The MediWorks Firefly WDR slit lamp provides you:
- A better eye exam experience as you can see what the doctor sees
- The opportunity for you to view and discuss any pathology on the eyes, eyelids and meibomomian glands that your eye doctor discovers at the time of your exam
- The definitive answer on whether your dry eye is caused by meibomian gland dysfunction (MGD)
- A permanent record for your file, which allows our doctor to show you any improvements or changes after you complete your red eye or dry eye treatment plan
No, TearCare® does not hurt.
When heat is applied to your lids, patients have described it as a spa-like experience. You will feel an almost immediate heat wave similar to you entering a hot tub. The smart lids will start at 41°C (105.8°F) and will increase 1°C (1.8°F) every 30 seconds until it reaches its maximum therapeutic temperature of 45°C (113°F). If the heat feels uncomfortable to you, we can adjust it and dial it back down.
For the manual expression of your meibomian glands, our eye doctor will apply numbing eye drops and you will feel a gentle squeeze on your eyelids every time the doctor clears your glands with the forceps. Patients describe it as feeling pressure being applied to the lids. It is normal for patients to experience watery eyes and tearing during this portion of the procedure.
TearCare®, similarly to Lipiflow® and iLux®, is considered one of the most effective treatments for dry eye caused by meibomian gland dysfunction (MGD).
Medications like Xiidra™, RESTATIS® or Cequa™ address the persistent inflammation component of the ocular surface and tear film but does not resolve your clogged meibomian glands or eyelid inflammation. For blepharitis (eyelid inflammation), a hypochlorous acid spray such as Avenova® is faster acting and more effective.
Our eye doctor will determine when Xiidra™, RESTATIS® or Cequa™ is adequate for your dry eye treatment. Depending on your symptoms and cause of dry eye, these medications can be complimentary to TearCare®. Please note that these medications are not always covered by medical insurance, usually require pre-authorization, tend to be expensive and typically take at least 1-3 months to show result.
Starting a regimen on one of these medication is a long-term treatment option and patients should not start it unless they can commit to it.
A moist warm compress or heated eye mask functions with the same underlying principle as TearCare®:
- Heating the lids to liquify any clogged oil
- Clearing out obstructions in the meibomian glands
Though they target the meibomian gland dysfunction (MGD) root cause of dry eye and provide relief, they are less effective on both counts due to:
- Inability to reach measurable therapeutic temperature of 41-45°C (105.8-113°F) to melt meibum since each microwave has non-uniform power levels and timer settings
- Inability to maintain consistent therapeutic temperature for at least 10 minutes. You constantly have to reheat the warm compress every few minutes as it cools off very quickly
- Less than optimal contact between the warm compress and eyelids
- Difficulty for you to effectively express the meibomian glands through lid massage with your fingers. Most people forget and don’t do the finger lid massage after using the warm compress.
In addition, squeezing meibomian glands with your fingers is like squeezing toothpaste out of tube on a pillow. The back of your eyelids is your eye, which is soft tissue (like the pillow). Anything you manage to squeeze out won’t come out easily.
During your TearCare® treatment, our eye doctor uses forceps (a flat tweezer-like surgical instrument) to provide equal pressure on both sides of your meibomian glands to unclog them. Think of it as squeezing toothpaste out of a tube while placing it on a hard tabletop or counter. It is much easier and faster!
Meibomian gland dysfunction, when left untreated, can have long-term health and lifestyle consequences:
- Inability to maintain stable and sharp vision, regardless of your prescription power or the quality of the lenses you purchased
- Constant watery eyes
- Contact lens intolerance (you can no longer wear contacts)
- Decrease in quality of life due to your inability to enjoy activities that are affected by wind, air, dust, air conditioning… such as biking, running, traveling by airplane or car
- Increase frequency of blepharitis or other eye infections
- Higher risk of complications from LASIK surgery
- Increased monthly cost in temporary relief treatments such as eye drops, heat masks… etc
- Tired or fatigued eyes
- Burning or stinging of the eyes
At the beginning stages of meibomian gland dysfunction (MGD), you may not have any symptoms. As MGD progresses, your meibomian glands will have decreased function, which is when you feel discomfort and dry eye.
At its worse, meibomian glands that are left inflamed or clogged for too long will eventually atrophy (die off) and our eye doctors may not be able to revive them or bring them back.
Severe pain in your eye is an eye emergency. Please contact us immediately for guidance and to schedule a same-day appointment.
Studies have shown TearCare® can provide dry eye relief from meibomian gland dysfunction (MGD) for 6 months to a year. Some patients who’ve tremendously enjoyed TearCare® have asked how often they can do it. Based on their individual needs, we can do another treatment every 3 months.
Normal functioning meibomian glands secrete clear oil. Clogged meibomian glands produce crusty, toothpaste-like or pus-looking meibum.
Clogged meibomian glands will make your eye easily sensitive to environmental factors such as wind, dust, air conditioning etc… Your vision won’t be as crisp because the tear film is unstable, which does not allow the light to reflect correctly and consistently onto your retina.
There are currently only 4 treatment options available on the market that are based on the tried and true method of applying heat to the lids and expressing the meibomian glands:
- Lipiflow® from Johnson & Johnson Vision
- TearCare® from Sight Sciences
- iLux® from Alcon
- Thermoflo I and Thermoflow IIx dual from MiBo Medical Group
Our office has selected TearCare® as the best treatment for our patients due to its:
- Proven effectiveness
- Ability to work equally well with both large or small eyelids
- Open-eyes system which allows patients to keep the eyes open during the treatment
Other adjunct meibomian gland therapies exist but they use different pathways for dry eye relief. Most of them are based on lid debridement and/or reduction of inflammatory markers. You can find them named as: BlephEx, NuLids, IPL (Intense Pulsed Light)… etc.
Please consult your optometrist or ophthalmologist to discuss which would work best for you. Not all therapies will be available in your area or at your local eye doctor’s office.
Though LASIK is meant to last a lifetime, your vision may still change with age and time. The following may still impact you, regardless of the type of refractive eye surgery you got:
- Under-correction: If you experience a refractive error, your doctor can adjust it and you can do a follow-up “enhancement” surgery to achieve the level of visual acuity you expect
- Eye health changes: eye diseases such as age-related macular degeneration (AMD), diabetic retinopathy… etc. can still affect your vision
- Cataracts: cloudiness of the lenses due to aging
- Presbyopia: most people will struggle with the ability to clearly focus up close after age 35-40 and may still need reading glasses
Long-term complications are considered rare and generally result from poor pre/post-op care, wound healing or infections.
Most side-effects resolve themselves over time. They include:
- Glare
- Halos around images
- Trouble driving at night
- Fluctuating vision
- Dry eyes
- Scratchy eyes
- Light sensitivity
- Small bruises on your eye
Our optometrists strongly recommend that moderate-to-severe dry eye patients treat their chronic dry eye symptoms seriously prior to doing any LASIK or refractive surgery. A stable tear film is crucial for the healing process in order to minimize long-term visual and comfort issues.
The surgeon will explain and help you decide if LASIK, PRK, SMILE, or LASEK is best for you during your complimentary pre-surgery consultation.
- PRK is a good option for patients with thinner, asymmetrical or irregular corneas as well as patients who are predisposed to chronic dry eye, and patients whose jobs or lifestyles cause them to take a lot of direct contact to the eyes. The visual results of PRK are comparable to LASIK and SMILE. PRK is considered to be the first generation of vision correction procedures with excimer lasers. The procedure involves reshaping the surface corneal tissue and not the inner corneal tissue like LASIK.PRK differs from LASIK in that no corneal flap is required but PRK has the longest recovery period out of all 3 laser surgeries.
- SMILE is often the right solution for patients with nearsightedness (it can’t correct farsightedness and astigmatism yet) and for those with thin corneas, dry eyes, or contact lens intolerance. SMILE causes less disruption of the corneal nerves than other laser vision procedures as it does not create a flap like with LASIK. As a result, you may have even lower chances of dry eye. However, SMILE takes a slightly longer time for recovery (1-2 days) when compared to LASIK (“instant” visual recovery).
Every patient is different and the surgeon will provide specific guidelines for your post LASIK care. For most patients, they can return to work and normal daily activities after 24 hours. Our optometrist will perform an eye exam after the day of the procedure to determine if you can resume driving. By the end of the first week, most may return to exercise and wear eye makeup. For contact sports, patients should wait at least one month.
For best surgery outcome, you are expected to have follow-up eye exams 1-day, 1-week, 1-month, 3-month, 6-month and 1-year after LASIK surgery.
LASIK surgery cost varies by location and providers but patients can anticipate to pay between $1,500 to $3,000 per eye. Insurance plans typically don’t cover the cost as this is considered an elective procedure. Financing option is usually available.
The fees typically cover:
- Pre-surgery care
- Surgery, including any medications given as part of the surgery
- Post-operative exams and care
- Follow-up “touch-up” surgeries (commonly called LASIK enhancement) if you do not get the vision correction you expect
Compared to PRK or LASEK, LASIK healing times are significantly shorter, with most LASIK patients returning to work and normal life very shortly after their LASIK procedures. Noticeable vision improvement after LASIK is virtually overnight, and it’s very common to treat both eyes on the same day.
- 20/20 or near 20/20 clear vision at distance or near, without the need for glasses or contact lenses (high-risk patients may only be able to get results comparable to their best-corrected vision but without glasses or contacts)
- Essentially painless
- LASIK surgery takes only about 10 minutes per eye
- Quick recovery time with no bandages or stitches – vision is corrected nearly immediately or within 24 hours of surgery
- Dramatic reduction of cost and dependency on glasses or contact lenses
There are many reasons you may have a bump on or around your eye. The most common ones are on, or under the lids and are called:
- stye: a small, red, painful lump that grows from the base of your eyelash or under the eyelid due to an infected oil gland or hair follicle. A stye may cause the eye to feel sore and scratchy.
- chalazion: a small, slow-growing lump or cyst that develops within the eyelid. They are not usually painful and rarely last longer than a few weeks. They develop when a meibomian gland at the edge of an eyelid becomes blocked or inflamed. A chalazion can sometimes develop into a stye.
The easiest way for you to get relief is to take the following steps:
- Use a warm compress to reduce swelling and inflammation every day.
- Clean your eyelids every day, twice a day by using a lid scrub or a hypochlorous acid (HOCl) cleansing spray. For lid scrub, we suggest OCuSOFT Lid Scrub Plus instead of the non-plus version because of its stronger anti-bacterial properties. For hypochlorous acid cleansing spray, we like Avenova, which you can buy in-office or on Amazon. The lid spray is more natural and may be better tolerated for people with sensitive skin.
If your stye or chalazion does not resolve itself within a few weeks, please consult your local optometrist for other treatment options and for the best treatment outcome,
Yes, just like blunt trauma to the eye, a black eye needs to be properly evaluated to rule out things like a corneal abrasion, inflammation inside of the eye, and possible internal bleeding or damage to the back part of your eye, the retina. An eye exam is strongly recommended to rule out any more serious eye emergency.
Yes, being hit in the eye with any kind of object can be dangerous. An immediate visit to your local eye doctor is recommended to ensure that you don’t have any corneal abrasion, bruising or internal bleeding of the eye.
A scratch on your cornea (the outer clear part of the eye that covers the colored iris part) can be dangerous because it can become infected or lead to scarring, which may cause reduced vision or blindness. Depending on how deep your scratch is, your eye doctor may prescribe antibiotics to address the infection or steroids to reduce inflammation so that your eye can heal properly.
This type of injury can also lead to another condition called “recurrent erosions” where the cornea has continued episodes of pain, light sensitivity, watering and possible scarring that become a chronic or lifetime problem.
If you feel pain or a feeling that something is in your eye, please contact us to determine the best treatment.
- Do NOT rub or touch your eyes as you can make it worse.
- If you are wearing contact lenses, take out your contacts on and do not wear them until you see your eye doctor.
- You may use artificial tears to irrigate the eye until you can be seen by your optometrist but a scratched eye should not be ignored, especially if you feel pain.
- Do NOT use redness-reducing eye drops like Visine
A scratched eye can get infected and may need antibiotics to heal. Your eye doctor may also prescribe a steroid to reduce inflammation. A scratched eye that does not heal correctly may leave a scar and will affect your long-term vision.
A chemical burn in the eye is an eye emergency that needs immediate attention to minimize long-term negative consequences to your vision:
- Flush your eyes immediately with cold water or saline for 5-10 minutes
- If you are wearing contact lenses, remove and throw out your contact lenses. Your contact lenses will have absorbed whatever chemical you accidentally spilled or sprayed onto your eyes and it will be nearly impossible to thoroughly clean them in a way that will make them safe to re-use.
- Give your eyes at least 24 hours to rest before re-applying contacts or before wearing any make-up that may touch your eyes.
- Light chemical burns will make your eyes look red, moderate to severe burns will turn your eyes white. Visit your local eye doctor for immediate care if you suspect something more serious. Your optometrist may prescribe antibiotics to help the healing process if your injury includes corneal abrasion.
When wearing contact lenses, having a foreign body sensation or feeling you have dirt in your eye is caused by many different reasons. The most common reason is that your eyes are getting too dry or your contacts are dirty and old.
- For immediate temporary relief, use artificial tears or eye drops to see if it helps. We recommend single-use preservative-free eye drops, especially if you feel the need to use eye drops more than 4 times per day because we want to avoid preservatives disrupting your tear film and exacerbating your symptoms.
- If you’ve been over-wearing your contacts or sleeping in them, stop wearing your contacts for a few days to allow your eyes to rest and use a new pair of contact lenses.
- If you’ve been working on the computer a lot, look into the distance for 20 seconds to allow your eyes a chance to refocus after every 20 minutes of computer viewing and remember to blink. Studies have shown that people working at a computer or on their digital devices tend to blink less than half as often as normal and do not blink fully, which dries out their eyes. Blinking is important because with every blink, your eyelids spread a fresh layer of tears across the surface of your eyes to keep them moist, comfortable and healthy.
- If the foreign body sensation persists, please consult your optometrist. You may have an infection or you may suffer from chronic dry eye associated with meibomian gland dysfunction (MGD). Your eye doctor may also recommend you try a different type or brand of contact lenses.
You should never try to remove anything that is actually stuck in your eye. If you can’t flush it out with water or saline, you need to see your local eye doctor. Trying to remove a foreign object yourself will usually just embed it further.
If something has pierced your eye such as a coat hanger of a piece of metal, you will need to go to an emergency room immediately. Quick action can prevent retinal damage, vision loss or premature cataracts
Any kind of foreign material in your eye can be dangerous. Usually, sand, dirt or dust can be flushed out of the eye with water, saline or contact lens solution. However, it can often scratch your cornea so you should see your optometrist if it feels irritated.
Glaucoma is a group of serious eye conditions when the optic nerve is being damaged, leading to progressive and irreversible vision loss. It is one of the leading causes of blindness for people age 60 and older. Even though glaucoma is more common in older adults, it can occur at any age.
Glaucoma is sometimes called the “silent thief of sight” because it slowly damages the eyes and can cause irreparable harm before there is any vision loss. But this disease is stealthy in more ways than one.
– Dr. Janey Wiggs, Massachusetts Eye and Ear Infirmary
The optic nerve damage is often, but not always, caused by abnormally high pressure in the eye. The optic nerve is a bundle of about 1 million individual nerve fibers that transmits the visual signals from the eye to the brain. Other theories suggest a lack of adequate blood flow to the optic nerve as possible cause for glaucoma.
By the time you notice vision loss symptoms, it may be too late. The vision loss cannot be restored and you can only save and maintain the current vision you have.
Different types of glaucoma will have different symptoms. The most common causes of glaucoma are listed below:
- Primary open-angle glaucoma, also called wide-angle glaucoma: this is the most common type of glaucoma, affecting at least 90% of all glaucoma cases, about 3 million Americans.It is caused by the slow clogging of the drainage canals, resulting in increased eye pressure (IOP). It is painless with no vision changes at first and will develop slowly as a lifelong condition. As the disease progress, you may experience:
- Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes
- Tunnel vision in the advanced stages
- Angle-closure glaucoma, also called closed-angle glaucoma, narrow-angle glaucoma: this is the less common form of glaucoma and is a medical emergency as it can cause blindness within a day of its onset. It is caused by blocked drainage canals when the angle between the iris and cornea is closing, resulting in sudden increase in internal ocular pressure (IOP). Angle-closure glaucoma can be chronic (progressing gradually) or acute (appearing suddenly). Please seek medical attention immediately if you experience:
- Severe headache
- Intense eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
- Secondary glaucoma: This is any type of glaucoma in which the increase in eye pressure was caused by another medical eye condition, physical injury, medication or in some rare occasion, eye surgery.
- Normal-tension glaucoma (NTG) or low-tension glaucoma: In this form of glaucoma, your optic nerve is damaged even though your eye pressure remains within the normal range. It is unclear why this would happen but some theorize that you may have abnormally sensitive optic nerve, or that you have lower blood flow going to the optic nerve due to a medical condition that impairs blood circulation, such as atherosclerosis, which is a hardening of the arteries from a buildup of fatty deposits (plaque) in the arteries.
- You may experience blind spots in your vision.
- Pigmentary glaucoma: Tiny bits of pigment granules from your iris (the colored part of your eye) break into the clear fluid and slowly clog or block your drainage canals. Rigorous physical activities like jogging may stir up the pigment granules and cause intermittent increase in eye pressure.
- Congenital Glaucoma: Infants and children may also have glaucoma due to a hereditary defect, an abnormal development during pregnancy when there’s incorrect or incomplete development of the eye’s drainage canals, or other medical conditions. For uncomplicated defect correction, microsurgery may be an option. For others, both surgery and medication would be required. Children with glaucoma may show the following symptoms:
- Unusually large eyes
- Excessive tearing
- Cloudy eyes
- Light sensitivity
When you arrive for your appointment, our optometrist will check for signs of glaucoma during the eye health check portion of your eye exam if you completed the optomap® retinal imaging or dilation. Visual field testing is also used to check if you have any blind spots in your vision, which is a common symptom of glaucoma.
Because most glaucomas progress so slowly with no vision loss symptoms in its earliest stage, our eye doctors use the most advanced technology in both retinal imaging and optical coherence tomography angiography (OCTA) to detect glaucoma early.
- We prefer the optomap® retinal imaging over dilation as it allows our optometrists to better gauge and monitor year-to-year changes to your retina and optic nerve, which therefore increases your chance to detect glaucoma early before you suffer irreversible vision impairment.
- Based on clinical findings, our eye doctor may also require an OCT/OCTA scan (ultrasound of your eye) to further measure Focal Loss Volume (FLV%), which is the current single best predictor of conversion to glaucoma according to the latest studies.
If you fall under one of the following categories, it is extremely important that you do a comprehensive eye exam (with eye health screening) instead of a basic routine eye exam during your annual check-up as you are more at risk of developing glaucoma:
- Age over 60: Each year of age slightly increases your risk of developing glaucoma. African Americans, Hispanics/Latinos are at increased risk after age 40.
- Race: African Americans are significantly more likely to get glaucoma than Caucasians, and they are much more likely to suffer permanent vision loss. People of Asian descent and Native Alaskans are at higher risk of angle-closure glaucoma. People of Japanese descent are more likely to develop low-tension glaucoma. Others of Irish, Russian, Hispanic, Inuit and Scandinavian descents are also at greater risk.
- Family history of glaucoma
- Medical conditions: Some studies indicate that diabetes, high blood pressure, heart disease, and sickle cell anemia may increase the risk of developing glaucoma.
- Physical injuries to the eye: Severe trauma, such as being hit in the eye, can result in immediate increased eye pressure. Internal damage from such a trauma can also cause future increases in pressure. Injury can also dislocate the lens, closing the drainage angle and increasing pressure.
- Other eye-related risk factors: thinner corneas and optic nerve sensitivity, conditions such as retinal detachment, eye tumors, eye inflammations… and high amounts of nearsightedness or farsightedness all increase your risk for developing glaucoma
- Corticosteroid use: Long-term use of corticosteroids (including cortisone, hydrocortisone and prednisone) appears to put some people at risk of getting secondary glaucoma.
For additional information, please visit one of the following resources and references:
- Glaucoma Research Foundation
- The Glaucoma Foundation
- International Glaucoma Association, “About glaucoma”
- National Eye Institute, “At a glance: glaucoma”
- Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34
Diabetic retinopathy is an eye condition that may develop in patients with diabetes (type 1, type 2, and gestational) and can lead to vision loss and blindness. It is the leading cause of blindness among adults in the US and usually affects both eyes.
When left untreated or when not under control, high blood sugar levels damage the blood vessels in the retina (the light sensitive part of the eye). Blood and fluids then leak into the eye, which then hinder light from reaching and focusing onto your retina.
In early stages, you may not show any symptoms and not know that you have diabetic retinopathy. As the disease progresses, you will experience:
- Spots or floaters
- Blurred or cloudy vision
- Seeing a dark or blank spot in your center field of vision
- Poor night vision
- Faded or washed-out colors
If you or your family has a history of diabetes, it is important for you to have regular annual eye exams. Our optometrist will use optomap® retinal imaging to detect early signs of blood or fluid leakage, giving you an overview of the general health of your retina.
Based on clinical findings, he or she may also require an OCT/OCTA scan (ultrasound of your eye) to review how much blood or fluid has leaked into your eye. Our Optovue AngioVue® OCTA features the latest angiography technology to view blood vessel changes at the micron level without dye injection to your eye, which helps our doctor detect risks to your vision much earlier than before.
Diabetic retinopathy will progress in stages:
- Mild non-proliferative retinopathy: At this earliest stage, microaneurysms occur, which are small areas of balloon-like swelling in the retina’s tiny blood vessels.
- Moderate non-proliferative retinopathy: As the disease progresses, some blood vessels that nourish the retina are blocked, swell and change shape. You may develop diabetic macular edema (DME) which is when your retina gets deformed because it is swollen with blood and fluids, therefore potentially affecting vision.
- Severe non-proliferative retinopathy: Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
- Proliferative retinopathy: At this advanced stage, abnormal new blood vessels grow inside your retina and into the vitreous humor, the clear gel that fills the inside of your eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, being thin with fragile walls, they leak blood and cause scar tissue to form, which then leads to vision loss from vitreous hemorrhage and also puts you at high risk of retinal detachment, causing blindness.
The goal of having regular eye exam is for our eye doctors to catch and monitor any microaneurysm formations early to avoid potential vision impairment. Our optometrist would prefer you keep your diabetes under control with preventive care over having you undergo invasive procedures like anti-VEGF eye injections or laser treatments to stop vision loss.
Even though laser treatments are effective at stopping internal eye bleeding, they are also known to scar the retina.
For additional information, please visit one of the following resources and references:
- American Diabetes Association, “Eye Complications“
- American Optometric Association, “Diabetic Retinopathy“
- American Academy of Ophthalmology, “What is Diabetic Retinopathy“
- National Eye Institute, “At a glance: Diabetic Retinopathy“
- Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34
A cataract is the clouding of your normally clear lens inside of your eye due to aging. It typically develops slowly over time and mostly affects people age 55 and over.
A clear lens allows light to focus onto the retina to produce a clear image. When clouding occurs due to a cataract, you will start experiencing the following symptoms:
- Blurry or hazy vision
- Trouble seeing at night
- Seeing colors as faded
- Increased sensitivity to glare from lights, particularly when driving at night
- Halos surrounding lights
- Needing more light to read in dark conditions
- Double vision in the affected eye
- Need for frequent changes in prescription glasses
Seeing through cloudy lenses is like seeing through a frosty or fogged-up window.
During your eye exam, our optometrist will help you determine what kind of cataract you have and will explain how it’s affecting your vision:
- Nuclear cataract affects and forms in the center of the lens. The nucleus tends to darken, changing from clear to yellow and eventually brown. This is the most common type of cataract associated with aging
- Cortical cataract affects the edges surrounding the nucleus of your lens. The cataract looks like a wedge or a spoke.
- Posterior capsular cataract affects the back outer layer of the lens. This type often develops more rapidly and interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night.
- Congenital cataract is a cataract that people are born with or that was developed during childhood due to genetics, trauma or medical conditions such as intrauterine infection, myotonic dystrophy, galactosemia, neurofibromatosis type 2 or rubella… etc.
There is currently no cure for cataracts. If a cataract is negatively impacting your quality of life, our optometrist may suggest cataract surgery to remove the cataract by replacing the lens inside your eyes. Similar to any age-related diseases, the best way to avoid or delay cataracts is to maintain a healthy lifestyle.
- Avoid and stop smoking
- Wear sunglasses to protect your eyes from the sun’s harmful UV rays
- Maintain healthy weight to avoid obesity
- Eat fruits and vegetables that contain antioxidants, Vitamin A, C, and carotenoids such as lutein and zeaxanthin. Good sources include sunflower seeds, almonds, spinach, kale and other green, leafy vegetables (consider supplementation as needed)
- Keep diabetes, cholesterol and other medical conditions in check
- Reduce alcohol consumption
For additional information, please visit one of the following resources and references:
- American Academy of Opthalmology, “What Are Cataracts?“
- All About Vision, “Cataracts: 3 common types, causes, symptoms and treatments“
- National Eye Institute, “At a glance: Cataracts“
- MedicineNet, “Cataracts”
- Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34
Aged-related macular degeneration (AMD) is the deterioration of the macula, the central portion of your retina that controls visual acuity (your ability to read, recognize faces and colors, drive, watch television, use a computer, and perform any other visual task that requires you to see fine detail).
AMD is the leading cause of vision loss in people age 50 and older. It is an incurable eye disease that gets worse over time:
- Early AMD: at this stage, no vision impairment is experienced however, our optometrist will diagnose the presence of medium-sized drusens (early aging of the macula that manifests itself as yellow deposits under the retina) during your retinal and OCT scans. Regular eye exams become important to monitor the progress of the disease.
- Intermediate AMD: some vision loss will occur but may not be noticeable. Symptoms include: blurry or fuzzy vision, straight lines looking wavy, objects seeming smaller than they actually are, dark/empty/gray areas appearing in your vision. Our eye doctor will look for larger drusens and pigment changes in your retina.
- Late AMD: vision loss is noticeable and permanent
Macular degeneration comes in 2 forms:
- Dry AMD is the more common form of AMD, experienced by 80% of AMD patients. The tissue of the macula gradually becomes thin and eventually stops working properly. You vision starts becoming dim and distorted until you lose central vision over time.
- Wet AMD is the less common but more serious form of AMD. It can progress rapidly. Dry AMD can turn into wet AMD. New, abnormal blood vessels grow under the retina and may leak fluids, therefore damaging light-sensitive retinal cells and scaring your macula. Your vision starts becoming distorted and blurry and as fluids continue to leak, scaring creates blind spots and permanent central vision loss.
Since AMD is an incurable disease, prevention and early detection is key to preserving your vision.
For anyone 50 years of age and older, we recommend optomap® retinal imaging as part of your eye health check-up during your annual eye exam, rather than dilation (unless necessary). Our eye doctor uses optomap® to detect drusens early and quickly assess the general health of your eye.
Based on clinical findings, our optometrist may require an OCT/OCTA scan to further assess the severity and progression of your drusens. Unlike other practices that may only have access to a regular OCT (ultrasound of the eye), our doctors use the latest angiography technology featured in our Optovue AngioVue OCTA® to view the vasculature of your eye without the need for uncomfortable dye injection into the eye, which helps guide best course of treatment for your care. The OCT/OCTA scan will reveal the extent and location of any blood vessel build-up or leakage.
Being wellness and preventive care focused, our eye doctors always prefer early detection over having you suffer partial/full vision loss and go through anti-VEGF eye injections to slow down the symptoms of intermediate or late stage AMD.
To help prevent AMD, here are some good habits you can adopt:
- Eat plenty of dark leafy greens, nuts, fruits and vegetables rich in antioxidants and carotenoids (kale, spinach, collard greens, turnip greens, broccoli, brussel sprouts, lettuce, peas, okra, nuts, seeds… etc). Studies have shown that high level of Vitamin A, E, C and carotenoids made of lutein, zeaxanthin and meso-zeaxanthin help replenish the pigments in your macula to protect it from deterioration
- Eat more fish or consider Omega-3 supplements
- Exercise regularly: a combination of regular exercise and healthy diet helps control high blood pressure and cholesterol, which both affect blood flow to the eye
- Avoid smoking: smoking speeds deterioration as it reduces number of protective nutrients, and oxygen delivered by the bloodstream to the eye
- Protect your eyes from UV and blue light by wearing sunglasses outdoors. Though UV light has not been confirmed to cause AMD, studies suggest that overexposure to both UV and high energy visible (HEV) “blue” light may accelerate the deterioration of the macula in the eye
- Consider MacuHealth vitamins if you are at risk of AMD: Many eye doctors may suggest AREDS 2 vitamin supplementation. However, our office currently prefers MacuHealth over AREDS 2 as the latest studies show debatable benefit and potential risk of higher Zinc dosage in the current AREDS/AREDS 2 formulation. Speak with our doctor to learn more.
For additional information, please visit one of the following resources and references:
- American Macular Degeneration Foundation, “About Macular Degeneration – Symptoms, Risks, Stargardt, Anatomy“
- American Optometric Association, Macular Degeneration Fact Sheet
- American Academy of Ophthalmology, “Age-Related Macular Degeneration Preferred Practice Pattern 2019“
- National Eye Institute, “At a glance: Aged-Related Macular Degeneration“
- Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34, “Two Big Controversies in Ocular Nutrition” pg 41
Meibomian gland dysfunction (MGD) is a common eye condition when the meibomian glands in your lids are clogged or have been compromised by chronic inflammation, demodex infestation, long-term use of contact lenses or failure to blink regularly when using digital device use without breaks.
When blocked, the meibomian glands secrete too little or no oil (meibum), which is needed to stabilize your tear film and help avoid your tears from evaporating too quickly.
Meibomian gland dysfunction is considered to be the primary cause of dry eye and is estimated to affect 86% of dry eye patients.
When available, an optometrist can check the structural quality of your meibomian glands by taking pictures of the inside of your lids with a meibographer as shown below.
- When the meibomian glands function properly, they will secrete clear oil naturally every time you blink to create a stable tear film.
- When blocked or clogged, the meibomian glands secrete little to no oil. Instead, they will secrete unhealthy crusty, pus or toothpaste-like oil when expressed with forceps.
- When left inflamed or clogged for too long, the meibomian glands may atrophy and die off. At that stage, you will suffer irreversible and permanent dry eye symptoms.
Demodex refers to 2 types of microscopic eyelash mites that live on humans:
- Demodex folliculorum, which live within hair follicles on eyelashes
- Demodex brevis, which live in sebaceous glands (oil glands) in the skin around the eyes
Most of the time, these mites are harmless and will go unnoticed. However, when they multiply and their population get out of control, Demodex can cause many ocular diseases like conjunctivitis, chalazia, blepharitis and contribute to dry eye symptoms, including eyelid itchiness and falling eyelashes.
These mites can also cause unwanted symptoms and skin problems like rosacea, androgenetic alopecia, non-specific facial dermatitis (acne-like blemishes). Demodex is transferred between hosts through contact with hair, eyebrows, and the oil glands of the face.
Blepharitis is an inflammation of the eyelids in which they become red, irritated and itchy and dandruff-like scales form on the eyelashes. It is a common eye disorder caused by either bacteria, a skin condition (such as dandruff of the scalp or rosacea) or demodex (eyelashes mites). It can affect people of all ages. Although uncomfortable, blepharitis is usually not contagious and generally does not cause any permanent damage to eyesight.
Blepharitis is classified into two types:
- Anterior blepharitis occurs at the outside front edge of the eyelid where the eyelashes attach.
- Posterior blepharitis affects the inner edge of the eyelid that touches the eyeball.
It is currently unclear whether blepharitis causes dry eye or dry eye causes blepharitis.
Blepharitis is often associated with either or both:
- Demodex mites: when bacteria multiply and overgrow at the margins of the eyelids and at the base of the eyelashes, a biofilm is formed. Biofilm is a toxic environment similar to plaque that forms on your teeth, from which parasitic eyelash mites called demodex can feed on. When untreated, demodex create a vicious cycle that worsens the eyelid inflammation and causes more dry eye symptoms.
- Meibomian gland dysfunction: bacteria in the eyelid biofilm produce substances called exotoxins that cause inflammation of the meibomian glands. Over time, inflamed meibomian glands become obstructed, which causes (and worsens) dry eye discomfort.
Dry eye is ultimately the dysfunction of the tear film. The tear film is a complex system that is comprised of the:
- Mucin layer: this mucous layer provides a “sticky” foundation and acts as a barrier to the eye surface
- Aqueous layer: this “watery” layer is produced by the lacrimal glands and provides moisture to the eye
- Lipid layer: this “oily” layer is produced by the meibomian glands and prevents the tears from evaporating
Each component needs to work in balance and harmony to keep the tear film stable. When you have an imbalance in these layers, the vision and comfort of your eyes are affected. Our doctor will evaluate what is causing the disruption in your tear film that makes you suffer from dry eye.
If you imagine the tear film like you would building a house:
- the mucin layer is the foundation
- the aqueous layer is the beams
- the lipid layer is the roof
When you have dry eye caused by meibomian gland dysfunction (MGD), your glands are clogged and are not producing enough lipid layer, meaning your roof has been compromised. With holes in your roof, you can’t maintain stable temperature in your house. Cool or hot air would escape out.
As such, when your lipid layer is compromised, your tears evaporate too quickly. You have to fix the roof (the lipid layer) for the house (the tear film) to be structurally sound and for you to live comfortably.
Tear film has 2 very important functions:
- Visual: ensure you have crisp and stable vision by keeping the surface of your eye moist, smooth and clear so that light can be easily focused onto the inside of your eye. If you ever felt letters are dancing around, you have experienced unstable tear film.
- Protective: maintain the integrity of the cornea so that you are not bothered by wind, dust, air conditioning and vents. Tear film help wash away foreign matter, rinse away dust particles and protect your eyes from bacteria that can cause infections.
Without a stable tear film, you will experience dry eye symptoms. The eyes will have more difficultly functioning normally and keeping your vision clear in all types of environmental conditions, regardless of how high/low the humidity is or how hot/cold the temperature gets.
Dry Eye is caused primarily by:
- Unstable or poor quality tear film, also called Evaporative Dry Eye (EDE)
- Insufficient tears, also called Aqueous Deficient Dry Eye (ADE)
Other factors may also contribute to dry eyes symptoms:
- Age – dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
- Gender – women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
- Medications – certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce tear production.
- Medical conditions – people with autoimmune diseases like Rheumatoid Arthritis, Sjögren’s Syndrome, Scleroderma, Lupus, thyroid problems and even sometimes diabetes are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, in-turning/out-turning of the eyelids (ectropion/entropion) or meibomian gland dysfunction (MGD) can cause dry eyes to develop.
- Environmental conditions – exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen, iPad or smartphone for long periods of time, can also contribute to drying of the eyes.
- Contact lens use or previous history of eye surgery – long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes.
- Screentime – reading, staring at a smartphone or computer, driving and other similar activities require concentration which tends to make people blink less often or make them do incomplete blinks, therefore leading to increased tear evaporation.
Eyeglasses:
- Can be an extension of your personality and make a great fashion statement
- Requires very little cleaning and maintenance
- Doesn’t touch your eyes to wear, therefore decreasing risk of eye infections
- Potentially cheaper in the long run since they don’t have to be replaced as often
- Can adjust amount of light entering your eye for optimal comfort, when using transition or blue light protection technologies
- Offers some protection from environmental factors like wind, dust and debris
- Doesn’t exacerbate dry eyes or sensitive eyes sensation
The main advantages of contact lenses are:
- You can show the beauty of your natural eye color better or experiment with different eye color with color contact lenses
- Contact lenses don’t clash with what you are wearing, or you don’t like the looks of eyeglasses
- Better overall and peripheral vision due to no obstruction from eyeglass frames
- More freedom of movement because contact lenses don’t get in the way when playing sports and exercising
- Contact lenses don’t get affected by atmospheric conditions and won’t fog up due to humidity or cold weather like glasses. No splattering during rain either
- Specialty contact lenses like orthokeratology (Ortho-K) and corneal reshaping therapy (CRT) can reshape your cornea while you sleep to temporarily correct myopia and allow you to see clearly the next day without glasses or contacts
To read more about the advantages and disadvantages of contact lenses by type, please visit the following American Optometric Association (AOA) page.
Choosing contact lenses over glasses depends on personal preferences in regard to lifestyle, comfort, convenience, aesthetics and budget. One is not better than the other.
Nearly anyone who needs vision correction can wear contact lenses. Contact lenses can provide vision correction for people with nearsightedness, farsightedness, astigmatism, or a combination of these issues. Finding the perfect lens for you is sometimes a process of trial and error. All of the lens parameters can be finalized only after you’ve worn the successful combination. Schedule an eye exam to talk with our optometrist about whether contact lenses would be a good vision correction option for you.
Changes in vision that occur with age include reduced pupil size, dry eyes, loss of peripheral vision, decreased color vision, and vitreous detachment. The most common vision problem that comes with age is presbyopia, which is the normal and unavoidable age-related loss of focusing ability. Different types of lenses can provide help for presbyopia. The risk of developing cataracts, glaucoma, and diabetic retinopathy increases with age too. Our eye doctor will discuss any age-related vision problems you’re experiencing at your next annual eye exam.
Taking your child to an optometrist for an eye exam is the best way to learn if your child needs glasses. Many children who need glasses aren’t aware that they do.
Signs of vision problems in children include sitting too close to the television, squinting, sensitivity to light, difficulty with eye-hand coordination, and avoiding visual activities like reading and drawing.
To see if your child needs glasses, schedule your child’s eye exam today. We will see children as young as 4 years of age.
You should bring your vision insurance and medical insurance information to your eye exam. If you have no insurance but have a current AAA membership, bring your AAA card for a discounted rate on your comprehensive eye exam.
If you currently wear any prescription lenses, bring your eyeglasses, sunglasses, and contact lenses so we can measure your current prescription
You should also bring any and all questions you may have. Contact our office if you have specific questions about any additional items you think you may need to bring to your eye exam.
You should see an optometrist at least once a year whether or not you believe you need vision correction.
With the right technology, the eye is the only place in your body where your doctor can evaluate the quality of your blood vessels without cutting you open. As such, an annual eye exam can detect not only eye diseases but also other systemic diseases like diabetes and high blood pressure, tumors, early sign of Alzheimer’s… etc.
Many serious eye diseases may start with no symptoms and when left untreated, can lead to vision loss and even blindness. With incurable eye diseases such as diabetic retinopathy, aged-related macular degeneration (AMD) and glaucoma, prevention is key in protecting and maintaining optimal vision.
So don’t neglect your eyes. Schedule your eye exam today.
