Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Glenn Beck recently announced he may be going blind from macular dystrophy. That would be more accurately stated as macular corneal dystrophy and should not be confused with macular degeneration. Macular corneal dystrophy is an uncommon disorder of the cornea of the eye and macular degeneration is unfortunately a fairly common condition of the central retina inside the eye.
Macular corneal dystrophy results in greyish-white opacities and haze in the stroma, the central layer of the cornea. The condition is inherited and always occurs in both eyes and is perhaps the most vision threatening of the corneal dystrophies.
Will Glenn Beck go blind? His condition is certainly very scary for a patient to endure because few things elicit fear like the loss of one's eyesight! Yes, macular corneal dystrophy ("MCD") can definitely cause a decreased vision in both eyes as well as some possible eye irritation and eye pain. If his macular corneal dystrophy is mild it can be treated with phototherapeutic keratectomy using the excimer laser, the same laser used to reshape the cornea in LASIK. The treatment for more advanced MCD is a corneal transplant which is most certainly a major surgery.
Both of those procedures should restore Glenn Beck's vision to an acceptable level of visual acuity. However, there is the possibility that after either of those procedures that the MCD may return.
More information on macular corneal dystrophy.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Current Research Shows that Biotrue Performs
Contact Lens Disinfection Better than Other Solutions
Bausch & Lomb has introduced BiotrueTM, their new multi-purpose solution for soft contact lenses. BiotrueTM promises to outperform other competitive solutions and to function like the tears of your own healthy eyes.
A perfect contact lens solution should perform the following functions perfectly:
1. Disinfect the contact lenses
2. Optimize the comfort of the contact lens
3. Clean the lens of proteins and lipids from the tear film
Disinfection of Soft Contact Lenses
Biotrue combines two effective disinfectants and has a pH equal to normal healthy tears of the eye which not only improves comfort, but also enhances the disinfectants. BiotrueTM does not remove certain useful proteins ( lactoferrin and lysozyme in their natural state) on the lens surface that have antimicrobial properties and therefore assist in the disinfection process. Lysozyme is a 
powerful antibacterial enzyme against gram positive bacteria such as staph and strep. Biotrue removes other non-useful proteins that accumulate on the lens surfaces. Other solutions cannot compare to Biotrue in their ability to maintain active lysozyme.
The result is that BiotrueTM outperforms other soft contact lens solutions in disinfecting the lenses. In a recent study, Biotrue was more effective against staphylococcus aureus than all other leading brands of solutions. Biotrue was more effective against MRSA (methicillin resistant staph aureus) than all solutions except Ciba's Clear Care (hydrogen peroxide system) in which it showed equal performance. In the test on the fungus fusarium solani, Biotrue was the second most effective solution behind Alcon's Opti Free Express. Finally, Biotrue was the most effective against Acanthamoeba.
Improving the Comfort of Soft Lenses
Biotrue most closely resembles the natural healthy state of the tears with a pH of 7.4-7.6. Healthy tears have a pH range from 7.3-7.7. Maintaining the eyes natural pH reduces irritation and stinging and assists the lens to perform properly on the eye. The perfect pH also helps the dual disinfectants in Biotrue to be more effective.
Biotrue contains hyaluronan, a natural lubricant found in the body that is very effective in creating a stable tear film and cushioning effect.
Cleaning Contact Lens Surfaces
Almost 500 different tear film proteins are present and can accumulate on the surface of a contact lens. Biotrue does remove the tear film proteins that are not naturally antimicrobial or that have become inactive and accumulate on the lens surface causing possible irritation, blurred vision or even potential eye infections.
Bausch & Lomb's BiotrueTM is a major advancement in soft contact lens solutions that is based on the biology of the eye itself. It can be used on all types of soft contact lenses including those with silicone. B & L also includes a complimentary lens case with every bottle of 10 ounce Biotrue purchased.
The author has no financial interest in Bausch & Lomb or Biotrue.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Using Bifocals to Slow Myopia (nearsightedness)
Research optometrists from several international universities (Queensland University of Technology in Australia and Hong Kong Polytechnic University) have completed a two year study to test whether the use of bifocals in children can slow the progression of myopia (nearsightedness).
The study included children with an average age of ten years with myopic progression of at least 0.50 diopters in the preceeding year. The children were prescribed one of three treatments:
1. Single vision lenses to correct the nearsightedness. This is the usual Rx by most doctors in the world today.
2. Bifocals with a medium powered lens for near, i.e. +1.50 D.
3. Bifocals with a medium powered lens for near, i.e. +1.50 D. AND a prism correction (3 prism diopters base in prism) in each eye.
Progression was monitored by objective (computerized refraction) means every six months. The results after two years revealed that the group placed in the bifocals with the prism correction (#3 group above) had progressed only -0.70 Diopters compared to the traditional treatment RX of single vision lenses only which had increased an average of -1.55 Diopters. The axial length of the eye also increased more in those using single vision lenses.
Summary: Bifocals with prism correction in children with myopia decreased the progression of myopia substantially!
This is important because high myopia increases the risk of a number of eye diseases in addition to requiring higher prescriptions and thicker lenses to enable the person to see clearly.
Recommendation of the study: Doctors should consider prescribing bifocals with prism correction for children that are showing annual increases in the amount of nearsightedness.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Contact Lenses will not only improve your child's vision, but also improve his/her self confidence!
Most adults have known for years, although some choose not to admit it, that other people look more attractive when not wearing glasses. It's not that glasses look bad. In fact there are many great eyewear designs and great lenses that can be flattering; and glasses provide a wonderful benefit for millions who choose to wear them. But, let's face facts. A review of People Magazine's most beautiful people reveals NO ONE WEARING GLASSES. When is the last time the swimsuit edition of Sports Illustrated had someone wearing glasses? Any eye doctor can tell you stories of people that present prior to their wedding to get rid of their glasses for that special day.
Despite this general knowledge, many parents have reluctantly chosen to keep their children in eyeglasses instead of contacts for reasons that usually aren't justified. Many eye doctors have known for years what I am about to reveal to you. In fact, I prescribed contacts for my own daughter when she was eight years old - well before the results of this study were known.
Contact Lenses will not only improve your child's vision, but also improve his/her self confidence!
The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) studied the impact of glasses vs. contacts on how children feel about themselves. A group of almost 500 ethnically diverse children in five different U.S. cities aged eight to eleven (8-11) were chosen at random to wear either glasses or contact lenses for three years. All the subjects had previously been wearing glasses to correct myopia (nearsightedness).
The children were then tested with the Self Perception Profile for Children which is a test for understanding self esteem and self concept. It is the gold standard for psychology in measuring these attributes.
The Result: Children in the contact lens group felt significantly better about themselves compared to eyeglass wearers in physical appearance, social acceptance and athletic competence. Additionally, those children who initially disliked eyeglasses also made gains in their own perceptions of academic performance.
A noted psychologist in the study stated, "Kids who perceive themselves as unattractive or not socially accepted by their peers tend to be at higher risk for depression, disordered eating behaviors and other negative adjustment outcomes."
This study certainly validates my own clinical experience after watching children and teenagers quickly gain self confidence and self esteem after I prescribe contact lenses.
Parents: I suggest you strongly consider contact lenses for your children ages eight and above!
Dr. J. R. Lacey
Optometric Glaucoma Specialist
Austin, Texas
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Crystalens AO
Premium Refractive Lens Implant
Bausch & Lomb has recently introduced their newest intraocular lens implant (IOL), the Crystalens® Aspheric Optic lens. The Crystalens® AO is the newest addition to the Crystalens line of IOL's. Crystalens is a premium refractive IOL that functions like a person's own accommodation. The other lenses are the Crystalens HD and Crystalens Five-o. The Crystalens family of lenses are the only FDA approved accommodating IOL's.
The Crystalens AO has prolate aspheric surfaces which minimizes or eliminates spherical aberration thereby providing a better quality of image for both distance and near vision compared to spherical IOL's. The Crystalens AO has zero spherical aberration so it also improves the depth of field. Unlike some "multifocal" IOL's, vision is unaffected by pupil size in this new lens.
Crystalens AO by Bausch & Lomb
The patient outcomes are more predictable with the new Crystalens AO. The new lens provides clear vision at far distances, arm's length (intermediate) distances and up close for reading smaller print. Night vision is improved in the Crystalens AO due to the enhanced contrast sensitivity. The lens itself is made of a proprietary silicone material. This lens is another great improvement to an already good line of premium refractive IOL's by Bausch & Lomb and should certainly be considered if you are having cataract surgery or are over 55 years of age and tired of wearing glasses and you want clear vision at near, far and intermediate.
Crystalens is a registered trademark of Bausch & Lomb.
The author has no financial interest in Crystalens or Bausch & Lomb.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Thin Corneas are a Major Risk Factor for Glaucoma
A major national study called the Ocular Hypertension and Treatment Study (OHTS) proved that the thickness of the cornea is one of the most powerful predictors for the development of glaucoma. Eyes with a corneal thickness of 555 microns or less (thinner corneas) had a 300% greater risk of developing glaucoma than those eyes with a corneal thickness of 588 microns or more.
Eyes with thicker corneas show artificially higher intraocular pressure (IOP) readings when measured; and conversely, eyes with thinner corneas show artificially lower IOP readings. LASIK patients must always advise their eye doctors of their LASIK procedure so that the true IOP's can be calculated. This is perhaps the underlying issue of "normal tension (pressure) glaucoma" which accounts for 25-33% of all glaucoma patients. Normal tension glaucoma patients virtually always have thin corneas!
Ultrasonic Corneal Pachymetry
Measurement of corneal thickness is not a routinely performed test in a general vision exam. The most common test used to measure the thickness of the cornea is by ultrasonic technology (corneal pachymetry). Topical anesthetic drops are instilled on the cornea of the eye. A probe is then touched to the cornea and the reading is completed. The accuracy and reproducibility are somewhat difficult to duplicate since the corneal thickness varies and increases toward the periphery. Additionally, the probe must be perpendicular to the corneal surface for maximum accuracy.
Because corneal thickness is such an important test it should be performed at least once on everyone over the age of 40 or those with other glaucoma risk factors so your eye doctor is able to accurately assess the true intraocular pressure of your eye.
Corneal Ultrasonic
Pachymeter used to
measure corneal thickness
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Warning Signs of Possible Eye Problems
Many vision problems have no warning signs or symptoms and can cause permanent vision loss; or the problem may worsen without proper treatment. Annual eye exams are the best way to ensure a lifetime of good vision.
Warning Signs of Vision Problems in Adults
- Blurred vision beyond twenty feet
- Difficulty reading and seeing small print in dim light
- Reduced vision at night especially while driving
- Frequent changes in your eyeglass prescription
- Glare from sun or bright lights
- Seeing halos around lights
- Areas of lost vision or reduced clarity within your field of vision
- Changes in the colors you see
- Seeing flashes of light
- Seeing spots
- Pain in or around your eyes
- Redness of eyes
- Dry, irritated or tired eyes
- Diabetes, High Blood Pressure, Multiple Sclerosis
- Swollen, red or sore eyelids
Warning Signs of Vision Problems in Children
- Blurred vision beyond twenty feet but clear up close
- Blurred vision at all distances
- Under performing in reading skills
- Squinting, closing or covering one eye
- Holding reading materials close to the face
- Tilting the head to one side
- Excessively rubbing eyes
- Eyes do not align properly. One eye turns inward or outward while the other eye looks straight.
- Redness or tearing or secretions from one or both eyes
- Premature birth
- Developmental delays
- Family history of high optical prescriptions
- Diabetes
- Swollen, red or sore eyelids
Remember that a vision screening only detects a few abnormalities. Have your child's eyes examined by an eye doctor!
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Eyelid Twitching Causes and Treatments
DEFINITION of Myokymia
Myokymia is the medical name for eyelid twitching. Myokymia is spontaneous contracture of the eyelid muscles, usually the orbicularis oculi muscle. Myokymia is usually unilateral (one eye only) and more often involves the lower eyelid instead of the upper. The condition is not serious and is usually self limiting.
Myokymia is not the same as blepharospasm although some choose to call myokymia a mild form of blepharospasm. Blepharospasm is a more forceful closure of the eyelid that can become uncontrollable.
SIGNS & SYMPTOMS of Myokymia (Eyelid Twitch)
Rapid twitching/flutter movement of the eyelid (either upper or lower lid) is the sign and the symptom of myokymia. The eyelid twitch may last a day or a month or longer.
Although the patient believes it is very noticeable to others, it is usually so subtle that others are not aware of the condition.
CAUSES of Eyelid Twitch (Myokymia)
Although the exact cause of myokymia is usually not known there are certain things that can trigger eyelid twitching. Common causes are:
- Stress
- Fatigue
- excessive caffeine
- alcohol
- eye strain due to possibly needing a new optical prescription or computer eye strain
- nutritional imbalances, possibly low magnesium
- allergies and histamine
- Dry Eyes
TREATMENT for Eye Lid Twitching (Myokymia)
1. Have your eyes examined for possible eye strain issues and follow the advice of your eye doctor.
2. Get plenty of rest, eliminate caffeine and alcohol and reduce stress.
Alternative Treatments for Myokymia
1. Quinine sulfate tablets (by prescription only) 130 mg. (half of a 230 mg tablet) at bedtime for one to two days.
2. Drink quinine water. Unfortunately, it only has 50-75 mg of quinine per liter. Therefore, one may need to drink up to two liters. A mild case may be resolved with only one liter of quinine water. Some energy drinks also have quinine but often contain significant amounts of sugar and caffeine and therefore are not good choices.
3. Botox injection
4. If allergy related, antihistamine eye drops or antihistamine tablets
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Avaira® Disposable Soft Lenses have High Oxygen Transmission and a Soft, Moist Surface to Provide Excellent Comfort and Eye Health
Avaira® is a premium third generation silicone hydrogel disposable soft lens by Cooper Vision. It is a 2-week replacement disposable soft lens. Avaira offers superior comfort as a result of a naturally wettable material that requires no surface treatment or additives. It also provides a very high level of oxygen transmission to help maintain healthy eyes! Most people choose contact lenses for clear, glasses-free vision to enhance their physical appearance, but comfort is arguably the most important quality that contact lens wearers desire. Avaira delivers exceptional comfort.
AvairaTM contact lenses offer improved comfort because of a unique material utilizing AquaformTM Technology. AquaformTM Technology helps the contact lens stay hydrated throughout the day by attracting and binding water thus reducing the feeling of dryness. Avaira material is also 30% softer than comparable two-week silicone hydrogel disposable soft lenses. Great vision and comfort are not the only pros of Avaira; allowing high levels of oxygen to reach your cornea equates to greater eye health, which is essential during contact lens wear. Additionally, Avaira contact lenses are UV-absorbing to block damaging rays from the sun. However, it is still very important to wear UV-blocking sunglasses to protect your entire eye and not just the part covered by your contacts. Even with all these great attributes, Avaira® is priced very reasonably making this lens an overall great choice for contact lens wearers seeking comfortable 2-week disposable lenses.
The Avaira lens is designed with aspheric optics that improve vision by reducing spherical aberrations in both the lens and the human eye. Unfortunately, Avaira is not yet available for patients with astigmatism or hyperopia (farsightedness). This is also not the lens for you if you wish to sleep in your lenses, as Avaira is only approved for daily wear. If you need a toric lens for astigmatism or are interested in having an extended wear contact lens it is important to discuss this with your eye doctor, as there are many great options for you as well.
Avaira is a registered trademark of Cooper Vision. The author has no financial interest in Avaira or Cooper Vision.
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Latisse will grow your eyelashes longer and thicker!
Latisse is the only FDA-approved prescription medical treatment to grow more eyelashes and to make them longer, thicker, and darker.
How Latisse Works
The active ingredient is bimatoprost ophthalmic solution, which is the same medicine used in certain glaucoma medications, specifically Lumigan (by Allergan). It lowers the eye pressure which is why it is so effective to treat glaucoma. However, one of the side effects is darker, longer, thicker eyelashes which is why it was then developed to treat hypotrichosis (not enough eyelashes).
It does not work immediately upon application. It takes 12-16 weeks to get the full effect and it must be used with consistency. If you stop using Latisse your lashes will most likely return to their previous appearance after a month or two. 
How to Apply Latisse
Latisse should be applied once per day at night. It comes with a bottle of solution and disposable applicators. First you must remove all eye make-up and contact lenses. Make sure your skin is clean and dry, free of any oils used to remove your make-up. Put a drop of the solution on one of the applicators. Then use the applicator to apply the solution at the base of the upper eyelashes. Next make sure to use a tissue to blot any excess solution beyond the lashes and dispose of the applicator. Apply the solution to the other eye and you are finished.
Download Graphic Directions on how to apply Latisse
Side Effects of Latisse
The most common side effect is itching of the eyes and redness. These side effects should not last long and may even go away with continued use.
Less common side effects are ocular irritation, dryness and redness of the eyelids. These symptoms occur on the eyelid where the product comes into contact with the skin. Another side effect is hyper-pigmentation or darkening of the skin where the product is applied. This is thought to be reversible upon discontinuation of the medication.
When this product is instilled directly into the eyes as a glaucoma medication it can cause increased brown pigmentation of the iris. This was not experienced in any studies of Latisse but people should be aware of the possibility. In studies of glaucoma patients, this effect primarily involved people with green eyes but those with hazel eyes and light brown eyes are also susceptible. The increased brown pigmentation appears to be a permanent change.
Documented Side Effects
A trial of 278 people who used Latisse documented notable side effects. According to the study, Latisse produced eye redness in 3.6 percent of patients, itchy eyes in 3.6 percent and darkening of the eyelid skin (hyperpigmentation) in 2.9 percent.
Latisse produced a 25 percent increase in eyelash length, a 106 percent increase in thickness and an 18 percent increase in darkness in this study.
Where do I get Latisse?
You must have a prescription from a doctor in order to purchase Latisse. It can be purchased from a pharmacy like you would get any other medication.