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.

Have you ever felt concern over prescription eye drops or dilation drops used by your eye doctor?

The most common eye drop is rated category c as outlined below. Nursing can be a higher risk period than pregnancy due to drugs being secreted directly through the milk. In our Fort Collins Optometry Practice we usually don’t dilate pupils during these critical time periods unless their are other potential eye problems;  like retina changes from diabetes or high blood pressure caused by the pregnancy. Fortunately, there is very little absorption of eye drops into the blood stream and by applying lite pressure to the drainage ducts even this small amount can be largely eliminated. And information about side effects is in process to greatly improve our knowledge.

Currently prescription medications including eye drops are rated by the Federal Drug Administration for safety during pregnancy and nursing. The FDA uses the five following categories:
Pregnancy Category A: Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Pregnancy Category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

While this database has been limited due the unethical nature of testing on humans a new research program called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) should help fill in some of the current gaps. The FDA will study mothers and their children born 2001-2007.  This will cover  almost one million births at eleven participating centers. Since a large number of these women took some prescription medication during their pregnancy it should greatly to our limited knowledge base in the current rating system.

While eye drops are usually low risk due their minute quantities and limited absorption,  these studies should help you rest more comfortably at the eye doctors office and with any other prescription. Of course, when contact lenses used to deliver prescription drugs are introduced in the next year or two they will need to be added to future research like this.

We value your time so we try to

explain what you need and want to

know

What follows is straight from the National Eye Institute. I never know if patients are getting too much information, not enough, or just nodding their heads and not understanding a word I am saying. It’s important and a reason we always return phone calls if you have further questions. All of my employees are instructed to have me call you back if you don’t feel like your questions have been answered. So- here is what the NEI suggests:

Talking to Your Doctor

Today, patients take an active role in their health care. You and your doctor will work in partnership to achieve your best possible level of health. An important part of this relationship is good communication. Here are some questions you can ask your doctor to get your discussion started:

About My Disease or Disorder…

• What is my diagnosis?
• What caused my condition?
• Can my condition be treated?
• How will this condition affect my vision now and in the future?
• Should I watch for any particular symptoms and notify you if they occur?
• Should I make any lifestyle changes?

About My Treatment…

• What is the treatment for my condition?
• When will the treatment start, and how long will it last?
• What are the benefits of this treatment, and how successful is it?
• What are the risks and side effects associated with this treatment?
• Are there foods, drugs, or activities I should avoid while I’m on this treatment?
• If my treatment includes taking a medication, what should I do if I miss a dose?
• Are other treatments available?

About My Tests…

• What kinds of tests will I have?
• What do you expect to find out from these tests?
• When will I know the results?
• Do I have to do anything special to prepare for any of the tests?
• Do these tests have any side effects or risks?
• Will I need more tests later?

Understanding your doctor’s responses is essential to good communication.

Here are a few more tips:

• If you don’t understand your doctor’s responses, ask questions until you do understand.
• Take notes, or get a friend or family member to take notes for you. Or, bring a tape-recorder to assist in your recollection of the discussion.
• Ask your doctor to write down his or her instructions to you.
• Ask your doctor for printed material about your condition.
• If you still have trouble understanding your doctor’s answers, ask where you can go for more information.
• Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.

Please Feel Free To Ask Any Questions You Have About Your Vision Or Call Back Later

Last Reviewed March 2009

Computer Eye Exam Fort Collins Eye Doctor

This is a short video of what an autorefractor does when it determines your eyeglasses or contact lens prescription. It is abstract but you can see the infrared beam and changing focus as the eye computer analyzes the wavefront from the optical system of your eye.  The final determination tells us the amount of nearsightedness, farsightedness, and astigmatism you have. The cross pattern is the infrared beam that you will not see when the instrument is measuring, however it evidently has enough visible red light to show up on video. The circular pattern of lines are the image you will see and watch as amazingly it clears and comes into a crisp focus as the autorefractor works away with it’s complex algorithm. This technology greatly enhances our ability to determine your prescription with pinpoint accuracy.

Refractive errors include myopia, hyperopia, presbyopia, and astigmatism, eye conditions that are very common. Most people have one or more of them. Refractive errors can usually be corrected with eyeglasses or contact lens.

What is myopia (nearsightedness)?

If you have myopia you can clearly see close objects, but distant objects are blurry. Myopia is caused by the eyeball being too long. Myopia occurs in different degrees from minimal to extreme. The more myopic you are the blurrier your vision is at a distance and objects will have to be closer to you so you can see them clearly.

What is hyperopia (farsightedness)?

If you have hyperopia, you can see distant objects clearly, but close ones are blurry. Hyperopia occurs when the eyeball is too short for the light rays to focus clearly on the retina.

What is astigmatism?

If you have an astigmatism, the surface of the eye (cornea) is not perfectly round, rather it is more oval and doesn’t allow the eye to focus clearly. The cornea is very important in helping the eye focus light rays on the retina. Astigmatism rarely occurs alone. It is usually accompanies myopia or hyperopia.

What is presbyopia?

If you have presbyopia, you have the loss of the ability to focus up close that occurs as you age. Most people are between 40 and 50 years when they realize for the first time that they can’t read objects close to them. The letters of the phonebook are “too small” or you have to hold the newspaper farther away from your eye to see it clearly. At the same time your ability to focus on objects that are far way remains normal.

If you are doing a search for a local eye doctor in Fort Collins for your family please take a moment to look over our web site. You can find many answers to the questions you have about your families eye conditions, eye problems, and eye symptoms. If you don’t see an answer leave a comment and we will be try to find the information you request. We would like to have the opportunity to serve you family eyecare needs. We are a locaaly owned an operated eye care center serving Fort Collins and all of Northern Colorado. We will make your vision insurance claims as effortless as possible and accept most vision insurance plams including Vision Service Plan, EyeMed, Anthem, and most others. Please give us a call at:

970-226-0959

Welcome to Dr Kisling-Fort Collins Eye Doctors Choice Website. Our vision is to be the premier resource for answers about your eye symptoms and eye problems. You can use the search box to find answers to questions about your eyes. You will find articles on contact lenses, dry eyes, glaucoma, eye nutrition pinkeye ad other eye diseases.

There is also information about eye examinations, eyeglasses, prescription eye glasses for different conditions;nearsightedness,farsightedness, astigmatism, and presbyopia.

We carry a unique selection of eyeglasses for women, men and children with the latest lens technologies including glare free anti-reflection coatings, no line progressive 5th generation eye glass lens designs, transition sunglasses tints, thin and light hi-index prescription lenses.

We also try to make your vision insurance processing as simple as possible. We welcome most insurance including Vision Service Plan (VSP).

If there is a topic you would like more information on please feel free to leave a request in the comment box. Thank you for visiting our website and we hope we can become your partner in preventative eyecare for a lifetime of healthy eyesight!

Twitchy eye? Many people become concerned when they start having an eyelid that twitches intermittently or even constantly. This may occur for weeks, months, or even years. Typically it does not occur constantly and has been coming and going for a month or so when the patient finally show up at the eye doctors office concerned they have acquired a serious vision problem. Most of the time after a lengthy eye exam and detailed analysis an accurate diagnosis is made-benign eye twitch. Essentially that means the doctor has no idea what is causing your eye problem but has ruled out  serious diseases

Sometimes a cause for eye twitching is found. Anything that causes ongoing low grade irritation of the eye can elicit twitches. An eyelash growing in towards the eye, dry eyes, a foreign body such as small particles of vegetation, insects, metal, etc. can all be provoke twitching eye lids. Some prescription medications and serious medical problems can precipitate eye twitches.

A well kept secret today is there are effective treatments for benign eyelid twitches. Specific types of topical antihistamine prescription eye drops frequently can alleviate the twitch, even though an eye allergy is usually not the cause. Reducing stress may help in many cases. Stress reductions techniques that help can include improving your sleep cycle by eliminating caffeine, relaxation techniques, and looking for areas to reduce the areas of high stress in your life. Cool packs on you eyes for 5-10 minutes several times per day can be tried as a palliative measure. Cold compresses probably reduce the nerve transmissions responsible for the eye twitching. If cool packs don’t work, warm packs sometimes will. Artificial non preserved tears can be used several times per day; they are not harmful and if a dry eye is part of the problem they could provide needed relief. Often a placebo effect can occur with artificial tears and is beneficial even when you are aware that it is a placebo.  Medications that can evoke eye twitches include stimulant drugs for attention deficient disorder, medications for Parkinson’s disease, some cold medications, and even asthma inhalers. If the problem is severe you should discuss your medications with your physician.

Some limited studies have shown complimentary alternative medicine may be useful is certain patients. Acupuncture has reportedly helped some people. Most simple eye twitches are probably similar to the twitches you have from time to time in you legs and arms. These are often due to muscle fatigue and electrolyte imbalances. Make sure you are well hydrated and have adequate magnesium, potassium, calcium, and vitamin D in your diet. Some healthy food to add are bananas, raisins, apricots, cantaloupes and leafy green vegetables like spinach. Avocado lovers can benefit also. Gentle stretching of leg muscle spasms has become the accepted standard replacing gentle massaging. You might try the eye equivalent of gentle stretching by slowly closing your eye, pause briefly, then open it slightly larger than normal and pause for a second. Try doing ten repetitions ten time per day.

When eye twitches become severe and spasm the eye closed it can be caused by an over stimulation of the brain center responsible for blinking. This has a genetic predisposition so if you have other family members with similar problems that is significant information you should tell your optometrist. Usually it begins with more frequent blinking and progresses to eye closure spasms. When eyelid twitches become constant and severe, they may keep the eye closed and interfere with vision. Injections of Botox, the face lifting drug, are a tremendous asset in these rare cases. Although many people are frightened by the though of injecting something into their eyelid that is so toxic it is considered a potential terrorist weapon, the doses used resemble homeopathy and are exceedingly safe. It would probably take at least 30 to 40 thousand doses at once to be lethal. Drugs in the same class as valium have had some success in treatment. As a last resort eyelid surgery can be attempted.

Uncontrollable, progressive eye spasms that effect you eye sight need further evaluation for serious underlying neurological diseases. The majority of cases are benign and the initial visit to an eye doctor can help you on the road to recovery.

The sudden appearance of a red spot on the white of your eye can be very unnerving as it appears that the eye is bleeding. When it materializes without a history of trauma or other health problems, there is usually not a serious problem. Still, is hard to imagine anything more disturbing to look at than a blood red eye.

The Front of your eye has a mucous membrane layer called the conjunctiva. This thin transparent tissue forms a loose covering over the white part of the eye, the sclera, and extends under the eyelids. It has a thin layer of surface cells called the epithelium and a layer of connective tissue below this where small blood vessels,nerves, goblet cells (that secrete mucous) are located. The conjunctiva is extremely sensitive to inflammation because of a large number of mast cells(the cells that release histamine when you are exposed to an allergen).

Since the conjunctiva is loosely bound to the underlying sclera there is a potential space for blood to accumulate in.  The small blood vessels in the tissue are capillaries, and they have fenestration to allow fluid exchange. Because they are so small and are subject to more movement and subsequent shearing forces in the loose conjunctiva tissue, it is not uncommon for a vessel to break and bleed. This blood spreads out in the space underneath the conjunctiva and appears to be a much larger volume than it is due to the thinness of the film of blood.

A number of events can trigger a hemorrhage under the conjunctiva.  Coughing, vomiting, sneezing, straining for a bowel movement all increase blood pressure temporarily and can cause a sub-conjunctiva hemorrhage. Some  activities such as rides at amusement parks with rapid acceleration and deceleration  increase the blood pressure in the thoracic cavity and the head, which has been shown to cause  hemorrhages. Merry go rounds can have the same effect. Rubbing your eyes may also mechanically burst a capillary as can any form of trauma to the eye.

Conjunctiva  hemorrhages are not painful and do not lead to sight loss. They are equivalent to a bruise and undergo color changes over several weeks as they resolve and gradually reabsorb.

Any bleeding seen on the eye needs a thorough eye examination by your eye doctor to rule out other serious problems. Trauma could cause an unknown eye perforation that results in blindness if not treated. Any recurrent episodes warrant evaluation for underlying problems and diseases that make you more susceptible to having fragile blood vessels.

High blood pressure, arteriosclerosis (accumulation of cholesterol on your blood vessels), some types of blood cancers,diabetes,HIV and other diseases increase the frequency of conjunctiva hemorrhages. Drugs can cause hemorrhages including blood thinners (Coumadin), aspirin, ibuprofen (Advil), and even Birth Control Pills in rare instances. Some systemic diseases; flu,measles, malaria, and rare viruses similar to Ebola are factors.
Conjunctival hemorrhage has been reported as a result of embolism from breoken bones and different types of surgery.

Some viral eye infections can cause  hemorrhagic conjunctivitis. Acute hemorrhagic conjunctivitis is a specific viral disease seen more commonly in lessor developed countries and is characterized by large outbreaks of eye infections with conjuctival hemorrhages.

One other rare cause of  conjunctiva hemorrhage is referred to as Vicarious Menstruation. Little or no uterine bleeding occurs but bleeding occurs monthly and can occur almost anywhere on the body, though it is more common in the respiratory track,noes, gums, and conjunctiva. There have been patients who have eye hemorrhages every month at the time of their menstrual cycle.

Relax, Call the office and let us take a look at your eye. The odds are overwhelming it is an innocuous event that will causes you no problems other than a slightly scary looking eye.  Although occasionally a torn contact lenses edge can cause the problem, it is often not necessary to stop wearing contact lenses for the eye to heal. If you have teenagers tell them “Twilight” wasn’t really fictions after all!

The conjunctiva tissue is small but vital to keeping mucous on your eye surface for a healthy tear film, allows the eyelid to smoothly resurface the cornea on and keep your vision clear, while preventing dry eyes. It is very active in the eyes own immuine system. Make sure you keep it healthy with routine eye check ups. Most vision insurance plans like Vision Service Plan (VSP) provide well coverage visits.

Did you cram for your eye exam? Does a cold,sweaty feeling creep over your body as you wait to go into The Room? You know, The Dark room with all the blinds drawn and the chair you plunk down into while Nurse Ratchet seems to be taking great joy in adjusting you into something that looks like old sparky, the infamous Florida electric chair. Well she looked at you like she was sizing up your left kidney for the guy out front didn’t she?

Then The Fort Collins Eye Doctor comes strolling in right on time-OK truthfully you had to wait a few minutes more alone,—in a dark room,—in a chair that somewhat resembles Old Sparky,— with plenty of time to think about what was coming next.

What’s coming next is an inadequate explanation of what we are doing as Eye Doctors or no explanation at all. Most people don’t seem to want to know so if you are feeling two steps away from having your eyes water-boarded (which by the way we utilize eyeball water-boarding and it works exceptionally well when someone has a toxic chemical spilled in their eye), it’s time for you to start asking questions. (And for your Optometrist to take the que and start answering them).

First and most important I personally have only given failing grades to two patients on their eye test so your chances of passing are better than 99.999%. Those two people were both receiving a failing grade in their personal relationships prior to their eye exam so if you are having a bad day and want to yell,scream and throw things it might be a good idea to reschedule you eye examination and spend the day trying out for a local hockey team.

I find a large number of patients become very concerned they will get the wrong prescription because the lens changes are so hard to discriminate. From my side of the vision exam it’s a different perspective. We start with an instrument called an autorefractor. It does exactly what it is called; automatically it  focuses through the optics of your eye and using mathematics called wavefront analysis it determine what prescription you need. You don’t have to do a thing except look straight ahead at the target, keep still, and have your head pressed against the top headrest. Magically things clear up after the instrument whirs and hums and prints out your prescription. We refer to this as an objective refraction or reading because it is entirely independent of your verbal responses.

Now the bad part. The assistant who wants your kidney for her brother in law escorts you back to the “room“. You know whats coming next-yes it is one or two,one or two,on or two. And you thought we had to learn math for optics? Every subsequent view looks blurry and keep getting worse. It clears up in between the two bad choices you are given but the optometrist seems intent on ignoring that and giving you worse choices.

Actually it is a well designed testing sequnece called forced choice (uh oh here comes that water board). Really, if you remember the old dial TV’s where you turned past the channel and back a few times you couold bracket in to the clearest place. This part of the eye test is subjective and depends on your responses of just noticable differences. It brackets in to the place of maximum clarity. Unfortunately, that endpoint is often where it looks equally bad with both choices. Still, we force you to make a choice. That allows your eye doctor to see how repeatable your responses  are and gives a very good idea of how precise the prescription will be. Most of the time in our eye center, it will be repeatable within the accuracy level that lenses can be made in today. That means if we check you tomorrow or next week the chances are very high your eyes will read for the exact same prescription.

Next I will compare those subjective responses with what the eye computer calculated. If there are significant differences I may repeat reading with both methods after using drops to prevent focusing changes effecting the finmdings, especially in children. An added check may be done with a retinoscope, the hand held forerunner to the autorefractor we use today. While it is very low tech, it does allow me to see any variations in focusing occurring while taking an objective measurement.

Finally, a good optometrist should check your old prescription and how well you can see with it. That is a good indicator of how much change we expect to see in the new prescription.

When you add all of these things together, it really works well and rarely is a prescription wrong per say. It is more common to missunderstand how much change a patient can tolerate (we can be right and wrong at the same time), or fail in communicating unusual visual needs that have to be adressesed (like somone working on computers 70 hours per week at a non standard distance.

Spend a few extra minutes to communicatre your visual needs and distances you work at with your optometrist. Also explain any problems you have had adjusting to new glasses in the past. Then you shouldn’t need to worry about how blurry things keep looking during your eye test-there is a 99.999% probablity you will see well in the end and get to keep your kidney!
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