Patients frequently ask me how long their pupils will remain dilated after the eye exam. Eye Doctors use different drops,different strengths, and different dosages when dilating your pupils. If you are having light flashes or symptoms that could indicated retina problems two different drops may be used in higher concentration and several doses. A routine exam may only require less dilation and milder drops.

Eye color effects the duration of dilation. Since brown pigment in the iris is essentially the only eye pigment, blue eyes lack significant color and gain their blue shade from light reflecting in the iris. Pigment binds the dilating drops and require higher doses but blue eyes react faster and more to dilation drops.

Different drops are often used for children’s eye exams and occasionally for adults that have inflammation in the eye from contact lens injuries, eye trauma, or autoimmune diseases and they may keep eye dilated for several days.

Finally, there are individuals with idiosyncratic reactions to the prescription eyedrops used to dilate your eyes. Basically, that means the optometrist is an idiot and has no idea why one out of hundreds of eyes are extremely sensitive to dilation drops and stay dilated for 24 hours or more. (The meaning of idiosyncratic is a well kept secret by all types of Doctors so please don’t reveal me as the source of explanation). If you have this type of reaction you can try and request a little known secret we use-simply diluting the drop!

The final answer is your eyes will usually stay dilated for several hours but it could be up to several days. Good luck and remember, after the first time you will probably have a fairly good idea of what to expect in the future.

As the H1N1 Swine Flu continues to spread pinkeye (conjunctivitis) is still uncommon and very mild. Rare cases have been showing up involving neurological complications that sometimes do manifest other eye problems.  Encephalopathy is a neurological syndrome that disrupts large areas of the brain. This has been seen in a limited number of patients and can result in eyes turning up or to the side, usually accompanied by a seizure. Other problems that may be seen in the future with encephalopathy are photophobia (light sensitivity) and nystagmus  (eyes rapidly moving in a tremor like manner). By this point the patient would normally be hospitalized from the other problems so it is highly unlikely to be seen in a home setting.

An unknown at this point is if the  influenza can be transmitted from the tears in the eye. The normal routes of transmission are through airborne droplets created by coughing or sneezing or touching a surface that has been contaminated. While the HIV virus is present in tears there are no known cases of transmission by this route. It is unknown if this will be the same with the new Flu virus.  Also, airborne droplets could contact the eye, drain into the sinuses and possibly result in infection. Until more is known it is probably best to err on the side of caution and wear some form of protective eyewear if you are around someone with flu symptoms.

Incredible images of a normal retina on the left and a damaged retina (tissue lining the back of the eye) courtesy of Robert N. Fariss, Ph.D., chief of the NEI Biological Imaging Core, and Ann H. Milam, Ph.D., former professor in the Department of Ophthalmology at the University of Washington.

Retinitis Pigmentosis is an eye disease that is primarily genetic and causes a slow, progressive loss of vision starting in the periphery and moving in, resulting in tunnel vision. Often eyesight will remain 20/20 until very late in the disease but with the extreme loss of side vision it can be very debilitating. Vitamin A has been used to slow the progression but doses of Vitamin A as low as twice the suggested normal dosage may increase the risk of hip fracture.

Ushers Syndrome, a combination of retinitis pigmentosa and hearing loss is common in Louisiana in the Acadian and Cajun population, French settlers that fled Canada and settled along the bayous of Louisiana. It is very uncommon to see this eye disease in Fort Collins since only a small percentage of cases result from spontaneous mutations.

If you are aware of any loss of peripheral or side vision it is important to schedule an appointment with your optometrist since other eye conditions like pituitary tumors and glaucoma can also create slowly progressive loss of side vision.

From the strange realms of the eye world comes a new procedure referred to as modified osteo-odonto-keratoprosthesis also called MOOKP. It sounds like something that would have been in the TV show Mork and Mindy for those who saw Robin Williams in his early days portraying an alien on earth.

A patient’s tooth is extracted, drilled with a central channel, and a lens is attached to the lens. After growing in the patients cheek or shoulder for a month or so it is implanted in the eye in cases where a corneal transplant is not possible.

Performed at Bascom Palmer Eye Institute, one of the leading Eye Hospitals in the world, the procedures was performed by a corneal eye specialist, Dr Perez,M.D.  assisted by a dentist Dr. Sawatari, D.D.S.

This procedure was initially developed in Italy. The last few years Italian Dentistry has purportedly been moving closer to the practices used in Northern America and Northern Europe.  I’m not quite sure what that implies; in Fort Collins I have never known my dentist to move teeth to places outside of the mouth. I even checked under implants at Harbor Dental and didn’t find a thing about eyeteeth. Tongue in cheek (or tooth), the early results look promising for the small group of people who can really benefit from this unique procedure.

The down side is all of the baby boomers who in 20 to 30 years will be toothless with dentures, There could be a whole new dark side to the tooth fairy. And a root canal in an eye tooth could raise fear of dentists to a new level.

Prozac is as common as aspirin today (and probably much safer).  It is in the category of selective serotonin re uptake inhibitors which is a long winded way of saying it makes the molecule serotonin stay around longer instead of being recycled.

This allows a prolonged action of  serotonin, one of the feel good molecules used to treat depression and a variety of other conditions. The eye has numerous receptor sites where serotonin acts, though they are not well understood at this time. Other prescription drugs you may have heard of somewhat similar to Prozac are Paxil, Zoloft, Cymbalta, Lexapro, and  Luvox.

One thing they share in common is a tendency to mildly dilate the pupils. This is rarely a problem, but if you have been told you have” Narrow Angles” or are susceptible to angle closure glaucoma it can be a concern. Farsighted patients (Hyperopic) have smaller drainage angles for the fluid inside the eye to escape back into the general circulation. With age, the lens inside the eye grows and moves forward, further restricting the drainage channels. When you enter into a dark room or movie theater the pupil naturally dilates also. When dilated, the colored tissue known as the iris bunches up it’s outside edges. This thickens it right at the location where the fluid is supposed to drain out. In a normal eye there is plenty of extra space to compensate for this but eyes with narrow angles start to be blocked by the bunched up iris tissue. Eventually, the drainage can be completely blocked and since fluid is  being produced in the eye the pressure skyrockets up.

Normally this results in an acute attack of a very painful, blurry red eye with nausea and headaches. Drugs like Prozac in a rare handful of cases have been known to push this process over the edge and precipitate angle closure glaucoma attacks. While highly unlikely, if you have narrow angles you should be aware of this, since this form of glaucoma is curable with early treatment.

The other possibility from this category of drugs is a transient rise in eye pressure for several weeks (though some cases report drops in pressure). If you have just started Prozac or a similar drug and your eye pressure readings are a little high, discuss this with your optometrist and have the pressures retested in 2-3 weeks. There is usually a return to normal if it is a mild medication induced increase.

A retest in a few weeks could save you money on unnecessary treatment and testing.

Finally, be happy that we have medications that have such better safety profiles than the prior generation.

The Optometric Nutrition Society

A Professional Society Whose Time Has Come

Dr.David Kisling of Fort Collins,Colorado has become an active member of The Optometric Nutrition Society.  Lifestyle modification and nutrient intake are proving to play an important role in vision health and eye disease prevention. Several studies have shown a correlation with nutrition and chronic eye disease. This area of study has become a focus of primary vision care doctors.

The purpose of the Optometric Nutrition Society is to:

To promote excellence in the care of optometric patients through nutritional support of eye health and the prevention and control of ocular and systemic disease.
To sponsor professional symposia as well as a website, and to generate materials to educate professionals regarding the role of nutrition in systemic and ocular health.
To provide a collegial atmosphere where health care professionals can exchange ideas and concepts regarding nutritional influences on vision.
Provide a resource pool of clinically relevant refereed studies that support the role of safe nutritional support for the management of ocular and systemic disease.
To monitor and validate claims made by industry regarding the quality and efficacy of nutritional supplements.
To encourage the inclusion of nutrition education in the curricula of optometry schools.

The society closely monitors peer-reviewed published science on nutritional influence on eye health, as well as safety and ethical issues regarding specific micronutrients included in supplements being marketed to vision patients.

For more information contact:

Name:    Dr David Kisling, O.D.
Address 181 West Boardwalk Ste. 201
Fort Collins,CO. 80525
Phone:     (970) 226-0959
Email       info@harmonyeyes.net

Babak A. Parviz of the University of Washington is working on futuristic contact lens technology. His research includes work on contact lenses incorporating sensors for glucose monitoring for diabetics and potentially contact leness as display monitors out of the science fiction realm. If you are interested in where contact lens technology may lead to in the future his work and publications are a fun read.

In terms of futuristic contact lens technology the question remains where the corneal molding technology disappeared to. Several years back a California company had developed a permanent technique for reshaping the cornea to adjust the prescription. It involved a prescription medication to soften the collagen bonds of the cornea temporarily, and several days of rigid contact lens wear to reshape the tissue while in this malleable state. Oddly, it seems to have vanished after having some very positive reports.

Current technology not being used clinically allows determing blood glucose levels by utilizing laser or infared light directed into the fluid inside the anterior chamber, the front part of the eye. This fluid is referred to as the aqueous humor and the glucose levels allow an estimation of the blood levels.

A new type of contact lens should be on the market within a year. Developed at Harvard University it will allow constant steady release of eye medications instead of the variation in dosing levels that ocurrs with prescription eye drops. Other competitors are in the market. I have seen the effectiveness of this using todays contact lenses saturated with eye medications in off label applications. It should be a great option for certain eye diseases. I suspect glaucoma will be one of the first contact lens applications where it will deliver results like an insulin pump can for a diabetic who has wide swings in blood sugar levels when control was tried with injections.

Patents exist for photochromatic contact lenses that darken with sunlight and act as a sunlens. When this will see the “light of day” is unknown. Patents also exsist for liquid contact lenses. Researchers have looked for eyedrops to act as temporary corrective liquid lenses for years-maybe someday an eyedrop a day will keep the eye doctor at bay.

Contact lenses with added components to prevent infections are under study and probably will reach the market place in the next few years.

Custom eye specific shaped contact lenses are certainly going to be a part of the future. Wether you know it or not, you suffer from more vision problems than nearsightedness and astigmtism. You also have trefoil, quadrafoil, spherical abberation and other optical misfortunes degrading your vision. The future will only look better!

SIX SIGNS YOU MAY HAVE GPC

FROM YOUR CONTACT LENSES

• Itchy eyes as contact lenses get older

• Lenses that slide and stick under the upper eye lid

• Irritation Every Time You Blink

• Mucous Discharge and Foggy Vision
  

• Lenses That Discolor and Develop a Film
  

• Intermittent Red Eye With Feeling Something is Scratching Your Eye
  

In the early years of soft contact lenses there was one choice, the Bausch & Lomb Soft Lens. The cost of a single pair of these miraculous new soft, comfortable lenses was between $300 and $400 when first introduced in 1971. Accounting for inflation, today that would be almost $2000. There was a very strong financial incentive to make the lenses last as long as possible. Using enzyme cleaners and sending lenses off for a special factory cleaning were common procedures. Lenses were often used for 3 to 4 years until they were yellowed and covered with numerous deposits from components of the tear film. Lipid bumps, calcium and mineral deposits, protein deposits and frequent tears and little missing chunks of the lens edges were tolerated well past the healthy tolerance of the eyes.

A new eye problem begin to show up in a number of the wearers of these new soft contact lenses. As lens technology progressed and prices came down lenses were replaced more frequently and the mystery red eye syndrome seemed to drop off. Then in 1981 the Hydrocurve soft contact lenses was introduced as the first contact lens for over night wear, the advent of extended wear contact lenses.  Cases of this new eye problem started to show up again and become common enough to recognize and diagnose.

The typical patient would come in to see the optometrist complaining about eyes that were red and irritated, possibly itching, and contact lenses that would slide around on the eye, sometimes falling out with blinking. On further questioning the lenses usually were sliding up as they would occasionally adhere to the underside of the upper eyelid. Frequently there would be some clear mucous or discharge from the eye, and some contact lens wearers would tell their eye doctor they kept seeing little spots on the surface of the lenses when they were handling them.

People have often admitted to me they turned their upper eyelids inside out as kids. For some unknown reason, girls more than boys, at least by admission. What was found in the 1980’s when inverting the upper eyelid is now referred to as Giant Papillary Conjunctivitis, or GPC. Usually it is referred to as GPC. There is a clear tissue that covers the white scleral part of your eye and extends underneath the eyelids as their surface lining. In GPC, giant papillae  (bumps of swollen tissue) form under the upper eyelid. These are described as giant but actually are about 1/3 millimeter in diameter. They do feel giant due to the highly sensitive nature of the clear tissue on the front of your eye, the cornea. Every blink rubs these bumps across the cornea and creates discomfort.

The cause of GPC has been disputed for years but most eye care providers agree there are two components, a mechanical irritation and an immunological reaction.

The lens edge constantly engages the underside of the eyelid with each blink that results in a form of low grade irritation and inflammatory reaction in a small percentage of contact lens wearers. There are probably multiple reasons such as how taunt or floppy the lid is, how the secretions make it more prone to slide over or stick to the lens, the variations in lid curvature that apply pressure to the lens at different areas, and if the conjunctiva tissue has a higher number of inflammatory mediators already present. Deposits on the lenses can also cause a mechanical type of reaction.

The immunological reaction is related to deposits that build up on the lenses. These can be your own tear lipids,proteins, preservatives in contact lens solutions that build up in the lens matrix, environmental allergens that build up on the lens, and in rare cases possibly the material the lens is made of. Since soft lenses are about half water they act like a sponge absorbing larger molecules and retaining them resulting in increasing levels over time.

Wearing the same pair of lenses for several years obviously caused an increase in this condition.  The hard lenses worn prior to soft contact lenses can still cause GPC, but because they are inert and do not absorb any water the incidence is very low. With the advent of extended wear, the eyes were given constant exposure to the mechanical and immunological irritants with no recovery time so the incidence started climbing again.

In the first era of contact lens technology lenses were frequently machined on a lathe when dry then re-hydrated. Bausch & Lomb developed spin casting the liquid material in a mold. Today automation and molding manufacturing techniques allow for much more precise and smooth lens edges. Lens that were hand inspected under a microscope in the past are now quality controlled by automated systems. These have been quantum  improvements in lens quality that have helped decrease lens edge induced GPC problems.  Extended wear contact lens materials are starting to be designed today to help resist deposits better.  For a number of years now the major contact lens manufacturers have been using large molecule preservatives that exceed the pore size of soft contact lenses. This greatly reduces the possibility of toxic preservatives inside the lens over time. Unfortunately, many generic solutions appear similar but often contain the older small molecule preservatives that can lead to GPC.

Even though the occurrence is much lower today, GPC can still be a major eye irritant and contact lens problem. There are several approaches to managing GPC. Switching to daily disposable lenses eliminates coating reactions completely since the lenses are thrown away daily and never exposed to disinfecting solutions. Usually, contact lens wearers with GPC have been wearing their contacts well beyond the suggested replacement cycle and become lax in cleaning the lenses. Returning to a normal 2-4 week replacement cycle and  discontinuing or decreasing overnight wear may be all that is required to return the eye to normal health.

Prescription eye drops are also a large part of treating GPC. A class of eye drops called mast cell stabilizers work to stabilize the cells membranes from releasing histamine that starts the inflammatory cycle. These eye drops are very safe and can be used year round when needed. Other options are available and today GPC is no longer the end of your contact lens career, only a small bump in the (eye) road.  Vision Insurance like Vision Service Plan Frequently offer plans that include medical treatment for conditions like GPC. You should do an annual review of all of your medical and vision coverage to make sure you are providing the best benefits you can for your family.

Do your child a favor when they visit their optometrist for back to school eye exam this year. Discuss sunwear protection with the eye doctor. Lifetime doses of UV radiation from the sun are associated with nuclear sclerosis. This is a type of cataract where the lens yellows then turns brown similar to plastic left outdoors for a few years. UV exposure has also been implicated as a risk factor for macular degeneration, and recent studies suggest even visible blue light may be damaging.

If you live in an area like Fort Collins at high altitude and snow,  closer to the equator, or spend time around lakes or the ocean, your child’s exposure rate is much higher.

Think of sun protection for the eyes just like sun protection for the skin. No reputable childcare center allows children on outdoor excursions without sunscreen. It should be the same for your child’s eyes. UV (Ultraviolet) protection with sunwear that is tinted or transitions lenses that are clear indoors and darken outdoors are both good options. If you child spends a large amount of time in outdoor activities consider sunglasses that wrap around on the side.  If you Normal eye glasses  may allow 35% of the light in from the side. Gray is the tint that alters color perception the least but brown is popular also.

For non prescription sun wear avoid the cheap $5.00 variety. Look for something with an 100% UV protection. Expect to pay $30 to $40 at minimum for the quality your child deserves. Poor quality sunwear may actually damage your child’s eyes by dilating them and allowing more UV exposure with inadequate protection.

By starting early you are providing preventative care for two of the leading causes of blindness.