy effects. An article from WebMD gives a good explanation, stating that the layer of skin covering the front of your eyes is “…the same type of skin that lines the inside of your nose. Because these two areas are so similar, the same things can trigger allergic reactions in both places.” Typical eye allergies that affect your eyelids, the layers of skin that cover the front and the inside of eyes, are referred to as allergic conjunctivitis by your Doctor of Optometry (OD).

One of the most common allergy triggers that can bother both your nose and your eyes is ragweed pollen. Ragweed grows across the US and its pollen releases during the fall months, with its highest pollen counts in mid-September. While ragweed does not grow in every single state, it can travel in the wind for hundreds of miles!

Two other common triggers in autumn are mold and dust mites. The leaves that pile up outside your home as they fall gracefully from the trees provide a nice, damp breeding environment for mold. Dust mites are invited to frolic around in homes, schools, and other commonplace indoor locations once heat gets turned on in the fall.

You’d probably never guess how much two things that are vastly loved can play a big hand in eye allergies – body fragrances and bonfires. Have you ever noticed that being around a friend or coworker in the spring and summer is perfectly fine but come fall, you’re constantly sneezing and rubbing your eyes around them? This could be because the perfume or cologne they brand themselves with during the cooler months contains an allergen that irritates your eyes. While bonfires are a fun way to gather under the stars around the warmth of an outdoor fire, wildfire smoke can irritate your sinuses and trigger your eye allergies as well.


The American Optometric Association shares that, “ocular allergies are the abnormal response of sensitive eyes to contact with allergens and other irritating substances.” and notes that eye allergies are, “one of the most common ocular surface diseases in primary eye care.”

When allergens come into contact with eyes’ mast cells, an important part of all immune systems, release histamines and other chemicals that can cause your eyes to become inflamed, red, swollen, itchy and watery in an attempt to fight off the allergen. These responses can also cause your eyes to become sensitive to light.

While we should thank the attempt, the response can be extremely frustrating! So, let’s move on to solutions.


Some solutions are very simple but can still be quite hard to secure. For example, taking a hands-off approach. It’s difficult not to touch your eyes throughout the day, especially when they’re itchy, but rubbing your eyes can only make things worse.

A few other short term simple solutions include avoiding eye makeup, applying a cold compress to your eyes, and wearing sunglasses while outdoors to act as a shield against allergens.

You might also want to consider purchasing a dehumidifier and an air filter, switching your bedding from cotton to naturally hypoallergenic silk which also serves as an inhospitable environment for dust mites, and swapping your contacts with glasses when your eyes are suffering.

While over the counter eyedrops can also be very helpful and soothing, consider scheduling an appointment with one of Cool Springs EyeCare’s practice ODs for a comprehensive eye exam to confirm there are no other causes for the symptoms you are experiencing and to construct a customized plan for you during the allergy seasons!

Can My Eye Really Fall Out?

It was big Olympic news. A long distance swimmer was accidentally struck in the eye by a competitor’s arm or elbow during a swim competition. He immediately “went blind” and thought “his eye had been knocked out.” Bad news for this Olympian-he had sustained blunt trauma to the globe and orbit. Good news for this guy-there is almost no physical way his eye could fall out. I have heard post cataract surgery patients swear that their past doctor took their eye out, removed the cataract and then put the eye back in. Good news for them…they had a cataract removed from inside the eye, replaced by an implant, yet did not have their entire eye removed.

This begs the question. If I am hit in the eye, can my eye really fall out? The answer is theoretically, yes, but practically, no!

The eyeball (globe) is connected in the socket very firmly by many muscles, connective tissue, tendons and the optic nerve. Each of these structures are so tightly connected to the globe that to disengage the eyeball would mean catastrophic trauma that crushes the face, head, skull and more often than not would result in devastating injury or death for the patient. Trauma does occur to the eye, and we treat this all the time in our offices. It can result from racquetballs, fists, motor vehicle accidents, chair and table legs or any number of other possible causes. Fortunately, the soft globe (eyeball) is well designed and protected by the bony orbit surrounding it. Ever get a black eye? The bruising and swelling around the eye is evidence that the protective bones surrounding the eye socket took most of the blow.

In some cases the eyeball itself receives a blunt concussive blow and this coup/contra coup force can cause damage inside the eye. When this occurs, we look for lacerations, torn or dislodged structures, blood inside the eye (hyphema) or retinal problems (swelling, hemorrhage or detachment.) We can even see dislodged or damaged eye muscles, stretched optic nerves and any number of other visually threatening sequelae.

We are here to treat whatever traumatic insult affects your eye, whether abrasions, inflammation, hemorrhage, glaucoma, lens or retinal problems. We have a doctor on call 24/7/365 for those and other reasons.

If you sustain a blow to the eye, it is best to let your eye doctor evaluate, diagnose and advise you of the best treatment to preserve or improve your comfort and vision. Yet be assured, even if it feels like someone knocked your eye out, it will still be inside your head…and you do not have to worry about it falling out!

Dr. Keg

A Tribute to Dr. Dave Brown

Dr. Dave BrownMy former partner Dr. Dave Brown passed away yesterday due to complications caused by COVID. Dave was a dedicated optometrist, good husband and father and all-around fine man. He will be missed by many.

Dave and I became acquainted when I moved to Nashville to run our eye disease center, VisionAmerica. Dave was on the board of directors, made up of leading optometrists from around the area. As was customary, I went to each of the doctor’s offices to meet them and find out how we could better serve their patients. Dave had his practice in downtown Franklin at the municipal building at that time. Over the years we shared patients back and forth between our eye disease center and his practice.

Eventually, I wanted to transition my practice mode into ownership and primary eye care. Dave was the right person, with the right practice, at the right time. My wife Susan and I got to know he and his wife, Mona and over the course of year-long discussions, which ultimately culminating in me becoming a partner with Dave. We started together and renamed the practice Cool Springs EyeCare in 2000.

Dave was a great partner. He was smart, built trusting relationships and was timely in his care. Since I had been practicing eye disease for so long, I had to be reminded of contact lens parameters, fitting and care as well as the subtle nuances of glasses prescriptions. Dave was always gracious with sharing his knowledge and taught me the practical aspects of optometric eye care. His independence likely prohibited him from working for me as the managing doctor, yet I never begrudged him leaving or continuing to practice in the area.

Though our partnership ended in 2004, we remained aware of each other’s pursuits. Dave told me once that “he could not stay retired as he could only pick up sticks in his driveway for so long!” He continued to see patients and do eye exams in the Franklin area for the past years. And of course, his wife Mona was always by his side. During my work with him we would meet regularly for lunch, he, Mona and me. My enduring memory, both during our partnership and through the times afterward, are of Dave and Mona, together as a couple, eating, talking and just being…together.

I am shocked and saddened by Dave’s untimely passing. I value what I learned from him and the times we shared together in practice. I am saddened for his children, whom he expressed so much love and pride for in each of our conversations. And I am of course feeling for Mona. Dave and she shared a special bond, both at home and at practice. They were an inseparable team. I think Dave knew he had out kicked his coverage and was grateful for every day he had with Mona. And I know she felt the same about him. The community has lost a dedicated and faithful original Franklin-ite.

I am thankful for getting to know Dave, and like so many others, will miss him.

Dr. Jeff Kegarise

A Close Up of Presbyopia

beautiful blonde pleased woman reading book while 2021 04 06 06 13 52 utcThrough each stage of life, from infancy through adulthood, your eyes and visual needs will change. One of those changes, and arguably the largest and most frustrating, will come in your early 40’s. Yes, we are referring to the need for reading glasses which is technically referred to as presbyopia.

Presbyopia is the gradual loss of your eyes’ ability to focus on near objects or tasks. The lens inside the eye loses its ability to change shape over time, which is necessary to focus at near. This is, unfortunately, a natural part of the aging process. Symptoms will include blurred vision up close, a tendency to hold reading material further away, or eyestrain after reading or computer work.

There are several ways to combat presbyopia, and the good news is, your optometrist can help!

1. Glasses

There are multiple glasses options available for our presbyopic patients. First, a simple pair of prescription reading glasses may help. With reading glasses in place, close objects will appear more in focus. However, since the distance prescription is now different than the near prescription, these glasses that were specifically designed to help with near, will unfortunately make vision in the distance significantly more blurry. This will result in a constant on and off with the glasses depending on the task at hand. Or, if there is also a need for distance correction, constant switching between distance and near glasses. For those who find this highly frustrating – enter multifocal glasses.

Multifocal glasses simply mean that both distance and near can be seen through the lenses; the top part is designated for distance, and the bottom for near. Even these come in two styles: blended or non-blended. The blended style is the most common and referred to as a progressive lens. The progressive lens gives clear vision at all ranges (far, intermediate, and close) and is more ideal for those who spend several hours on the computer throughout the day. The non-blended style is referred to as a bifocal. This style still gives distance in the top but has a small box in the bottom nasal corner of the lenses for reading. There is no intermediate/computer area in these lenses.

2. Contact Lenses

Several contact lens options exist for presbyopic patients as well! There are multifocal contact lens options which incorporate distance prescription as well as near prescription into the lenses. There is also an option referred to as monovision, where the dominant eye is set to see far and the nondominant eye is set to see close. Both multifocal and monovision contact lenses can take some getting used to, but after adapting, most patients do well with one of these options.

3. Surgery

Although traditional LASIK does not correct for presbyopia, LASIK can be performed in the monovision format – where one eye is corrected for far and the other eye is corrected for near. Since not all patients adapt well to monovision, it is wise to test this out for several months in contact lenses before opting for surgery. Furthermore, when it is time for cataract surgery, there are multifocal implant options now available.

4. Other Options

Hold tight for other presbyopic treatments in the pipeline! Vision focused pharmaceutical companies are working on clinical trials for the development of eyedrops to treat presbyopia. When this option is ready and available, we’ll make sure our patients are of the first to know!

Written by Dr. Aimee Jacobs

As I See It—Podcast!

As I See It

Our doctors not only wrote the book on patient care, but now they’ve launched a growing podcast that is starting a patient revolution!

As I See It is hosted by Dr. Jeff Kegarise and Cole Evans. They discuss, in depth, a variety of topics, such as frequently asked questions about eye care, at what age you should start bringing your child to the eye doctor, understanding how they can see signs of diabetes through an eye exam, how long you can really wear contact lenses, and so much more.

Dr. Jeff invites guests on from across the country to help bring insightful, valuable discussion and eye care education directly to his patients!

Listen to an episode here!