Healthy Eyes 101

In this episode Dr. Steven Suh interviews Dr. Katie Wulff, an optometrist, about a specialty gas-permeable contact lens called scleral lenses. Some people have abnormal corneal curvatures and irregularities which make it difficult for them to see even with glasses or soft contact lenses. Stephen Curry, an NBA star with the Golden State Warriors, wears scleral lenses because of his corneal condition called keratoconus.

Rigid gas-permeable contacts (RGP) and scleral contact lenses have a smooth, spherical, and hard surface which will neutralize these irregular “hills and valleys” on one’s cornea. The reason soft contact lenses do not work as well is because they “mold” onto these corneas and do not vault over them, thus replicating the abnormal curvature. Regular RGPs can be helpful in many cases but they have limitations. Scleral lenses do not sit on the cornea like RGPs but sit on the white part of the eye (sclera) so they are usually more comfortable.

Scleral contact lenses can help maximize vision in patients with these corneal conditions:

• Keratoconus
• Pellucid marginal degeneration
• Ectasia (abnormal corneal warpage and thinning) after LASIK surgery
• Corneal scarring
• Severe dry eyes
• After corneal transplants
• Corneal irregularities after radial keratotomy (RK)

Scleral lenses are much larger than standard rigid gas-permeable and soft lenses. Since they are customized for each patient’s eye, several visits are needed to ensure that the lens is fitting properly. Inserting these lenses onto the cornea may be much more difficult than other types of contacts. Because of their potential to restore sight in many of these patients, these specialty lenses can help delay or avoid the need for corneal cross-linking or corneal transplantation.
Here is another article on scleral lenses.

To find out more about Dr. Katie Wulff and her practice, go to Comprehensive EyeCare of Central Ohio’s website or Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

In this episode Dr. Suh interviews Dr. Ken Beckman about all aspects of dry eye disease. They first delve into the common signs and symptoms. Dr. Beckman then discusses the special tests that can be performed at your eye doctor’s office to confirm which type of dry eye disease you may have. Lastly, he does a comprehensive review of the wide-ranging treatments that are available today.
Below are links to some more information about topics that are discussed on this episode.

• Tear osmolarity measures the salt concentration of human tears to aid in the diagnosis of dry eye disease.
• InflammaDry detects high levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with chronic dry eyes.
• Lipiscan is a high-definition oil gland imager that allows eye care professionals to assess meibomian gland structure
• This is one of the brands of moist heat eye compresses that Dr. Beckman recommends in his office to help patients with evaporative dry eyes – the most common cause of dry eye disease.
• Lipiflow is a procedure performed in the office that heats and massages the eyelids to improve outflow of the natural oil from the glands that are so vital for a stable tear film layer.
• This is a nice summary article about the three prescription dry eye medications – cyclosporine-A (Cequa and Restasis) and lifitegrast (Xiidra).
• Punctal plugs, a quick, in-office procedure covered by insurance, are a nice adjunct to combat dry eyes.
• Autologous serum drops are eye drops made from a patient’s own blood plasma and serum.
• Scleral contact lenses can be worn to treat severe dry eyes. This is an old article but still relevant.
• This is a nice summary article on dry eyes from the American Academy of Ophthalmology
• Dr. Beckman was one of the lead authors in this landmark, peer-reviewed journal article that changed paradigms about dry eyes.

You can find out more about Dr. Beckman and Suh's practice at their website and on Facebook.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Dr. Sugat Patel, a retina specialist, joins Dr. Suh to discuss retinal detachments (RD), a potentially sight-threatening condition. Around 5 in 100,000 people per year will develop a retinal detachment.
A posterior vitreous detachment, separation of the liquefied vitreous gel from the retina, will occur eventually in most people. It is a major cause of flashes of light or floaters in the vision. Sometimes this may also lead to a retinal tear.

If the normal inner eye fluid (aqueous) gets under the retina through the tear, then the retina will lift off of the eye wall. This is a rhegmatogenous retinal detachment. When the retina detaches, most people will notice a scotoma, or a dark/blind spot, in their side (peripheral) vision. This scotoma may get bigger quickly and infringe on the central vision. This is an emergency and the patient needs to be evaluated by an eye care specialist immediately. Trauma and myopia (nearsightedness) are risk factors for this type of RD.

Exudative detachments occur when fluid leaks from the choroid, the nutrient layer underneath the retina. This can happen from uveitis (inflammation), bleeding, or an ocular tumor.

Tractional detachments occur when something inside the eye is pulling on the retina such as scar tissue from advanced diabetic retinopathy and retinopathy of prematurity.

Retinal tears can be treated with an in-office laser or with cryopexy (extreme cold therapy). Laser retinopexy is the more common way to treat this condition because it seals the tissue down quicker and with less inflammation.

For patients with small, asymptomatic RDs, laser retinopexy can be performed instead of surgery in the operating room. Even larger, asymptomatic RDs with tears in the upper part of the retina can be treated in the office with pneumatic retinopexy where a gas bubble is injected into the vitreous cavity to push the retina back into place. Laser or cryopexy is then used to seal down the area around the tear.

If a RD needs to be fixed in the operating room, various techniques can be used alone or together to fix the retina. A scleral buckle is a band that encircles the eye to help bring the eye wall closer to the retina. A vitrectomy is surgical removal of the vitreous gel which is what usually tugs on the retina in the first place. Laser is then used to seal the area around any retinal tears. Sometimes a gas bubble or silicone oil may be used to keep the retina in place.

All RDs need attention quickly, but macula-on detachments should be fixed more urgently because the macula is still functioning and has not separated yet. The center of the macula (fovea) is the most important area of the retina that enables one to see to read and to see details far away.

Post-operatively, patients may have some discomfort. With scleral buckles, there may be some double vision, which is usually temporary, because the buckle goes underneath the eye muscles. If a gas bubble is placed, the vision may be very fuzzy for several days. The patient may need to be in a certain head position for two to ten days to let the gas bubble push against the area where the main part of the detachment was located.

The success rate for primary RD repair is around 90-95%. Some risk factors for re-detachment include younger age, trauma, and underlying inflammation.

To find out more about Dr. Patel and his practice, go to Midwest Retina’s website.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

In this special 20th episode, Dr. Suh talks with Dr. Jim Caudill, an ophthalmologist from Charleston, West Virginia, about their work with Medical Ministry International (MMI), a Christian medical mission group whose volunteers participate in one- and two-week projects to developing nations.
Several of the leading causes of visual impairment in the world are preventable or treatable. People with uncorrected refractive errors, which means they are nearsighted, farsighted, and/or have astigmatism, can see better with a pair of prescription glasses. But in many developing countries, prescription glasses are not easy to obtain. Cataract, a clouding of the natural lens, is responsible for about half of the world blindness, which represents about 20 million people. Lack of access to or lack of financial means for surgery as well as longer life expectancy are some of the factors that have led to this increasing number of untreated cataracts.

In the developing world, being blind decreases one’s life expectancy by one-third. 50% report loss of social standing and decision-making authority. Children may be unable to attend school because they must care for their blind relatives. The annual worldwide productivity cost of blindness is estimated to be in the hundreds of billions of dollars.

Many charitable medical organizations have been around for decades to do short-term trips in these developing countries to lessen the burden of their much-needed medical care. MMI has been around for over 50 years. They provide dental, medical, surgical, OB/GYN, eye care, and physical therapy services around the world with short-term missions and in their permanent centers.
For more information about Medical Ministry International, click here.
To find out more about Dr. Jim Caudill, go to his practice's website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

On this show Dr. Steven Suh and Dr. Julia Geldis have a thorough conversation about contact lenses.

Contact lenses have some advantages over glasses. People with higher prescriptions find that they are more comfortable from a vision standpoint because contacts do not cause as much minification or enlargement of images as with glasses. They are usually preferable when playing sports and doing other physical activities.

Dr. Geldis is comfortable with children wearing contacts as young as eight years old as long as they are mature and can take good care of them. There is no maximum age when people have to discontinue wearing contact lenses as long as their eyes are healthy, and they do not have dry eyes or other conditions that make it unsafe to wear them.

Two main types of contact lenses

• Gas permeable lenses – can give better quality vision but may be harder to adapt to initially
• Soft contact lenses – easier to get used to; most popular type
  • Different options: daily disposables; two-week disposables, one-month disposables; day-and-night extended wear (have to be careful when sleeping in any kind of lenses - increased risk of infections and inflammatory conditions)

Presbyopia and contact lenses - options for seeing up close when people get into their 40s

• Reading glasses over your contacts
• Monovision – dominant eye is set for distance vision and the non-dominant eye is set for near vision
• Multi-focal lenses – both eyes will be able to see distance and near because of different refractive zones in the lenses

It is not recommended that one wear contact lenses when swimming, showering, or sleeping.

At their appointment new contact lens wearers will be taught how to put them in, take them out, and care for them.

Eye infections and inflammation are more likely to occur when people overwear them or do not clean them properly. With regards to the contact lens cases, always dispose of the old disinfecting solution - do not top it off. Rinse the inside of the case with the solution and let it air dry. Change your case every 1-3 months.

Colored contacts and “costume” contacts (popular around Halloween) are all right to wear if they are prescribed by an eye care professional.

In this era of COVID-19, always practice good hygiene when handling the lenses. If you test positive or suspect that you have this virus, please do not wear your contacts and keep your hands away from your face!

Here is another resource to learn more about about contact lenses.

https://www.aao.org/eye-health/glasses-contacts/contact-lens-102

To find out more about Dr. Julia Geldis and her practice, go to Comprehensive EyeCare of Central Ohio’s website or Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.