Alamo Optometry Blog

April 27, 2014

Seasonal Allergies and Daily Disposable Contacts

Filed under: Uncategorized — gkblog @ 1:51 pm

(As appeared in Alamo Today, April 2014)

            If there is one thing we can count on this time of year, it is seasonal allergies.  Speaking from a personal point of view, I know dealing with the running nose, sneezing, itchy eyes, and tearing are no fun.  I am already having patients come into the office with complaints similar to my own.  The treatment plan for each person is different, but the drugs, drops, and contact lens modalities we use are similar.

            To tackle the allergies, most of us take either a prescription or over-the-counter antihistamine.  These usually help alleviate some of the systemic symptoms of runny nose, congestion, etc.  However, the main side effect of these medications is ocular dryness.  If the eyes are dry, it can actually worsen some of the ocular symptoms because there are now fewer tears to wash away the allergens in your eye.  So instead of flushing those allergens out of the eye, they now stay on the ocular surface and exacerbate the symptoms of itching, swelling, and tearing.

            For this reason, I also recommend topical drops to help in the fight against allergies.  These drops do not solve the problems, but generally enable the patient to function in the spring months.  There are several types of drops that can be used depending on the severity of the symptoms.  For a mild case, I usually recommend non-preserved artificial tears and an antihistamine drop like Bepreve or Lastacraft; these are only two of the several prescription drops to utilize.  These drops are site-specific; they only have their effect on the histamine-releasing cells on the eye and therefore do not have the broad systemic effects of oral antihistamines.  For the more advanced case, I recommend a short-term use of a topical steroid, which will calm the eye down relatively quickly.  Because of the potential side effects of a steroid, a drop of this kind should only be used for a relatively short period of time.  I usually instruct my patients to use the drop for about a week, and then use the topical antihistamines to keep the allergic reaction at bay.  I believe the use of steroids should only be used when indicated, but is a wise treatment choice in those patients that are really suffering.

            For those contact lens wearers, this is the time of year that leads to decreased wear time, build-up on the lenses, and overall intolerance of wear.  Most patients wear their lenses for less time, and/or dispose of them more often.  For all of my potential contact lens patients including those with allergy issues, I recommend daily disposable contacts.  These lenses are thin, easy to adapt to, do not require any cleaning or solutions, and are always comfortable because you put a fresh lens on every day.  Whether you are a recreational wearer for sports or weekends or wear them every day, these lenses are best for convenience, lens hygiene, and lens comfort.  A new lens leads to better vision and eye health because of no lens build up and a decreased risk for infection.  Even though wearing contact lenses during the spring months might be difficult, having a fresh lens every day provides the possibility of longer and comfortable wear. 

Obviously, every patient and situation is different.  Some patients don’t like taking drops and some patients are in love with their current lenses so daily disposables might not be an option.  At your visit, you will be evaluated on your particular signs and symptoms and be given the appropriate treatment plan.  The issues and treatments discussed have generally worked well for my patients in the past.  Most of the time, it will be a combination of these that will work best.

Macular Pucker

Filed under: Uncategorized — gkblog @ 1:50 pm

(As appeared in Alamo Today, March 2014)

Since I discussed the macula and macular degeneration last month, I decided to tackle another common finding regarding the macula.  A macular pucker or epiretinal membrane, results when scar tissue forms over the macular area of the retina.  This condition usually does not progress to the point where surgical intervention is necessary, but I have had several patients recently who required surgery.              

                An epiretinal membrane usually develops secondary to trauma/surgery to the eye, but more commonly by posterior vitreous detachment.  A posterior vitreous detachment, or PVD, occurs when the viscous gel that is in the back portion of the eye pulls away from the retina and causes a sudden onset of floaters.  This sudden onset of floaters is the usual cause of patients calling the office to schedule an office visit.  A PVD is quite common and is completely benign; however, if this does occur, a dilated examination needs to be done to rule out any retinal tears or detachments.  As the gel contracts away from the macula, it can leave a layer of scar tissue on the surface of the retina.  This membrane that is left is similar to cellophane and over time it can crinkle and tug on the macula causing it to bulge.  The main complaint of a macular pucker from patients is decreased or distorted vision.  Some may notice that images are cloudy or filmy because they are looking through this cellophane-like membrane.   In a percentage of cases, the epiretinal membrane does not contract and the patients’ vision is not affected much.   A macular pucker is diagnosed through a dilated exam and does not require a specialist referral until vision decreases.  If needed, another test called Optical Coherence Tomography (OCT) can take highly sensitive images of the macula to ascertain the exact amount of macular bulging and if there is a macular hole.  However, monitoring is all that is required for most patients.

                In those patients who experience a drop in vision, surgery is required.  When vision becomes compromised, the forces of the membrane on the macula cause severe bulging of the tissue or a macular hole develops.  A macular hole occurs when the membrane contracts so much that part of the macula is not fully attached to the retina.  If surgery is needed, the retinal surgeon will remove the vitreous gel in the posterior portion of the eye and will also remove the membrane.  This surgery is very delicate as it is difficult to remove the thin membrane without damaging any of the retina tissue underneath, which is why surgery is not performed until the drop in vision becomes too symptomatic for the patient.   The procedure is done as outpatient, and depending on the severity of the condition, special head positioning or tilting might be required after the surgery to help the eye heal properly.  Vision improves after surgery, but it generally does not completely return to pre-macular pucker level. 

                As is usually the case, routine eye exams can help diagnose and manage a macular pucker.  If needed, we can refer to a retinal specialist if further testing or surgery is required.


Filed under: Uncategorized — gkblog @ 1:49 pm

(As appeared in Alamo Today, February 2014)

               The macula is probably the most talked about and questioned structure in the eye.  Patients are constantly asking about the macula and macular degeneration because they either have someone in their family or a friend that is battling this disease.  I will discuss the macula, some new treatments for the disease, and what you can do to help decrease your chances of getting macular degeneration.

                The macula is located in the central part of the retina (the back surface of the eye).  As light enters the eye, it is focused directly onto the macula, which is centrally located and is 5-6 millimeters in diameter.  It is comprised of cones, which are the photoreceptors that allow sharp vision and color vision; there are no cones elsewhere in the retina.  These cells then transmit the image through ganglion cells that form the fibers of the optic nerve.  The images travel via the optic nerve to the brain.  The macula has a yellowish color which is different from the normal red color of the retina.  The retina is red from all of the blood traveling through it.  The macula has certain pigmented materials such as lutein and zeaxanthin; which are derived from diet alone as these are not made by the body.  These components are vital to the health and maintenance of the macula and they act as an ultraviolet filter for the macula and are also believed to help protect the macula from macular degeneration.

                Even though the treatments for macular degeneration are getting better, there is still no cure.  Injections into the eye of either Lucentis or Avastin have shown the ability to slow down, and in a lot of cases, halt the progression of macular degeneration.  Getting a direct injection into the eye is not necessarily fun; however the likelihood of having vision preservation far outweighs the injections.   Older treatments including laser are not current options because the side-effects are sometimes worse and the possibility of vision improvement is minimal.

                Unfortunately, as previously mentioned, there is no cure for macular degeneration.  There are no drops, pills, etc. that can prevent it.  Your likelihood for the disease does increase as you age; therefore it is very important to maintain your overall health.  It has been shown that smokers, diabetics, and those with poor diets are more likely to suffer from the disease.  That being said, there is a genetic component to the disease that cannot be altered at this point.  For the most part, if it genetically programmed, there is very little that can be done.  The things that can be done are lifestyle modification and maintaining your overall health; this includes smoking cessation, properly managing your diabetes and high blood pressure, and having a well-balanced diet.  If your intake of green vegetables, which is the main way to maintain lutein and zeaxanthin levels in the macula, then vitamin supplementation is a wise thing to do.  There have been several studies that have conclusively shown that adding these along with other minerals have slowed down the progression of macular degeneration. 

                As with most conditions of the eye, annual comprehensive eye exams are the best for early detection.  In the early stages of the disease, your vision might not be affected, but there are some macular clinical signs that are evident.  Early diagnosis and treatment is still one of the best ways to stretch out the course of the disease which will allow for good vision for a longer period of time.


Filed under: Uncategorized — gkblog @ 1:48 pm

(As appeared in Alamo Today, January 2014)

                Recently a patient came into the office with a red and inflamed eyelid.  These are relatively common; the most likely culprits are styes, trauma, allergies, or blepharitis (bacterial infection of the eye lashes).  However, this condition was different in that it was an infection of the eyelid and soft tissue around the eyelids, or preseptal cellulitis.  A cellulitis can be potentially dangerous and the correct diagnosis needs to be made between preseptal and orbital cellulitis. 

                Preseptal cellulitis is a bacterial infection of the eyelid and surrounding soft tissue.   The eyelid area becomes red, swollen, warm to the touch, and potentially painful.  In contrast to a stye, a cellulitis covers a larger area of the eyelid whereas a stye is more localized.  In preseptal cellulitis, the infection is contained in the anterior portion of the lid and has not penetrated the septum (a thin membrane within the eyelid to help prevent infections from spreading deeper into the lids) to the posterior portion of the eye.  It is usually caused by an upper respiratory infection (flu) or sinus infection that has spread to the eye.  Direct insect bites or scratches are also potential ways the bacteria can penetrate the eyelid.   It is much more common in children and it responds well to oral antibiotic therapy.    Vision is not affected and the eye is able to move unrestricted in all directions.  The patient is usually getting over an illness or has been around sick people, but does not actively have a fever.            

Differentiating between a preseptal and orbital cellulitis is very tricky because both clinically present the same.  In orbital cellulitis, the affected eye will appear bulging relative to the healthy eye, the vision will be decreased, and eye movements will be restricted.  The person is concurrently ill and is possibly running a fever.  Functionally, the difference between the two is that in orbital cellulitis, the infection has spread posterior to the back of the eye and to the surrounding structures in the facial area.  This can result in permanent vision loss, neurological problems, and potentially meningitis if it gets into the bloodstream.  Therefore, orbital cellulitis requires hospitalization with continuous IV antibiotics to help control the infection. 

                Granted a cellulitis does not happen very often, but it reiterates the need that sometimes the simple red eye might not be so mundane.  If you notice eyelid redness and swelling that is not localized or is spreading with an associated illness, a cellulitis should be considered.  Preseptal cellulitis is much more common than orbital and is very responsive to oral antibiotics and the symptoms start to resolve in a few days.  The patient should be followed just to ensure the infection is clearing.  However, if an orbital cellulitis is suspected, direct referral to the hospital is required.

Happy Holidays 2013

Filed under: Uncategorized — gkblog @ 1:46 pm

(As appeared in Alamo Today, December 2013)

Now that 2013 is almost done, I think it is always good to review the past year, and at the same time look forward to the coming year.  First and foremost we need to thank our patients and community for supporting the office.  Without family and friend referrals, our office would not be what it is.  We strive to provide the best care, services, and products and we are extremely grateful that our efforts are appreciated by the community.  Our staff commitment is to continue our superior service and hospitality for all of our patients and family members.

We are constantly being asked during this time of year about flexible spending accounts (FSA) and how to use them at the office.  The government has a wide range of specified expenses that qualify as a medical expense.  These include any office co-pays, any necessary or elective surgical procedures (including LASIK), and many medical devices.  Included in that list is any vision correction device (glasses, computer glasses, contact lenses, sports goggles, etc.) and sunglasses.  As long as your purchase is made by the end of the year, it will count on your 2013 account balance.  It is also recommended to fully utilize any vision benefits you have either through your medical or vision insurance.  We are happy to look up your benefits for you.  We just need to know which insurance you have, and some information about the primary member on the account.  Vision insurance benefits can be found online and it takes only a few minutes.

This past year brought about 2 new daily disposable contact lenses to the market.  Vistakon’s Tru-Eye and Alcon’s Total Vision1 are adding more options to the popular daily disposable modality.   Both of these lenses add a new dimension in health profile, comfort, and vision.  We have found that patients are adapting and appreciating the benefits of daily disposable contacts and these additions make the transition from monthly lenses very easy.

Looking forward to 2014, there are insurance changes that are going to affect us all.  We definitely don’t have all of the answers but we are working towards complying with the new requirements.  Regarding using insurance at the office, most if not all group vision insurance is not going to change.  For those who have VSP, Eyemed, and Medical Eye Services through your employer, those plans will remain the same as in 2013.  Assuming your employer decided to keep the same plan for 2014, it will be the status quo.  Most individual medical plans will also have benefits, but that will vary from plan to plan.  Through these individual plans, the big change will be pediatric benefits.  Qualified plans will cover the exam and basic materials for dependents under 19.  Again, the allowances will be different depending on the plan, but kids will have frames to choose from to have their prescription filled for no cost to the patient. 

Finally, in this holiday season and all year round, it is important to think about those who could use our help.  We always collect old frames and sunglasses and donate them to a local charity in January.  They are distributed to people who cannot afford quality glasses.  As long as the glasses are wearable, the condition does not matter.  Regardless of appearance, they will definitely assist a person in need to help them see well.  We wish everyone a happy and healthy holiday season and look forward to seeing you in the years to come.

Common Eye Myths

Filed under: Uncategorized — gkblog @ 1:45 pm

(As appeared in Alamo Today, November, 2013)

When patients ask me questions regarding vision and the eyes, most of the time they are related to eye myths, or things “that they have heard” and would like a firm answer from a professional.  Obviously I cannot address all of them here, but I will tackle some of the more common questions.

 Myth:  Wearing glasses or contacts will make my vision worse.

Fact:  If your vision is going to change, it is going to change regardless of whether you wear glasses, don’t wear glasses, or wear them part-time.  Most of the prescription changes that occur are secondary to genetics and our environment.  I tell most patients that if this was true, prescriptions would hardly change and that the “eye exercises” that are advertised would work all of the time therefore negating the need for glasses or contacts.  If there was something that worked a high percentage of the time, the need for eye correction would lessen dramatically.  As of now, that does not exist.

 Myth:  Older patients develop a “second sight” which means their vision is improving.

Fact: As patients age, cataracts develop.  This is a clouding of the lens inside the eye.  As the cataract matures, most often patients will become more near-sighted.  Depending on the person, this could allow them to read better, but possibly make the distance vision worse.

 Myth:  You only need an eye exam if you notice your vision deteriorating.

Fact:  Many eye diseases and conditions will not cause decreased vision.  A great example is glaucoma.  The patient will start to notice changes only near the end of the disease process.  Other systemic conditions such as diabetes, high blood pressure, and high cholesterol can initially not have any vision changes but can be diagnosed during a routine eye exam.

 Myth:  Eyes can be transplanted.

Fact:  The technology does not exist at this time to transplant eyes.  The neural connections between the eye and brain are just too numerous and sophisticated to be able to transplant.  Between the over 125 million rods and cones, the optic nerve, and the immense blood supply to the eye, there is too much complexity to tackle this at this time.  However, a cornea can be transplanted.  Since the cornea does not contain any blood vessels or the complexity of the retina, it makes it easier to transplant.

 Myth: Reading in dim light will harm your eyes.

Fact:  Reading in poor light will cause eye strain, squinting, fatigue, and possible headaches, but it will not damage the eyes.  It is recommended to have good lighting and proper prescription correction whenever you are doing near tasks such as using the computer, reading, and your phone.

 Myth:  Eating carrots and other vegetables will improve your vision.

Fact:   Carrots are rich in vitamin A which is essential for retinal health, but it will not improve your vision.  In addition, the vitamins and anti-oxidants found in green vegetables such as spinach and broccoli help in the health and function of the macula.

 Myth: Eye conditions like macular degeneration and cataracts are hereditary.

Fact:  Diseases such as macular degeneration and glaucoma can have a hereditary component.  However, just because a parent or sibling has one of these does not mean you will.  If the genetics are present for these diseases, then at this point there is very little that can be done to offset that.  To help their cause, patients should not smoke and maintain their overall health and keep any vascular conditions such as diabetes and hypertension under good control, as that can contribute to a worsening of those conditions.  Cataracts are an age-related finding and assuming you live long enough, you will get them.  They might not get to the point of needing surgery, but they will affect a person as they age.

Retinal Detachments

Filed under: Uncategorized — gkblog @ 1:43 pm

(As appeared in Alamo Today, October, 2013)

           Thankfully there are very few ocular emergencies that we deal with at the office; however this is one of them.  Whenever someone calls into the office with the possible signs of a detachment, that person is usually seen in the office the same day. 

            There are several signs and symptoms that a patient needs to know to be able to correctly assess the situation.  Most patients will experience an increase in the amount of floaters, flashes of light, possible loss of vision, and areas of gray or black in their visual field.  Most patients have floaters; but in this case, there is a large change in the quantity and/or size of them.  In addition, there is usually accompanying flashes of light.  These floaters and flashes are consequences of the forces of the retina pulling away from the back surface of the eye.  Even though a patient can have an increase in their floaters with flashes and not have a detachment, it is extremely important to have this evaluated as soon as it happens.  In addition, there will be loss of vision in the affected eye; this can vary from a very little change to severe vision loss.  Vision loss in a detachment is determined by whether or not the macula is still attached.  Since the macula is the only area of the retina where sharp 20/20 vision is achieved, if the detachment does not include the macula, the vision loss will be minimal.  However, if the detachment is very near or including the macula, vision will be less than 20/400, or the equivalent of the big “E” on the eye chart.  Lastly, a person will notice an area of gray or black in their vision that corresponds to the area of the retina that is detached.  It is also important to note that a person will not experience any pain from a detachment because there are no pain receptors in the retina.  Patients often note that they either just woke up with the symptoms or it happened in the course of a normal day. 

            After a dilated evaluation reveals a detachment, the patient is then referred to a retinal specialist that same day or the next day.  It is advisable for the patient to go straight to the specialist because they are already dilated and the sooner treatment is initiated, generally the better the prognosis.  Surgical repair can either be done in office or will require an outpatient procedure.  This is determined by the surgeon and the evaluation is based on the location, vision loss, size, and duration of the detachment.  In addition, other factors include age, other associated medical conditions such as diabetes, and if there has been a hole or detachment in the other eye.  Even though the surgery is delicate, the recovery from the surgery can be tedious.  Patients often have to lie face down for a period of time to help ensure the retina remains attached. 

            Some detachments just “happen” and there is not necessarily a cause.  However, conditions such as trauma, high myopia (near-sightedness), diabetes, and other systemic conditions can increase your likelihood.  In the end it doesn’t necessarily matter how the retina became detached, it just matters how quickly you can have your retina checked via dilation and be referred to a specialist in a timely manner.  It is important that if you experience flashes of light, floaters, loss of vision, or an area of black or gray in your vision that you are checked that day.  I would much rather see a patient with these symptoms and not have a detachment than a patient waiting a period of time for the symptoms to “go away” and then possibly have permanent decreased vision because they waited too long.

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