Bariatric Surgery Patients Take Note

2 12 2014

A recent review of ophthalmic complications from bariatric surgery (weight loss) is bringing to light some of the complications that can affect the eyes and the vision system as a result of these surgeries.  In the journal, Obesity Surgery, researchers noted an increased risk of problems related to nutritional deficiencies. (1)  Since these surgeries reduce the amount of intake of food and thus nutrients, persons who do not take vitamin supplements prescribed can have serious complications to the eyes and vision.   The biggest risk is low Vitamin A.  Vitamin A in critical for the function of light receptors in the retina, which helps keep good night vision.   It can also cause severe dry eye and corneal problems as a result.   Eye muscle paralysis and involuntary eye movements  are another possibility.   Other vitamins and minerals needed for function are Vitamin E, Vitamin B1 (thiamine) and Copper.

The AREDS2 study on age related macular degeneration demonstrated less risk of the disease when people had more antioxidant vitamins (Vit. E  & C, Zinc) as well as carotenoid pigments (Lutein and Zeaxanthin) from the food we eat.  The pigment helps protect the macula area of the retina and our body doesn’t produce it.  It makes sense that the macula could deteriorate faster if you have poor nutrition.

With bariatric surgery, it may be hard to digest a tablet let alone swallowing some of those big pills.  There are liquid or chewable vitamins that can be used to help minimize malnutrition by absorbing the vitamins more effectively.  Check with a pharmacist or nutritional expert on the availability of such items.

If you have had bariatric surgery, it is important to have annual eye examinations to make sure the eyes stay healthy.  Make sure you are getting your diet supplemented with a multi-vitamin/mineral supplement that you can take easily and absorb and try to get fruits and vegetables with dark colors in your diet.

Reference

1. Rui Azevedo Guerreiro, Rui Ribeiro. Ophthalmic Complications of Bariatric Surgery. Obesity Surgery, 2014    http://link.springer.com/article/10.1007%2Fs11695-014-1472-y

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Acuvue Contacts Change

1 07 2014

While Acuvue is not my lens brand of first choice for most people, there are some patients that are more comfortable with that lens’ thinner design.  One of the benefits of using an independent optometrist like myself and not a chain store, mall doc is I can use whatever lens brand I feel is best for the patient no matter what company it is.  So Acuvue has a place in our arsenal of lens brands.

Vistakon, owned by Johnson & Johnson and the manufacturer of Acuvue lenses,  has recently decided to go from selling 6 packs of their lenses to 12 and 24 packs.  So instead of a 3 month supply, they will come in 6 month or 1 year supplies.  All Acuvue lenses are technically 2 week replacement lenses (except the 1-Day Dailies) and I recommend normally to take them all out every night.  I don’t believe they deliver enough oxygen for the cornea to be healthy and have more risk of long-term damage or infection, in my opinion, though the FDA has recommended up to 6 nights wear with Acuvue Oasys.   Of course the FDA has approved lots of drugs that you later see ambulance chasing lawyers advertising to sue for you from damage those same drugs have done.

We realize this will cost more up front to patients but because of basically buying them in bulk, you would actually save more money over the year than buying 8 boxes of 6 packs to get through a year like before.  Just like buying a 24 roll package of paper towels is cheaper from Costco or Sam’s than if you buy 1 roll at Walmart or grocery store since you buy so many in bulk.

WE HAVE NO CONTROL OVER THIS!

I believe with so many patients over wearing their lenses, the thinking behind this move is to get patients to change them every two weeks like they are supposed to.  You are just defeating the purpose of disposables by not changing them out like you are supposed to.  You change your underwear everyday or your bath water every time don’t you?  Same principle.  Changing your lenses regularly keeps your vision your best, more comfortable and less dry and they can deliver oxygen to your eye more by not being coated with proteins, lipids and calcium from the tears.  Studies done by the industry show patients change their contacts more often like they are supposed to if they have a lot on hand.  So take care of your eyes and replace your contacts on schedule.  Put an alarm in your phone calendar or your Google calendar to remind you if you have to.  You only have two eyes and they have to last you a lifetime.

I want to let our patients know before they need more lenses to be prepared for the difference in Acuvues’ policy.

 

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





You Can Now Be Green With Envy…Or Gray…Or Blue….Or…

5 06 2014

This week Alcon finally released what we have been waiting for a very long time.  A breathable soft contact that changes your eye color.  Air Optix Colors are now available to order!  And we have sample contact lenses to try on in our office with an appointment.

You see in the past, the leading brand of opaque eye changing colors were the Freshlook Colorblends brand.  While these were generally acceptable lenses for daily wear use, they were often dry in our High Plains environment, got dirty quickly, were flimsy and hard to handle for some people.  Some people tend to abuse contacts and since these don’t breathe well, their corneas would get swollen or cause new blood vessels to grow in to the corneal tissue to help feed it oxygen.  This led to scarring and the patient might not be able to wear contacts any longer.

alcon-air-optix-colors-grp-195x285

With the release of Air Optix Colors, these new color contact lenses from Alcon are made of a highly breathable silicone hydrogel contact lens material to help eyes remain white and healthy-looking, and they feature an ultra-smooth plasma surface technology for consistent, all-day wearing comfort.

While these lenses are still for daily wear use ( no overnight wear), they breathe a lot more and will keep the cornea much healthier.  They will resist deposits more and will stay wetter on the surface.  They are designed to be replaced monthly and come in six packs.

The Air Optix Colors have essentially the same color availability as the Freshlook Colorblends, with some slight improvements, so they look more natural than ever.

Currently, lenses are available for people with no prescription, with nearsightedness, farsightedness, if you need reading glasses or a bifocal but not currently for astigmatism.  If there is only a small amount of astigmatism power, the lenses may still work for you. During your exam, we can determine if you are a candidate and even try on some demonstration lenses to see if the vision is adequate.

So, if you are wondering what it would look like with a different eye color, either a dramatic or subtle one, make an appointment for a contact lens evaluation today and we can try some on you with no obligation to purchase boxes if you don’t like them.   Call us at 935-2020 to schedule an appointment today or log in to our website at www.visionsource-dumas.com

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Tiny bubbles…

2 06 2014

No, I’m not going to sing for you.  Your ears and the neighborhood dogs will thank you.   But you can go to YouTube if you want to catch up on Don Ho singing his trademark song.  http://www.youtube.com/watch?v=mlCiDEXuxxA

The tiny bubbles that make me happy are actually from hydrogen peroxide contact lens disinfection systems.   There are for the most part two basic types of contact lens disinfection systems on the market:   1. Multi-purpose disinfection systems (e.g. Optifree PureMoist, B&L Renu or Biotrue, etc..)  or 2. Hydrogen Peroxide (H2O2) disinfection systems (e.g. Alcon Clearcare, B&L Peroxiclear).   In the old days we had heat systems that boiled the contacts but not anymore.  The only other type is a plug-in unit that uses UV light and ultrasound technology (Purilens).

H2O2 is the most effective type of disinfecting system for contacts.  It simply kills almost any germs that could contaminate your contacts.  Typically you put your contacts in some sort of basket in a vertical case that you fill up with the peroxide solution and it begins to bubble.  Much like when you put H2O2 on a wound before bandaging.

This bubbling action also tends to clean the lens very well without even rubbing the lens. This can save on torn contacts if you are rough handling the contacts or use a more fragile material.   You still have to be careful removing the contacts from the cage when done.  A cleaner lens is also a more water-loving lens and thus not as dry at the end of the day.  When the lenses get dirty, it irritates the linings of the eyelids, which produces more mucous and byproducts, which coats the lenses and makes them more hydrophobic, just like a waxed car.  When patients have any kind of dry eye problem, we recommend using a H2O2 solution to minimize preservative sensitivity reactions, known to cause inflammatory dry eye.

If it is so great, why don’t we recommend it for everyone as our first choice?   Well, a couple of reasons:  Number one, it’s a little more complicated to use.  The solution only goes into the case… never anywhere else.  Not on the contact and especially not to rinse the eye like saline.  Trust me, it burns like FIRE!  You do it one time and you hopefully learn your lesson.  I know I did.  While it doesn’t cause permanent damage, it can really hurt for several hours afterward, like if soap got in your eyes.  It remains H2O2 until the catalyst disc in the bottom of the case turns the H2O2 into salt and water.  Plain ol’ saline, like what your crying tears are made of.   That’s one of the beauties of  it.  There are no harsh preservatives to irritate your cornea and make them feel drier.  Just gentle saline the contacts are soaking in when they are done.   So, it is more complicated in using it which makes more room for error.

Secondly, it takes time for the chemical conversion of H2O2 to take place.  With Clearcare you must wait at least a minimum of 6 hours before removing your lenses from the case to be able to wear safely.  You can leave them longer but any sooner and the solution will not be completely neutralized resulting in the burning pain I alluded to earlier.  However, Bausch & Lomb has just released a new product called Peroxiclear, which only takes four hours to fully disinfect and convert to saline.  This may help those people whose jobs are very demanding and require short notice to be called back out to work yet providing superior disinfection and cleaner lenses.

Third, is the cost.  While it is only $2 or $3 dollars more in some cases, for some that is a big difference.  While I want my patients to use the best products first, sometimes they can’t.  So often times we will have patients try a multi-purpose solution first and see how that works for them.  The majority of time, that works great for them.  No discomfort, no eye irritation, no infections and for less cost.  But if they begin to have any difficulties in those areas, we definitely switch their disinfection system to a H2O2 system.

So, if in doubt which solution would be best to use, you can always check with our office first.  Trust me though, tiny bubbles makes my contacts feel fine.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Pregnancy and Vision

3 03 2014

I’m going to be a grandpa!  Wow, how did that happen? Weren’t my kids just in school? Yes, it happens that fast. Virtually in the blink of an eye.  Anyway, a new era is about to begin and it got me to thinking about pregnancy and vision.

I see many young mothers to be and they often have many questions about their vision.  Will the pregnancy affect their vision?  Will it make their eyes worse?  The answer is…maybe.

So just what could a new “mother to be” expect to happen with their eyes?  Most of the time, nothing will change. However, since there is a flood of different hormones throughout their body sometimes we can see a few common things.  The most common are:   1. Dry eyes  2. Blurred vision

Dry eyes can cause fluctuating vision, burning and dryness, redness, watering and a sandy, gritty sensation.  This can be helped by a variety of different types of treatments including eye drops and even temporary tear saver plugs that help keep more of your own body’s natural tears.

Blurred vision  can be caused by dry eye but often I see changes in astigmatism and nearsightedness due to corneal shape changes.  With the hormonal changes and water retention, it makes the cornea change it’s shape, thus changing the refractive power of the eye and thus requiring a lens change.

When blurred vision is really a problem, it is because of blood sugar changes.  We never change a prescription on pregnant women until they have had a blood glucose screening to make sure they don’t have gestational diabetes.  If their blood sugar gets higher from the pregnancy, it makes the crystalline lens swell and causes them to become more nearsighted.  The vision usually goes back to where it was once the blood sugar goes back to normal with treatment.  If pregnant women have some relatively small refractive vision changes, it is left alone for the last month of pregnancy and up to one month post part-um since it will usually go back to normal on it’s own.

 Of course if it’s a really big change, we can work with people to help them see with temporary disposable trial lenses until the vision equalizes and we can get a final prescription.  If you are having trouble seeing, please come in and let us help you!  You  don’t want to miss out on such an important time of your life just because your vision is blurry.

It is really important to have  a pair of glasses to wear for when you are in the hospital or if you are laid up in bed and don’t feel like putting on contacts.  You will be plenty tired and worn out both physically and emotionally at times.   A pair of glasses comes in real handy at 3:00 AM in the morning for when that cranky baby is fussing and you just went to sleep.

Rarely, a few more serious eye problems can develop as a result of pregnancy or childbirth.  The main one would be hemorrhages from high blood pressure or from vomiting during preclampsia.   Usually these resolve on their own without any damage as long as the high blood pressure is kept under control.    It is rare they need any surgical intervention.  The worst case scenario would be where the pituitary gland is swollen and putting pressure on the nerves of the eyes.  This is rare but has been known to happen occasionally due to pregnancy hormone changes. Rarely, a blockage or stroke in the eye can occur as well.

While it is extremely rare that pregnant mothers will have any vision problems, there are things that can affect the vision adversely.  The point is to have the eyes examined and make sure it is not anything serious if you are having any kind of trouble with your vision.  Most of the time it is not serious.

Watch for future blogs about how a baby’s eyes develop before they are born and when to start having their eyes examined to make sure they have normal vision and are healthy.  You are taking part in one of God’s most precious creations.  It is not something to take lightly.  Children are a blessing from God so make sure you steward that gift as best as can.  Delight in your children and take joy in them.  Trust me, they grow up way too quickly.

“For you formed my inward parts; you knitted me together in my mother’s womb. I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well. My frame was not hidden from you, when I was being made in secret, intricately woven in the depths of the earth. Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.”   Psalm 139:13-16

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Might you have mites?

3 10 2013

Mites?  On my eyes?  You got to be kidding me?!  Aren’t those little bugs like chiggers or lice?  Well…….yes.   They are technically a parasite that we all have on our skin.   I know, it sounds gross.  Perfect with Halloween coming up don’t you think?  Scary, little monsters eating our dead skin cells and living in our hair follicles or oil glands.   Probably itching already aren’t you?

There are two types of mites that tend to affect humans and especially around the eyes.  One is Demodex folliculorum that burrows into the eyelash or eyebrow hair follicles.  The other is Demodex brevis, which is a smaller version that often burrows into the sebaceous glands along the eyelid margin.   They are about 300 microns in length, which is about 3X the width of human hair so you are not going to see them crawling around without a microscope.   When Demodex mites infest a dog, you know it as “mange.”

We all carry the little bugs on our skin as do animals but when they get out of control is when they cause problems.  With the eye, it can cause a type of blepharitis or inflammation of the eyelid margins.  Often the lids are  red, irritated, dry, sometimes there is greasy debris along the base of the lashes as well as oil glands plugged up as well.  Bacterial or seborrheic blepharitis are more often to cause this but when it is difficult to get rid of with normal treatment, Demodex may be the underlying cause.   

To detect Demodex, your eye doctor examines the eyelash margin for characteristic greasy-looking “sleeves” around the bash of the lash.  This is the parasite’s body with the head remaining in the hair follicle. They can be seen by epilating (plucking) an eyelash which they are attached to and observed under high magnification with the microscope.

Treatment for Demodex normally consists of daily, eyelid cleansing with commercial eyelid cleaner such as Ocusoft Plus EyeLid Scrub, diluted tea tree oil and possibly antibacterial/steroid combination ointments to smother the mites and reduce inflammation, tea tree oil shampoo and face wash, thoroughly washing sheets and discarding pillows and treating pets that live in the house.   As we learn more about them, new treatments are being proposed such as Ivermectin.    Ivermectin has been used successfully in veterinary medicine in demodicosis of cats and dogs.  It is currently used off label in demodicosis of humans immuno-competent or infected by HIV.   There is growing evidence that acne rosacea of the face is related to immune reactions to Demodex too.

Demodex is as prevalent as dust mites,  which also can cause humans problems.  It’s just when they become overpopulated through poor hygiene or if your immune system weakens from age, disease or age that they can become problematic.

So if you are waking up with irritated, dry, red eyes, make sure your doctor has considered Demodex as the underlying cause.  It “mite” have been overlooked.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Red eye my eye

26 09 2013

Okay, I’m going to say it ONE MORE TIME.   Please do not use “red eye” reliever drops.  You know the ones, they often go by the trade names of Visine, Murine, Cleareyes, etc…   Here’s why:

Red eye reliever drops work by shrinking or constricting blood vessels.  The smaller the blood vessels are,  the less red the whites of your eyes look.  There are actually small muscles in blood vessels that can make the blood vessels constrict.  The chemicals in these drops that cause this are called “vaso-constrictors.”

After using vaso-constrictors for some period of time, usually a few days, the blood vessels first get smaller for a short period of time but then they also reverse themselves and get bigger than they originally were before you started using the drops. This effect is called “rebound hyperemia.”  So now your slightly red eye is worse than it was.  Or at the least, not clearing up.   It’s the same type of chemical in nose sprays for congestion such as Afrin, etc…  Congestion is swelling due to enlarged blood vessels.  If you use nasal decongestants too much, it does the same thing.  Your nose will stay clogged up all the time at some point from the bigger blood vessels.

Redness of the eyes is almost always caused by either inflammation or infection, which causes inflammation.   Bacterial, viral or other infections can cause a red eye.  Inflammatory diseases like arthritis, lupus, Crohn’s disease, etc… can cause a red eye.  Allergies to many different allergens such as pollen, animal dander, contact lens solution preservatives and makeup, etc…can cause an eye to get red.  Irritants like smoke and dust can cause redness.  Especially poor tear quality or “dry eye” can cause redness as well.    Of course, some medications, drinking alcohol in excess or drug use can cause the eyes to look red too but we will limit this discussion to that caused by inflammation or infection.

So when you use a “red eye” reliever, all you are doing are temporarily making the eye LOOK less red.  You are doing nothing to decrease the inflammation or infection.  In most cases, you are just going to make the eye look and feel worse.  It’s better to try to identify the nature of the underlying problem and treat that.

At least once or twice a month, I have a patient that will come in with a chronic, red eye that is just not clearing up.  Usually it’s sore or painful and sometimes the vision is reduced.  When I ask about any medicine or drops they are using, lo and behold, they tell me they are using a “red eye” drop.  I ask them, “does it burn like fire?” and almost always they emphatically say, “Yes!”  Yet they keep using it.  When I examine their eye, not only is the eye red, but the cornea is usually dried out, swollen and irritated from the chemicals in the drops.  That makes the vision blurrier.

The cure?  I simply tell them to stop using the “red eye” drops, use cold compresses for comfort and put them on a steroid eye drop to reduce the inflammation and to wean them off the other drops.    By the time people come in for an office visit, the original offending problem such as an infection usually  has already cleared.  We just need to clear up the inflammation.   Sometimes an antibiotic or other medication is needed but it’s rarely the case.

So instead of wasting money on something that is camouflaging the actual problem, make an appointment to see what the real problem is.  Trust me, most people end up in my office later anyway and it just takes more time and money on their part.

On second thought, go ahead and use it all you want!  (that is a tongue in cheek comment)

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website www.visionsource-dumas.com for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”