Thankfully this is rare but that grayish/bluish/greenish spot down there is a melanoma in the back of one of our patient’s eyes. You probably don’t need explanation of how bad a diagnosis that is to receive.
How was it diagnosed? By comparing images and appearance in the microscope and comparing to results from 2011. The changes were subtle but enough to raise suspicion.
The diagnosis has been confirmed and she is undergoing a full metastatic workup (full body MRI, chest X-ray, etc.). Treatment should save her life and amazingly with the early diagnosis save some of the vision in this eye.
So are you going to get a choroidal melanoma diagnosis the next time you come in? Probably not.
However, just one more reason we need you to come in when scheduled. She had no pain nor any change in her vision. Had this patient not come in when she was supposed to……oh goodness.
“I can’t say thanks enough. Seeing that good out of my left eye yesterday after being blind in it for over 30 years is truly a blessing I don’t take lightly.” -patient in our office with an old cornea transplant successfully fit in scleral contact lenses.
Most folks think of contact lenses as a nice option when you don’t want to wear eyeglasses. However, there are also speciality contact lenses which function as medical devices to treat conditions and/or correct irregularities that negatively affect vision. Today we’ll talk about scleral contact lenses.
A scleral contact lens gets its name from the fact that it is large enough to bridge the entire cornea and rest on the sclera (the strong and tough white part of the eye). This has two great benefits. First it covers any imperfection in the cornea. Cornea irregularities can make vision uncorrectable with glasses. These irregularities can be caused by diseases such as keratoconus and pellucid marginal degeneration or from past surgery such as LASIK or radial keratotomy aka “RK.”
The second benefit is that the lens holds a constant reservoir of sterile saline up against the delicate cornea. This prevents the cornea from drying out and is the reason we sometimes use the lens as a “shell” to protect and heal excessively dry corneas. Rather than the cornea being exposed to open air and drying out, it is bathed in sterile saline.
Because the lenses are used for more than simply correcting eye sight, they are often covered by medical insurance as a medically necessary device. Our insurance specialists will be happy to discuss your plan coverage with you.
The customization of these lenses is like nothing you’ve ever experienced before. A typical fitting consists of 3-4 visits ranging from 30 minutes-2 hours. Because the lens settles on the eye over time, the doctor will fit the lens on your eye and then let it settle before finalizing adjustments. The lens is analyzed using a medical microscope, corneal topographer and with our digital scanning laser. Adjustments are made in microns (one inch = 25,400 microns for reference).
Scleral lenses are made of rigid gas permeable, “GP” or “RGP” materials. Today’s materials allow oxygen to be transmitted through the lenses at a rate high enough to maintain proper ocular health. Higher even than many soft contact lenses.
The most difficult part of wearing a scleral lens is learning how to insert the lens because it is so large. However, once it is in comfort is terrific. Many patients can wear their lenses all day; even in our dry high altitude Prescott air.
Scleral lenses have allowed us to save the career of a Dentist in her 40s. She brought in disability papers for our doctors to sign because she could not see clearly enough to work. He was able to get her seeing better than she has in over a decade and is back to providing high quality care.
We have helped multiple patients avoid corneal transplants because they can see so well and are comfortable in their lenses. Call us today to schedule a consultation.
Here’s a quick video showing how to insert, remove and care for lenses:
“….he highly praised your skill and kept asking for your name.” -patient describing their conversation with surgeon in California after being successfully fit with scleral contact lenses in our office
A quick Facebook post is not nearly enough space to convey our heartfelt thanks. We see our practice as much more than a place to save your sight, purchase designer eye wear or simply see better. We love what we do and consider it an honor that so many folks entrust their care to us.
When we moved to our new building a year ago, we planned on having an open house but life quickly got in the way. So at the six month mark we decided we would celebrate a one-year anniversary and started planning. The band Moonglow and chef Michael Holevar came on board and our staff quickly got excited.
To be honest, our patients blew us away. We never expected over 400 RSVPs. Greeting patients, introducing them to our families, and having them thank us was overwhelming.
Congratulations to the raffle winners:
1. Phyllis Collette – Cup/gift certificate
2. Jennifer Swaner – Cup/gift Certificate
3. Wendall Despain – Shamir lenses gift certificate
4. John Jewett – Europa Frame
5. Brian Sinclair – Cup/gift certificate
6. Joe Croynale – Cup/gift certificate
7. Rich McNeely – Oakley Sunglasses
8. Nancy Walker – BeBe Sunglasses
9. Will Hughes – Cup/gift certificate
10. Bonnie Parsell – Cup/gift certificate
11. Kathleen Charriere – Shamir lenses Gift certificate
12. Don Hesson – Europa Frame
13. Marlene Nichols – cup/gift certificate
14. Maren Parker – cup/gift certificate
15. Lynn Hammack – GRAND PRIZE – Any frame and lenses
Brother #1 noticed some “gnats” moving around in his vision like he was looking through a snow globe. After they didn’t go away for a few days he called his older brother, the eye doctor, who told him he needed to be seen immediately. Long story short he had a large retinal detachment. Same day major surgery with significant recovery no doubt saved his eye but vision is now 20/100.
Brother #2 texted me: “What are you doing today?” “Running like crazy. Full schedule of patients. What’s going on?” “I have some new floaters.” “Alright dilate yourself (brother #2 is the eye doctor after all) and stop in during your lunch break.” It’s always an extra honor when an eye doctor trusts me with such a serious condition.
My staff was not impressed when I told them I was squeezing in yet another patient. I assured them that he will dilate himself so we don’t have to wait the 20 minutes for the drops to work and I don’t have to explain what’s going on–he already knows. All to well.
Turns out brother #2 had a retinal tear in his right eye. Fortunately no fluid had accumulated underneath causing a retinal detachment. A 10 minute laser procedure to “spot weld” the area around the tear and he was back to work.
Quick action meant his vision was saved.
If you experience new floaters or flashes of light, you have to come in immediately.
Because they don’t work as well as a highly skilled optician with years of experience.
Listen: we love gadgets, gizmos, and technology more than anyone and love implementing it into our office. However, there is a huge difference between flashy computerized whatchamadoodles to look cool vs. useful high tech.
If I were running an optical business online, or with hundreds of locations around the world, I would absolutely implement the measuring by computer image only. Why? I could bring someone in off the street and within 5 minutes teach them how to run the computer. It is difficult and expensive to train opticians on all the subtleties of frame selection, adjustment and measurements.
Our product is caring, and we care about achieving the perfect fit. Every time.
Most folks’ eyes are near identical twins of each other and if not twins at least similar enough to be siblings. If you’re someone who has different prescriptions between the two eyes, this post is for you. How do you know? Well your lenses may be different thicknesses or you may notice a significant difference in power written on your contact lens boxes. You may be bored or get headaches when trying to watch 3D movies.
The problem that this difference creates is called aniseikonia. The problem with aniseikonia is more than just how do you spell it or say it. The problem is that one eye sees an image of one size and the other eye sees an image of a different size. When your brain tries to put these two images together, it gets confused and mad leading to eyestrain, double vision, and headaches.
Enter the SHAW lens.
Eyeglasses made with the SHAW lens are the only spectacles available that correct aniseikonia. Enough flowery prose; let me tell you about a few of our patients.
Annie (not her real name) was a sweet 10 year old when I first saw her as a patient. Her father, a local general surgeon, had chatted with me about her over the past few years. She has amblyopia or “lazy eye” due to a big difference in prescription between the two eyes. She would never wear her glasses and no amount of patching or drops or visits to specialists over the past 4 years could get her seeing better. Long story short: we put her in SHAW lenses and every time I see her around town, she’s smiling and wearing her glasses. Her vision is improved and she’s starting to use both eyes together.
Bob is a retired Californian in his early 70s. He’s worn glasses since the 3rd grade and never goes a waking moment without his specs. He is very far sighted with lots of astigmatism and a moderate difference in prescription between the two eyes. Three days after picking up his glasses, I received this email:
“You need to know this is the first time in some 50 years or so of wearing glasses that I have not suffered from what was thought to be irritable bowel syndrome, some levels of nausea and other tension related issues. It is like a whole new world for me emotionally. You can use that statement plus my name and reference if you want to do so.”
Above is a printout for Bob’s glasses using the SHAW software. On the left is a standard set of progressives and the right is his SHAW optimized lenses. This shows that we have doubled the field of vision Bob can use with both eyes together. On the bottom, the red dots moving to green show him going from double vision to clear, comfortable and single vision.
With a money back guarantee (which we have never had a patient take us up on because they all love their lenses) we love ’em. Learn more at www.shawlens.com
It’s always fun when my buddies come and see me at the office. They always put stuff on their history form like they’re pregnant or allergic to bullets just to see if I pay attention.
I’ve also noticed a pattern. They ask how I’m doing and I go: check this out and pull out the iPad to show them cool eyeballs that I just saw. Of course there is nothing to identify the patient in the photo so if you’re looking to hit the HIPAA whistleblower lottery, you’re gonna have to keep looking.
Without further ado I present a short collection of cool eyeballs where most everyone simply came in complaining that their eyes were irritated.
[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]Bullseye! I love this patient. He thought his eye had been hurting for four days because he had a stye. Nope-chunk of metal dead center of your cornea my friend.
[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]We often use cobalt blue light and sodium fluorescein dye to highlight irregularities on the ocular surface. See that faint line yellow line running behind the eyelashes? It’s called the Line of Marx (different guy – save the Obama comments). This buildup of dead cells works like a dam blocking beautiful olive oil consistency tears from lubricating your peepers.
[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]This 6 year old was sent over from the pediatrician. No it’s not melanoma – just a little flat rock that was really suctioned on.
[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]“Got some metal in my eye, waited three days, went to ER, they took it out, but a week later and it still hurts.” Yep-gotta get the rust out and that ain’t happening at the ER, Urgent Care, Primary Care doc, etc.
[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]Uhmm. Ouch. You know how your lips get chapped? Yeah your cornea can sort of do that too when it gets really dry. This one was sad because this lady was in her 70s with long term Diabetes damage so her nerves are jacked up preventing the eye from helping heal itself.
[/fusion_builder_column][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]Lard, butter, crisco take your pick for the analogy. Once again, those glands along the eyelid are supposed to secrete olive oil (vegetable oil, Wesson oil, etc.) consistency tears. If the glands ain’t happy-ain’t nobody happy.
So what’s the point of all this? Eyeballs are neato and irritated eyes can be caused by lots of different things.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]
Wow. We’ve had a handful of patients today asking us about this and it’s not even 11 am. The short answers are: this is not quite ready for prime time and no doctor can simply look in your eye and tell you Alzheimer’s yes or no.
The study out of Australia being cited only had 40 patients. For something this large and important, we need thousands of patients to be studied.
On to the good news:
Just a few years ago researchers were excited and publishing results in postmortem eyes and mice eyes. So to move to results in real live humans so quickly is very encouraging.
[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”]Much easier and less invasive than traditional PET scans
The patient gets a retinal photograph using a specialized camera developed by NeuroVision Imaging LLC and software developed at Cedars-Sinai Medical Center in Los Angeles. They then take a dietary supplement containing curcumin. The next photograph is compared to baseline and the curcumin stains the beta amyloid plaques which are the hallmarks of Alzheimer’s.
Because the retina is an extension of the brain, the plaques are present in retinal tissue as well as the brain. Doctors have been using these plaques to diagnose Alzheimer’s for years using PET scans which are expensive and much less friendly. The other exciting aspect is the thought of detection 15-20 years sooner using this device compared to a PET scan.
Now whether or not patients want to know they are in the early stages of Alzheimer’s is a Pandora’s box beyond the scope of this post.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]
I’m not much of a traveler but I’ve flown 24+ hour trips at least a half dozen times and will embark on the next ones in late January when we head back to Cambodia.
The internet is full of advice on how to make long haul flights more enjoyable (ie: drink heavily before boarding and chase with NyQuil) but I figured I’d throw out some pointers specifically relating to the eyes.
1. Take out your contacts. The humidity in most planes is below 10%. Even compared to mile high Prescott, that’s dry.
2. Use lubricating drops before you need them. In much the same way it is better to use lotion before your hands are cracked and bleeding, it is better to use eye drops before your eyes feel like a campfire in the middle of the Sahara. My favorite brand is Systane. A drop in each eye before boarding, after eating, and after waking up works great.
3. Bring along your computer glasses. If you don’t have computer glasses then you’re working your eyes harder than you have to while reading this….but that’s for another post. Most long haul flights have personal TVs (AVOD: audio and visual on demand) and those are about the same distance as your computer monitor.
4. Drink water. I know you don’t want to have to try to maneuver inside those tiny lavatories (who in the world calls ‘em lavatories outside the airplane world anyway?) or bother your seatmates but this is more important than those annoyances. Oh and for some more lavatory laughs, check out Mike Rowe’s (from Dirty Jobs fame) Facebook post.
Drink water the day before travel and the day of. If you start out well hydrated, then you don’t have to try and make up for it on the plane (bad idea). This is especially important as caffeinated beverages and alcohol are diuretics and dry you out.
5. Take a nap and use your eyeshades. These will help prevent further drying of the eyes (notice a theme?). Along with super dry air, the cabin has air constantly flowing through it. You might not feel this breeze but your eyes do.
6. Buy a first class seat. Your eyes will feel much better I’m sure.
It seems so simple yet most of us can’t seem to get it right so a refresher course is in order.
Below are some helpful tips from our website but let me add some “blog extras.”
*Do NOT reuse solution* Let me reiterate that: do not “top off” the solution in your case. Each time you take your contacts out of your case, you should dump the solution out and let the case air dry. Here’s how I recommend leaving your case:
That lets the case air dry. If you just lay it face down on the counter, all the solution won’t evaporate. If you lay it face up, your wife’s hair spray will probably land in the case.
Run your case through the dishwasher every few weeks to clean it.
Wear one day contacts and you don’t have to keep up with how old your contacts are or worry with solution.
Helpful tips for contact lens wear
Always wash and dry your hands before handling contact lenses. Non-moisturizing soaps are preferred as they do not leave a film on the contacts.
Use only the products recommended by our doctors. We have selected the best cleaner/storage solution for you based on your prescription, type of contacts and health of your eyes. Saline and rewetting drops are not designed to disinfect lenses.
Use only fresh solution. NEVER re-use solution.
Clean the storage case after each use, and keep it open and dry between cleanings.
Always follow the recommended lens replacement schedule prescribed by our doctors. Waiting until lenses feel irritated means microscopic damage has already occured to the lens and your eyes.
It is always best to not sleep in your contacts. If you must, inform our doctors so they can work with you to find the best options available.
Put on lenses before makeup, lotions or creams to limit the chance of getting those in your eyes or on your contacts. Take lenses out before removing makeup.
On the rare chance your eyes become red, irritated, painful or your vision becomes blurry, remove the lenses and call our office.
