Alamo Optometry Blog
LASIK
Saturday, March 6, 2010
LASIK (As appeared in Alamo Today, March 2010, page 24) During the past few months, I have had more patients inquire about and proceed with LASIK. Most people at this point are pretty well-informed about the subject and have either gone through the procedure themselves or know someone who has. Since there have been more questions about it recently, I will cover some of the frequently asked questions without going into the technical aspects of the procedure itself. What is LASIK? LASIK is an acronym and stands for Laser ASsisted In-Situ Keratomelusis. A thin flap is made in the shape of a horseshoe within the cornea and then peeled back to expose the inner structures of the cornea. The excimer laser is then applied to the tissue to remove and reshape the cornea depending on your correction. The flap is then put back in place and heals on its own. What is the difference between LASIK and PRK? PRK or photorefractive keratectomy, was the precursor to LASIK. The main difference between the two procedures is that in PRK a corneal flap is not made. Patients usually decide to do PRK instead if they are not an optimal candidate for LASIK due to thin corneas and/or large pupils. Even though the end results are the same, the healing time with PRK is longer and only one eye is done at a time. What is wavefront technology? This is an optimized or "personalized" version of LASIK. The procedure is the same except for the program the computer uses to apply the laser treatment. Everyone has corneas that are just a little irregular and has hills and valleys in addition to being near-sighted or far-sighted. This procedure seeks to eliminate all of the known impediments to vision, so the only limit is what your brain can process for you. This leads to crisper and improved vision especially at night. Am I a candidate for LASIK? There is a wide-range of prescriptions that can be corrected by LASIK. Large amounts of far-sightedness, near-sightedness, and astigmatism can be eliminated with the procedure. Keep in mind that there are FDA limitations on the amount of correction that can be done by LASIK and that some prescriptions might not be optimal for full LASIK correction, but can be done nonetheless. A comprehensive eye examination is required to fully assess your prescription and eye health and must be done within 6 months of the surgery. How long is the recovery? Assuming the procedure goes well, you can be back to work within a few days. Most people schedule the surgery at the end of the week so they have the weekend to rest and are ready to go on Monday morning. What are the side effects? The main side effect from the procedure is dry eyes. Most people will experience some dryness/stinging/burning after the surgery. For some people it could last for a few months. For most, it is mild and resolves within a few weeks. There is always risk for infection, but that is minimal as you will use an antibiotic drop the day before the surgery and for a few days after. If you have large pupils, there will be a chance of glare and haloes in dim lighting, especially night driving. Are there any age limitations? Most surgeons will wait until you are 21 to do the procedure. There is no maximum age for the procedure; however, it is not recommended into your 60's because of cataract formation which will blur your vision. Keep in mind that your prescription needs to be stable to do the procedure. So regardless of age, if your prescription is always changing, LASIK will not halt the progression. When you are older and need reading help, monovision is a viable option for most patients, but it must be trialed with contacts first to ensure adaptation and good vision before proceeding with the surgery. Obviously this is meant as some general information regarding the procedure. There are many other things that need to be discussed, along with other refractive surgery or contact lens options. We are more than happy to do your exam here in the office and give you an opinion on your visual and refractive surgery needs. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Eye Terms
Wednesday, February 3, 2010
Eye Terms (As appeared in Alamo Today, February 2010, pg. 29) When I have patients in my office and I am explaining to them the results of my examination, I try to explain terms and conditions in a manner that is easy to understand. At times that is difficult, but I believe my patients need to leave the exam understanding what went on and why my recommendations were given. To help assist, I will give some straight-forward definitions of everyday conditions I see in the office. Myopia: "near-sighted", this means that without any type of correction on, it is easier to see close than far. Depending on how high the prescription, it might even be very difficult to read since you will have to hold reading material extremely close to have it in focus. Hyperopia: "far-sighted", it is easier to see farther away than up close. Far-sighted people are always working to keep objects in focus and the closer the point of focus, the more power and work needed. Patients with a high prescription generally will have sustained near-point issues like fatigue, headaches, avoidance, etc. Keep in mind this only refers to your distance vision, not up close difficulty (see next). Presbyopia: "short-arm syndrome". This diagnosis is given when your ability to focus up close starts to decline. Keep in mind this is a completely normal process that starts in your 40's and stops somewhere in your mid 50's. Remember this does not mean you are far-sighted, that defines your distance vision only. Astigmatism: This occurs when your cornea is not completely round. A simple analogy is that it is shaped more like a football or egg. It is not a disease; it is just how your eye was formed and developed. This can be corrected with glasses, most contact lenses, and LASIK (also depending on other factors.) Cornea: This is the clear front portion of the eye that is in front of the iris (colored part of the eye). This structure is where contact lenses are placed and what is operated on in LASIK. The cornea has no blood vessels so it only receives oxygen from the air and your tears. Cataracts: This is another age-related finding in which the lens, which is inside your eye, becomes harder and denser. This eye structure continues to grow throughout life, so as you mature, if becomes a barrier to clear vision and needs to be removed. The three main contributors besides age are UV exposure, diabetes, and therapeutic steroid use. Surgery to do this is simple with a relatively quick recovery. Macular Degeneration: Everyone seems to be concerned about this condition, including myself. This is a disease that degrades your sharp, central vision along with color vision. The macula is the very small area in your central retina that gives you 20/20-corrected vision and color vision. Once this vision is lost, you do not get it back. As of now, there is no cure. There are many treatments, but they are aimed at treating the bleeding blood vessels in the retina, which hopefully halt or slow down the progression. There is a genetic link to this disease, but currently the best thing you can do to improve your chances besides annual exams is to not smoke. Everything else equal, there is a 4-6 fold increase risk for any person who currently smokes or smoked a considerable amount in the past, but has since quit. Retina: This structure has 10 layers and of all the organs in the body, it uses the third most amount of oxygen (behind the heart and brain). The retina interprets the light images it receives and changes it into an electrical signal that is sent to your brain to process via the optic nerve. Optic Nerve: The optic nerve is the wiring connection between the eye and the brain. The optic nerve does not contain photoreceptors, so it does not interpret any images you see; hence this is your blind spot when you look out into the world. Glaucoma is a disease that slowly kills the optic nerve, so end-stage of the disease is blindness since no signal is sent to your brain from the affected eye(s). Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Glaucoma
Wednesday, January 6, 2010
Glaucoma (As appeared in Alamo Today, January 2010, pg. 27) Since I have had a few cases recently of glaucoma, I believe a discussion on the disease itself and its treatment is needed. There seems to be a lot of confusion and misinformation regarding this sight-threatening disease. First of all, let’s talk about the definition of glaucoma. Glaucoma is a group of diseases that slowly kills your optic nerve and is a leading cause of blindness in the world. The typical age of onset is late 60’s and later, and affects about 4% of the population. The exact cause of glaucoma is not known at this time. However, the end-stage result of glaucoma is blindness, since the optic nerve is the wiring connection between your retina and brain. Glaucoma usually develops when the pressure in the eye becomes elevated. This can usually happen when too much fluid is produced, or the drainage channels in the eye do not drain the fluid properly. However, a patient does not have to have high pressures to have glaucoma. Up until recently, glaucoma used to be a completely pressure-dependent disease. Studies have now shown that not to be the case. Unfortunately, the exact etiology still eludes us. One of the big problems with glaucoma is that it is a “silent” killer; it does not bring you into the office. It does not give you a headache, blur your vision, make your eye red, etc., like the normal conditions that bring you in for an eye exam. I tell my patients that when you can start to appreciate some peripheral vision loss, you are already about 75% of the way to full progression of the disease. Therefore, annual exams are extremely important for early detection because we can only stretch out the course of the disease, not cure it. The difficulty with glaucoma is that the diagnosis is usually not definitive. Most patients I see are initially labeled as “glaucoma suspects”, pending further tests. When the diagnosis is not evident, we try to elicit some personal and family history that can help sway the verdict one way or the other. Information such as age, ethnicity, family history of glaucoma, personal history of diabetes, hypertension, or heart disease can be instrumental in assessing a patient. Glaucoma is more common as we age and has a strong genetic component. African-Americans have a higher incidence of glaucoma; however, the exact reason is unknown. In addition, if a patient has any condition that is vascular (related to blood vessels) in origin such as diabetes and hypertension, they would need to be followed more closely if they are suspected of having glaucoma. If you are sent to the glaucoma specialist for an evaluation, he or she will run specific tests on your optic nerve, retina, visual field, and they will also measure the thickness of your cornea, which has been shown to be a contributing factor in glaucoma. If a diagnosis of glaucoma is determined, drops to lower and control your pressures are usually prescribed. Since glaucoma is a chronic disease, it is imperative to know for sure if you have glaucoma, because you will be treated and monitored for the rest of your life. Frequent visits to help monitor the progression will occur several times a year. It is also paramount for patients to continue to take their drops. Since patients initially do not experience any visual symptoms, non-compliance with treatment is high because the patient otherwise feels and sees fine. As described above, glaucoma is a disease that is difficult to diagnose and continue to treat because of the long-term care needed for the patient. At your annual exams, we will measure your pressures and assess eye health including the optic nerves to determine the likelihood of glaucoma. I always recommend to my patients that if some uncertainty exists regarding glaucoma, to get a consult at the specialist. I definitely prefer a conservative approach and have a full evaluation and determine that there is no disease versus waiting several years to have a consult and you have progressed in that time frame without any treatment. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Flexible Spending Accounts (FSA) vs. Health Savings Accounts (HSA)
Thursday, December 3, 2009
Flexible Spending Accounts (FSA) vs. Health Savings Accounts (HSA) (As appeared in Alamo Today, December 2009, pg. 27) The holiday season has arrived and on top of all the hustle and bustle that brings, insurance decisions for a lot of people need to be made for this year and next year. Many companies have their open enrollment during this period, so cafeteria, vision, and medical plans can be in effect as of January 1. In addition, many of our patients want to (and often need to) fully utilize their benefits for this year or they will be forfeited. To help clarify, here is a brief introduction to the common types of benefits that can be used at our office. A Flexible Spending Account (FSA) is one of a number of tax-advantaged financial accounts that can be set up through a cafeteria plan of your employer. An FSA allows an employee to set aside a portion of his or her earnings to pay for qualified expenses as established in the cafeteria plan; most commonly for medical expenses but also often for dependent care or other expenses including eye care, dental, and orthodontics. Money deducted from an employee's pay into an FSA is not subject to payroll taxes, resulting in a substantial payroll tax savings. Depending on the employer, an FSA may be utilized by paper claims or an FSA debit card, also known as a Flexcard. The important thing to remember is that any unused money not spent by December 31 will be forfeited by the employee. As the end of the year approaches, it is paramount that you know how much is left in your account to ensure full utilization. By comparison, a Health Savings Account (HSA), is a tax-advantaged medical savings account available to employees who are enrolled in a High Deductible Health Plan (HDHP) for your medical insurance. The funds contributed to the account can be made by both the employer and employee and are not subject to federal income tax at the time of deposit. Unlike a flexible spending account, funds roll over and accumulate year over year if not spent. Funds may be used to pay for qualified medical expenses at any time without federal tax liability. Like an FSA, most HSA patients have a debit card that can be used to cover any out-of-pocket expenses. The government has a wide range of specified expenses that qualify as a medical expense. These include any office co-pays, pharmacy bills, any necessary or elective surgical procedures (including LASIK), dental bills, orthodontics, and laboratory bills. Included in that list is any vision correction device (glasses, computer glasses, contact lenses, sports goggles, etc.) and sunglasses (prescription and non-prescription). As long as your purchase is made by the end of the year, it will count on your 2009 account balance. In addition to these tax-friendly accounts, do not forget to utilize your vision insurance. At our office, we are providers for Vision Service Plan (VSP), Eyemed (which can include vision coverage for Anthem Blue Cross and Aetna if the plan has a eye care provision), and Medicare. All plans have an exam benefit and have variable material allowances towards glasses or contact lenses. Some plans recycle on the change of the new year, so this is an optimal time to use your benefits. Between your vision coverage and your FSA or HSA, most if not all of your charges will be covered. Since this can be confusing for some people, we are available to answer any of your questions regarding insurance and FSA/HSA utilization. We are able to verify any insurance coverage on-line within a matter of minutes as long as we have all of the necessary information. You will always receive a detailed receipt showing your purchase if any proof is needed by your employer. We look forward to seeing you this holiday season and in the years to come. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Adult Vision Over 60 Years of Age
Wednesday, November 4, 2009
Adult Vision Over 60 Years of Age (As appeared in Alamo Today, November 2009, pg. 34) At last we reach the final article in our series. Here we tackle the vision and eye health issues over age 60. As your body and eyes age, vision changes do occur; some are natural and some are not. Conditions such as presbyopia (decreased ability to read) and cataracts are a normal part of the aging process. Other issues such as glaucoma and macular degeneration are more likely as you age, but are not a normal age-related finding. Even though cataracts are considered an age-related finding, they are so common that it is almost considered normal. According to some studies, half of all people over 65 have some degree of cataract formation, and that increases with age. A cataract is a clouding of the lens inside your eye. Cataracts cause a slow decrease in vision, a dulling of colors, and increased glare. The procedure to remove cataracts is extremely simple and is the most widely performed procedure in the United States. Age-related macular degeneration (AMD) is the leading cause of decreased vision among our seniors. The macula is in the center part of your retina, where light comes to a focus. Your macula is responsible for giving you good acuity and color vision. All detail work whether it is driving, reading, or recognizing faces is controlled by the macula. It is important to keep it mind that from macular degeneration alone one will never go “blind.” You will always have your peripheral or side vision intact; however, the periphery of your retina does not allow sharp vision. Your likelihood for AMD increases as you age; generally 1 in 5 over 70 and 1 in 3 over the age of 85 are affected. There are many new treatments available that we did not have even a few years ago. However, these are targeted to halt the progression, not to regain what has been lost. Glaucoma is a disease that causes irreversible damage to the optic nerve. The optic nerve carries the visual information it receives from the retina to your brain. Unfortunately, at this time, there is no cure for glaucoma; we are only able to slow the process down. Glaucoma is also a problem because it does not bring you into the office, i.e. it does not blur your vision, make your eyes red, give you a headache, etc. I tell my patients that by the time they can functionally see a decrease in their vision and peripheral vision, the disease has progressed about 75%. Early detection and treatment is paramount for this condition. The above-mentioned eye conditions generally take a long time to progress. These following conditions result in rapid progression and should be addressed as soon as possible: - You experience a sudden increase in floaters and/or flashes of light, or a dark curtain comes across your field of view. This can be a sign of a retinal detachment and requires a dilated examination as soon as possible. - Sudden eye pain, redness, headache with nausea. This is likely an acute attack of glaucoma caused by rapid increase in the pressure within the eye. - Sudden double vision. There can be many causes for this including a binocular vision disorder (eye-teaming) or diabetes. However, it could also indicate an underlying health condition such as a stroke. Even though I have only touched the surface of potential vision issues that affect humans as they age, it is important to understand that early diagnosis and treatment is key. Generally speaking, the earlier the diagnosis, the better the prognosis. Annual dilated examinations for these patients should be mandatory. As stated above, some issues can begin to affect your eyes without any tangible signs for you to notice. We have a great network of retina, glaucoma, and cataract surgeons at our disposal that we can refer to if needed. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Adult Vision Ages 41-60
Wednesday, September 30, 2009
Adult Vision: Ages 41-60 (As appeared in Alamo Today, October 2009, pg. 27) In our next-to-last installment in our series, we will address vision and eye health issues after ago 40. The most noticeable condition at this point is presbyopia. As those of you in this age range can attest, it is the need for reading and up-close help. In addition, systemic issues like diabetes and hypertension, medications including anti-depressants and antihistamines, and a family history of eye diseases such as glaucoma and macular degeneration come into play. Presbyopia or the “short-arm syndrome”, affects everyone at this time. It may affect some sooner than others, but there will be a point in time when through your distance correction (or no correction if your distance vision is fine), where you will need to address your up-close vision. The key thing to remember is this a completely normal part of the aging process. The decrease in focusing ability is the result of your lens in the middle part of your eye becoming less flexible. This flexibility allows the eye to change focus from near to far objects. For those of you that have never had to wear glasses, it tends to be a little more of a shock, because for the first time in over 40 years, you are having difficulty with vision. For the rest, it is simply a necessary change to your current vision correction. Keep in mind that there are many options for correction including progressive lenses, bifocals, and near-vision only glasses. In contact lens wearers, depending on your correction, bifocal contacts and monovision are always viable possibilities. Many systemic ailments including diabetes, hypertension, auto-immune diseases, and high cholesterol affect the eyes. A dilated evaluation of the retina allows the only view of the blood vessels without an invasive procedure. Being able to observe the size and appearance of the blood vessels can go a long way in telling whether you might have the disease in question. If you do have a condition, it is a good way to determine how well it is being controlled. The best thing you can do is follow-up with your treating doctor to ensure your treatment plan is successful and to have your eyes checked annually. Patients do not realize that certain conditions and medications can have a large impact on the eyes. Medications such as antihistamines, any hormone therapy including birth control, and diuretics for high blood pressure can have a drying effect, which can cause blurred and fluctuating vision, and decrease contact lens comfort and wearing time. Some antidepressants can affect focusing ability, and these patients might notice a difficult time reading. Steroids like prednisone, when taken for long periods of time can increase the pressure in the eyes (a possible sign of glaucoma) and lead to premature cataracts. It is paramount that your eye doctor knows all of your medical history including all prescribed and over-the-counter medications. Even though you might not think it is relevant to your eyes, it is very likely that it does. Lastly, it is around this age that patients’ parents are developing eye issues like glaucoma and macular degeneration. Our patients are obviously concerned for their loved ones, but are also concerned for themselves. These diseases do have a genetic component; however, it is not absolute. It does not mean that you will also be afflicted, but it does mean that you need to be more vigilant in your overall health and eye care to help ensure if something does develop, it will be caught early and treated aggressively. Patients in this age group have both visual and health issues to be addressed. Whether it is presbyopia, dry eyes, or diabetes management and detection, your eye doctor should be a major part of your overall care. Our office is well-equipped to assess and recommend options for all of your vision and medical needs; and when a referral to a specialist is required, we have a local network of qualified doctors to help. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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Adult Vision Ages 19-40
Friday, September 4, 2009
Adult Vision Ages 19-40 (As appeared in Alamo Today, September 2009, pg. 29) In this installment of our series, we will tackle what to expect from your eyes and how to take care of them from after high school until age 40. For most adults, this is the time of healthy eyes and good correctable vision. The two main issues for this age group are visual stress from heavy computer use, fatigue, poor lighting, etc., and injuries from sports and work. For a majority of patients, simple vision issues like near-sightedness, far-sightedness, and astigmatism can be well-corrected with glasses and contact lenses without having to deal with presbyopia or other eye diseases which will be discussed in later articles. As you start out in the world after school, your eyes and vision are integral to your success. Whether you need them for long hours studying pursuing a college or post-graduate degree, beginning your career in your chosen field, or enjoy sports, your vision will be paramount in your endeavors. The first thing to remember is that healthy eyes and good vision go together; if you don't take good care of your eyes, they will not help you in your daily life. A healthy diet consisting of fruits and vegetables will only help your overall health, including the eyes. Supplemental vitamins are also recommended if your diet is lacking in some of these areas. In addition, hydration is very important. Dryness is a big problem with heavy computer use, and staying hydrated can help alleviate some end-of-day redness and discomfort. Exercise helps improve blood circulation throughout the body and helps remove toxins in the bloodstream away from the eyes. Smoking cessation can be extremely beneficial to your overall health. Besides the heart, lung, and other systemic diseases that smoking can lead to, the risk for macular degeneration later in life in increased about 4-6 fold. As always, routine eye care in conjunction with the above suggestions will help maintain your overall vision and ocular health. Now that we have addressed the health issues with the eye, we need to discuss how to deal with the visual stress that is present in our daily world. The most common causes are computer use and long hours reading documents and contracts. Even though computer use has become a major part of society, most people compound the problem by not having the correct eyeglass prescription, having improper lighting and incorrect viewing angles and working distances. As the day progresses, eyestrain and visual fatigue manifest themselves as tired eyes, red eyes, dry, stinging, burning, and focusing difficulties. Making some adjustments like keeping your eyes above the level of the computer monitor, taking a break from the monitor every 30 minutes and let your eyes rest, blinking, staying properly hydrated, and reducing a lot of artificial light and glare can go a long way in relieving visual fatigue and stress. In addition to taking care of your eyes at work and college, the eyes need the proper care for sports and at-home activities. Sports such as basketball, football, baseball, and racquetball require the safety from protective eyewear or goggles that regular eyeglasses and contact lenses do not provide. Frames and goggles for adults and kids at our office made by Liberty provide both a fashionable and functional option for vision and eye protection. The lenses can be made in most prescriptions and made out of polycarbonate, which offers both UV protection and shatter-resistance. At home, some of the everyday activities that we do can pose a danger to the eyes. Things such as mowing the lawn, woodworking, and using strong household chemicals require safety goggles. Non-prescription safety goggles can be found in some hardware stores and depending on the type of glasses, prescription lenses can be put into them. Even though a majority of patients in this age range are healthy and have good correctable vision, there are always issues and pitfalls are present at work and home that can lead to vision loss. Staying healthy with routine medical care in conjunction with coordinated eye care will help you optimize your vision and eye health. Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.
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