Keratoconus is a progressive corneal disease that effects roughly 1 in 2000 Americans according to the national institute of health. It causes blurred vision that may not be correctable with standard spectacles or soft contact lenses. Other symptoms can include glare, haloes, and rarely, pain. Keratoconus is not an inherently blinding condition, but in its severe forms it can result in the need for a corneal transplant. Scleral lenses offer keratoconic patients significant visual rehabilitation and are comfortable and stable. They can be successful for nearly any patient, even those who have failed other contact lenses in the past like corneal gas permeable lenses and hybrid lenses. They are also shown to reduce or alleviate the need for a corneal transplant.
Dry eye disease patients can do exceptionally well with scleral lenses. Because these devices hold a layer of moisturizing tears against he ocular surface all day, they can offer relief from dry eye symptoms and improved quality of life. Many studies highlight the reduction or discontinuation of the need for eye drops and medications, as well as improved visual acuity and visual stability.
Post corneal surgery patients (LASIK, Corneal Transplant, RK, PRK) can be left with corneal surface irregularities that prevent them from seeing as crisply as they would like, especially at night. These irregularities cannot be corrected with spectacles, soft contact lenses or other surgeries. Scleral lenses can give back the crisp 20/20 vision that allows you to see clearly at night or follow a golf ball off of the tee.
At Kirkwood Eye Associates, we have invested in the latest technology to fit scleral lenses. We are one of the only practices in the state to offer Eyeprint custom molded scleral lenses that accurately match the ocular surface down to 2 microns. We are one of the first to have a machine that utilizes complete scleral surface mapping to design lenses that are accurate down to 10 microns. Both of these options far exceed the ability to fit with diagnostic lenses alone. Call today to see if scleral lenses can change your life.
Attention scleral lens wearers! We at Kirkwood Eye Associates are proud to be national leaders in scleral lens fitting for dry eye, keratoconus, and irregular cornea patients. We are excited to announce the addition of the EyePrint Pro Scleral Device System to our practice. This highly customized scleral lens fitting utilizes a compound that is inserted onto the surface of the eye and makes an impression of the globe. That impression is 3D analyzed and a perfectly molded scleral device is produced for your eye.
Kirkwood Eye Associates First To Offer Low Level Laser Therapy Dry Eye Treatment in the Saint Louis Area
We at Kirkwood Eye Associates are excited to offer the next generation tool in the fight against dry eye disease. We are the first practice in St. Louis to offer Low Level Laser Therapy (LLLT) to treat meibomian gland dysfunction (MGD) and dry eye diseases (DED). This revolutionary treatment is done in office and is safe, painless and effective in unclogging tear glands and up regulating tear production to allow for a more stabile and robust tear film.
We have always strived to offer the latest in-office therapies to treat dry eye including the Lipiflow, the iLux, the ABmax Blepharo-exfoliator, punctal occlusion, amniotic membrane therapy, demodex treaments and more. In-office dry eye treatments have many advantages over at-home therapies and prescription drugs. They often cost less over time, have little or no side effects, don’t require nightly care regimens and, best of all, they target the cause of the tear film dysfunction and allow the eye to work for itself, instead of relying on prescription drugs.
How does LLLT work? Simply put, a mask is placed over the eyes and upper face that is equipped with high energy diodes that emit a specific wavelength of light. This up-regulates the action of the cells powerhouse known as mitochondria. This achieves two results. First, this increased metabolic activity inside the tear glands generates heat that melts blockages in the meibomian glands and lacrimal glands, allowing tears to flow more freely. Second, the increase in metabolism charges the tear glands, increasing tear output. Added bonus… this treatment also boosts collagen production around the eye area and can help alleviate wrinkles.
The result is clear and robust lipid and aqueous production, the two building blocks of our tear film. The treatment lasts 15 minutes and is painless. I can be repeated as often as necessary to alleviate symptoms and keep them at bay. We often combine this therapy with eyelash exfoliation to clear away dirt, bacteria and biofilm from the lid margin that can clog and disrupt gland function. For more severe cases, it can also be combined with the iLux meibomian gland expression system.
This brand new technology is FDA approved and has been used for years in Europe with great success. It is not covered by insurance but treatments often cost less than a month of dry eye medications like Xiidra or Restasis and don’t require daily drop instillation that sting and bad taste.
Conditions that would benefit from LLLT:
Dry Eye and meibomian gland dysfunction (MGD)
If you have dry eye of any severity, from mild contact lens dryness to stinging eyes at the computer, to severe painful dry eye secondary to an autoimmune condition, call us to set up an appointment for this exciting new treatment.
As the Coronavirus pandemic continues, patients continue top ask about aspects of their health pertaining to their every day life, including contact lens wear. When it comes to contact lens wear, the American Optometric Association (AOA) and the Center For Disease Control (CDC) both state that contact lenses are still a safe and contact lens wearers shows no greater risk from COVID-19 than those wearing glasses. Here are some pointers and myth-busters to guide you through the outbreak.
Contact lenses themselves will not give you COVID 19. Proper hygiene is always important when handling contact lenses, and this is even more important than ever because of the need to touch your face and eyes. Be sure to wash your hand thoroughly!
Exercise proper hand washing technique. The CDC recommends at least 20 seconds of hand washing, followed by hand drying with unused paper towels. This should occur before every contact lens insertion and removal. If soap and water are unavailable, use a hand sanitizer that contains at least 60% alcohol. This is less ideal because residual alcohol can cause mild sting and temporary irritation, but it's still better than not sanitizing hands at all.
Routinely disinfect contact lenses. If you are in a single use (daily disposable) contact, be sure to discard at the end of each wear. If you are in a reusable contact lens make sure to follow the manufacturer recommended care regimen.
If you do get sick, discontinue lens wear. Contact lenses should never be worn if your have an acute illness like a cold or the flu. If you experience flu-like symptoms, discontinue contact lens wear and stick to glasses.
Glasses are not proven to offer protection. Glasses and contacts carry the same risk because they both require face touching. Proper hygiene will allow either modality to be utilized safely.
If you have a contact lens prescription that is nearing expiration or has expired, call our office at 314.394.3045. We are working with our patients to ensure you have access to lenses as needed. We are also accepting appointments, but no walk - ins at this time. No federal laws related to the Contact Lens Rule prescription verification process have been suspended or waived.
We continue to be here for you and your eye care needs throughout the "Stay at Home Order" in Saint Louis city and county. To learn more about the extra precautions we are taking, click below.
Individuals should continue to consult the Centers for Disease Control and Prevention guidance on how to protect themselves from COVID-19.
It’s no secret that most of us spend too much time in front of a screen. Many people spend all day at work staring at a computer monitor, only to come home and spend hours on a phone or tablet. This kind of extended near work takes a toll on our tear film, the protective layer of hydration on the surface of our eye.
Our pre-corneal tear film is an extremely complex and important component of our visual system. It protects our sensitive ocular surface from the environment and any disruption in this layer leads to symptoms ranging from tired eyes to burning, tearing and itching. The tear layer also serves a very important optical function. The surface of our eye is rough and uneven… not ideal for focusing light precisely on the retina. Our pre-corneal tear film fills in these irregularities and creates a smooth and uniform surface for refraction. This is the reason that the majority of dry eye sufferers present with complaints of blurred and variable vision, not eyes that feel dry or uncomfortable.
So why does screen time lead to tear film instability and dry eye? This mainly is due to our lack of full and complete blinks while focusing on our near work. Any extended near focusing (even a book) causes us to blink one-third as much as we normally would, but screens make it even worse. Images on digital devices change and refresh so quickly, we not only blink less, we have incomplete blinks because. A full and complete blink may mean that we miss something on our facebook timeline!
This issue is that a lack of blinking (and complete blinking) leads to blocked up tear glands. Our eyelids contain glands that make up two of the three layers of our tear film. Accessory lacrimal glands secrete the watery part of our tears and (most importantly) meibomian glands secret oils that cover and protect our tears, holding the system together between blinks. In order for these glands to properly express their contents, one must achieve a full blink that causes small muscles around the glands to contract, expressing their contents. When we chronically fail to do this, the oils and tears start to coagulate in the glands and lead to blockages, causing dry eye.
Another cause of dry eye symptoms (blurred vision included) is an accumulation of microorganisms along the eyelash line (blepharitis). These can include bacteria (mainly the staph that typically inhabits our skin surface) and parasites like the demodex mite. Our lashes provide the shelter, oils and moisture to promote microbial growth. Combine that with the fact that most people fail to wash their lashes on a daily basis and you have a recipe for infestation.
These microorganisms do more that just gross us out… they release exotoxins, oil destructive enzymes and other byproducts that irritate our ocular surface and inflame our eyelid margins. They can even cause more direct damage by infesting our glands leading to improper tear production and styes. If you suffer from chronic styes, we can help!
So what can be done? If you are not experiencing any symptoms, its still worth getting check out. Early detection of lid disease through examination and gland imaging is paramount in preventing dry eye symptoms. This is also the best time to begin lid hygiene with doctor recommended lid scrubs to prevent blockages and infestations. It is also important to remember to take frequent breaks from digital device and BLINK!!
If you’re already experiencing ocular fatigue, discomfort or blurred/variable vision, it may be time to consider in-office treatment. These treatments can be tailored to treat your specific lid disease. Treatments often include blepharo-exfoliation that removes dirt, metabolic debris, bacteria and parasites from the eyelid margin. This helps allow the tear producing glands in the lids to function optimally. Additionally, meibomian gland expression ( iLux ) is a new and extremely effective method of instantly and painlessly improving tear quality and reducing dry eye symptoms through the unclogging of blocked glands. These treatments have shown a success rate of over 85% in our practice.
While treatment like these are not covered by insurance, they are far more effective than over-the-counter or prescription eye drops and tend to be far cheaper when extrapolated over a years time.
At Kirkwood Eye Associates, we remain committed to being at the forefront of dry eye therapy, most of which is now done in the office, reducing or removing the need for daily home therapy that is less effective and more time consuming (and typically more expensive). In office treatments include blepharo-exfoliation, iLux meibomian gland expression (replacing lipiflow), amniotic membrane therapy, punctal plugs, bandage contact lenses and more.
Call us today if you’re tired of tired eyes!
The Skin Cancer Foundation's Seal of Recommendation is granted to sun protection products that have been reviewed by and meet the specific criteria of an independent Photobiology Committee (experts in the study of the interaction of ultraviolet light and the skin). In order for sunglasses to earn the Seal of Recommendation, they must filter out at least 99 percent of ultraviolet A (UVA) and ultraviolet B (UVB) radiation.
"The Seal of Recommendation is a symbol of safe and effective sun protection that is recognized by consumers worldwide," said Perry Robins, MD, President of The Skin Cancer Foundation. "One of the first programs offered by the Foundation, it quickly gained acceptance from consumers for setting the standard for effective sun protection. Maui Jim received our Seal because all of their sunglasses exceed our requirements and protect against 100 percent of UVA and UVB rays."
All Maui Jim sunglasses are able to meet the stringent requirements of The Skin Cancer Foundation because the company's PolarizedPlus2® lens technology uses up to nine layers of protection on both sides of each lens to eliminate 100 percent of UVA and UVB rays and 99.9 percent of glare from above, below and behind each lens.
Maui Jim lenses block 100% of all harmful UV rays, protecting your eyes from damage and long-term health risks. Sunglasses that do not provide UV protection can actually cause more damage because they shade the eye, allowing for more UV rays to hit the pupil.
Another reason these lenses are top of the line? Blue-Light protection. High-energy Visible Radiation (HEV), also known as blue light, has lower energy rays than UV, however recent research suggests they can penetrate the eye and cause damage. Maui Jim patented lens technology, provides HEV reduction without removing the blues.
Maui Jim sunglasses won't change the world, but they'll change the way you see it; vivid colors, improved clarity, and crisp details—all while blocking glare and harmful UV.
It is important to remember that there is no surgery to “cure” keratoconus. In other words, surgery does not free patients from the need for corrective lenses (and typically rigid contact lenses). There are three surgeries available that serve a purpose certain individuals with keratoconus.
Corneal Cross Linking
This breakthrough surgery has been a game-changer in keratoconus management since it was FDA approved in late 2017. Corneal Collagen Cross Linking (CXL, C3R) is a procedure that stabilizes the corneal shape, preventing further progression of keratoconus or other corneal ectasias. The procedure involves bathing the cornea in riboflavin and then exposing it to UV light. This causes a reaction that increasing the cross-linking of collagen fibers in the cornea, therefore increasing corneal rigidity and preventing further steeping of the cornea. It is important to note that this procedure does not get rid of the optical effects of keratoconus, instead it simply stops the progression in an effort to maintain best-corrected visual acuity and prevent corneal scarring or the need for corneal transplantation. This procedure combined with scleral lens fitting has become an extremely effective management technique for those with keratoconus, pellucid marginal degeneration and post-refractive surgery ectasia.
Intrastromal Corneal Ring Segments
These corneal implants were initially developed to help stop the progression of keratoconus, but studies have since found that they are not effective in doing so. They are still used by some specialists as a way to flatten the cone in hopes of making rigid contact lens fitting easier. With the advent of cross-linking and scleral lenses, this procedure has been made largely obsolete.
A corneal transplant is a last-case scenario for any corneal disease. Most transplant patients still need a rigid lens (like a scleral lens) in order to see adequately, and chronic steroids are typically needed to prevent rejection. That said, if a cornea becomes too steep or too scarred to be functionally corrected with scleral lenses, a corneal transplant can be a great option to restore sight.
Presbyopia is a natural process that typically occurs in the 40’s and reduces ones ability to read when vision is corrected for distance. This problem is a frustrating one, especially for those who enjoy contact lenses. When contacts are used to correct far away vision in someone who is presbyopic, additional options are needed to allow comfortable reading. Over-the-counter reading glasses and mono vision are two options that offer both advantages and compromise. Multifocal contacts continue to improve in viability but typical “one-size-fits-all” lenses don’t offer options for patients with astigmatism. It is important to remember that, unlike bifocal or progressive glasses where distance and near vision can be put in different parts of the lens, contact lenses are stable on the eye and all powers must be contained in a small pupil-sized region, making the task of crisp vision at all distances much more difficult. Here we will discuss options for patients with astigmatism who need distance and near correction and desire binocular vision free from reading glasses:
Custom soft multifocal toric lenses
Unlike one-size-fits all soft contact lenses, custom soft lenses are made based on a patients corneal parameters including diameter, curvature and eccentricity (rate of flattening). Not only is the fit customized to improve comfort, the optics are also made to specifically match the patients prescription. These lenses are made-to-order and therefore all specifications are customizable, even the material the lens is made from.
Imagine never squinting and shielding your eyes from blinding sunlight, or feeling the strain of eight-plus hours under fluorescent bulbs. That’s the allure of Acuvue’s anticipated line of light-sensitive, vision-correcting contact lenses, Acuvue Oasys with Transitions. Each contains a filter that senses the amount of light entering your eye and automatically darkens or lightens to maximize comfort. The contacts, which have been in the works for over a decade, received FDA clearance in 2018. They were also voted one of TIME Magazine's Best New Inventions in 2018. Here's why.
ACUVUE® OASYS with Transitions is a first-of-its-kind contact lens for contact lens wearers. These lenses combine a proven ACUVUE® OASYS (senofilcon A) material with Transitions™ Light Intelligent Technology™. The result is a lens that seamlessly adapts to changing light, providing all-day, soothing vision.
When asked about experiencing moments when bothered by light, 64% of consumers admit to being bothered by bright light daily. 94% of those who reported they were bothered by bright light daily use compensating behaviors (such as eye shading, squinting, turning off lights and turning down screen brightness) to manage it.
ACUVUE® OASYS with Transitions™ activates in less than a minute and quickly fades from dark to clear when going from outdoors to indoors.
At Kirkwood Eye Associates, we are proud to be one of the first practices in the Saint Louis region selected to carry this revolutionary new contact lens. To make an appointment or to learn more information call, 314.394.3045.
The fact is, nearly 90% (and more by some estimates) of dry eye syndromes can be traced back to eyelid disease. Our lids contain so many structures that are vital for producing and maintaining a healthy ocular surface environment including accessory lacrimal (tear) glands, meibomian (oil) glands, the lid wiper structure and more. If any of these structures are inflamed or obstructed, they won’t work properly and this results in a breakdown of the complex structure of the pre-corneal tear film.
What are some of the causes of lid disease?
Demodex Blepharitis: This condition is caused by an over-infestation of the demodex mite in and around our eyelash follicles. Everyone has demodex mites, but some people have an over-colonization on their eyelids. This, in my opinion, is the single most common cause of dry eye syndrome because it results in inflammation, reduced basal tear production and meibomian gland dysfunction. These patients are often mis-diagnosed as having an autoimmune condition or ocular rosacea.
Ocular Rosacea: It is my experience that almost all ocular rosacea patients suffer from demodex blepharitis. In fact, there is strong evidence that rosacea in all forms is strongly linked to the demodex mite. Rarely, patients can show red and inflamed eyelid margins with no form of infestation, but this is definitely the exception to the rule.
Bacterial Blepharitis: We all have trillions of bacteria that live on us and inside of us, referred to as our normal flora. Sometimes, a few too many of these organisms accumulate along the eyelashes. The eyelashes offer protection, moisture and oils that all combine to promote microbial growth, making bacterial blepharitis a common culprit of dry eye. The bacteria promote inflammation, thereby reducing gland function. They also produce exotoxins and lipase that disrupt our tear film and ocular surface. This condition can be difficult to treat with traditional therapies because the bacteria will form biofilms along the lid margin, protecting them from soaps and other treatments. These biofilms also clog tear and oil glands on the lids.
Meibomian Gland Dysfunction: The meibomian glands line our eyelids and secrete an oil (lipid) layer that coats and protects our tears. This lipid layer is solely responsible for the stability and even distribution of tears across the ocular surface and also prevents the tears from evaporating between blinks. Almost all dry eye has some component of meibomian gland dysfunction. These glands can become clogged for a number of reasons including genetics and all of the conditions listed above. Extended electronic device use (and the subsequent lack of blinking) is the main cause for the steep rise in this condition in recent years. Once these gland become significantly clogged, they must be opened through in-office procedures.
What Can Be Done?
The first step is getting a proper diagnosis by your eye doctor who specializes in dry eye and lid disease. Testing for dry eye includes meibomian gland imaging, digital tear film analysis, vital dye corneal staining analysis, blink analysis, tear film osmolarity testing and ocular surface and eyelid examination. We often epilate (pluck) an eyelash for microscopic examination in the exam room.
There are a variety of at-home treatment options including prescription drops, eyelid cleaners and heat therapy, but most patients fail to find sufficient relief with these products and exercises. For the majority of cases, we start with tailored in-office treatments to remove the offending cause of the lid disease and treat the clogged glands. There are a variety of procedures that can target demodex mites, bacterial blepharitis, eyelid margin inflammation, meibomian gland obstructions, bacterial biofilm and more. From there, we send the patient home with maintenance therapy products to enhance the in-office treatments.
Most of these procedures are brand new and not covered by medical or vision insurance. However, the cost is typically less than the cost of over-the-counter and prescription eyedrops when extrapolated over time… and are far more effective! The goal of modern dry eye therapy is to greatly reduce or remove the need for eye drops during the day.
Next time you feel any one of the common symptoms of dry eye (variable vision that changes with the blink, itching, burning, excessive tearing, redness, tired or heavy eyes, reduced contact lens wear time), look at your eyelids! They’re usually the ones to blame.
Andrew Biondo, OD, FSLS is the Primary Medical Director at Kirkwood Eye Associates in Kirkwood, MO. Serving the greater St. Louis area, Dr. Biondo has 12 years of experience as an eye care provider, health educator & consultant to the specialty contact lens industry. His special interests include contact lenses, dry eye disease, glaucoma, macular degeneration, laser eye surgery & preventive vision care.