All posts by Harvard Sylvan, OD

Myopia Signs and Symptoms in Children

Posted by Harvard Sylvan, OD on Tuesday, September 11, 2012

Myopia, also called nearsightedness, is a common problem where light rays passing through the eye are focused before they reach the retina. The retina is the light sensing membrane at the back of the eye that contains the rods and cones that collect and transfer the light via the optic nerve to the brain that then produces the images that we call ‘seeing’.

Ideally, light passing through the eye will come to a sharp focal point at the retina. When light is focused in front of the retina, as in myopia, distance vision becomes blurred. The degree of blur depends on how far the focal point is in front of the retina. While distance vision is blurred, near vision is usually clear. Myopia in children is usually the result of the length of the eye being too long with regard to the focusing power of the cornea and/or lens or the focusing power of the cornea and/or lens being too strong for the particular length of the eye.

The most common signs that should alert parents that their child may be myopic are squinting when looking at objects that are not close and sitting close to the TV. Headaches are also common as are complaints of ‘eyestrain’. Poor grades may be another sign as the student may not be able to see the board in school clearly. Difficulty in sports may also be due to myopia. There is a genetic basis to myopia. If both parents are myopic, there is a greater chance that the child will also become myopic. The age at which a child develops myopia varies, but generally, 7 to 12 years old is a common age range.

Blurred distance vision due to myopia is most frequently corrected by prescription glasses or contact lenses. If the child is mature enough to handle contacts, daily disposable contact lenses, such as CooperVision’s Proclear 1 Day lenses, are recommended.

Myopia control is the subject of much research as there is a significant increase in the prevalence of myopia globally. Several studies have demonstrated that taking part in outdoor activities for some portion of the day results in less myopic development. One theory is that the ambient outdoor light is a key factor in less myopic development. Certain topical drugs can be used to slow the progression of myopia, but they cause a reduction in the ability to see up close and they also cause the pupil to dilate and therefore increase light sensitivity. The use of special bifocal contact lenses and lenses that reshape the cornea have both demonstrated some ability to slow the development of myopia but are not yet approved for that use.

If your child is having trouble academically or in sports, squints when looking at objects that are not close, sits too close to the TV or complains that he/she can’t see objects in the distance that others can see, have an evaluation by an eye doctor to determine the underlying cause.

The Difference Between Dry Eye and Allergies

Posted by Harvard Sylvan, OD on Tuesday, August 28, 2012

The two most commonly experienced eye related problems (not including needing glasses or contact lenses) are dry eyes and ocular allergies. Although some symptoms are similar, there are distinct differences between the two eye conditions. In fact, dry eye and ocular allergy can occur simultaneously. If you are a contact lens wearer, both dry eye and allergies can make wearing contact lenses more difficult.

Dry Eye

Tears are not made of just water. There are numerous components to tears, but think of them simply as having three layers – mucin, water and lipids. A dry eye situation occurs when either too little water/mucin is produced, or if too little lipid is produced. The lipid layer is the outer layer of the tears and its primary role is to prevent the tears from evaporating or spilling over the lid margins. The lipid layer is produced by glands on the edge of the lids called meibomian glands. The majority of dry eye is caused by a decrease in this lipid layer. Certain medical conditions can also cause dry eye. The most common symptoms include burning, a sandy, gritty feeling, redness and sometimes reflex tearing.

Allergies

While eye allergies can also cause redness and tearing, the main symptom is itching. An ocular allergy is caused by sensitivity to a substance that is not usually harmful. When the allergen interacts with cells called mast cells, a substance called histamine is released which causes itching, redness, and swelling. Most allergies are due to environmental factors like pollen, cat dander, dust mites, etc. There are also more serious ocular allergies that require medical intervention.

Treatment

Treatment is different for dry eye and ocular allergies. Dry eye treatment includes treating the meibomian glands, the underlying inflammation, and using tear lubricants. The treatment for ocular allergy includes using antihistamine/mast cell stabilizers (to prevent the release of histamine from the mast cells), artificial lubricants, cool compresses and avoidance of the allergen (if possible).

For contact lens wearers, your doctor may choose a contact lens with a material that is more resistant to drying out like CooperVision’s Proclear lenses. For allergy sufferers, wearing a 1 day disposable lens will give the best chance for successful lens wear. CooperVision’s Proclear 1 Day and Proclear 1 Day Multifocal lenses provide the best option as they are resistant to drying out and get replaced each day.

Many people use over- the- counter products to self- treat dry eye and ocular allergy problems. It is estimated that the cost of doing that exceeds the cost of prescription products which are more effective. If you feel that you have dry eye or ocular allergies, see your eye doctor for a complete evaluation and recommendations for the best treatment options.

The Benefits of Multifocal Contact Lenses

Posted by Harvard Sylvan, OD on Thursday, August 16, 2012

Eye doctors are well aware of the growing number of presbyopes in the U.S. Fitting presbyopes provides a huge opportunity for contact lens practice growth. The number of presbyopic patients is expected to double by 2030 and will account for 20% of the population. It is estimated that over 30% of patients in the average practice are presbyopes. In addition, approximately 2 million current contact lens wearers are becoming presbyopic each year… and the majority of them want to continue to wear contacts. Soft multifocal contacts provide distinct benefits for both patients and practitioners.

Benefits for Patients

We all know that for presbyopic patients, soft multifocal contacts allow them to participate in numerous activities without the hassle of glasses and provide better peripheral vision. Many people also use computers. Multifocal contacts eliminate the need to tilt the head back like patients have to with glasses. Glasses can also become uncomfortable on the bridge of the nose and on and behind the ears as well. Multifocal contacts are also a great option for patients that want to look their best. There are also benefits for children with accommodative or convergence excess problems. Most children don’t want to wear bifocal glasses and multifocal contacts allow them to have the additional plus that is needed at near. With multifocal contact lenses, younger patients may benefit from more self confidence.

Why Multifocals?

Many doctors still utilize monovision to fit their presbyopic patients, but humans have a binocular visual system. There is an old adage that states, ‘two eyes are better than one’. Multifocal contacts provide improved intermediate vision that may be lacking with monovision and maintains binocular summation which enhances stereopsis and, usually, both distance and near acuity. Numerous studies have concluded that when given the opportunity to experience both multifocals and monovision, the majority of patients prefer multifocals 1,2,3 In a supplement to the July 2012 issue of Contact Lens Spectrum entitled, ‘Multifocals: The New Standard of Care’, Dr. John Schachet states, ‘We've established that multifocal contact lenses have replaced monovision as the standard of care’. I concur with that statement.

Benefits for Eye Doctors

There are also benefits to fitting multifocal contacts for doctors. The main benefit, besides the gratification of satisfying the needs of the patient, is the increase in patient referrals. Invariably, when I have successfully fit a patient with multifocals, that patient is enthusiastic and excited and always seems to have a friend, family member or co-worker that is referred for a multifocal fitting. That leads to an increase in practice revenue and profitability.

Fitting multifocal contacts benefits both patient and doctor and is the win-win solution that eye doctors are always seeking.

Fitting Children with Contact Lenses

Posted by Harvard Sylvan, OD on Wednesday, August 8, 2012

Many parents ask when it is appropriate for an eye doctor to fit children with contact lenses. As we have written before, there is no specific age limitation to children wearing contact lenses. There are even babies who have been fit with contacts. The main considerations for a parent to consider are the motivation and maturity of the child and his/her ability to insert and remove the lenses; especially when the child is not at home. A good indication of motivation is the child asking for contact lenses rather than the parent suggesting it. I have had patients as young as 8 years of age who have been successful contact lenses wearers and been very adept at inserting and removing the lenses.

There are many advantages to fitting children with contact lenses:

  • For sports and other outdoor activities: Contacts are less cumbersome than glasses, provide better peripheral vision, won’t fog up or get splattered by dirt or raindrops and eliminate the possibility of the glasses breaking and perhaps causing an eye injury.
  • For children with focusing and/or convergence problems:Often, bifocal glasses are prescribed. As most children and teenagers do not want to wear bifocal glasses, they may remove them after leaving their homes. Fitting children with contact lenses will increase the likelihood of the needed correction being worn.
  • Psychological benefit of fitting children with contact lenses:In many cases, especially if the prescription is high, fitting children with contact lenses will give them a better self image and more self confidence.

Daily disposable contacts are the ideal lenses for children. These lenses are worn during only one day and then discarded. No cleaning and disinfecting is required. A fresh, clean and comfortable lens is utilized each day the lenses are worn. Contact lens related problems are minimized when wearing one day disposable lenses. Also, if the child has allergies, one day disposable lenses are the best option for contact lens wear.

If you are considering having your child fit with contact lenses, ask your eye doctor about CooperVision’s Proclear 1 Day lenses. These lenses are made from a material that resists deposits, drying out and provides excellent all day comfort.

Acanthamoeba Keratitis and Contact Lenses

Posted by Harvard Sylvan, OD on Monday, July 16, 2012

Acanthamoeba keratitis is a serious infection of the cornea that is caused by certain strains of a particular type of amoeba called acanthamoeba. Acanthamoeba are single cell organisms commonly found in soil, water (swimming pools, hot tubs, showers, etc.) and the air.

Here are some tips that may decrease the risk of developing acanthamoeba keratitis for contact lens wearers.

  • Don’t use tap water when cleaning or rinsing your contact lenses or case
  • Don’t ‘top off’ or reuse disinfection solution
  • Don’t wear contact lenses in a hot tub, swimming pool, freshwater lakes and rivers, or the shower.
  • Wash your hands and dry with a lint free towel prior to inserting or removing your contact lenses
  • ALWAYS replace your lenses according to the schedule given to you by your doctor.
  • FREQUENTLY replace your contact lens case (at a minimum, cases should be replaced whenever a new bottle of disinfecting solution is opened)

Some symptoms of Acanthamoeba keratitis are:

    • Pain – often more pain than would be expected by how the eye looks

    • Redness
    • Tearing
    • Sensitivity to light
    • Decreased vision
    • No improvement or symptoms getting worse if already being treated for a corneal infection (as it is difficult to identify acanthamoeba keratitis in its early stages, it is frequently mistaken for and treated as bacterial keratitis)
    • Should any of the above symptoms be present, stop wearing your contact lenses and see your eye doctor as soon as possible.

    Remember, that by following your doctor’s instructions and properly handling your contact lenses, the risks of acanthamoeba keratitis will be minimal and you can enjoy wearing your contact lenses.

Sleeping in Contacts

Posted by Harvard Sylvan, OD on Wednesday, June 27, 2012

Many contact lens wearers find that they occasionally fall asleep with their contact lenses still on and want to know if that is okay. Other patients find that sleeping in contacts is desirable and want to know for how long they can do so. Sleeping in contacts without any negative effects to the eye is dependent on several factors. Some of these factors are the lens material, lens thickness, the prescription, and the length of time the eye is closed while sleeping in contacts.

When the eye is closed, the cornea receives oxygen from the blood vessels in the underside of the lids. When sleeping in contacts, the lens material must have enough oxygen permeability to allow oxygen to diffuse through the lens to reach the cornea. Currently, the highest oxygen permeability is found in lenses made from a silicone hydrogel material such as CooperVision’s Biofinity lenses. If contact lenses are not made from a silicone hydrogel material, the thinner a lens is and the higher the water content a lens has, the higher the oxygen permeability will be. However, the oxygen permeability is no where nearly as great as in a silicone hydrogel lens. The more nearsighted (myopic) a person is, the thinner the center of the contact lens. The more farsighted (hyperopic) a person is, the thicker the center of the lens. People who need a correction for astigmatism or are wearing multifocal contacts will also have slightly thicker lenses. The material, design, thickness and prescription all influence the amount of oxygen passing through a contact lens.

Sleeping in contacts for overnight wear requires a lens that has received extended wear approval from the FDA. Just because a lens has been approved for extended wear does not guarantee that a person sleeping in contacts will be able to do so successfully. That is dependent not just on the amount of oxygen reaching the cornea, but on the composition of the tears, the amount of deposits on the lens, the amount of lens dehydration and tear exchange beneath the lens.

When sleeping in contacts for a short period of time, just remove the lenses upon awakening. It may be necessary to instill some contact lens approved rewetting drops to loosen the lens prior to removal. Problems are rare when sleeping in contacts for a short period of time, like napping. If you plan on sleeping in contacts overnight, you may want to use rewetting drops after you wake up to help improve comfort and vision. Sleeping in contacts overnight does have a higher risk factor for corneal problems. If you are sleeping in contacts and develop pain, redness, blurred vision, etc. make sure to contact your eye doctor immediately.

Growing the Multifocal Practice Part 2

Posted by Harvard Sylvan, OD on Tuesday, June 26, 2012

There are several ways to boost the number of patients with presbyopia who wear soft multifocal lenses in your practice. The first and most important way is for the doctor to recommend, or at least offer soft multifocals as an option to all patients with presbyopia who may be suitable candidates. Here are some more tips to help you grow your multifocal practice

  • Realize That Patients Rely On Your Opinion: Patients need to know all of their vision correction options when it comes to presbyopia. In a recent European survey, patients were asked why they chose the contact lenses that they were wearing. The number one reason by far why they wore the lenses that they wore (61% - the next closest response was 20%) was because of ‘the recommendation of the doctor.’ In a study in Denmark last year entitled “Sight over Forty,” most patients with presbyopia said that they were unaware that soft multifocal contacts even existed as an option and that 50% of them were interested in trying them if their doctors had suggested them.
  • Train Your Staff: Another important factor is to train your staff to be knowledgeable about presbyopia and soft multifocal lenses. There are opportunities for trained staff to discuss presbyopia and the options to correct it when patients call the office, at the reception desk upon entering the office, during pre-testing, and in the dispensary. Staff should have enough of an understanding to be able to guide patients to ask the doctor if they may be a suitable candidate for soft multifocal lenses. It is helpful if any of your staff members with presbyopia wears soft multifocal lenses in the office. They can discuss their own experience with soft multifocal contact lenses with patients.
  • Learn About New Product Offerings: There is a new multifocal contact lens option that should help you build out your multifocal practice even further. Proclear 1 day multifocal contact lenses can appeal to a broad group of patients with presbyopia. One day disposables are certainly the most convenient and healthiest contact lens option.
  • Identify Ideal Multifocal Candidates: Whether its emerging presbyopes who prefer the one day modality, patients who would like to wear contact lenses occasionally or even patients interested in switching over to multifocal contact lenses from monovision, there are a variety of patients that you can fit with multifocal contact lenses. All of your single vision one day patients who now have presbyopia and current patients with presbyopia who are wearing one day lenses as monovision are ideal candidates. Many current soft multifocal wearers in a two week or monthly modality may be interested in wearing a daily disposable now that a viable option is available.

The key is to be proactive. Informing and educating your patients with presbyopia about soft multifocal lenses and making a recommendation that will benefit them will result in a definite increase in the number of patients wearing these lenses.

Eye Safety Reminder

Posted by Harvard Sylvan, OD on Tuesday, October 26, 2010

As Halloween is approaching and cosmetic (vanity) contact lenses are often in high demand, it is important to remember that a contact lens is a medical device and requires a prescription. Even though you may consider contacts an accessory or part of your costume, you should not disregard the fact that the health of your eyes may be at risk. Any contact lens that is not FDA approved may not be safe for use. In addition, it is imperative to understand and comply with the proper disinfection routine, the correct insertion and removal technique and the recommended wearing schedule.  Not following proper care and handling guidelines can potentially lead to serious, sight-threatening eye infections.  Another important fact to remember is to not share contact lenses with anyone else.  Occasionally you will see fashion or costume contact lenses advertised online or on TV.  Be cautious of any contact lenses advertised from a non-trusted source. 

The potential dangers and risks of non-prescription contact lenses far outweigh any fashion benefit. Remember – to ensure the safest wearing experience, contacts require a prescription from a licensed eye care professional as well as the necessary wearing instructions and follow up care. Always consult an eye doctor before considering any type of contact lenses.

To find an eye doctor near you, please click here. Have a safe and happy Halloween!

Think Twice About Lady GaGa's Wide Eyed Look

Posted by Harvard Sylvan, OD on Thursday, July 15, 2010

A new trend in cosmetic contact lenses has caught a lot of attention in the media lately due in part to a recent music video debut from pop phenom Lady GaGa.  A ‘Circle Contact’ is a specific type of cosmetic contact lens that is manufactured in South Korea, in which the iris appears larger due to the opaque design of the large diameter contact lens covering a portion of the sclera (the white part of the eye).  This trend is modeled after Japanese anime cartoon characters, in which the eyes (and in particular, the pupils) of characters are enlarged to make the appearance of doll-like eyes. While Lady GaGa’s look from her “Bad Romance” video is reportedly computerized, the trend of purchasing the non-FDA approved contacts is growing.

Watch this clip from ABC News detailing the dangers of this trend.

‘Circle Contacts’ are not FDA approved and are not approved for purchase in the US as sales of lenses without a valid prescription have been banned since 2005.   While the cartoonish-look may be desirable to some, the potential dangers and risks outweigh any fashionable benefit.

Contact lenses are a medical device. To prevent potential eye problems, some of which may be serious, contacts need to be fit properly, require a prescription from a licensed eye care professional and the health of the eye needs to be monitored periodically.   Always consult an eye doctor before considering or using any type of contact lenses.  To find an eye doctor closest to you, please click here.

 

High Tech Contact Lenses? Part 2

Posted by Harvard Sylvan, OD on Tuesday, April 6, 2010

What do stents, catheters, and contact lenses have in common?  As one is metal, one is rubber and one is made from a combination of water and plastic, there wouldn’t appear to be any similarities.  So, what exactly do they have in common?  To perform properly, they all need protection from protein deposits.  Stents and catheters need protection against proteins found in blood plasma and contact lenses need protection from deposits formed by protein in tears.

There are two things to which all contact lens wearers can relate – dryness and discomfort due to deposits on lenses and lenses becoming dryer as the day progresses.  Fortunately, there is a contact lens material that is very resistant to both protein deposits (the most common type) and dehydration.   The material is PC hydrogel and CooperVision’s PC hydrogel material is the only one that has FDA clearance to be labeled as ‘may provide improved comfort for contact lens wearers who experience mild discomfort or symptoms relating to dryness during lens wear (non-Sjorgen’s only)’.

Interestingly, this material was not developed by a contact lens company, it was created by a biotech company that was looking to develop a material that was very resistant to protein deposits for devices associated with cardiology (stents, catheters, guide wires, etc.).  Those devices come into contact with blood plasma which contains a significantly higher amount of protein than do tears.  A material was created by incorporating PhosphorylCholine (hence ‘PC’) which is a part of the human cell membrane.  Protein does not stick to our cells in part because of PC.  When incorporated into these medical devices there was a significant reduction in the amount of protein deposits that formed.  The biotech company started looking for other objects that needed protection from protein deposits and realized that contact lenses were an ideal choice.  A new material was developed that incorporated PC and was called PC hydrogel.

Not only did PC hydrogel lenses have excellent resistance to protein deposits, the lenses were found to be very resistant to drying out.  Although this was not why the material was developed, it has become the main advantage.  

PC hydrogel lenses are available for virtually every vision correction.  Even with the increasing popularity of silicone hydrogel lenses, PC hydrogel lenses are still a viable, and often preferred, option.  The material is unique because it attracts and binds water to keep lenses moist all day, translating into long wearing comfort for you. 

PC hydrogel lenses are not approved for overnight wear.  If you do not plan on sleeping with your lenses on and want a lens that does not dry out easily, has minimal deposits and provides long wearing comfort each day, ask your eye care provider for lenses made with PC hydrogel material, such as the line of Proclear lenses from CooperVision. Welcome to the biotech world!

About The Author

Harvard Sylvan, OD

Dr. Sylvan is the Director of Professional Relations at CooperVision, Inc.  Prior to CooperVision, he was on staff as a contact lens specialist at a private practice in Connecticut. He has also owned and managed multiple offices in a professional retail environment, as well as consulted for several contact lens companies.

About On Eye

On Eye is the contact lens blog from CooperVision. On this site, you will find insights about fitting, technology, and the business of contact lenses. The On Eye blog is designed to meet the needs of both Eye Care Practitioners and consumers. ECP and medical professional-specific portions of the blog will be password protected in order to protect and reserve the privacy of the profession. To read more about our terms of use, please see the Legal tab.

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