Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun's ultraviolet rays

 

Read more: Healthy Vision Tip: Wear Sunglasses

Have you ever wondered what happens to the visual system as we age? What does the term "second sight" mean? What is presbyopia? What are the eyes more susceptible to as the aging process occurs? What can be done to prevent certain aging factors of the eye? The answer lies in a theory known as apoptosis (no that's not the name of the latest pop artist).

Apoptosis is the pre-programmed life of every cell in our body. Most studies show that it's a function of our programmed DNA. It's the ability for cells to survive and thrive in the anatomical environment. The body's ability to withstand and thrive during the aging process depends on proper nutrition, good mental health, exercise, and adequate oxygen supply. That's why studies have shown smoking can shorten your life by a decade or more.

In regards to aging and the eye, there is a phenomina during the 6th to 7th decade of life called "second sight". This is simply progressive nearsightedness in older adults secondary to cataracts. Close to 50% of the population over 60 years old has cataracts. Cataracts are a clouding of the natural lens of the eye that can impair vision causing glare and loss of detail. When patients experience second  sight, it is sometimes quite convenient for them: they see up close without their reading glasses they have been depended on since their 40s.

Another aspect of the aging process is loosing your reading vision you had all your life. This is called Presbyopia. Presbyopia is a Latin term which means "old eyes."

What happens in Presbyopia?

Before our mid-forties, the natural lens of the eye is very pliable and can easily focus on items up close. But in our mid forties, the lens tends to lose it's elasticity. While experiencing presbyopia, you generally hold reading material farther away to see it more clearly. Presbyopia can be managed through Bifocal or multifocal  glasses or contact lenses, and some surgeries.

As aging occurs, the eyes are more susceptible to cataracts, glaucoma, macular degeneration and vascular disorders of the eye as well as dry eye syndrome.

To help prevent and manage these conditions, there are a variety of options.

  1. Maintaining yearly dilated eye exams for preventative care.
  2. Protect your eyes against the sun with UV sunglasses.
  3. Take antioxidant vitamins to help bolster the protection of the macula of the retina.
  4. Use artificial tears to hydrate the eye and keep your body hydrated by drinking plenty of water.
  5. Keep emotional, physical, and mental stress to a minimum.

Being Educated on how we age is the first advancement of good ocular health and diminishing the chances of early apoptosis.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Geriatric Vision

You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying extra out of pocket it for it.

Where did this come from? Why should you have to pay out of pocket for cataract surgery? Shouldn’t your health insurance just cover it?

In trying to answer those questions, you will first need a little history of both cataract and refractive (correcting errors of refraction such as nearsightedness, farsightedness and astigmatism) surgery.

Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.

Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.

The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable so they fit through a tiny incision of around 3 millimeters.

Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.

Medicare and most other insurance do not cover refractive surgery (Lasik, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by means other than surgery, such as glasses and or contact lenses.

Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.

The merging of cataract and refractive surgeries is why there are now options not only to get your cataract removed but also to have your astigmatism (irregular shape to cornea) and presbyopia (the inability to see well up close that hits nearly everyone in their 40’s) corrected.

This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.

Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.

If you want to address your astigmatism and or presbyopia at the time of cataract surgery to be less dependent on wearing glasses after surgery then paying for those components is going to be an out-of-pocket payment for you.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Why Do I have to Pay Out of Pocket for Cataract Surgery?

That Depends On The Option You Choose

Should you pay extra for cataract surgery? Many surgeons refer to these options as “Premium,” “Advanced,” “Custom” or “Refractive” cataract surgery.

First let me describe the three basic choices that are available today.

Option 1 - Basic cataract surgery

Basic surgery is what we have been doing for the last 30 years. The cataract is removed through a small incision in the eye, in almost all cases with the assistance of an instrument called a phacoemulsifier. This is an ultrasound-driven instrument that breaks the cataract into small pieces before it is then sucked out of the eye.

Once that is completed an intraocular lens is placed in the eye. This lens is called a fixed-focus lens, which means the lens allows you to see well in one place in space. Most of the time the lens is chosen for good distance vision (but it can be chosen for good near vision instead).

With this lens you see well at the distance chosen but can’t see well at other distances unless you use glasses. The other issue with this lens is if you have significant astigmatism you will still need glasses to correct that astigmatism at all distances (even the distance you chose to have the lens focused).

Option 2 - Cataract surgery and astigmatism correction

In this surgery, the cataract is removed as in the basic surgery but the surgeon is also going to do something to correct your astigmatism. There are three ways to accomplish this:

  • You can make cuts in the cornea by hand.
  • You can use a laser to make cuts in the cornea.
  • You can insert a special implant, called a toric lens, to correct the astigmatism.

In some cases of severe astigmatism, it might be necessary to combine several of these approaches.

In this option the person would end up with good distance vision but would definitely need glasses for close-up tasks like reading.

Option 3 - An extended-range implant

For this surgery there will be a special implant inserted that tries to give you more range of focus without always needing to put glasses on.

Generally in this surgery the surgeon will also try to correct any astigmatism to give you the best chance of seeing well without glasses. When we talk about zones of vision we usually break it up into three categories: distance, intermediate (computer, card playing, playing pool), and near (reading).

Our current armamentarium of lenses is good but it is not the same as having a 20-year-old’s eyes again. Most of the implants in the extended-range implant category do well at two but not all three of the visual zones. Most people picking this option will be able to get through about 90% of their day without using glasses.

In the U.S. there are two types of extended-range implants - accommodating lenses and multifocal lenses.

The accommodating lens gives you good distance vision, fairly good intermediate vision but is a little weak with close-up reading.

The multifocal lenses split your focus into two places - one is distance and then the second focus is either intermediate or near.

There are pluses and minuses to each of the choices and the decision of which one or which combination is best for you should be decided after a discussion of your visual needs and desires with your surgeon.

The Decision

Now that I have outlined the choices, there is still the question of should you or should you not go for them.

Remember, this decision is mostly an economic one. Do you want to spend the money to be able to be LESS dependent on glasses? Notice I specifically said LESS dependent, not FREE of glasses? If anyone is promising that you will be free of glasses, it should make you think twice.

Although some people will be able to function glasses-free it is inappropriate and less than honest to tell you that you will definitely be free of glasses.

First let’s look at option 2, astigmatism correction. If you have significant astigmatism (in my view 1 diopter or greater) fixing the astigmatism will result in improved clarity of vision in almost all circumstances, so if you can at all afford it I recommend you go for that fix.

Option 3 is a bit more complex. For example, if you have other underlying eye diseases - especially Macular Degeneration, Diabetic Retinopathy or significant Glaucoma - an extended-range implant might not be recommended. With those diseases, you are generally not going to get enough benefit out of the new lenses to justify the cost. If you have no other eye disease and you can afford these new lenses, they do allow you to function at a significantly greater range of distances without glasses than the fixed-focus lenses do.

One thing you may have noticed that is missing from the discussion so far is the new option of a laser to assist in the removal of the cataract.

The latest development in cataract surgery is the use of a Femto second laser to do PARTS of the cataract surgery (the majority of the surgery is still done by hand). Although many surgeons do use the Femto second laser when they are correcting astigmatism or implanting extended-range implants that is not what you are paying extra for.

In fact, asking you to pay extra just for the use of the laser is against Medicare and many other insurers' rules and policies. Cataract surgery is considered a “covered service” and you cannot charge extra for a covered service because you are using a different machine. The only way you can charge extra for cataract surgery is if you are correcting astigmatism or presbyopia, because surgical correction of these problems are “non-covered services”.

In conclusion, if you want to be able to do more visual tasks without constantly having to reach for your glasses, you don’t have any other significant visual disease and the costs your surgeon is charging for the additional services are within your ability to pay then, yes, you should consider paying extra when you need cataract surgery in order to take full advantage of what our modern technology can do.

One last caveat: These added services are OPTIONS, not necessities. You should not be “bullied” into paying for them. If you feel like you are having your arm twisted or the office is acting more like a used car salesman than an advocate for your health get another opinion before you agree to do anything.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Should I Pay out of Pocket for Cataract Surgery?

A recent study published in JAMA Ophthalmology has demonstrated in older women a correlation between having cataract surgery and a decrease in death rate from all causes.

The data comes from a prospective longitudinal study called the Women’s Health Initiative. This study involved women 65 years or older and collected data from Jan. 1, 1993, until Dec. 31, 2015.

In the study, there were 74,044 women who had been identified with a cataract and within that group 41,735 had undergone cataract surgery during the study time period.

The results showed that of those in the group who had cataract surgery, the mortality - or death - rate was 1.52 deaths per 100 person years. That means that in any given year if you took 100 women who had cataract surgery about 1.52 died in that year. The mortality rate in the women who did not have cataract surgery was 2.56 deaths per 100 person years. Those numbers mean that women who had cataract surgery were 40% LESS LIKELY to die in any given year than women who did not have surgery.

An important aspect of this study is that the authors accounted for several reasons that might have increased the death rate in the non-cataract surgery group. They adjusted for issues such as smoking, alcohol use, Body Mass Index (a measure of a degree of excess weight), and physical activity. Controlling for those factors means that the higher death rate in the women who did not have cataract surgery cannot be explained or blamed on them having a higher rate of smoking, alcohol use, being overweight or being less physically active.

Although the authors excluded any of those above factors for the mortality difference they did not have any specific reasons as to why this difference exists. There just may be some inherent reason why having better vision leads to a healthier existence and therefore a lower risk of death.

 

Why are these results important? They demonstrate that there may be an additional benefit to having cataract surgery besides the improved vision (which is enough of a benefit on its own) as it may also help you to live a longer more enjoyable life.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Cataract Surgery and Life Expectancy

Red, Itchy, swollen eyelids are often due to a condition called blepharitis. Blepharitis tends to be a chronic condition due to thick eyelid mucous gland production that sticks to the bases of the eyelashes. This adherent mucous can allow bacteria to overgrow and also attract and retain allergens. The standard treatment for blepharitis is doing warm compresses and cleaning off the eyelids with a mild baby shampoo and water solution.

This treatment works for some people but there are many more sufferers who have chronic irritation and relapses despite this treatment. If the warm compresses and eyelid scrubs are not quite keeping the condition under control there are several other additional treatments that can be used to control the symptoms.

One such treatment that your doctor may decide to use an antibiotic/steroid combination drop or ointment. We usually use these for short periods of time to try to bring the condition under control. They are not good to use chronically because it can build resistant bacteria and the steroid component can cause other eye issues like cataracts and glaucoma. The treatment is very safe for short term use but chronic use is usually not a good option.

There are also antibiotic eyelid scrubs such as Avenova which can be prescribed and used on a more chronic basis.

Oral Doxycycline can also be used more chronically in very low doses. Doxycycline is an antibiotic that when used to treat infections is generally prescribed in a dose of 100mg twice a day. For chronic Blepharitis suffers we generally use a much lower dose of around 50 mg a day. At that dose we are using the Doxycycline to help thin out the mucous production from the eyelid glands more than for it’s antibiotic properties.

In summary, Blepharitis can be a chronic issue that requires some persistent “maintenance” work be done to keep it under control with further intervention sometimes needed for flare-ups.

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Read more: What can I do for my red and itchy eyelids?

Itching, burning, watering, red, irritated tired eyes... what is a person to do? The symptoms aforementioned are classic sign of Dry Eye Syndrome, affecting millions of adults and children. With increased screen time in all age groups, the symptoms are rising.

What causes this? One reason is that when we stare at a computer screen or phone too long, our blink reflex slows way down. A normal eye blinks 17,000 times per day. When our eye functions normally, the body produces enough tears to be symptom free, however, if you live in a geographical area that is dry, or has a high allergy rate, your symptoms could be worse.

Dry eye syndrome can be brought on by many factors: aging, geographical location, lid hygiene, contact lens wear, medications and dehydration. The lacrimal gland in the eye that produces tears, in a person over forty years old, starts slowly losing function. Females with hormonal changes have a higher incidence of DES (dry eye syndrome). Dry, arid climates or areas of extreme allergies lend to higher incidences of DES as well.

A condition of the eyelids, called blepharitis, can cause a dandruff like situation for the eye exacerbating a dry eye condition. Contact lenses can add to DES, so make sure you are in high oxygen contact lens material of you suffer from DES. Certain medications such as antihistamines, cholesterol and blood pressure meds, hormonal and birth control medication, and others may cause symptoms of a dry eye. Check with your pharmacist if you are not sure.

And finally, overall dehydration can cause DES. Some studies show we need 1/2 our body weight in ounces of water per day. For example, if you weigh 150 lbs, you need approximately 75 ounces of water per day to be fully hydrated. If you are not at that level, it could affect your eyes.

Treatment for DES is varied, but the main treatment is a tear supplement to replace the evaporated tears. These come in the form of topical ophthalmic artificial tears. Oral agents that can help are Omega 3 supplements such as fish oil or flax seed oil pills. They supplement the function of meibomian glands located at the lid margin. Ophthalmic gels used at night, as well as humidifiers, can add to moisturizing your eyes. Simply blinking hard more often can cause the lacrimal gland to produce more tears automatically.

For stubborn dry eyes, a method of retaining tears on the eye is called punctum plugs. They act like a stopper for a sink, they are painless and can be inserted by your eye care practitioner medically in the office. Moisture chamber goggles are used in severe dry eye patients to hydrate the eyes with their body’s own natural humidity. This may sound far out but it gets the job done.

Being aware of the symptoms and treatments for dry eye syndrome can prevent frustration, and allow your eyes to work more smoothly and efficiently in your daily routine. If your eyes feel dry as the Sahara, or the eyes water too much: know that help is on the way through proven techniques and products. You do not need to suffer needlessly in the case of Dry Eye Syndrome anymore. 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Eyes feel Like the Sahara Desert : What do I do?

A refraction is a test done by your eye doctor to determine if glasses will make you see better.

The charges for a refraction are covered by some insurances but not all.

For example, Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn’t cover most “routine” procedures - only health-related procedures.

So if you have a medical eye problem like cataracts, dry eyes or glaucoma then Medicare and most other health insurances will cover the medical portion of the eye exam but not the refraction.

Some people have both health insurance, which covers medical eye problems, and vision insurance, which covers “routine” eye care (no medical problems) such as refractions and eyeglasses.

If you come in for a routine exam with no medical eye problems or complaints and you have a vision plan then the refraction is usually covered by your vision insurance.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: What Is Refraction And Why Doesn’t Insurance Always Cover It?

Motherhood.., the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has recently proven that there is a transference of emotion and programming from birth and infancy between a mother and her child... a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind? These questions and more can be answered through a term called “triadic exchanges” in which infants learn social skills.

The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now their world is no longer just one person, their mother, but a third party which teaches them the art and skill of organizing their social skills and interaction.

Interestingly, if a mother is blind, it does not adversely affect the child’s development. A study published in the Proceedings of the Royal Society B showed no deficit in their advancement. The sheer fact that the infant looks into the mother’s eyes helps with connectedness and emotional grounding.

Looking into mom’s eyes and face teaches facial recognition and expressions of emotions and is primarily how the child learns in the first few months of life. Additionally, infants tend to show a preference to viewing faces with open eyes rather than closed eyes, thus stressing the importance of the mother or caregiver’s gaze.

Some health benefits to gazing into the mother’s eyes is a lower incidence of autism, or spectrum disorders, better social skills, higher learning capacity, and emotional groundedness.

The beauty of a mother’s gaze is that the child can feel the emotions of love, security, safety, and overall well being by connecting with her through eye to eye contact. This sets the stage for the future development of social skills, visual recognition of people, and their readiness for social interaction in the world.

A big thank you to science and mothers for proving what we already know, that the values in life can be taught to a child “through a mothers eyes” setting the course of proper interaction for life skills and relationships.

 

References:

1. Kate Yandell, Proceedings of the Royal Society B ,04/10/2013.

2. Maxson J.McDowell, Biological Theory, MIT Press, 05/04/2011.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: Through a Mother’s Eyes

Knowing the difference between the various specialties in the eye care industry can be confusing, especially given the fact that they all start with the same letter and in many ways sound alike.

So, here’s a breakdown of the different monikers to make life a little less confusing for those wanting to get an eye exam.

Ophthalmologists

Ophthalmologists (pronounced “OFF-thal-mologists”) are eye doctors who went to four years of undergraduate university, four years of medical school and four to five years of ophthalmic residency training in the medical and surgical treatment of eye disease.

Many ophthalmologists then go on to pursue sub-specialty fellowships that can be an additional one to three years of education in areas such as cataract and refractive surgery, cornea and external disease, retina, oculoplastic surgery, pediatrics, and neuro-ophthalmology.

Ophthalmologists are licensed to perform eye surgery, treat eye diseases with eye drops or oral medications, and prescribe glasses and contact lenses.

Optometrists

Optometrists are eye doctors who went to undergraduate university for four years, then went on to optometry school for four years.

Many optometrists choose to pursue an additional year of residency after optometry school, though this is not a requirement for licensure. Optometrists are licensed in the medical treatment and management of eye disease, and prescribing glasses and contact lenses.

In some states, optometrists can perform certain minimally invasive laser surgical procedures, but on the whole, optometrists do not perform eye surgery. In addition, optometrists usually have different sub-specialties than ophthalmology, including vision therapy, specialty contact lenses, and low vision.

The analogy I use most often in comparing optometrists to ophthalmologists is that of a dentist and oral surgeon. Many people choose to have optometrists as their primary eye care provider and to undergo medical treatment of eye disease, but when surgery is needed, they are referred to the proper ophthalmologist.

Opticians

Opticians specialize in the fitting, adjustment, and measuring of eye glasses. Some states require that opticians are licensed, and others do not.

If you have any questions about which professional is the right fit for your needs, check with your eye-care professional’s office and they’ll be happy to answer them for you.

 

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Read more: The Three O's of Eye Care: Ophthalmologist, Optometrist and Optician