Dry Eye Disease and Fish Oil

One of the most common reasons that patients come in to the office are symptoms related to dry eye disease. These generally are watery eyes, sandy gritty eyes, burning eyes, and itchy eyes. While one can have other disease processes with these same symptoms, dry eye disease is the culprit in the vast majority of these cases. One of the most common approaches of the past and sometimes presently was to simply use artificial tears as a first line treatment. While this is still a good approach a new addition to our arsenal of treatment has become more a routine part of my treatment options. This is the use of fish oil supplements. This has been in the literature and in lectures for a number of years now. Using these gel capsules has been quite useful to most of my patients with dry eye disease. There are a number of companies that make these supplements with varying degrees of quality. I try to educate my patients to only get these fish oil supplements that are of pharmaceutical grade only. These are made in a nitrogen atmosphere and therefore one does not get the "fishy burps" that can be associated with non pharmaceutical grade fish oil supplements. Not only do these supplements help with dry eye, but they have systemic applications as well, ie. brain and heart healthy. I have personally been taking these supplements for about a year now and have not had to use any artificial tears at all since I began taking them. We do carry one brand in the office for sale to our patients made by Pro Omega. Feed back from patients has been quite positive with the use of this fish oil supplement. If you have certain diseases which have side effects of severe dry eye such as Shogren's disease and others, do yourself a favor and try this. You will be glad you did!

1 day or Daily Contacts

Dailies have been around for a number of years now. I have used them selectively in the past for people who have bad allergy problems, a history of giant papillary conjunctivitis, or people who wear them for sports or the gym. Lately though I have begun to change my thinking on my approach to these great lenses.

Just think if dailies had been first on the scene. Who in their right mind would want to wear their contacts for longer periods of time and keep up with when to throw them away and buy solutions for them.

In terms of ocular health one cannot find a better alternative than dailies. With a fresh lens every day and no solution toxicity problems, you just can't get any better.

Ciba has long manufactured a good daily lens and has now come out with a newer lens that provides comfort from initial insertion all the way through till the end of the day. I have been working with this new lens for about a month now and have been quite impressed with it. So much so that I am now beginning to recommend this lens as a first option for new wearers and even previous wearers. Patient feedback has been awesome and quite positive.

While expense is slightly more the improved comfort and corneal health far outweighs the difference in price and one does not have to purchase solutions.

So Dr. Nick says to both patients and doctors...Give it a try! You will be glad you did.

Bifocal Contact Lenses

Patients constantly come in and tell me that their last doctor told them that they could not wear bifocal contacts because of this reason or that. While in the past we had a poor choice of lenses and the success rate many years ago was indeed very low(20-30%), that is not the case today.



Newer lenses today not only correct for both your distance and near but we can also correct for your astigmatism as well in a soft contact lens.



Gas permeable lenses also achieve these goals as well and with sharper vision. There is also a new gas permeable/soft lens hybrid bifocal lens that is available today as well.



I try to counsel my patients to have realistic expectations with any of these lenses. If you expect your vision to be crystal clear and perfect at all distances as it is with your glasses then these lenses are not for you. However, you can expect to be able to do about 85% of your daily activities with bifocal contacts. If the print is extremely small or if the lighting is poor then you may need to put on a low power reader to supplement your lenses for specific tasks such as these.



My success rate with these newer lenses is now about 90% which in this field is fantastic. There will always be some that for whatever reason will not be able to wear them. But most of my patients love the freedom these newer lens designs offer. Most of them don't even know that they are available until they come into the office.







I encourage anyone to at least ask about these new lenses from your eye care practitioner.

Contact Lens Solutions

I would like to talk a little bit about contact lens solutions today. While most people are OK with a variety of multipurpose solutions, there are those who cannot tolerate either one brand or the other and in some cases no multipurpose solutions at all.
Recently in my practice I have begun to see an increasing number of solution related problems. Many people will have worn contacts for many years with no problems and then it seems that suddenly their "contacts" seem to be uncomfortable and irritable. Many times a change in material of contact lens is just the ticket for good ocular health and comfort. However in my practice I have been seeing more corneal toxicity reactions to these multipurpose solutions. The cornea over time in some cases builds up an intolerance to these solutions and one must reduce the exposure to these chemicals. Hydrogen peroxide based systems have been around for a while and have been a good alternative for these cases.
More recently I have been using the Purilens system. This is a system that completely eliminates all chemicals. This system uses a device with a hydrosound unit that cleans your lenses cleaner than you could ever do manually and then an ultraviolet lamp that disinfects your lenses in the same unit. The contacts are being treated in a preservative free saline solution so there is absolutely nothing to react to. All of my patients that I have put on this system absolutely loves it and they claim that their lenses have never felt better. If you have recently started having these type of symtoms you might consider the solution that you are using in addition to type of contact.

Don't Be Cheap with Progressive Lenses

EXPERT INFORMATION ON EYE CARE PROGRESSIVE LENSES CONTACT LENS CARE AND OCULAR MEDICAL ADVICE

PROGRESSIVE LENSES AND PRESBYOPIA

While all of us would like to feel eternally young, when we reach age 40 or so the need for the dreaded “B” word (bifocal) will eventually be broached by your eye care practitioner. Line bifocals go all the way back to Benjamin Franklin. These allow you to focus from distance to near without having to take glasses on and off or to remove glasses to focus at one distance or the other.

The reading need begins around age 40 give or take a few years one way or the other. It gradually changes and increases over about a five to seven year period and then stabilizes out. This is caused by a gradual change in the ability of the crystalline lens inside of the eye to change shape. This changing in shape allows one to focus from distance to near and back. Tiny attachments to the lens called zonules gradually lose their abilty to cause the lens to change shape and hence to allow focusing at different distances. This is a natural maturing (aging) change and will happen to all of us.

As a member of the baby boomer generation I recognize the yearning to resist crossing over to this dark side of aging, but alas there is nothing that we can do about it. In light of this fact then let us go with the best type of correction for this condition. While line bifocals were OK many years ago, in today’s computer using society these are not very ergonomically practical. The distance portion gives great distance acuity and the reading portion gives great reading at book and magazine distances. However, the computer distance (usually approximately 20-24 inches) becomes a complete blur or at the very least very difficult to see without getting closer to the screen and then craning one’s neck and causing all kinds of neck and shoulder pain.

This then brings us to our discussion of progressive lenses also known as no line bifocals. These lenses have been around for over 20 years and have gone through a number of generations. Each new change in technology has gotten better and better such that the newest lenses work quite well for most people. While the earlier generations of these lenses are still available and are less expensive they also carry with them the inherent problems and side effects of those earlier generations.

The earlier generations have narrow reading areas, peripheral distortions and hard to find intermediate distances. Either you or someone you know may have tried one of these earlier types of progressives and could not get used to them. This is certainly understandable with these earlier lens designs. They unfortunately are still sold on a regular basis many times because they are cheaper.

Come on people, this is your sight. This is how you make your living. Don’t be cheap when it comes to correcting your vision properly! This now brings us to the point in the discussion of the newest generation of progressive lens technology. This newest generation has come about over about the last year or so. There are several companies that have come out with their own version of these new lenses. You may hear the buzz phrase of “digital surfacing” bandied about in conjunction with these new lenses.

Bear in mind that digital surfacing is just a manufacturing technique as opposed to a lens design. Digital surfacing simply means that it can reproduce any lens design perfectly time after time even if it is an older lens design. Don’t be confused between ‘lens design’ and ‘digital surfacing’. I have tried all of these new lens designs. To be perfectly honest I did not think that I would notice much of a difference before I tried the first one. I am happy to report that I was pleasantly surprised and shocked at what a huge difference there is in these new lenses from everything that we have had in the past. This is a giant leap in technology.

A good comparison in layman’s terms would be the difference between a regular TV and an HD TV. Everything is clearer and sharper. Contrast sensitivity is improved therefore making night driving easier and better. Wider reading and intermediate areas are found and larger depth of field can be seen. Almost immediate adaptation occurs from patient feedback. We have patients in our office who could not adapt to any of the earlier generations and wore two separate pairs of glasses. I convinced them to give these new lenses a try and we have not had one single non adapt. As eye care physicians, we owe it to our patients to not only educate our patients but to promote these newer lenses. We are not doing our patients a favor by continuing to offer only the ‘older 14 year old technology’ simply because we do so out of habit or we can’t get our opticians out of the habit. We owe it to our patients to offer the absolutely very best that is on the market today.

Brand names for these newer lenses are as follows:

Truclear and Truclear HD- These lenses are exclusive to Vision Source practices across the United States and Canada. Pros; Good value. Truclear HD can go into amaller frame sizes. Con: not available in all materials at this time.

Kodak Unique- Available to most independent practices and opticians. Available in most materials . Can go into smaller frame sizes

Physio and Physio 360-Same as above but also available in the thinnest lens available today.

Hoya ID- In my opinion this is the best progressive lens in the world today. Not only does it have the great contrast sensitivity, wider reading areas etc. but the intermediate area for computer distances is incredible. I can sit at 40 inches from my computer screen and it is just as clear as if I were at 15 inches. Amazing clarity at all distances. This lens is perfect for pilots with great undistorted and crisp acuity at all distances. We recommend this lens to any pilot with presbyopia(over 40 with a reading add).

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