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.
An annual eye exam is about more than just updating your prescription for contacts or glasses. While this is important to ensure you're seeing to the best of your ability, there are other reasons a visit is crucial at least twice a year. A routine eye exam can detect other serious health problems before you're even experiencing symptoms. Did you know that many people first learn they have serious health conditions like brain tumors, high cholesterol, diabetes, high blood pressure, and even cancer from a routine eye exam?
Our eyes are a very effective window to our overall health. During a comprehensive eye exam, your doctor can observe and evaluate the health and condition of the blood vessels in your retina. These are a good predictor of the health of the blood vessels throughout your body. Conditions such as diabetes, hypertension and hypercholesterolemia all are visible by changes in the appearance of the retinal blood supply and blood vessels. Your doctor will also look for eye muscle imbalance, vision disorder, and eye disease that could potentially cause future problems.
Many people wait until they notice a change in their vision to see a doctor. But eye problems are often silent - meaning they have no symptoms, which can be dangerous if you are waiting to see a change before making an appointment.
Annual eye exams are especially important for anyone with diabetes or who might be at risk for the disease (due to obesity, family history, etc). More than 30 million Americans with diabetes and another 84 million are at risk for developing diabetic eye disease which is a leading cause of blindness among adults. In its early stages, diabetic eye disease has zero visible symptoms; only a comprehensive eye exam can detect signs of the disease. The sooner treatment is sought, the likelier the vision can be preserved. If no treatment is given, vision loss will ensue.
So you've had a vision screening? It's not the same as a complete exam. Screenings are partial, limited eye evaluations that take place outside an eye doctor's office. While they can be helpful in detecting some problems with vision, it is a limited exam. At your optometrist's office, a thorough eye exam takes deeper look at your vision and how it affects your overall health. Eye history and family history are also considered as a preventative measure to stop eye disease before it begins.
What are you waiting for? Don't put it off any longer. Even if you think you have perfect vision, an annual eye exam can be one of the best things you can do to protect your overall health and wellness. Start the new year right with a visit to Kirkwood Eye Associates.
We are excited to be the first practice in the St. Louis area to offer the iLux Dry Eye Treatment System.
The iLux treats meibomian gland dysfunction (MGD), the leading cause of dry eye disease. Patients with MGD are unable to properly produce and sustain the vital lipid layer of the tear film, resulting in variable blurred vision, eye strain, irritation and tearing. This occurs when the oil-producing meibomian glands in the eyelids quit working properly, resulting in solidified and unhealthy oils being released onto the surface of the eye. The most common cause of MGD is extended near work (i.e. computer, tablet, smartphone).
The iLux device targets the oil-producing meibomian glands in the eyelids. It uses heat and compression to unblock the glands and clear thickened and unhealthy meibum, allowing the production of clear and healthy secretions that stabilize the tear film and result in improved vision and comfort.
The treatment takes about 10-15 minutes and can be done in the exam chair. It is not covered by insurance and costs $335 total for both eyes. Results can last up to a year but some find it beneficial to repeat 6 months after the initial treatment. Some patients notice symptom improvement immediately, but improvement can continue for up to 4 weeks as the new oils refill the glands.
Please see the FDA study results and information video below and feel free to call us with any questions.
Here at Kirkwood Eye Associates we are proud to announce that we are the first practice in St. Louis to receive the new SimplifEyes daily disposable, soft contact lenses by SynergEyes. This revolutionary soft lens is the first of its kind and promises superior vision and comfort thanks to the inclusion of Tangible molecules imbedded in the contact lens matrix.
Contact lens dryness and discomfort is the number one reason for contact lens drop out. Soft lenses “steal” our tears in order to keep their shape, making patients with even the mildest dry eyes symptomatic at the end of the day. Tangible molecules effectively bind water molecules and retain them within the lens matrix for much longer than standard soft contact lens materials. This allows for all day comfort and visual stability, even in those who have failed other types of soft contact lenses due to discomfort.
As a specialty contact lens practice, we have used Tangible coatings with tremendous success on rigid gas permeable lenses since the technology was introduced two years ago. This is the first soft contact lens product to incorporate this revolutionary molecule.
Currently, SimplifEyes lenses are only available to treat near sightedness (up tp -6.00) and far sightedness (up to +4.00). They do not offer powers to correct astigmatism, though this could be an option in the near future. The lenses are “single-use” and should be disposed of after one day of wear. They are not approved for overnight wear. They are priced less than other premium daily disposable lenses.
If you are a current Kirkwood Eye Associates contact lens patient who has been seen for a contact lens evaluation within 12 months and you are interested in trying SimplifEyes lenses, contact our office for a free 5 day trial pack (if your prescription is within the current available parameters). If you are not a patient or have not had a contact lens evaluation in the past 12 months, call for a fitting today and receive your free trial. Please contact our office with any questions.
Dry Eye Disease is a chronic condition that affects millions of Americans. The disease exists along a spectrum that starts at mild (often asymptomatic) to severe and debilitating. At Kirkwood Eye Associates, we follow a progression in treatment options to meet the need of any dry eye patient. While dry eye is not curable and in many cases requires life-long treatment, it can be controlled effectively.
Mild/Moderate dry eye can manifest with no symptoms at all, or can cause mild symptoms of blurred vision, itching, redness, tearing, and grittiness. When we see this stage, we first must determine the type of dry eye and whether the symptoms are caused by the tear glands (the main lacrimal gland and accessory lacrimal glands) or the eyelid oil glands (the meibomian glands). While eyelid glands are more often to blame, it’s typically a combination of the two systems. Initial treatments include warm compresses, omega 3 supplements, lid cleansers and tear supplements (artificial tears).
Severe dry eye can range from the constant need of drops or other supportive therapy, to severe pain and depression. Treatment options here are plentiful, mainly because there is no perfect treatment. Which treatment is best for an individual patient depends on a multitude of factors. Here is a list of dry eye therapies offered at Kirkwood Eye Associates:
Medical Therapy: Prescription eye drops including corticosteroids, Restasis and Xiidra are commonly used to reduce inflammation and improve the ocular surface environment, allowing some patients to produce more tears.
Punctal Occlusion: The watery part of our tears is secreted onto the surface of the eye from the lacrimal gland and then drains off of the eye through the puncta (one on the upper and one on the lower lid near the nose) into the nasal cavity. Punctal plugs are small, painless devices that slow the drainage of tears off of the surface of the eye. This allows your own natural tears to stay on the eye longer, reducing surface dryness.
LipiFlow: This unique in office procedure utilizes a device that is placed on the eyes and uses a combination of heat and pressure to clean out the meibomian glands that are crucial for producing the oil layer of our tear film. This oil layer protects the tears from evaporating and helps distribute them evenly over the surface. Chronic inflammation can cause these glands to clog, eventually leading to gland atrophy (death), making regular expression extremely important to the long term health of the eye.
Serum Tears: A newer technique gaining popularity is the utilization of your own blood serum as a healing agent for the ocular surface. This process involves drawing blood and spinning it down to a serum that is put in drop bottles. They are then used as eye drops to promote comfort and healing of the ocular surface
Scleral Shell: This technique is reserved for individuals with severe tear deficiencies, but it can be highly effective and life changing. A scleral shell is a large rigid contact lens that fits over the cornea, trapping behind it a layer of hydrating saline. Comfortable and easy to wear, these devices bathe the cornea in hydration, alleviating the symptoms of dry eye throughout the day. The also have an added benefit of vision correction, as they can be powered to allow you to see without the need for glasses.
Andrew Biondo, O.D., is the Primary Medical Director at Kirkwood Eye Associates in Kirkwood, MO. Serving the greater St. Louis area, Dr. Biondo has 8 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.