Recently, a ‘new’ eyedrop has been promoted called Vuity. The medication is supposed to reduce the need for reading glasses in patients over 40. The medication, Pilocarpine 1.25%, has been used for 50 years for treatment of glaucoma. It has fallen out of favor with new classes of medications being preferred (such as Prostaglandin Analogues and Carbonic Anhydrase Inhibitors) for a combination of better effectiveness with new medications and headaches caused by Pilocarpine.
The way the medication works is by the pinhole effect. The pinhole effect is another way to correct light rays that are landing on the retina and works by extending the depth of field by shrinking the pupil size. Probably the best example of this is a Pinhole Camera. The Pinhole Effect is already being employed in some LASIK procedures, known as the Kamra Inlay. Results with that procedure have been mixed, with anywhere from outright success to blurred vision, not only at near, but at distance as well.
It is very possible that this medication will be helpful in temporarily correcting near vision for people over 40. With any miotic medication (shrinking the pupil size), a dilated eye exam is extremely important to guage whether the patient is at risk for a retinal tear or detachment, a potentially blinding condition. The medication may impact night driving, as the pupil size increases (dilates) naturally in low light situations to allow more light in. Lastly, I’m curious to see if this medication also causes headaches widely reported by previous Pilocarpine users.
I don’t intend to only outline negative consequences of the medication but we need to temper expectations as this medication hits the market. I don’t see them “replacing reading glasses” outright, unfortunately. I do, however, think it may enhance reading for patients temporarily.
We wanted to provide guidance regarding tearing / watery red eyes due to Follicular Conjunctivitis. Conjunctivitis is a non-descript pink eye caused by allergies, bacteria, or viruses. Viral types cause copious amounts of tearing for no reason and starting in one eye before usually moving to the other. While this does not necessarily indicate COVID-19, ANY viral conjunctivitis is EXTREMELY contagious for a period of 10 – 14 days. Should you notice these symptoms STAY HOME FROM WORK, especially if fevered or coughing and isolate from family members as best as possible. Be strict about hand washing and disinfecting. Do not patch an eye as viruses and bacteria thrive in low lighting and oxygen deficient environments. Discontinue all contact lens wear. It is a possible sign of COVID-19.
Second, Plaquenil (Hydroxychloroquine) has been in the news recently as a possible treatment or suppressor for COVID-19. Plaquenil is an anti-malarial drug commonly used for Rheumatoid Arthritis, Lupus, and other connective tissue disorders. Patients taking Plaquenil need to be evaluated for macular toxicities due to overdosage of the medication. Currently, the optimal amount of Plaquenil needed to treat COVID-19 is not known and overdosing on the medication can lead to blindness and even death. Two healthy individuals died from self-treating with Chloroquine due to toxicity. If you are started on Plaquenil make sure you schedule an eye exam with an Independent doctor of Optometry or Ophthalmologist.
Be safe, be smart, and be well. We are only seeing emergent cases at this time to comply with CDC recommendations.
Cat Scratch Fever (Ocular bartonellosis)
This one was the patient encounter I remember most. I was working in commercial optometry at the time at a busy box store. The patient I was seeing hadn’t been dilated in 5 years (probably more). I asked the patient if he would like to have a dilated eye exam today. He asked the benefits of dilation and I gave him my standard answer: “We are checking for diabetes, high blood pressure, and any holes, tears, or detachments but not limited to those things.”
A dilated eye exam can tell us so many more things about the eyes beyond the things I listed. Syphilis, AIDS, and even ‘Cat Scratch Fever’ (nah nah nah) are 3 things I wouldn’t even think to begin to list as something we would typically find in a routine exam, but are all things that are possible to find upon routine examination. This day, however, I found the one thing that I never wanted to find.
While using my BIO (a device that looks like a miner’s hat used to evaluate the eyes) I found an area in the back of the eye that looked pigmented and elevated. Typically, the thing that I worry about the most during a dilated eye exam is a retinal detachment (when the ‘seeing’ part of the eye becomes detached and no longer works leading to blindness). In this specific case, I hoped that I was mistaken and the patient had a retinal detachment and not a melanoma, but in my heart I knew. This is the most obvious case I’ve experienced that a trip to a private optometrist may have saved this patient’s life.
At the time of diagnosis, only 4% of patients are known to have another type of cancer even with PET/CT scans. Over the following years, however, physicians usually find more tumors because at the time of diagnosis even PET/CT scans will not find microscopic tumors.
I have only seen one of these tumors in my 8 years of checking retinas and I hope it’s my last.
I was still a somewhat green Optometrist, about a year out of graduation, when a young, healthy 15 year old girl sat in my exam chair. Her medical history was unremarkable (as a majority of young people’s medical histories would be), but she complained that she felt her eyes weren’t focusing quite right at the end of the day in her contacts or glasses. She also was complaining of persistent headaches that seemed unrelated to her eyes.
A lot of times, patients who have uncorrected far sighted problems will pass all tests at a pediatrician screening, DMV visit, or even nurse’s office check, but will have end of day headaches for doing too much focusing. This can cause difficulty focusing during school and an aversion to reading to avoid the impending headache.
When looking in the back of the eye, this is what I saw in both eyes:
This is a swollen optic nerve and can arise from many different things including a tumor behind the eyeball or ‘fluid on the brain.’ There are probably not many times I wish for ‘fluid on the brain’, but this is one of those cases. The patient was seen in the following days by a neurologist for an MRI of the brain and orbit both with and without contrast. Thankfully, the MRI came back normal, but we still had the reduced vision and the headaches to consider. Typically, when a patient is seen for this combination of symptoms, a spinal tap will then be done to rule out ‘fluid on the brain.’ Sure enough, the patient’s intracranial (inside the head) pressure was elevated. Because there was no discernible cause, it was considered Idiopathic. This patient was ordered to decrease body weight and begin taking a medication called Diamox to reduce the cerebrospinal fluid.
Most changes to the optic nerve (like Glaucoma) cause a change in vision starting with the peripheral (or side) vision before it affects central vision. This patient had already lost significant peripheral vision and the vision loss was beginning to encroach on her central vision and was beginning to make tasks difficult. Luckily, with the decrease in pressure, the vision started to slowly return. This does not always happen and had this patient waited longer, she may have lost more vision.
Over the next few blog posts, I’ll be outlining at least a few cases from memory in which an annual eye exam has either saved someone’s vision or life. There have been recent attempts to confuse and misinform patients regarding the impact of the eyes and health. Annual eye exams are extremely important to one’s overall health and can uncover things that can save your life that you would have never found otherwise.
— Dr. H
Scleral contact lenses are likely the most versatile lens option Optometrists have at their disposal. A variety of ocular surface conditions can be treated anywhere from severe Dry Eye Syndrome to Keratoconus to Donor Corneas.
A scleral contact lens is based on the idea that the cornea (or clear front part of the eye) remains untouched by the lens which rests on the white of the eye (the sclera). Because the cornea does not touch the lens, we must add fluid to the contact lens to allow for both comfort and vision. The fluid in the lens remains trapped against the cornea meaning that the cornea is bathed in fluid the entire time the patient is wearing the contact lens. Not only does this mean that the cornea remains moist, but also means there are no gaps between the cornea and the lens. In short, this means that the lens is “optically perfect” because all gaps are filled in between the lens. Soft lenses, for example, slide around to wherever they want leaving gaps. If you ever talk to someone who has worn RGPs / “hard contacts” (a bit of a misnomer), they will mention clarity is always better in an RGP, and it’s for a similar reason.
The lenses are large, however, and can be a bit tricky to handle. This YouTube video shows how to effectively handle, clean, insert, and remove the scleral contact lenses easily.
Scleral lenses are not for everybody, simply in terms of upkeep. However for those who want the best possible clarity or for those who are unable to achieve satisfactory clarity with soft lenses, scleral lenses may be the best option. Often times, if scleral lenses are indicated for a medical reason, the lenses can be fully covered by either medical insurance or vision discount plans.
If you are interested in improving your vision or in scleral contact lenses in particular, schedule an appointment with Dr. Ryan Hooper in Rocky River, OH by clicking HERE.
Check out Angelina and her new specs! She was thrilled to pick them up today!
I am a wearer of Orthokeratology lenses myself. I started doing corneal reshaping in 2012 in Optometry school. Ever since, I have had clear vision in both the daytime and nighttime without the hassle of contacts during the day. Though rare, I’ve always been concerned about the risks associated with LASIK since there are no second chances with our eyes. No more daytime dryness with lenses, torn or ripped contacts, or broken eyeglass frames. Playing basketball, applying makeup, swimming… none of these are an issue when using Orthokeratology.
If your contact lens prescription says -3.00 D and under, chances are you’re a shoe in for Orthokeratology. Orthokeratology is not for all prescriptions, so make sure you ask during your appointment if it interests you!
In regards to adults and children alike, most people assume that because someone can see clearly, their eyes are healthy.
While most diseased eyes typically present with a visual issue, there are a myriad of things that can be affecting somebody with no visual symptoms. Retinal detachments are the pathology that my mind drifts to first, but I’ve even seen systemic issues like a choroidal melanoma present asymptomatically, or without symptoms. Hypertension, diabetes, early cataracts, glaucoma, and even pituitary gland tumors are all things that we are able to detect during the course of an eye exam. I’ve had at least two patients tell me that their eye doctor detected their pituitary tumor.
With children, things become a little more tricky. During a pediatric exam, a child is screened by checking the vision in both eyes individually. What are not checked are the movement of the child’s eyes, the ability of the eyes to function properly when reading (such as tracking with the eyes), and the periphery of the eye. If a child has a refractive disorder or vision problem that is missed by the pediatrician and not caught by an eye doctor until after the age of 8, the problem may never be fully correctable (termed amblyopia).
Retinoblastoma is one of the most common cancers in children. There are inherited and non-inherited forms. The tumor typically starts growing in the periphery of the eye and would most efficiently be discovered with a dilated fundus examination performed at a routine eye exam.
On the right, this picture shows the typical view of a direct ophthalmoscope (in white) which pediatricians use to check a child’s eye. Everything else is not being seen.
The picture above shows a child with retinoblastoma (white on the bottom, underlying the blood vessels) that would be missed assuming only the optic nerve would be evaluated by a pediatrician. The vision in this child would likely be unaffected.
With the school year ending and a new school year approaching, there is no better time for you AND your child to have a full eye exam.
Check out Baylee and her new specs! Baylee’s favorite color is purple!… But also pink… And probably blue too.
Many school aged children have near vision issues that don’t result in blurry vision that we think about when we look far away. The eyes can struggle to see up close like people who need cheaters. To them, this is their NORMAL. They aren’t aware anything is wrong. Make sure to have your child examined before the new year in order to avoid missing an ocular issue!