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.
#10. CONTACT LENSES ARE UNCOMFORTABLE
Designed to be as comfortable and non-intrusive as possible, modern contact lenses are barely noticeable. Early iterations of contact lenses could be uncomfortable for some wearers because they were made of glass or hard plastic. They're now made of high-tech materials such as silicone hydrogel. With these materials, oxygen is able to enter the eye easier, nourishing the cornea and so that users often don’t even notice them.
#9. CONTACT LENSES ARE A HASSLE
Wrong! One-bottle contact lens care systems make cleaning and disinfecting your contacts simple. You can also choose to eliminate contact lens care altogether by wearing daily disposables or 30-day extended wear contact lenses.
#8. ASTIGMATISM MEANS I CAN'T WEAR CONTACT LENSES
Modern contact lenses have come along way over the years. We are now able to cater to many different eye conditions, including astigmatism. This can actually be corrected by a wide range of toric contact lenses. Even better... astigmatism prescriptions are available for daily disposable, extended wear and monthly lenses.
#7. I'M TOO OLD TO WEAR CONTACT LENSES
Says who?There is no set age limit as to how old you can be to wear contact lenses. Contacts now come with the option of varifocal and bifocal. This means that older eyes can wear lenses, regardless of whether they require prescriptions for distance and/or reading.
#6. I'M TOO YOUNG TO WEAR CONTACT LENSES
Similarly to the lack of an age limit on contact lenses, there is no universal age regarding when you can start wearing them. Prescribing contacts is at your own parental discretion. The maturity and capabilities of the child should be considered when deciding whether contacts are suitable for your child. Fortunately, contact lenses are very easy to maintain. Daily disposable lenses require no special storage or cleaning, making them perfect for our younger patients.
#5. CONTACT LENSES ARE TOO EXPENSIVE
Simply not true. Contact lenses can sometimes be less expensive than a good pair of eyeglasses. Even daily disposable contact lenses, once considered a luxury, can cost only about a dollar a day.
#4. CONTACT LENSES FALL OUT EASILY
Older contact lenses were composed of rigid materials, making it easy for them to pop out of the eye during intensive activities like sports. Rigid materials also had the potential danger of damaging the eye in the event of blunt trauma. Modern lenses are designed to fit much more closely to the natural contour of the eye. This means it is very rare for them to pop off of the eye, making contact lenses a convenient option for vision correction in sports.
#3. I WILL NEVER BE ABLE TO GET THEM IN MY EYES
Of course you will! It might seem difficult at first, but our team of eye care professionals will make sure you learn how to apply and remove your contacts before you leave the practice. Most people become adept at handling contact lenses much faster than they anticipate!
#2. CONTACT LENSES CAN GET STUCK BEHIND MY EYE
FALSE. Simply put, it is not possible for contact lenses to get stuck behind your eye.
The Conjunctiva lines the inner eyelids, folding back on itself to cover the sclera (white of the eye). Because of this, there is physicall no way for a lens to gain access to the rear or either side of the eyeball. Phewf!
#1. WEARING POORLY FITTED LENSES CAN DAMAGE YOUR CORNEA
There is some truth to this one... Don't trust just anyone with your contact lens fitting! Your cornea is the part of the eye that reflects light. It is the transparent front part of the eye (the window) that covers the iris, pupil and anterior chamber. To prevent damage to the cornea, be sure to get regular eye check ups from your eye care professional to ensure you are wearing the best contact lenses for your eyes. We have many options and specifications that will guarantee your comfort and the safety of your vision.
Breathe new life into your wardrobe with the season's freshest trends.
Purchasing new frames can be overwhelming. But with a little guidance, the experience can be fun and exciting. Eyewear is a declaration of your personality and has the ability to introduce you to strangers without speaking a word. Eyewear has even become a signature staple for many celebrities. Think, Steve Jobs, John Lennon, Elvis. So where to begin when choosing new frames? Here are some suggestions to help you find your signature pair.
Consider Your Script
Starting off, we recommend you take your prescription strength into consideration. Not every script will look good in every frame. Our professional Opticians can immediately direct you away from any frames that aren't ideal for the lenses your prescription will require. For example if you're nearsighted with a strong, negative script, your lenses will be thicker. Thick lenses will look better in a smaller frame because the lenses get thicker as they spread out from the center. So a small frame will eliminate the thickest part of the lens. A large one would allow that bottle cap effect.
Compliment Your Coloring.
Skin tone plays an important part in finding the best frames to compliment your appearance. There are hundreds of skin tones but to simplify it; You have either a warm (yellow-based) or a cool (blue-based) skin tone. Here's a helpful trick: check out your veins. If they're more blue than green, you have a cool skin tone and should consider frames that are black, reddish brown, slate blue, or dark tortoise. Do your veins appear more green? That means you have a warm skin tone and will be best off in camel, khaki, or copper. For the outgoing warm, try a bold fire engine red.
Contrast the Your Face Shape
Pick frames that contrast your face shape, not ones that imitate it. An oval, symmetrical face shape is generally ideal but the percentage of people that possess that face shape is rare. Choosing frames that help us achieve this "oval effect" tend to compliment ones face shape the best.
If a weak chin is problematic for you, a frame that's slightly wider at the bottom edge will give the lower portion of your face what your chin is lacking. If you have a circular round-face, try frames with sharp angles: rectangles, trapezoids, and the super trendy hexagonal frames will look awesome. Round glasses would accentuate fuller cheeks. If your cheeks and jowl expand further than your forehead, choose a frame with a dramatic top edge to avert eyes up. Check up the helpful chart below to identify frames suitable for your specific face shape.
Illustration by Vic Blankenbaker
Above all else, you do you! All of these suggestions are merely that... suggestions! Go with your gut. If you find a frame outside these guidelines that makes you feel good about yourself, break the "rules". There are hundreds of styles, shapes, color and brands when it comes to eyewear. This article aims to ease the process for you. But it won't work for every person, every time. Glasses are one of the first things people notice about us. What impression do you want to give off? It's your vibe. Own it with a pair that makes you feel fab, confident and mostly YOURSELF.
If you have burning, tearing, fluctuating vision; or if you’ve found benefit in warm eye compresses, the LipiFlow procedure can be of great benefit to you by improving symptoms and decreasing the need for medications, warm compresses or artificial tear drops.
The procedure is completely safe and non-invasive and lasts twelve minutes. Plan on being at the office for at least thirty minutes total. Most people have no issue driving home after the procedure and it is not painful.
If you are unsure if your symptoms are related to the oil layer of your tear film, a LipiView oil layer analysis can be administered to measure the thickness of your tear films oil layer. The procedure is not currently covered by any insurance carriers at this time, but you can use HSA or FSA.
While this treatment is not ideal for everyone, there is nothing else available that can relieve oil layer deficient dry eye as well as LipiFlow. We will only have the LipiView and Lipiflow system in office every three months. The treatment will be available this upcoming Wednesday, September 6th and Thursday September 7th. To make an appointment, click the button below. If you have any further questions, please call the office and ask to speak to Dr. Biondo directly.
How would you describe the way you see the world without your glasses or contact lenses? While we would hope a child in school would be brave enough to say they can’t see the board at the front of the room, that can be difficult to admit for a young student. Also, they may not even be able to identify that their vision is poor.
One in four children have a vision problem that can interfere with learning. A child needs many abilities to succeed in their studies and good vision is a key component. Reading, writing, chalkboard work and using computers are just a few of the visual tasks students perform daily. A child's eyes are constantly put to use in the classroom. When his or her vision is not functioning properly, education and participation can suffer.
60% of students identified as problem learners have undetected vision problems. All parents, we want to see our children do well in school and do all we can to provide them with the best educational opportunities. A child may not tell you that he or she has a vision problem because they may think that the way they see is the way that everyone sees.
Signs that may indicate a child has difficulty seeing include:
80% of everything children learn comes from what they see. Most students are visual learners and in order to allow them to excel in their studies, accurate vision is crucial. We invite you to watch and share this video so that parents, guardians and teachers in order to encourage the awareness of children's vision issues. Ensure your child is seeing the blackboard clearly by making an appointment with Dr. Biondo today.
Our main specialty at Kirkwood Eye Associates is the treatment and management of Keratoconus. We offer the latest in visual correction through our scleral lens prosthetic devices that offer patients with this condition the ability to see clearly with all day comfort and consistency.
Until now, keratoconus management revolved around offering the best possible vision combined with careful monitoring of the progression. What was lacking was the ability to treat the condition itself, as keratoconus is a progressive disease that can result in the need for full corneal transplantation. Recently, the FDA approved a procedure known as corneal collagen cross-linking (C3R or CXL). This procedure, performed for over a decade in other developed countries around the world, is a safe and non-invasive treatment that aims to stop the progression of the disease in its tracks.
CXL involves applying riboflavin (vitamin B2) to the cornea and exposing it to ultra violet light A (UVA), resulting in a reaction that strengthens the corneal tissue thereby stoping the
progression of thinning and protrusion seen in keratoconus and post-LASIK ectasia. The procedure lasts 30-60 minutes and has a relatively fast recovery time. While it does not correct the corneal shape, it does stop it from getting worse and therefore preserves best-corrected visual acuity and greatly reduces the risk of corneal transplantation.
The procedure is very safe and well tolerated and it is recommended for most any keratoconus patient under the age of 45, and a patient at any age who has post-LASIK ectasia. Because the cornea naturally cross-links with age, patients over 45 who show stable topography may not need CXL. The UVA light is absorbed by the cornea and the riboflavin. This is important because it can be harmful to the posterior cell layer of the cornea (the endothelium) if it is able to penetrate that far. For this reason, patients with corneas that have become excessively thin may not be good candidates for the procedure, although drops can be added prior to treatment to temporarily swell the cornea to a safe thickness.
CXL does not cure keratoconus and those who are dependent on visual correction devices such as gas permeable lenses, hybrid lenses or scleral lenses will most likely continue to need these after the procedure is completed. Still, the stabilization will help to ensure that functional vision will always be possible and that the risk of corneal transplant is greatly diminished. To see if you would benefit from this new and exciting treatment option, contact Dr. Andrew Biondo and the team at Kirkwood Eye Associates for evaluation today. Combined with the revolutionary scleral lens systems for visual rehabilitation, normal visual function is more obtainable than ever before for patients with keratoconus and post-LASIK ectasia.
We recommend wearing sunglasses year round to protect your eyes from the sun's harmful UV rays, and you may be wondering what type to wear. Polarized lenses offer many advantages over their non-polarized counterparts and we highly recommend them as these lenses provide improved safety and vision.
Polarized lenses were made popular by fishermen and boaters who needed something to protect them from the glare off the water. Polarized lenses block light rays that would normally enter your eyes after reflecting off of surfaces, such as a body of water or a shiny surface. The light that enters your eye after passing through a polarized lens has been filtered, offering the best visual quality and UV protection.
1. Reduced Glare
On a sunny day, you may notice that objects on the horizon appear hazy, or that the light reflecting off your dashboard is nearly blinding. A polarized lens removes the effects of glare by blocking reflections off of other surfaces. This improves comfort and provides relief as you take in views without squinting. Roadways and water create major glare and create dangerous situations for drivers who may already struggle with their vision. Glare can create uncomfortable eye health issues for those with sensitive eyes, and may even cause migraines in patients who are prone to them.
2. Increases Visual Clarity
Wearing polarized lenses reveals colors and images like never before. You will see crisply and cleanly, noticing intense detail that may surprise you. Squinting to see images stresses the eyes and creates uncomfortable eye health issues like redness, irritation, fatigue, and headaches. Polarized lenses neutralize this issue and allow eyes to feel more comfortable and well rested.
3. Enhanced Contrast
Polarized lenses eliminate the harsh glare from the sun and help enhance colors and contrast leaving a remarkably crisp field of vision. Not only do polarized lenses reduce eye strain and make for safer driving and boating, they improve and enhance your perception of colors. Polarization can provide extremely crisp images with dazzling colors, which is why it is often used in photography.
4. Reduce Eye Strain
Polarized lenses also reduce eyestrain. Most of us squint when we experience glare; when glare is gone there is often no need to stress your eyes to see clearly. So, if you drive a lot or spend a lot of time on or near water, consider polarized lenses that will help reduce the impact of a glare. Polarized lenses are the best option when glare is an issue because they absorb light from scattered angles. Enjoy your surroundings and spend more time doing the outdoor activities you love..
Non-polarized sun lenses filter all light whether it is ambient or reflected. By doing so, glare is diminished, but not eliminated. Colors may vary and details are not as crisp. People wear sunglasses for different reasons. Whether you sport your shades as a fashion statement, for comfort, or for your eye health, consider polarized lenses the next time you are purchasing sunglasses.
It is estimated that 41% of the population in the United States is myopic, or near-sighted. This is a 66% increase from just 30 years ago, and the incidence continues to rise. This is problematic for both financial and health reasons. The cost of vision correction, especially in those more highly myopic is becoming increasingly expensive. More importantly, individuals who are more myopic have a higher risk of glaucoma, early cataract, retinal detachment and some forms of macular degeneration, regardless of whether or not they correct their myopia with LASIK or some other vision correction surgery.
There are many theories as to why we are becoming increasingly near-sighted. Most parents point to the increased use of electronic devices and overall increase in near-work. But there is no evidence to support that. The most recognized theories have proposed that we are becoming more near-sighted because we are spending more time indoors and not getting outside enough. Our eyes, as they develop, aren't exposed to long distances and therefore continue to elongate making us more near-sighted. The receptors in the eye responsible for this growth regulation are located in the periphery of the eye. Based on this theory, a child would be fine to sit and read a book all day, as long as they sat outside to do it.
We typically develop near-sightedness during our school ages and this is the time that we can do something to slow or stop the progression. There are three options currently available that have shown an impressive ability to halt the worsening of myopia in children.
The first and arguably most effective is orthokeratology, or ortho k. This is a system that utilizes an overnight contact lens device to gently shape the cornea to remove near-sightedness and allow the child to see all day without the need for contacts or glasses. It is safe and easily reversible (simply discontinue the overnight use of the device). Some studies have shown a 100% decrease in the progression of myopia and this treatment is FDA approved for children of all ages. This is the best option because it eliminates the need for daytime glasses or contacts and has the best data to show that it stabilizes myopia
MULTIFOCAL SOFT CONTACT LENSES
The second tool in slowing the progression of myopia is the use of multifocal contact lenses. It is believed that the signal to grow the eye longer, and therefore make it more near-sighted, is triggered by your peripheral vision. As we spend more time indoors, our peripheral vision is exposed to more closed rooms and short distances as opposed to the infinite sight lines of being outside. Wearing certain types of multifocal soft contacts can trick your peripheral vision into thinking its outside while allowing the central vision to function normally.
DROP THERAPY WITH ATROPINE
Atropine drops have proven very effective in slowing or even stopping the progression of
myopia in children and teenagers. This sounds like a perfect solution if not for the side effects seen with atropine use. This medication causes strong dilation of the pupil, making the child light sensitive and subject to glare at night. Atropine also inhibits the eyes ability to focus, making reading and near-work almost impossible. There are studies underway that are examining lower concentrations of atropine that those readily available to see if the side effects can be reduced or eliminated without losing the myopia control effects.
What is myopia? Click the video below for more information.
Eyelid mites, know as Demodex, are believed to inhabit the eyelids and lashes of over 40% of the people in the United States. Theses mites, which live around two weeks and like to come out to eat and breed while we sleep, can cause ocular symptoms that are often mis-diagnosed as dry eye or ocular allergy.
Demodex mites like to feed on the oily secretions of our hair follicles and oil glands, making the eyelids an ideal environment. They mites will burrow into the eyelash follicles and the meibomian glands that produce the oily layer of our tear film. For many people, there are no symptoms and the body’s natural defenses keep the mites in check. For others the infestation can lead to itching and burning eyes, redness and irritation, blurred vision and eyelid inflammation.
It’s surprisingly easy to contract a demodex infection, which may explain why so many people have them crawling along their lids and lashes. Direct contact with infected skin is one means of contracting the mite, but some have been found to travel on dust, making it hard to avoid. There is also theories that pets may act as transmitters between hosts.
Demodex infections can be easily diagnosed during an eye exam with a slit-lamp biomicroscope. The slit-lamps used in the exam rooms aren't powerful enough to view the mites directly, but an infection will show a very specific cylindrical dandruff pattern on the base of the lashes that is diagnostic for demodex mites. Demodex is also well documented to cause skin conditions, especially on the face including acne, rosacea and dermatitis.
Eliminating the mites can prove tricky because they are not susceptible to many sterilization techniques. They also avoid daylight so they stay hidden within hair follicles and glands during the day and wait to emerge as we sleep to reproduce. Luckily, tea tree oil has proven effective at removing the infestation. It should be noted that tea tree oil is toxic to humans as well as the mites so it is not recommended to apply standard tea tree oil to the face and especially the eyes. Kirkwood Eye Associates offers tea tree foams that have been specially formulated for ocular use and can be used as complete face wash to clear signs of rosacea and acne as well. The foams are to be used twice daily and most importantly just before bed when the mites are known to come out. Kirkwood Eye Associates also recommends an initial in office treatment with concentrated tea tree and cleansing to achieve maximum results.
If you experience irritation in or around the eyes, there is a good chance that the demodex mite is to blame. Call 314-394-3045 and set up an appointment today for an evaluation and treatment plan.
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.