Alamo Optometry Blog

(As appeared in Alamo Today, April 2011, pg. 28) 

            Several patients have come into the office lately complaining of ocular migraines.  There are some different terms for this condition including aura, ocular migraine, ocular aura, and retinal migraines.  Even though they have slightly different meanings, I will lump them into one for the purposes of this article.  Initially, these can be very scary as patients are concerned that they are losing their vision and/or possibly having a stroke.  Thankfully, neither will happen just from having an ocular migraine; however, depending on the exact symptoms, some eye and health conditions need to be ruled out.

            An ocular migraine like a typical migraine, involves a blood vessel disturbance.  This can be caused by many things such as diabetes, high blood pressure, and physical exertion.  However, it is very common that these “just happen”.  It usually occurs without any triggers and happens when people are in front of the computer, watching TV, or driving.  The visual aura that people usually see is similar but can be variable and it can affect one or both eyes.  Most patients report seeing bright or shimmering lights, zigzag lines, cloudy vision, and tunnel vision.  Your central vision usually isn’t compromised, but it could be a little blurry.  These visual disturbances last anywhere from a few minutes to about 30 minutes.  If there is continued decreased vision, floaters, flashes of light, red eyes, etc., then an ocular migraine is not the diagnosis.  The symptoms go away as quickly as they came with no prolonged visual changes and have no lasting visual or ocular consequences.  These are commonly followed by an actual migraine about 1 hour after the aura starts.  It is possible to not get the headache, but it is more likely that a migraine follows the aura.  Initially these can be very scary and patients usually call the office to schedule a visit.  This is advisable as there could be other causes and other conditions that need to be addressed depending on the symptoms, age, and medical history of the patient.

            Unfortunately, there is no treatment for ocular migraines.  However, I always recommend to patients to take their normal headache medications at the onset of the visual disturbances, since it is common to get an actual migraine about an hour after the onset of the visual aura.  These headaches are usually severe and could last several hours.  Taking Tylenol, Excedrin, etc. for the headache will not prevent it from coming, but it will blunt the severity.  I would rather tell my patients to take the medication and not get the headache than to wait until the headache starts; at that point it is too late.   

            It is more common for normal migraine sufferers, women, and patients with diabetes, high blood pressure, and auto-immune diseases to get ocular migraines.  There are no strong medical studies explaining the etiology of this condition.  Even though there is no treatment, it is important to make sure that there is no medical reason for the ocular disturbances.  The aura can easily be mistaken for symptoms of a retinal hole or detachment, stroke, or other neurological issues.  Granted these conditions are pretty rare, but they do happen.  An office visit to go over your personal medical history, exact symptoms, and an eye evaluation will help differentiate an ocular migraine from other potentially sight-threatening conditions.

 (As appeared in Alamo Today, March 2011, pg. 21)

            My patients are always asking me about “new technology” in contact lenses and if their prescription would work for contacts.  Recent advancements in contact lens technology and manufacturing have made contact lens comfort and vision easier than ever.  Depending on your prescription, eye health, motivation, and how often you want to wear contacts, there is likely a contact lens for you.     

Daily disposable contacts are gaining popularity among patients and doctors alike.  For doctors, we like that patients are getting the healthiest option for contact lens wear   Patients enjoy the freedom of no solutions and cases, convenience, and the cost is very comparable with 1-month disposable contacts because there is no solution and cases to purchase in addition to the contact lenses.  These lenses are very thin, and therefore easy to adapt to.  From an eye health perspective, these are the best lenses for you because there is no build-up on the lenses, which can lead to decreased wearing time and possible infections.  The other advantage is you can wear these lenses as much or as little as you like.  If you want to wear them just for sports, recreation, vacation, or just going out to dinner, these lenses are the choice for you.  These lenses can be worn to correct your distance vision in addition to monovision, which allows for distance vision in one eye and near vision in the other.  However, even if you want to wear them every day, dailies are still the most convenient and healthy lenses on the market.

            The newest contact lens material to be developed recently is silicone hydrogel.  This base material is now being utilized by all of the major contact lens companies; each company has their own version which accounts for some of the differences in stiffness, oxygen flow through the lenses, and patient comfort.  Most of these lenses are now FDA approved for extended wear, the time does vary for each material.  Obviously, there are some potential health issues with the eyes that come along with sleeping in your lenses, so it is not for everybody; that can be determined at your exam and at follow-up visits.  This new material makes the lenses firmer, and allows for an average of a 4 to 6 fold increase in oxygen flow to the eye versus older lenses.  All types of lenses including multifocals and monovision are now available in this material.  Most people enjoy the freedom these lenses give you and the increased end of day comfort.  If your eye receives more oxygen, it will be less fatigued and red at the end of the day.

            Toric contact lenses are now better than ever.  If you have astigmatism, that means the front part of your eye (the cornea) is more oblong-shaped, similar to an egg.  Because the eye is not equally curved, a toric lens is needed to help you see well.  These lenses are still soft and you care for them the same as any other lens.  Toric contacts are now available in daily disposable and in the silicone hydrogel material.

            Finally, it is important to remember that contact lenses are medical devices, and can cause eye health consequences if not worn and cared for properly.  That is why annual exams are mandatory to ensure good vision and eye health.  We will patiently work with you to determine which prescription and type of lenses would be best for you.  Our goal is that your vision and comfort with your lenses is the best that it can be.

(As appeared in Alamo Today, February 2011, pg. 29)

It seems as though we have had more cases of floaters in the office lately.  I am not sure if it is something in the water or just coincidence, but the number of patients complaining of flashes and floaters has increased.  This can be a potentially serious eye condition that warrants immediate attention, so I will discuss some of the causes and symptoms and what to do if you experience any of the effects.

            When patients call the office complaining of sudden onset of flashes and floaters, the most common diagnosis is a posterior vitreous detachment or PVD.  The vitreous gel, which fills the posterior 2/3 of the eye, is made of tightly-packed collagen fibers that are translucent.  Over time, the fibers that make up the gel liquefy and condense, causing it to move forward and pull away from the retina.  Since there is now an area of fibers that are situated in front of the retina, as light enters the eye it goes through this area of detachment and casts a shadow onto the retina; this is what the patient perceives as floaters.  This situation alone is completely benign and might cause slightly decreased vision but will have no long term effects on the eye.  However, as the gel pulls away from the retina there are tractional forces that develop and can pull a part of the retina away causing a retinal hole and/or detachment.   This is what needs immediate surgical intervention by a retina specialist. 

            If the retina is detached from the back of the eye, it is not receiving any oxygen and will die like any other tissue or organ in the body.  Generally speaking, the prognosis for visual recovery is related to how quickly the diagnosis and treatment is initiated and the location of the detachment.  This is why it is absolutely imperative that if you notice a sudden onset of floaters, flashes of light, decrease in vision, a veil or curtain coming over your vision, or any combination of these that you have your eyes dilated as soon as possible.  If you have any of these symptoms, we will always squeeze you in for a same day appointment.  If the diagnosis is a PVD, there is no treatment.  We will discuss some precautions and some things to watch for and do a repeat dilation in 6 weeks.  Most studies have shown that if a retinal complication is going to occur, it is going to happen within the first 6 weeks, most likely sooner.  If there is a retinal hole and/or detachment a prompt referral to a retinal specialist is ordered.  Many treatments now can be done in office without the need for hospitalization. 

            Patients will invariably ask if there is anything that can be done to remove the floaters, and unfortunately the answer is no.  The only way to clean out the floaters is to do a procedure called a vitrectomy, which involves going into the eye and removing all of the vitreous and replacing it with clear fluid.  However, the risk of retinal complications is relatively high with this procedure.  Therefore, retinal surgeons will not do surgery for a benign condition, albeit an annoying one, to risk loss of vision.  Thankfully, your brain learns to “tune out” the floaters over time so they are not as noticeable.  They never actually go away or disappear; your brain just learns to suppress them.  If you actively look for them, are out in the sun, or around a lot of light or glare it is relatively easy to find them. 

If you have had a recent episode of floaters with or without flashes of light, please have your retina evaluated as soon as possible.  I would rather you come in for an office visit and the diagnosis is floaters versus waiting for the symptoms to go away and having possible decreased vision from a retinal complication.

Styes

 (As appeared in Alamo Today, January 2011, pg. 26)

            I was recently asked by one of my patients who read my articles to discuss eyelid styes.  I was so excited that at least someone was reading the articles besides family members that I would honor her request.  These are very common and can happen in any age group.  Most of the time no drug treatment is needed unless the area affected is large and painful.

            The first distinction to be made is to define the differences between a stye and a chalazion.  A stye, or hordeolum, is an infection or blocking of the glands that are at the edges of the eyelids.  These infections are mostly caused by normal bacteria that live on and around the eyes.  Lid hygiene is very important to keep the lids clean, for women it is very important to completely remove all makeup around the eye as that can lead clogged ducts.   A stye usually starts out as a localized area of swelling, irritation, and discomfort that can last for a few weeks and takes on the appearance of a pimple.  Styes generally do not directly cause decreased vision but can cause some tearing and irritation which can blur your vision.  I always recommend warm compresses to help the stye express.  The more you apply warm moist heat, the better; I recommend at least 15-20 minutes at a time.  I have found that boiling an egg and then wrapping it in a moist washcloth works best because the egg will hold its heat for a long period of time.  Simply putting the washcloth in the microwave does not work because the cloth cools off too quickly and is of little use.  Depending on the size and how solid the stye is, it can take anywhere from a few days to a few weeks to resolve.  It is very important to not attempt to express these on your own as without correct diagnosis and treatment; styes can cause further issues and mild bacterial infections of the front part of the eye.

            By distinction, a chalazion is best described as a cyst in the eyelid that is caused by inflammation in the glands in the eyelids; chalazions are much more common in the upper lids than the lower lids.  These nodules, or cysts, generally are painless and don’t cause the tearing and irritation that styes cause.  Topical and oral antibiotics are of little use because the root of the problem is not an infection.  Chalazions don’t look like a stye because there is not a drainage channel for the contents to escape.  Chalazions tend to take longer to resolve, for some people up to a few months.  Again, warm compresses are recommended, but if there is no resolution, injection with steroids to help shrink the nodule or surgical excision are options.  If excision is needed, it is done in office with local anesthetic, and the recovery is quick.

            As a general rule, most people use the word “stye” as a catch-all for both hordeolums and chalazions.  When I see patients in the office, I can assess the situation and try to express the stye in the office.  It might cause a little more discomfort initially, but will ultimately help the process along.  Because of the infectious nature of the stye and the bacteria present in the glands, I always prescribe an antibiotic drop to be used for a few days just as a prophylaxis against a conjunctivitis or corneal infection.  Most of the time styes will heal on their own with persistent use of warm compresses.  However, it is very important to not just assume any eyelid bump is a stye or chalazion.  More severe eyelid and systemic issues can mimic the initial appearance of a stye but require prompt medical treatment.  Anytime you have an eyelid bump of any kind, we can see you in the office and initiate treatment or send you to a specialist if needed.

Holiday Open House and End of Year Planning

(As appeared in Alamo Today, December 2010, pg. 33)

             It is amazing that we are getting near the end of the year.  This year has had its ups and downs, but mostly business has been positive.  To show our appreciation and to share in the holidays with our patients, our office is hosting our first Holiday Open House and Trunk Show on December 9 from 4-7 p.m.  We will be having our normal frame selection available plus the representatives from Kate Spade and Coach with their entire frame lines to look through.  We will be having hourly raffles, food and drinks, and conversation with our patients in a non-examination situation. 

In addition to preparing for our Open House, we are constantly being asked during this time of year about flexible spending accounts (FSA) and health spending accounts (HSA).  I thought I would give a quick review about both of these plans and how to fully utilize them by the end of the year.

            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.  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.

            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, 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 2010 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), Medical Eye Servies (MES), 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.

We are looking forward to our first annual holiday open house and trunk show.  We plan on having it be a staple of our and the community’s holdiay season.  We invite anyone to come in on December 9 to look at our office, meet our staff, shop our glasses and sunglasses, and enjoy mingling with local friends and family.  We look forward to seeing you this holiday season and in the years to come.

InfantSEE Program

(As appeared in Alamo Today, November 2010, pg. 29)

        Our office has recently enrolled in the InfantSEE program, which allows an infant from 6 to 12 months of age a one-time, no charge comprehensive eye examination.  We believe that this is an extremely valuable program and are proud to be providers. 

            An InfantSEE assessment between six and 12 months of age is recommended to determine if an infant is at risk for eye or vision disorders. Since many eye problems arise from conditions that can be identified by an eye doctor in the infant’s first year of life, a parent can give an infant a great gift by seeking an InfantSEE assessment in addition to the wellness evaluation of the eyes that is done by a pediatrician or family practice doctor.  This program is meant to be an adjunct to the pediatrician exams and testing, not a replacement for scheduled well-baby visits.

            According to the American Optometric Association (AOA), one in every 10 children is at risk from undiagnosed eye and vision problems, yet only 13 percent of mothers with children younger than 2 years of age said they had taken their babies to see an eye and vision care professional for a regular check-up or well-care visit. Moreover, many children at risk for eye and vision problems are not being identified at an early age, when many of those problems might be prevented or more easily corrected. Some 4.02 million children were born in 2004, according to the U.S. Census Bureau. In approximately 4 percent, strabismus (an eye turn) will develop, and amblyopia (where one or both eyes are not correctable to 20/20 vision) will develop in 3 percent-this equates to as many as 100,000 infants born each year who are at risk for serious eye and vision problems.

            Early intervention is critical to successful and cost-effective treatment. Despite the nation’s present system of preschool vision screening, there exists a lack of understanding by the public of the importance of periodic professional eye and vision assessments. Unfortunately, during the course of their young lives, most children probably never see an eye care practitioner who can provide the kind of professional eye assessment necessary to identify critical eye and vision problems at an early stage, explain those conditions to parents, and provide the care necessary to correct those problems.

            When you call the office to schedule the examination, make it at a time when your child tends to be rested and fed.  The goal of the evaluation is to ensure that your child is within normal expected ranges for such things as vision and prescription, eye movements, pupil function, and ocular health.  The data that is collected at the exam is then kept in your child’s chart and can be used as a baseline for future examinations.  If a condition is found that requires further testing, your child will be referred to the appropriate specialist.  In addition, we can forward the information to your child’s pediatrician so he/she is kept informed about the process and the results of the evaluation.  We have some toys in the office to help focus your child during the exam and to help entertain any other siblings that are present in the exam room.  We look forward to providing this valuable service to the young children in our community to ensure everyone gets off on the right foot regarding their vision and ocular health.

 Why Do I Need to Get My Eyes Checked?

(As appeared in Alamo Today, October 2010, pg. 29)

             Lately at the office we have noticed that many people are deciding that just because their glasses are fine and they see “OK”, there is no need to have their eyes checked.  There can be several issues with the eyes including binocular vision disorders, and retinal issues that would not necessarily affect vision or have any tangible symptoms that would bring you into the office.  I am not sure if it just poor education on my part or patients are just not fully aware of how important vision is and the importance of preserving ocular health.  Regardless, here are just some of the reasons why vision and eye health should not be ignored.

            I think most people would be surprised at how many medications and medical conditions can affect the eyes and vision.  Some of the obvious ones are diabetes, high blood pressure, and high cholesterol.  Most of these patients are aware of the potential ocular side effects of these conditions and are therefore following up with their medical doctor and coming into the office for annual exams.  However, as an example, I have had a few patients lately who suffer from colitis, and did not know of the potential effects on the eyes.  They were astounded to find out about the inflammation associated with colitis and any other –itis disease such as hepatitis, arthritis, and auto-immune conditions such as lupus and sarcoidosis; and how it can go to the eye and cause an iritis, and it can happen with or without a flare-up of the systemic condition. 

            In addition, many of the medications that our patients take, including prescription and over-the-counter, can and do have ocular effects.  Some of the most common of these are anti-histamines, anti-depressants, birth control and hormone replacement.  Many people feel that because these medications are so commonplace and in some instances not prescription that they don’t need to be revealed at an eye exam.  Knowing this information can definitely help in diagnosing such issues as contact lens intolerance, dry eyes, and blurry vision.  Obviously, these and other medications affect some people more than others; however, knowing about the medications and changes in dosage can help elicit a reason for a problem or can help diagnose a problem that at the time might have no symptoms, but would lead to issues down the line. 

            I think the take home message here is that because the eye is an integral part of the body, all systemic issues and medications need to be discussed with the doctor.   Generally, patients that have diseases such as diabetes, high blood pressure, and high cholesterol have been educated enough that they understand the potential effects on the retina and that through a dilated exam the blood vessels can be viewed and evaluated for overall health.  I tell patients all the time that the retina is the only place in the body where blood vessels can be observed without an invasive procedure.  If the retina looks healthy and normal, you can generally assume that the vessels in other organs such as your liver and kidney are also satisfactory.  In contrast, once in while a diagnosis of diabetes, high blood pressure, multiple sclerosis, and a congenital retinal disorder (which was done recently) can be made just from the eye exam alone because of a prescription change and/or certain changes in the retina or optic nerve. 

            Preventative care in any field including general health, dentistry, and eye care generally reduces issues that would have developed down the line if left unchecked.  It is generally a good idea to have your teeth checked regularly before pain and/or expensive procedures need to be done because a condition went unchecked for years.  The same goes for physicals.  A large percentage of the time, everything is fine.  If something is found in the course of the exam or ancillary testing, the prognosis is almost always better after an early diagnosis and early treatment.  The same can definitely be said of the eyes.  Even if your glasses are “fine”, we recommend using your insurance for a comprehensive examination to ensure that your overall health is being maintained along with your vision and ocular well-being.

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.

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.