Alamo Optometry Blog
September 5, 2010
Amblyopia
(As appeared in Alamo Today, September 2010, pg. 26)
Amblyopia or “lazy eye” as it is commonly referred, by definition means an eye that is not correctable to 20/20 vision. Many times in practice I find that patients are using this term incorrectly; they always say that they have a “lazy” or “bad” eye when with their glasses or contacts they see very well. The important distinction that has to be made is that this refers to best-corrected vision, whether that is with glasses or contact lenses. Most forms of amblyopia start in childhood; making it even more important for a child’s vision and eye health to be evaluated to ensure the eyes and vision are developing normally.
The most common form of decreased vision is from strabismus, or an eye turn. If one eye is not focused on the same point as the other eye, that retina never receives a clear image, and therefore does not develop normally. This is why it is mandatory that an eye turn be corrected with surgery and/or glasses at an early age. Since the wiring between the eye and brain does not completely mature until about age 10-12, it is imperative that in this time frame vision must be maximized. Compared to the other types of amblyopia, this is the most easily noticed by parents because of the obvious eye appearance and care is usually sought early on in development.
The other main cause of amblyopia is refractive. A refraction is a measure of the amount of nearsightedness, farsightedness, and astigmatism needed to be corrected to attain 20/20 vision. When the prescription is extremely high, it is likely that the patient will not see a sharp 20/20. Because of the optics of the eye in conjunction with the thickness of the lenses, a patient will still see well but not as clearly as someone with a lesser prescription. Another variant of refractive amblyopia is anisometropia; this just means that the prescription between the eyes is very different. An example is when one eye is very nearsighted and the other eye has no prescription. Since the brain can only see well out of one eye, it tends to ignore the other eye because of the blurry vision. However, since the eyes are generally straight and the child can see well, it is very difficult for parents and teachers to pick this up. A child will generally respond well to visual tasks and will respond with the correct answers when asked about what they see. However, they are seeing out of only 1 eye, and have poor or non-existent binocular vision or eye teaming due to the fact that the other eye cannot contribute good vision. Again, this needs to be treated early with full-time glasses to maximize any vision that can be gained when the child is young. The goal is to minimize the visual acuity difference between the eyes, maximize eye teaming skills, and to protect the “good” eye from trauma as much as possible to avoid having two eyes that do not see well.
Some other less common causes of reduced vision are trauma and disease. Most types of trauma to the eye can cause permanent damage to the eye. Conditions such as a retinal detachment and chemical burn (acid or base) can cause permanent vision loss. Diseases such as macular degeneration and glaucoma cause decreased vision in one or both eyes that cannot be fully corrected with glasses. Amblyopia develops in these cases from either the macula in macular degeneration or the optic nerve in glaucoma becoming diseased and not being able to function properly.
Even though all of the causes of decreased vision were not discussed here, it is clear that there are many reasons for children and adults to have their eyes checked on a regular basis to help maximize their current vision and prevent further vision loss. Keep in mind we see patients of all ages and look forward to seeing you in the office.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
August 6, 2010
School and our Children’s Vision
(As appeared in Alamo Today, August 2010, pg. 24)
It is hard to believe that most of summer vacation is behind us and school will be starting up soon. August is usually the month where most parents prep their children for the school year. The list usually includes school supplies, clothes, backpacks, etc. and yearly physicals are done with their pediatrician to ensure a healthy start to the year. Even though most of you realize the importance of vision and eye health, it is vitally important for your child to be able to see well at all distances and have good eye-teaming skills to be able to learn and prosper at school. I will cover some of the main eye issues related to difficulty at school.
I would say the most common diagnosis I find at the office is myopia, or near-sighted. For students that sit far away from the board or in the back of a large lecture hall, having uncorrected or under-corrected myopia will lead to blurry vision and an inability to see the material on the board, screen, or overhead. I have found it common for younger children with this situation to have classroom issues in addition to lower grades due to the fact that they tend to be disruptive in class because they can’t see clearly more than a few feet in front of them. I am obviously not saying that all classroom issues are visually related, but that in some students a simple pair of glasses makes a large difference.
At the opposite end of myopia is hyperopia, or far-sighted. These students are in a constant state of focusing to allow clear vision. The closer the point of focus the more work that is necessary to clear the image. That is why distance objects are easier than near ones. A low amount of hyperopia is actually desirable, since near-sightedness tends to evolve as the child enters adolescence, so it gives them a little head start. However, in larger prescriptions, hyperopia can cause near avoidance, headaches, fatigue, eye turns, and an overall indifference to sustained up-close tasks. This can easily be diagnosed in the office as part of a comprehensive examination.
The last prescription issue that can be a hindrance to vision is astigmatism. This is caused by the cornea, the clear front surface of the eye, not being completely round. An easy analogy is that it is shaped more like an egg than a ball. It is important to note that this is not a disease; it is just the way the eye is shaped and can be treated with glasses or contact lenses just like myopia and hyperopia.
In addition to having a prescription, all patients including children should have their binocular vision status evaluated. It is quite possible to not have any of the above-mentioned prescription issues, but have poor eye teaming skills. If the eyes are not aligned properly and do not work well as a team, there will be learning and reading issues. These tend to present themselves more for reading than distance, but can definitely affect both. When the eyes do not work as a unit, a child might experience double vision, “stretching” or “ghost images” of letters, skipping of letters or lines of text, eyestrain, headaches, near avoidance, or any combination of these. Depending on the exact diagnosis, the condition can be treated with glasses or vision therapy.
I recommend having your child’s vision checked by an eye care professional instead of just relying on a school or pediatrician screening. Most children that need to be evaluated are generally picked up by these screenings, but the comprehensive evaluation I give at the office not only encompasses vision and binocular vision, but also includes neurological testing, color vision, peripheral vision, and an ocular health examination of both the front and back portions of the eye. We look forward to seeing your students in the office soon.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
July 1, 2010
Ultraviolet (UV) Light
(As appeared in Alamo Today, July 2010, pg. 24)
Summer is finally here and the rain is done (hopefully). Now that we will be heading out into the sun, it is time to discuss UV protection. The harmful ultraviolet rays from the sun can have several ocular consequences in addition to all of the other body and skin conditions. I will address some of the potential eye issues here.
First of all, ocular UV protection should be a priority year round. Even though we receive more ultraviolet in the summer months than in winter, we are exposed every day, regardless of weather and temperature. Ultraviolet exposure is cumulative throughout life, and approximately 75% is accumulated by the age of 18.
Exposure to UV has ocular complications such as cataracts and pingueculas. Everyone knows that cataracts form later in life and are a normal part of the aging process. However, long-term UV exposure can expedite the process. Studies have shown that people that live on or near the equator generally get cataracts about 10 years earlier than people who live closer to the poles. This is due to the fact that those people receive the most daily UV radiation throughout the year. A pinguecula is the common yellow-looking bump and the white part of the eye. Many people have these and they are completely benign. Over time these tend to become red and irritated in dry and/or allergic conditions and prolonged contact lens wear can cause more irritation. The more inflamed the eye gets, the quicker these pingueculas tend to grow. Keeping the eye lubricated and having UV lenses are your best defense against further complications.
For eye protection, the best thing you can do is have UV-blocking lenses in your glasses. Fortunately, there are several ways this can be accomplished. The first thing to remember is that your lenses do not have to be tinted to be UV-protected. Conversely, all tinted lenses do not block ultraviolet light. Simply having tinted plastic lenses in your glasses will not block any of the harmful rays from the sun; plastic lenses do not inherently have any UV protection. To obtain the necessary protection, a UV filter must be present in the lenses. This is a clear filter and it does not alter the appearance or color of the lenses in any way. For those of you who enjoy wearing sunglasses, the most common way to get this is to have polarized lenses. In addition to blocking the sun’s harmful rays, these lenses eliminate glare, which make vision sharper and more comfortable. The effects are especially noticeable in high-glare situations such as driving, skiing, and water sports. For those that want tinted lenses and clear lenses without two separate glasses, then transitions lenses might be an option. These lenses come inherent with UV protection and are clear indoors and dark outdoors. Like polarized lenses, transitions lenses are available in single vision, bifocals, and progressive lenses.
Some people just don’t like to wear sunglasses. As was mentioned before, the lenses do not need to be tinted to block UV. Patients that are uncomfortable with tinted lenses can have their clear glasses made out of polycarbonate lenses. These lenses have a UV filter and are thinner, lighter, and are impact-resistant compared to plastic lenses. Lastly, there are contact lenses that come with UV protection. Even though that is very important, only the area covered by the contact lenses is protected; the rest of the eye, eyelids, and surrounding area are therefore left exposed.
Patients of all ages should wear some form of UV protection outdoors. Whether they are inexpensive over-the-counter sunglasses for your children or higher quality polarized lenses for the adults, this protection is like “suntan lotion for the eyes” and will definitely reduce the ocular consequences of UV radiation. You are welcome to come into the office anytime if you have any questions and we can demonstrate the improved vision and contrast with our Maui Jim polarized sunglasses.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
June 7, 2010
The Three O’s (Optometrist, Ophthalmologist, Optician)…What’s the Difference?
(As appeared in Alamo Today, June 2010, pg. 29)
I am consistently asked what the difference is between an optometrist, an ophthalmologist, and an optician, and which one I am. There are a lot of differences between us, but also much in common. I will delve into the training and professional services each one provides.
An optometrist (O.D.) tends to be the primary health care professional for the eyes. An optometrist must complete a college degree, and then attend a 4-year optometry program. To be licensed, there are several national exams that are administered to ensure proper training and competency. Optometrists can examine, diagnose, and treat disorders of the eye and the surrounding structures. When you schedule an exam at our office you will receive a comprehensive evaluation which will test and evaluate vision and necessary prescription glasses and/or contact lenses, binocular vision status, glaucoma screening, neurological status as it relates to the eyes, and eye health evaluation of the front part of the eye and retinal evaluation through dilation. For vision enhancement, an optometrist can prescribe glasses, contact lenses, low visions aids, or have a LASIK consultation.
As state laws do vary, what medical conditions optometrists can treat does change from state to state. Eye conditions such as allergies, conjunctivitis (pink eye), floaters, and styes are treated often and are seen in the office regularly. Even some more difficult conditions such as foreign body removal, corneal ulcers, and retinal co-management of diabetes and hypertension are done often. Since optometrists do not do surgery, there are some conditions that require an ophthalmology consultation. Some of these include cataract and retinal surgery, and those are made after careful examination and patient education.
An ophthalmologist is a medical doctor who has specialized in the eyes. They have graduated from medical school and then completed residencies in their chosen specialty like retina, glaucoma, and cornea. As in optometry, there are national examinations that must be passed to practice and to specialize in a chosen field. Most ophthalmologists do not do primary care exams. As a majority, they conduct specialized care like and surgery for LASIK, cataracts, glaucoma, and retinal disease. Most ophthalmologist offices that conduct primary care exams are done by optometrists. Of course that does vary from office to office, but is the case most of the time. A comprehensive examination conducted by an ophthalmologist and optometrist are very similar. The same tests are conducted and an eye health evaluation will be conducted. Obviously, if a patient is being referred for a particular condition (e.g. glaucoma) specialized tests will be run that would not normally be done on the routine patient.
In comparison to an optometrist and ophthalmologist, an optician is not a doctor. Opticians attend school to learn about optics, glasses, lenses, etc. and are then tested by their licensing board. Most opticians are certified, but some are not. Opticians are trained in frame selection, dispensing, adjusting, and repairing. They are also valuable for optimal lens selection and measurements depending on the prescription and type of frame. If an office has a lab on site, they can edge, tint, and finish the lenses to fit your frame. Training and experience can vary for opticians. The more training and experience an optician has, the better the quality and accuracy of the prescription glasses made. Our certified optician does most of these tasks in our office.
Even though all optometrists, ophthalmologists, and opticians are associated with vision, their function within that field varies widely. Hopefully these definitions will help you understand who we all are and what we do. Our full-service optometry office conducts comprehensive exams for all ages and looks forward to helping you with all of your eye care and vision needs.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
May 6, 2010
Dry Eyes
(As appeared in Alamo Today, May 2010, pg. 24)
Dry eyes seem to be affecting everyone these days. Whether the cause is allergies, medications, age, or contact lenses, the resulting irritation, redness, and overall scratchy feeling are both visually and cosmetically disruptive. Sometimes the remedy is easy and sometimes it is complex, but it can be attacked by several different means.
Dryness can be caused by several reasons but the two most common are insufficient tear production and poor tear film quality. Most patients are unaware that one of the major causes of poor tear production is medication-induced. The leading contributors are antihistamines, antidepressants, and any hormone therapy or changes in hormone levels. This time of year antihistamines are popular to treat seasonal allergies. However, from an ocular standpoint, these drugs help alleviate allergies but contribute to dryness.
Since the tears are made up of 5 layers, a defect in any layer can cause an unstable tear film. The most common layer for disruption is the outermost layer called the lipid layer. This layer helps limit tear evaporation and is produced by the glands on the edge of our eyelids. Any lid or eyelash irritation or infection can cause these glands to not work properly. When this happens, the tears evaporate too quickly into the air which gives a burning and stinging feeling.
Now that we know some of the causes of dryness, the big question is how to treat it. I tell my patients that depending on the severity, there are many options. The most common is artificial tears. These are good for augmenting tear volume, but do not help restore function or increase production. For mild cases, a drop in each eye once or twice a day generally improves comfort. The main thing to remember is to use non-preserved or sterile tears as preservatives tend to sting and therefore make the eyes redder.
For more advanced cases, I have found that Restasis works very well. This is a medicated drop used twice a day that augments tear production. It can take up to 2-3 months to reach full effect, but after that period, most patients notice an improvement in comfort. These patients might still feel the need to use tears, but the frequency will be less.
Another treatment option that is used by severe dry eye sufferers is punctal plugs. In each eye we have a “faucet” that makes the tears called the lacrimal gland and 2 “drains” that remove the tears from the eye and drain into the back of the nose and down the throat. A plug is put into one of these drains to help keep the tears on the eye longer. It is usually only necessary to plug one in each eye. They are easy to put in and last as long as needed. Patients that also have allergies should not do this because the allergens in the tears now stay on the eye longer and cause more havoc.
In addition to these remedies, some lifestyle changes will also help reduce eye dryness. The first one is to stay hydrated and reduce caffeine intake. Remaining hydrated will help with overall tear volume and since caffeine is a diuretic, it will make a dry eye situation worse. When we do sustained up-close work like computer use and reading, we tend to stare. Obviously, when you stare you don’t blink, and therefore leads to the tears evaporating into the air. I always advise taking breaks every 20-30 minutes to rest the eyes and to make it a point to blink during long sessions at the computer. Also, it is best to keep your monitor a little below eye level, and that will force your upper lids to lower a little and leave less surface of the eye exposed to the air.
Obviously, dry eyes are more complex than can be discussed here. However, after your examination and depending on your individual situation and needs, a personal treatment plan will be recommended to you.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
April 7, 2010
Allergies and Daily Disposable Contact Lenses
As appeared in Alamo Today, April 2010, pg. 24
Just about this time of year, seasonal allergies are in full swing. 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.
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. In some patients, it also helps with some of the ocular issues of tearing, itching, and redness. However, the main side effect of these medications is dryness. If the eyes are dry, it can actually worsen some of the ocular symptoms because there are fewer tears to wash away the allergens in your eye.
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 artificial tears and a drop like Patanol. The tears are used to help lubricate the eye and flush out the allergens that are sitting on your eye causing the itching and redness. Patanol is used to counteract the effect of the allergens on and around your eye while also helping to prevent further episodes. For the more advanced case, I recommend a short-term use of a topical steroid, which will calm the eye down quicker than Patanol. Because of the potential side effects, 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 Patanol 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. Lastly, when combined with a rebate for a year supply and not having to purchase solutions and cases, cost is very similar to a year supply of 2-week or 1-month disposable lenses.
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.
Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: www.alamooptometry.com and become a fan on our Alamo Optometry Facebook page.
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.
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.
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.
December 3, 2009
Flexible Spending Accounts (FSA) vs. Health Savings Accounts (HSA)
(As appeared in <a href=”http://www.yourmonthlypaper.com”>Alamo Today</a>, 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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