Acuvue Releases New Daily Disposable Contact Lens That Is A Perfect Match For Teenagers

Acuvue has released a new soft contact lens referred to as Acuvue TruEyes. This lens is a perfect match for kids and teens who are just starting contact lens wear, and teenagers who have problems keeping up with contact lens cleaning and disinfecting regimens.

The Acuvue TruEyes Contact Lens Combines The Healthy Eye Properties Of Daily Disposable Contact Lenses With The High Oxygen Permeability of Silicone Hydrogel Soft Contact Lens Materials Ideal For Low Humidity Climate Like Northern Colorado

Daily disposable contact lenses have long been a favored choice for children and teenagers first starting to wear contact lenses. By starting with a fresh new contact lens every day, there is no concern about improper disinfection of the lenses. Daily disposable contact lenses do not suffer from buildup of deposits on the lens surface that can cause eye infections, allergic reactions, and other vision problems. Unfortunately , some teenagers actually leave these contact lenses in for extended periods of time and often end up sleeping with their contact lenses on -they have been known to leave in the same pair of lenses as long as wearing the same clothes! The Acuvue TruEye contact lens is made of a material called Narafilcon A.  Narafilcon A is a silicone hydrogel contact lens material, or falls in the category commonly referred to as SiHy contact lenses. SiHy lenses currently account for over half of the new contact lenses being fit today. Hydrogel is the soft contact lens that has been widely used for years, he addition of silicone greatly increases the permeability of the contact lens to oxygen.  The permeability measures 100 which is almost 400% higher than the Acuvue 2 lens which measures at 28. At a level of 28, when the lens is left in overnight the clear corneal tissue underneath the contact lens almost doubles in the amount of swelling that would normally occur at night. The Acuvue TruEye transmits enough oxygen through the contact lens that corneal selling is negligible in a clean lens. (As lenses age they develop coatings from deposits that reduce the permeability).

Increased Contact Lens Permeability Solves A Serious Dilemma in Teenager Contact Lens Wear

The dilemma has always been between lowering the risk of infection by eliminating improper contact lens care and disinfection versus having a higher margin of safety for non prescribed overnight wear of lenses. We have had daily disposable contact lenses for a number of years and silicone hydrogel contact lenses in 2 to 4 week disposable contact lenses for several years but not both on one lens. The TruEyes contact lens now offers that option, and is a welcome addition for young contact lens wearers. It also is a nice option for adults who wear contact lenses occasionally and don’t want the hassle of maintenance and cleaning and may prefer to leave them in after a long day or extended flight.

Other Properties of the Acuvue TruEyes Contact Lens

The TruEyes contact lens is 46% water and has a benzotriazol ultraviolet absorbing agent in the lens to help protect the eye. The FDA does not consider this adequate UV eye protection but it does help, and should be considered as a preventative measure for children in terms of lifetime UV exposure  for cataracts and macular degeneration risk. The TruEye contact lens blocks over 99% of the  UVB radiation (280-315 nanometers) and over 90% of the UVA radiation (316-380 nanometers). It has a lite blue handling tint to make the lens easier to see from the addition of Reactive Blue Dye #4.

Increased wetting and contact lens comfort is achieved by adding Polyvinylpyrrolidone (PVP) to the lens material. The Acuvue Advance and Acuvue Oasys contact lenses have utilized PVP to improve the comfort of the lenses.  PPV absorbs up to 40% of its weight in water and helps retain it in the lens. Not only does this contribute to a lens that stays wetter, it also presents a smoother surface to the eyelids when they slide across the lens surface with blinking.  This is presumably related to the lowest reported lubricity value among the silicone hydrogel materials. Lubricity is the measure of the reduction in friction between two different materials and a wetting agent in between (in this case the tears). Presumably the PPV alters the surface of the contact lens and allows less friction to be transmitted from the eyelids to lens surface, and from the posterior lens surface to the cornea tissue underneath the contact lens. This reduction in friction translates to an increase in comfort. The PPV in conjunction with the silicone hydrogel material is referred to as Hydraclear Plus. The Plus part is an increase in the amount of PPV incorporated into the contact lens material. The Acuvue TruEyes contact lens also has a lower modulus of elasticity at  0.66 compared to other silicone hydrogel lenses that run 1.0 and above. The modulus of elasticity is the lenses tendency to be deformed elastically or not permanently when force is applied. A lower modulus means the contact lens is less stiff or rigid, and tends to drape more assuming the shape of the eye instead of retuning to its original shape. Usually a lower modulus is more comfortable. However, there is some evidence that a higher modulus may slow prescription changes in children.

This is a welcome addition to our contact lens armamentarium, especially for the pre-teen and teenager contact lens market. Fortunately, this lens  already has a track record in Europe where it has been available for several years. For the dry eye contact lens patient in Fort Collins it is another option to help by combining a fresh wetting clean lens surface every day with an optimized wetting contact lens material.

Keratoconus | Eye Doctors Contact Lenses And New Options For Treatment

Keratoconus is an eye disease that causes vision to gradually worsen over time, as the transparent corneal tissue that covers the front of the eye thins and bulges forward, forming the cone shape that keratoconus is named for.

Eye Doctors find rapid increases in nearsightedness and astigmatism are common with frequent changes in your eyeglass prescription. Scarring of the cornea can also occur in some cases resulting in significant vision loss.

Fort Collins Keratoconus Cases Probably Effect At Least 200-400 Individuals |Tell Your Eye Doctor If You Notice These Symptoms:

• The appearance of long light streaks in your eyesight at night
• Visual Glare and halos around lights, especially car headlights and taillights at night
• Double Vision
• Distorted Vision
• Blurry Vision making it difficult to read
• Ghost like images of white light surrounding objects you are viewing
• Eye sensitivity to light

Eye Doctors Agree Keratoconus usually shows up most commonly between the teenage years of 16 up to age 30

When this corneal eye disease manifests at earlier ages optometrists often find a more aggressive form with ongoing, frequent changes in your eyeglass or contact lens prescription. The best guess is the occurrence rate is about 1 in 2000 people.

Optometrist And Eye Research Institutes Know Surprisingly Little About Keratoconus But Knowledge Is Starting To Grow

It is hard for eye doctors to pin down the exact rate of this eye disease because it can be very mild and remain undiagnosed, especially when it burns out early (form fruste), or stops progressing after several years. Corneal Keratoconus creates irregular astigmatism, causing curvatures on the cornea tissue that are not nice smooth curves. Instead the eye curvature resembles the surface of a potato with dips and valleys on a very irregular shape. This type of shape makes it very difficult for your optometrist to provide a prescription for eyeglasses that results in clear vision. The lenses would have to be made in very strange shapes to result in clear vision. Even lenses that have been designed in this manner are rendered ineffective the moment your eyes look off the center of the lens. Irregular astigmatism also occurs without keratoconus, but it does not tend to progress and result in the characteristic steepening of the cornea resembling a cone shaped area. Usually keratoconus presents in one eye and over time well over half of the eye patients will have both eyes involved.

In the past, much speculation centered around eye rubbing and ocular allergies. Some eye physicians have speculated that Keratoconus is triggered by eye rubbing that starts an inflammatory cascade in the cornea. Frequent eye rubbing also could cause mechanical tissue breakdown in areas of the cornea that are already compromised. Research by eye doctors has shown between 6-8% of patients with keratoconus have a family history, indicating there can be strong genetic components in a small percentage of families. Over 90% of the time if you have Keratoconus it is unlikly to be passed on to your children. Several areas of chromosomes have been identified as potential genetic markers and are being investigated further.

Also, certain eye diseases such as retinitis pigmentosa, retinopathy of prematurely (damage to the retina tissue in the back of the eye from premature birth), Leber’s congenital amaurosis (a degenerative disease of the optic nerve), and vernal keratoconjunctivitis (a type of allergic eye disease) appear to occur more frequently in conjunction  with Keratonus.

Some disease of the body also have a degree of co-occurrence with Kerataconus- Ehlers-Danlos syndrome, Down syndrome, osteogenesis imperfecta, pseuodoxanthoma elasticum), mitral valve prolapse in the heart, Laurence-Moon-Biedl syndrome, Rieger’s syndrome and neurofibromatosis. Several of these diseases interfere with normal collagen development and may precipitate kerataconus by disrupting collagen development in the cornea.

The changes to the cornea from Kerataconus are mostly unknown. The cornea consists of 5 layers and is about 1/2 mm thick (550 microns or about the width of 5 human hairs). The epithelium layer is the surface layers of cells. Underneath the eyes epithelium layers is a thin basement membrane sitting on the anterior limiting membrane, also know as bowman’s membrane. The bulk of the corneal thickness is in the stromal layer, where the collagen protein fibers run across the cornea, adding the tensile strength. Tensile strength is the degree a material can be stressed and still return to it’s original state and shape. Collagen is the memory material of the cornea. The structure of collagen changes in the center area of the cornea with shorter fibers, that cross more, run at different angles, run though each other, form connections to Bowmans membrane, and also form connections originating from Bowman’s membrane. It has been suggested from research by Jan P.G. Bergmanson, OD, PhD, PhD h.c, DSc, & Jessica H. Mathew, OD that this alteration in structure near the central cornea may help explain the nature of Keratoconus in the future, With shorter fibers running in differing directions with various connections the central cornea would seem to be more prone to breakdown of the normal collagen structure. Optometrists have found the bulging cone area characteristic of Keratoconus cones usually form close to the central cornea, slightly inferior, which seems to substantiate the altered central corneal tissues may play a part in the eye condition. Early changes may occur in the surface epithelial cells disrupting the basement membrane. When keratoconus begins, whatever the cause may be, protein damaging enzymes called proteases increase and start damaging the epithelial basement membrane. This is the membrane formed underneath the lowest level of epithelial cells. Subsequent breaks in the corneal anterior limiting membrane occur and the cornea starts to thin centrally, probably due to the susceptibility of the different surface anatomy of the collagen fibers under lying Bowman’s membrane. As these breaks occur the surface epithelial cells can contact the stromal level of the cornea where most of the structural framework of this eye tissue is located. Small proteins called cytokines are released and alter the fluids around the cells, leading to scarring of the cornea.  Stromal fibers may move through the anterior limiting membrane. Whatever the cause, a disruption of the normal collagen structure causes the memory shape to lose its capacity and irregular shaped corneas to subsequently develop. There are indications of changes in the different enzymes that degrade proteins and induce changes in the collagen and the spaces surrounding the cells in the cornea. Cathepsins are one type of protein that increase as kerataconus starts to occur. These could lead to destruction of the so called extra cellular matrix, the substances surrounding the cells and lead to degenerative effects in the cornea.
They may also indirectly cause a reduction in the antioxidants and increase oxidative damage to the cornea, another theory that has been proposed. Matrix metalloproteinase-2 is also activated and changes the extra cellular matrix surrounding the corneal cells. Keratocytes are numerous cells in the cornea that produce the collagen for the fibers and the extracellular matrix components, turning mostly dormant by birth. In Kerataconus they have been observed to have increased apoptosis (increased programmed cellular death). There is a reduction in the number of collagen fiber and they also reduce in diameter. While there is little indication of dry eye causing Keratoconus, at our Dry Eye Institute of Northern Colorado, we do seem to see a possible correlation. Dry Eye Syndrome increases inflammatory compounds in the tear film that do cause cellular damage in the epithelium layers. It is possible this could start the cycle of damage that  helps initiate damage to the eye that optometry eye exams have found over the years. While this has not been suggested yet, there is a reasonably high level of floppy eyelid syndrome associated with obstructive sleep apnea and Keratoconus. Eye researchers Cintia S De Paiva, Lindsey D Harris, and Stephen C Pflugfelder have demonstrated it is possible that eyes exposed at night by staying partially open can create Keratoconus like change in the cornea. Most likely, keratoconus will be found to be several different disease processes and also multifactoral. Multifactoral eye diseases have multiple factors that combine to create the eye condition. For instance, the different collagen structure in the central cornea makes the eye susceptible, changes in enzymes may alter the tissues and start causing minor breakdowns in the epithelial surface cells, enzyme changes may lead to increased oxidative stress further weakening the eye tissue, and constant rubbing of the eyes may push the eyes over the edge by inducing mechanical damage to the eye tissues that could only occur with a compromised cornea. A genetic alteration of the cornea could make the cornea of the eye more susceptible to the entire chain of events.

Your eye doctor will initially treat Kerataconus with contact lenses. Treatment of Kerataconus usually begins with a rigid gas permeable contact lens when vision can no longer be maintained clearly with spectacle lenses. Sometimes, a gas permeable lens will be fit over the top of a soft contact lens in a piggyback contact lens fitting, with a soft contact lens and a rigid gas permeable contact lens on top of it. While used years ago, piggyback contact lens fittings fell out of favor due to the complications from reduced oxygen flow with older soft contact lenses. With the new super oxygen permeable silicone hydrogel soft contact lenses, it is enjoying a small resurgence. It is primarily used to increase eye comfort for the keratoconic eye patient. There are also combination contact lenses available today, such as the SynergEyes contact lens that is a rigid contact lens with a soft skirt attached surrounding the lens. The primary issue with Kerataconic contact lens fittings is matching the steeply curved cone with the surrounding flatter eye tissue, while dealing with the irregularities of curvature that are present. While custom mapping technology is highly touted as the way to achieve the required fit, the truth is observation of contact lenses on a keratoconic eye by an optometrist and adjustments based on how dyes accumulate under the contact lenses is still the most accurate method to achieve an excellent final fit. Due to the drastic changes in curvature the contact lenses require multiple different curves as you move toward the edge of the lens. While many different lenses have been developed with special names as the ultimate Keratoconus contact lens, they are all variations on the basic concept of a steep contact lens center and a gradient of changing curvatures to the edge. Rigid contact lenses work because the light bending capacity of the tears is very close to the light bending capacity of the cornea. The tears fill in between the irregular eye surface and the smooth surface on the back of the lens. This essentially removes the irregular astigmatism and nearsightedness by utilizing the back contact lens surface as a new regular surface where light is altered, and often restores the corrected eyesight close to 20/20. Eye glasses may only achieve 20/40 vision or much worse because the irregular surface remains. Occasionally Scleral rigid gas permeable lenses are used. These are gas permeable lenses larger than normal that extend out onto the white part of the eye. All contact lenses today are gas permeable, or designed to let air pass through to keep the cornea healthy. Soft contact lenses are usually not referred to as gas permeable because of historical changes. Hard lenses were the first contact lenses and they were made of a material that passed no oxygen through the lens. When changes were made to the polymers used to make hard contact lenses that allowed them to breathe or pass needed air to the underlying cornea, they were renamed rigid gas permeable contact lenses. Rigid because they are still a hard material with only 1-2% water, and gas permeable because unlike the older hard contact lenses they now transmitted air to the eyes. Soon they became called by the acronym of RGP’s to save a few words (even prior to the texting era). With time they also came to be referred to as gas perms, in spite of the fact that all soft contact lenses are also gas permeable. Soft contact lenses are never rigid however, as they normally are composed of about 50% water. This softness comes at the price of increased flexibility and they drape across the eye, imitating the irregularities of a Keratoconic cornea and do not correct the vision back to optimum levels. Once your eye doctor has achieved an excellent fit and optimized your contact lens prescription, there may be frequent changes in your contact lens prescription as the Keratoconus goes through progressive changes.

Your Eye Doctor May Be Able to Avoid Corneal Transplants

While only 10-20% of eyes will undergo ongoing serious changes, they do present challenges to fitting contact lenses on eyes with Kerataconus. At some point, scarring of the cornea can start to occur and patients become intolerant to contact lenses. In years past, the only remaining option was a corneal transplant. While corneal transplants enjoy a relatively high success rate, there are still risks and problems. Recently there have been some new exciting options starting to evolve.

Permanent Contact Lenses-Intacs

Intacs are small rigid half rings similar to portions of a gas permeable contact lens that are implanted in the cornea. They were originally developed to reverse nearsightedness, but did not prove as effective as originally thought and were replaced by LASIK eye correction procedures. A few years ago they found a new use in stabilizing Kerataconus. They are not a cure for Kerataconus, but can restore some more regularity and allow some patients to continue contact lens wear while avoiding a corneal transplant. They also appear to have some effect in decreasing the rate of change in Kerataconus. While they are promoted as being completely removable and reversible if patients have problems, this is not entirely true. About 10-15% of Intacs cause some complications and issues that cannot be resolved if they are removed. Still, it is often a better option than jumping straight to a corneal transplant.

Kerataconus Corneal collagen cross-linking therapy

Corneal collagen cross-linking therapy (CXL) is intended to stabilize the tissue by forming more bonds between the existing collagen fibers and also increasing the size of the fibers, making the cornea much firmer and less likely to continue deforming. It involves pretreatment the cornea with riboflavin (Vitamin B2) for 30 minutes then using radiation from the ultraviolet A band light spectrum (normally around 370 nanometers) to increase the cross links over about a 30 minute period. While it has been more extensively in Europe, it is starting to enter the U.S. market. The riboflavin acts to keep the UVA from completely passing through the cornea so the UV can act to create more cross links. Riboflavin also may have a photo reactive effect that further increases cross linking of the collagen bands. Questions still surround this treatment. It is not an FDA approved treatment in the United States but is undergoing clinical trials, and currently is used off label as a treatment for Keratoconus. The FDA (Food and Drug Administration) regulates drugs and medical devices but not eye doctors. Any procedure that uses drugs or medical devices can be performed by an eye doctor if you are properly informed, share in the decision, and it has an acceptable possibility of helping. The riboflavin still allows a significant amount of UVA to pass through the cornea. This could potentially increase future risks for cataract development. UVA with riboflavin is cytotoxic (damaging to cells) and can damage the endothelial cells that line the back of the cornea and are vital for its long term health. Corneal thickness needs to be factored in to keep this type of damage far enough away from the endothelium cells of the cornea. A minimum corneal thickness of 400 microns has been suggested but a better choice would be 450 to 500 microns. Cellular damage to the keratocytes, changes to the matrix of the cornea, and changes to the epithelium do occur in the cornea after the procedure. Normally they regenerate over the next 6 months. Riboflavin has poor penetration into the cornea so the surface layers of epithelium cells need to be removed. It is unknown if the effect of increased rigidity created by this treatment will last indefinitely, or if there are any other long term problems from increasing the cross linking and rigidity of the cornea. Some cases of persistent haze, infections, and increased eye pressure reading have been noted. The increased eye pressures may be partially due to an artifact since we know thicker (more firm) corneas read artificially high with most current glaucoma instruments. With careful consideration about the stage of Keratoconus and treatment of the eye at the appropriate stage, cross linking of collagen fibers in the cornea appears to be a great addition to eye doctors armetarium in treating keratoconus. While it may improve the condition mildly in many patients, it should always be considered as a stabilizing treatment and not a curative treatment.

New treatments for Keratoconus and other eye diseases are improving at a rapid rate. If you are a family members have concerns about Keratoconus, feel free to contact Dr David Kisling in Fort Collins, Colorado at (970) 225-0959.

Check Yourself For Dry Eye Syndrome Symptoms

Your Eye Safety Comes First-Tips On How To Create A Safe Work Environment

1. Create a safe work environment

Minimize hazards from falling or unstable debris that could create eye injuries. Make sure that tools work and safety features (machine guards) are in place and that workers and volunteers know how to use tools properly.
Keep bystanders out of the hazard area.

2.Evaluate safety hazards.

Identify the primary hazards at the site. Identify hazards posed by nearby workers, large machinery, and falling/shifting debris. In Northern Colorado, freezing temperatures may create a different set of hazards than what a tropical environment would.
3.Wear the proper eye and face protection.
The American National Standards Institute (ANSI) serves to administrator and coordinate the United States private sector voluntary standardization system, focusing on competitiveness and safety of workers. Z87 defines the parameters for eye protection for the applicable hazard. Z87 standards specify stronger eyeglass frames that have a larger rim to reduce lenses ejecting into the eye from high velocity objects. They also dictate thicker lenses with a 3.0 mm center thickness. Unfortunately, glass lenses that are 3.0 mm are much less impact resistant than materials like polycarbonate. Glass also tends to shatter into multiple pieces. In my opinion, policies should exclude glass lenses, even if they meet z87 safety criteria.
Make sure the eye protection is in good condition, fits and will stay in place.
4.Use good work practices to protect vision.

Brush, shake, or vacuum dust and debris from hardhats, hair, forehead, or the top of the eye protection before removing the protection. This helps prevent brushing particles and toxic compounds into the eyes. Do not rub eyes or eyeglasses with dirty hands or clothing. Clean eyewear regularly but be sure to thoroughly rinse all debris off before using a drying cloth on the lenses to avoid scratching the lenses. Ammonia based cleaners can damage some lens coating and should be avoided.
5.Anticipate eye injuries and prepare in advance. Have eye wash stations or adequate quantities of sterile solution strategically placed so eyes can be irrigated continuously for 15-20 minutes if needed from toxic chemical spills.

Please Note That All Of This Material Is For Educational Usage And Not For Designing,Prevting  Or Treating Any Eye Condition

Ft Collins Sees The Eyes of Nic and Nac

Well it’s back to being a foster parent-Nic & Nak are two Sugar Gliders that have joined out family. In case you don’t know, sugar gliders are marsupials who carry their young in a pouch, and they love to live as adults in anything resembling a pouch. They are well known as coming from the Australian Island of Tasmania, but they live in New Guinea and several other countries.

Great Eyesight Without Glasses

Excellent Night Vision

Faster Than A Speeding Moth In Flight

With Huge eyes on the side of their heads, they look like little Ewoks. The Protruding cutest eyes you will ever see function to provide superior night vision an a large filed of view. They do have 3-D vision but in a smaller filed of vision. There is some disagreement about color vision problems, but they do appear to have good  color vision to detect fruits, flowers, and different types of insects. Previously it was thought the only color they cold see was red. Those protruding eyes allow sugar gliders to nab a moth at night in flight while gliding 200 feet through the air,  missing all the tree branches, and tucking in for a perfect landing on a tree 50 feet above the ground. They have a blood supply under the retina and a tapetum lucidem tissue that serves like a mirror to reflect light back through the retina to increase night vision. They also have a tuft of blood vessels that comes out of the optic nerve into the vitreous fluid inside the eye. These blood vessels are not permeable (they do not leak out blood). This is stated to help night vision and the retina is referred to as avascular, or not having blood vessels in he retinal tissue. That menas the blood supplies has to diffuse from the choroid tissue underlying the retina. Why this makes better night vision is a mystery to me.

These Are Really Cool Critters With Eyes You Can’t Help But Marvel At!

Optometrist | What we do Today

Optometrists are health care professionals serving as primary care providers for eye care. Primary care providers are the initial entry into the health care system and function to treat the common vision and eye diseases seen. In the event there is a need for more complex treatment, such as invasive surgery into the eye, or uncommon eye diseases, optometrists refer patients to secondary providers such as ophthalmologists and neurologists who specialize in specific problems with the visual system. Optometrists perform eye examinations to determine the refractive status of the eye and determine the health of the eyes. Optometrists determine the need for prescription eye glasses by  computer analysis of the eyes optics and refinement with an instrument capable of over one million different prescriptions. This is a forced choice test where you are requested to give a verbal response on which view appears better, one or two. An optometric exam also measures the eye pressure as one test for glaucoma, a microscopic exam of the front half of the eye, and a view of the posterior part of the eye, often with the aid of dilation drops.

Fort Collins Optometry Dry Eye Services For Northern Colorado

Only a very small number of optometry eye clinics provide dedicated services for dry eye treatment. We have developed the Dry Eye Clinic of Northern Colorado to address the rapidly growing epidemic of dry eye syndrome in the Fort Collins Region.

Optometric Eyeglass and Contact Lens Services

Most optometry offices include an optical dispensary where glasses can be fitted and provided with the appropriate prescription for the patient. Optometrists may order lenses from an outside lab or fabricate them entirely on site.

Contact lenses are also fitted and measured by optometrists. There is normally a contact lens service that provides diagnostic lenses to wear for a short time period before the contact lens prescription is finalized. Most offices provide annual contact lens supplies after a lens is fit.

Other Optometry Special Services

Other services provided by optometry include treatment of eye diseases. Laws vary from state to state as to which prescription eye drops can be used and what conditions can be treated. Currently 44 states also allow oral drugs to be used by optometrists in treating eye and eyelid disease. Oklahoma has allowed optometrists to use laser procedures for several conditions for a number of years. In Colorado, we have good legislation and can treat the majority of eye problems you may have. You are also assured of getting any needed referrals to the top eye surgeons and other physicians since we have had the opportunity to see their patient outcomes over time.  All of the 19 optometry schools in the United States train students in the treatment of eye diseases, minor surgical procedures, and the care involved in LASIK eye surgery to treat nearsightedness. There is an ongoing trend to unify state laws to allow optometrists to provide eye services as they have been taught in school without restrictions on the types of drugs used or by procedure. This will be a great benefit and aid the families of optometrists. Under the current laws it is very difficult to move to a different part of the country when a spouse is transferred or other reasons necessitate a move.

Other optometric services include vision therapy for crossed eyes, lazy eyes, and vision related learning problems. Visual aids and training for the partially sighted population is another specialty. Doctors of Optometry also provide rehabilitation vision care for people who have visually related problems from head injuries, and hospital based treatment  of eye problems.

Educational Requirements for Doctors of Optometry

Optometry requires an undergraduate degree with an emphasis on biology and another 4-5 years attending an accredited optometry school, which usually entails a semester externship of training at a clinic or hospital. Students are required to take National Board Examinations and often State Board Exams before starting practice. Continuing education classes are required annually to assure optometrists stay up to date with changing technology. Students may complete a residency at a hospital or clinic in eye disease, family eye care, pediatric vision, low vision for the partially sighted. While not required, these allow for further specialization that may be needed to practice in a hospital or specialty clinic.

While optometrists take national and state boards, there is a process now beginning to add a new board certification level. This will be an ongoing process, requiring regular continuing education classes and competency tests.

Eye Doctors We Recommend

Frequently we are being asked to help our eye care patients leaving Fort Collins for an Eye Doctor recommendation in other areas of the country. With time, I will add to this list of eye doctors I personally know -their skill levels and special expertise they have, and some very specialized eye doctors such as eye doctors that specialize in very small parts of the eye like retinal specialists. Some of these eye doctors are far from Fort Collins but I know them form research writings, continuing educations courses,  and the eye institutes they trained and serve in. I also will list some other types of health care providers in Ft Collins that I am aware of the quality of work they do, and lastly some non healthcare  professionals that I have known for a number of years and trust. If you are a long term patient and would like to be added to our list, please contact our office at 970-226-0959. We will not endorse any multilevel marketing providers simply because most people are looking for someone to replace a trust based local Fort Collins eye doctor or other health provider in the mew area they are moving to.

Foloowing are the categories:

Eye Doctor Guide-Leaving Fort Collins

California, LaJolla

ARENA EYEWORKS OPTOMETRY – DR. MICHAEL GOLDSMID

Eye Doctor Explains Constantly Dilated Pupils From Adie’s Tonic Pupil Syndrome

Occasionally parents or individuals will notice the eye pupils appear to be abnormally large and stay dilated all of the time. Patients may complain of sensitivity to light and occasionally have problems focusing and reading at near distances. This may occur in one or both eyes. About 3/4′s of the time it occurs in one eye only. While many reports indicate the occurrence age as in

Eye Pupils Examined For Adie's Eye Condition

the 20-to 40 year age bracket, most of the cases we have seen in our Fort Collins Optometry Clinic tend to be young girls in their early teens. The prevalence is seven to eight times higher in females than in males.

An Eye Exam by Your Ft Collins Optometrist is Essential to Rule Out Serious Vision Conditions

Diagnosis can be somewhat tricky. If only one eye is dilated the determination needs to be made by an eye care professional if one eye is dilated more than normal, or if the other eye is constricted making the other eye have the appearance of an abnormally enlarged eye pupil by comparison. This can occur in Horner’s Syndrome. While usually benign, a number of serious health condition may cause Horner’s Syndrome in the eyes. A tumor near the apex (top) of the lung is one of the problems you would not want to develop to an advanced stage when an eye exam and visit to your optometrist could help detect serious causes of Horner’s Syndrome at an early stage. To help your eye doctor diagnose Adies Pupillary problems, a prescription eye drop called Pilocarpine can be applied to the eye in a very diluted from. The loss of nerve stimulation causes the eye drug receptor sites to become hypersensitive and eyecare patients with Adie’s Tonic Eye Disorder will constrict to a concentration that has little effect on a normal eye.

Adie’s Tonic Pupil is a dysfunction of the parasympathetic nerve fibers. First a short explanation of the nervous system of the body. The central nervous system is composed of the brain and spinal cord. The peripheral nervous system is everything else, and has two parts, the autonomic system and the somatic system. The autonomic nervous system has two branches, the parasympathetic and the sympathetic. Combined, these generally control functions automatically, we don’t will our eyes to dilate (it can however be trained) or our heart to beat. The somatic nervous system is the part of the nervous system under our conscious control, that helps us move arms and legs when we want to go someplace, like to the optometrist office to find out why the eyes pupils are staying dilated all the time.

The parasympathetic nervous system controls functions in a manner usually opposite to the sympathetic system. The parasympathetic system is the opposite of the sympathetic fight or flight response when the body is in a state of arousal. Parasympathetic nerves increase tearing from the eyes, fluid secretions in the mouth, increase bladder and bowel function, move blood out to the surface layers of the body and digestive track. In comparison, the sympathetic nervous system moves blood away from the surface tissues and the digestive track, so the individual in a threatening environment can increase their chances of survival by protecting blood flow to vital organs.

The parasympathetic nerves also connect to the iris, the colored tissue that surrounds the black pupil. The iris determines the size of the pupil. The parasympathetic nerves act to constrict the pupil (by increasing the iris size leaving a smaller opening) when activated by sunlight. The sympathetic nerves act to dilate the eye pupil (decreasing the iris size by bunching it back toward the outer edges which exposes more open space thus enlarging the pupil). Just as a reminder, the pupil is a hole through the colored iris of the eye that allows light into the eye. Smaller pupils allow less light inside the eye which is important on sunny days. Dilated eye pupils allow more light inside the eye to help in dark environments and at night. When the parasympathetic nerves are compromised, the sympathetic nerves are unopposed in activating the iris muscle that draws the iris back and results in a larger pupil. Sometimes this problem extends past it’s base to the attached culinary body where a muscle functions to focus the eye for near vision. When this muscle contracts, it alters the shape of the lens inside the eye creating more curvature to allow focusing at close distances. If the damage to the parasympathetic nerves extends to the ciliary body, the ciliary body can’t contract normally and there will be an eye focusing problem that causes blurred vision when trying to read with symptoms of eyestrain and occasionally headaches. Other symptoms may include sensitivity to light due to the inability of the pupils of the eyes to constrict in bright light.

Your Eye Doctor Can Help You With Treatment

Once it has been determined your eye condition is Adie’s Tonic Pupil (also known as Holmes-Adie’s Syndrome or Ross Syndrome when there is an alteration in sweating), several treatments are recommended. Sunglasses need to be worn outdoors even when photophobia (light sensitivity) is not a symptom. A larger pupil allows more ultraviolet light and blue light to enter the eyes and can increase the risk over a lifetime for developing macular degeneration and cataracts. This is especially important to eye doctors in areas like fort collins and Northern Colorado where the number of sunny days and light reflected off of snow greatly increases UV exposure. Prescription eyeglass lenses may be needed to help with near vision. This is normally not a progressive condition and the pupils may even become smaller with time, even though the lack of response to light will continue. Occasionally, prescription eyedrops have been used to decrease the dilation of the eyes pupil.

How Does Your Optometrist Determine The Cause of the Constantly Dilated Pupils?

Well that’s why they call Eye Doctors Offices Practices. Like a lot of other eye diseases and conditions we just don’t know yet. The very definition of Adie’s Tonic Pupil is an idiopathic tonic pupil (idiopathic is a nice word diverting the attention away from the fact that we have no idea). Rightfully so, idiopathic sounds like the Eye Doctor has an idiot disorder themselves! Even after numerous years as a Ft Collins Optometrist, the rapid expansion of knowledge serves more and more to show me how little we really know about eye diseases and disorders.

There is a significant incidence of Adie’s Tonic Pupils that occur shortly after a viral or bacterial infection of the body. Most colloquial eyecare provider reports indicate a viral infection. Somehow an infection is causing inflammation that damages the parasympathetic nerves connecting to the iris muscle. Since migraine headaches occur at a much higher frequency in females than males, and also after puberty, one can only speculate there could be some kind of correlation with changes in hormonal levels. Migraine headaches also frequently damage neurons and cause small losses of peripheral vision that are not noticed by the eyecare patient. Migraine headaches may create a disruption of blood flow or some other mechanism that acts in conjunction with an infection in the body to damage the Pupillary eye response. Twenty percent of Adies Eye Syndrome occur in both eyes. Other symptoms that can occur are increased and decreased areas of sweating and the loss of deep tendon reflexes (When your Doctor whacks your knee and the involuntary kick is lost). It may be found to have multiple different causes in the future.

Some known cases are of Adie’s eye disorder include complications of retinal detachment surgery involving a sclera buckle, other types of eye surgery, eye trauma, diabetes, Herpes Zoster infections (the chicken pox virus), syphilis, some dental, surgery, Guillain–Barré syndrome which rarely is caused by vaccinations, and some internal organ problems. While I have not seen any documented cases, I suspect that viral infections like West Nile Virus which has been so prevalent in Northern Colorado probably result in an occasional case of Adie’s eye disorder. Most  viral infections remain latent in the body after they are resolved, and viral infections like Herpes Simplex sit dormant in the ciliary ganglion (where the parasympathetic nerves for the eye aggregate together) until some form of stress causes the virus to follow the nerves back to the lips causing cold sores or to the herpes eye ulcers. Any virus laying dormant in the ciliary ganglion could possibly be reactivated by stressors like infections in the body and damage the parasympathetic nerves. Most of the time, we just don’t know what causes the Pupillary disorder and can only speculate.

Glaucoma and Adie’s Tonic Dilated Pupils

Little research is available on Adie’s Tonic Pupil and Glaucoma. Because the iris tissue is typically bunched up by Adie’s pupil eye disease it could result in blocking the drainage of eye fluid leading to a rapid increase in the eye pressure. This could result in an uncommon form of the eye disease called angle closure glaucoma. Theoretically, the effect of the parasympathetic nerve dysfunction on the ciliary body should result in an increase in eye pressure. I am not aware of any studies that substantiate this. In past years the drug Pilocarpine was frequently used to treat glaucoma by stimulating the parasympathetic system and increasing the outflow of the fluid inside the eye (resulting in intraocular eye pressure reduction). The effect of the Adie’s Tonic Pupil on glaucoma remains unknown, but probably is significant only in rare cases.

Perhaps the most important thing to learn about this eye condition is that it does not progress or cause blindness and vision loss. You can lead a normal, healthy life after appropriate diagnosis and treatment by your optometrist.

Is the Fish Oil Your Optometrist Recommended Safe?

A recent lawsuit in March questioned the safety of fish oils often recommended by eye doctors for dry eyes. Studies are underway to see if the omega-3 fatty acid fish oil supplements help in the treatment of macular degeneration. California has some of the most stringent regulations on PCB”s (polychlorinated biphenyls) in the country, requiring much lower levels than the F.D.A. PCB’s are known to cause cancer at higher doses. A group in California tested a number of fis oil supplements and found a wide range of PCB levels.

Your Eyes | Your Vision | Your Health

Until more is known, you should use the brands thought to be the highest quality available.  The lawsuit alleges that supplements made or sold by CVS Pharmacy, Rite Aid, General Nutrition Corp., Solgar, Twinlab, Now Health, Omega Protein and Pharmavite  violate California’s Proposition 65. Not all of the supplements are considered in violation. GNC has on Omega-3 product named in the lawsuit but another that is not. It must be noted that this is not the F.D.A., and the F.D.A. has given no indication that there is a problem with these supplements.

From an Eye Doctors Perspective

At this time when we recommend fish oil omega-3 supplementation we normally suggest Carlson’s Cod Liver Oil or Nordic. These seem to be some of the most pure, contaminate free products in the marketplace. If we find anything to indicate otherwise, or products to add we will add them to our list. These two products also are in the natural triglyceride form. While there is very limited research, some optometrist prefer the natural form of the omega-3 products.

Do Not Start Taking Fish Oil Supplements Unless You are Under The Care of a Qualified Health Care Providor, While Healthy For Many Conditions, They Have the Potential For Serious Complications in Some Conditions and When Taken With Some Prescription Medications