The Sum of All Fears

20 10 2015

How many people saw the movie with Ben Affleck and Morgan Freeman called, “The Sum of All Fears ?”   Terrorists build a nuclear bomb and blow up Baltimore during a football game and Ben Affleck has to try to stop WW3 with the Russians.  Scary as it is because it is realistic, for most people the sum of all fears is going blind.   A recent poll found that Americans rank “losing eyesight” highly among the worst health concerns that could affect them.  I have always heard speaking in public is the number one fear of adults.  But that you can overcome, as I did.  Short of a miracle, blindness is forever.

Blindness occurs at different levels however.  When people say someone is blind, that doesn’t necessarily mean they can’t see anything at all, like pitch black darkness.  If you are legally blind, that just means you see worse than 20/200 even with the best pair of prescription glasses possible.  You might be able to see cars and trees but they are so blurred you can’t make out the details, even if you get up closer.  Some people have “no light perception” where they cannot even see a light at all.   That only makes up about 15% of people considered legally blind.  A better term for a lot of these people who have some vision, while not very clear, is “visually impaired.”

With the large increase in the aging population now that the baby boomers are becoming senior citizens,  we see a lot more macular degeneration.  It is the leading cause of blindness in those over 65 years old.   The central retina deteriorates and causes vision loss in the central vision making reading difficult or even impossible.  In worst cases people can’t see straight ahead to drive or even a person’s face they are talking too disappears in the central blind spot.  The often can see something out of the corner of their vision, like a chair on the side of the room but when they turn to look directly at it, it disappears.

People with a visual impairment like this often can be helped with low vision devices.    Whether a hand held magnifier, high powered reading glasses or a closed circuit television, there are different tools available for those with low vision.   They are like tools.  Some times a pair of pliers can be used for lots of different tasks, but sometimes you just need a pair of needle nosed pliers to do the job well.  Or the same can be said for shoes.   Sometimes casual shoes or tennis shoes  work, sometimes dress shoes are needed but sometimes you need to have some good work boots.

Low vision devices are no different.   When ordinary spectacle glasses and bifocals just don’t help enough to see anymore,  sometimes we need a different tool for the job.   A hand held magnifier may work great for a short glance at a medicine bottle.   Trying to read your mail might require a magnifier on a stand that you don’t have to hold and try to focus just right.  Reading a letter or looking over papers for more than 5 minutes would probably do better with the CCTV that can magnify what the person is looking at and display on a monitor screen 40X bigger.

There are other “tools” that can be used around the house for low vision patients to make their life easier and to help keep their independence.  Examples are large number phones, large number playing cards, voice assisted devices, large letter pill organizers, etc…  They can also help with counseling and other referrals to help stay independent as much as possible.  We can refer those with low vision starting at 20/70 best corrected visual acuity  to the Texas Department for the Blind Services for help from the state.  They can come to your home for an assessment of your needs around the house and see what they can provide.  The nearest local office is in Amarillo and their phone number is 806-351-3870 if you have questions about how they can help.  It’s your tax dollars so don’t feel bad about asking for help if you need it.  That is what they are there for.

The best way to avoid going blind is to have regular, annual eye wellness exams.   Most people with medical eye problems still see fine, until the end stages when it’s too late and all the damage is done.   Even if you think you see great, have your eye’s health examined every year.    Better to prevent problems and catch them early then waiting and then it’s too late.

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 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!”


Don’t be in Denial of West Nile

7 10 2015

West Nile Virus disease is here to stay in Dumas, Moore county and the Texas panhandle.  More cases are reported every week most likely due to the wetter than normal summer this year.

Ten years ago, we had never heard of it.  We were more likely to get sleeping sickness or malaria than something esoteric like West Nile Virus.  West Nile is a virus that originated in the Middle East and has made it’s way to the US and is moving westward.  It can infect humans, birds and horses from a mosquito bite and it can be deadly if it gets into the nervous system.   People with weakened immune systems are at most risk but it can even knock down a seemingly healthy person.

It really hit home this last month when one of my employees came down with a brain infection (encephalitis) from a mosquito bite in her backyard here in town.   She is recovering slowly after being unconscious for over a week and on a respirator and feeding tube.   Short of a miraculous healing, it will take many, many months to recover.  I have two patients that I have also seen that have the after effects of the disease.  One doesn’t have any eye problems but the other has damage to his optic nerve of the left eye, leaving him with permanent damage to his vision.

By the time people are having eye problems, they are probably in the hospital.  I have yet to see anyone in my office with early symptoms and I hope not to.  The problems that happen with the eye can have devastating complications to the vision.  Inflammation or infection can occur inside the back chamber of the eye (vitritis), in the retinal tissue (retinitis and choroiditis) as well as inflammation to the optic nerve (optic neuritis).   All can cause permanent vision loss.

Since eye problems from West Nile Virus are usually not the first sign of illness, I write about it more to create awareness of this relatively new disease to our area since it can be devastating to the body and even fatal.

Early signs and symptoms take 2-14 days incubation after a recent mosquito bite.  They vary from person to person such as fever, headaches, neck ache, joint pain, diarrhea, vomiting, fatigue and less commonly a rash on the check, back or legs.   The severe form that affects your nervous system can cause disorientation, seizures, brain infections and even death in 1% of cases.

I would encourage city, county and state agencies as well as school officials to increase awareness of the disease and prevention.  Contact them and ask what they are doing to kill mosquitos to prevent the disease.   Spraying alleys and enforcing ordinances for residences with trash and high weeds around houses and vacant lots are important.   You yourself can make sure to apply insect repellant that contains the chemical DEET when going outside and especially on your children.   Avoid putting on moisturizer creams and fragrances that might attract mosquitos as well as not going out after dark when they are most active.  Consider wearing pants and long sleeve shirts too.  Make sure to remove standing water out of old tires, buckets and flowerpots, etc., which can be used as breeding sites.

If you look at the maps that show incidences of infection, Moore county is not indicated.  ( Centers for Disease Control )   I would speculate that cases are reported from the hospital they are being treated at when diagnosed, not WHERE they were bit and infected.  In the case of my employee, she hadn’t traveled anywhere and knew she had been bit in her backyard garden a few days earlier when she got really sick.   So take care out there.   We don’t have to live in fear, we just need to be aware and be smart to help prevent the spread of the disease.   Even though we live in the middle of nowhere, Moore county is not immune.


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 25 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website 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!”

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Retinoblastoma (Cancer of the Retina)

12 05 2015

One of the saddest cases I have ever seen was a little girl who was brought in by her father because one eye looked white in the pupil of one eye.  I have seen a white pupil often in adults, usually from an advanced cataract or even a retinal detachment.  But in a child, your first thought is cancer of the eye. You may have seen the story recently about the mother that detected a problem in her child by taking a cell phone picture.  Either on Facebook or CNN:

or ABC News:

First of all, the pupil is the window into the eye.   Some say it’s the window to the soul but definitely it is a window into the overall health of the body.  It looks black normally because light doesn’t escape or reflect out easily as in some animals like cats and dogs.   If the pupil is big enough or you get enough light to shine in, you can see a reddish-orange reflection with the right tools.

The retina is the inner back lining of the eyeball that detects light and sends the signals through the optic nerve to our brain in order for us to interpret what we see.   The eye is the camera, the brain is the TV set basically.  I used to say the retina is like film in a camera but with everything digital now, I have changed the analogy to the digital sensors in your phone or digital camera.  Anyway, the retina have ALOT of blood supply.  Between that and the layer of pigment cells on the outer layer, the color generally appears reddish-orange.

Eye doctors use that reddish-orange reflection to determine the amount of refractive error like nearsightedness or astigmatism a person has for glasses.  That is how we can tell what power glasses need to be for little babies or people who can’t talk.  It is also how we know if your child is malingering (faking) the need for glasses.

If that reflection is dim, has shadows, or a different color, that tells us there is something wrong with the pathway for light entering the eye.  Either the lubricating tear film on the front surface, the cornea, the crystalline lens, the vitreous fluid, or the retina could have a problem.

Retinoblastoma is a fairly rare cancer that usually develops in very young children but it is possible for an adult to develop it too.  It is from a genetic mutation of the retinal cells and the risk of passing the gene to offspring can be higher for those families that have had someone affected.  It is very aggressive and can spread to other parts of the body very quickly.  The sooner the eye is removed that better chance of survival.  Yes, the eye needs to be removed quickly.  As tragic as that sounds, children adapt fairly well since they are not seeing out of the affected eye anyway.

I encourage young parents to take a picture of their child with a flash straight on from 3-4 ft away.   I do it to screen children and to help them relax by showing them their picture so they get comfortable with me examining their eyes before I do more.  Both pupils will either be dark if the pupils are too small or both a reddish-orange glow, which is the reflection off the retina. If it is orange, you can enlarge the picture and look for shadows, which could indicate a problem with the surface of the eye or cataracts.   Yes, children can have cataracts, though rare.   If a reflection is white, it could be a refractive error (nearsightedness, astigmatism, etc.), a cataract, a retinal detachment or retinoblastoma possibly and you would want that checked immediately by having the child’s eyes dilated.  They may have to be given a sedative to get them to cooperate and get a good view. If the doctor is not getting a view because the child is not cooperating or crying, the child should be referred to someone who will perform a sedated eye examination, most often a pediatric ophthalmologist.

As a side note, there should also be a little white reflection on the cornea, the front surface of the eye, from the flash.  That white dot from the flash should both be in the same relative position to the pupil of each eye. If not, your child could have an eye turn.

Also, all children under 18 are mandated to be covered for at least a wellness eye exam once a year under the Affordable Care Act (Obamacare).

Please have your kids eyes examined at 3-4 years of age at a minimum and every year after that.   Just because they seem to get around doesn’t mean that both eyes are okay.  If one is not seeing well or turned, the vision won’t develop properly and it is permanent after age 6-7 years old when the optic nerve quits developing.  Don’t take any chances with the vision and the health of your child.


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 25 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website 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!”

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8 09 2014


I have had my share of them over the years.  More than average I dare to say.  I have had medical tests, CT and MRI scans, dental visits and special mouth guards to prevent teeth grinding while sleeping and have taken more over the counter and prescription drugs than the local drug addicts during my years.  I still remember my first severe headache on a trip with one of my friends to Six Flags of Texas in Dallas.  What a miserable time.  Ultimately I had sinus surgery ten years ago, which relieved almost all of them.

Believe me, I know how you feel.  When the pain is so bad you wish someone could drill a hole in your skull to relieve the pressure and all you can do is lie on the cold, tile floor with an ice pack on your head after taking tons of medicine and pray “God, please take away the pain.”  I’ve been there.

If I could break down my patient’s main reasons for wanting an eye exam into three categories, they would be in this order:

1. Blurred vision –either just a slight blur or a major blurring at distance or near, with or without lenses.

2. Wellness checkup – they see okay with or without vision correction but want to make sure everything is healthy and maybe update their contact lens prescription while having no apparent problems.  Perhaps previously diagnosed with a medical eye condition and ensuring there is no progression.

3. Headaches – There are so many things that can cause a person to experience a headache, it can give somebody….. well, quite frankly,  a headache trying to find the cause.
Since there are so many causes of a headache, a good patient history is absolutely important.  When did they start, do you have a history of headaches before, how often do they happen, how long do they last, what region of the head do they hurt at, what time of day do they generally happen, are they disabling or can you still function, do you have any vision abnormalities like spots or wavy lines before or during the headache, does medicine help the pain, do you get dizzy or nauseous with the headache, do they seem to happen related to certain activities such as reading or computer use, what other medical problems do you have that you know about, what medicines do you use or recently stopped using?  Doctors have to consider the patients age, sex, family history, history of seasonal allergies, medicines being used or even discontinued recently and any medical conditions you might have.    Your diet, water intake and sleep apnea even can play a large role.  Headaches are perhaps one of the most challenging diagnoses due to the many possible causes.  I will cover the most common in order of prevalence that I often encounter.

1. Uncorrected basic vision

When someone comes in with a complaint of frequent headaches, after the preliminary testing, one of the first tests we do is a refraction of the eyes.  That is the part where we determine how the eye can see and what glasses prescription might be needed to make the patient see more clearly and see more comfortably.  You know, “Which is better, one or two?”

The most common cause of headaches that I see in my office is uncorrected farsightedness, especially in school age children.  If the patient is farsighted, they can see far away easier than up close.  They may be able to see up close too but they have to work twice as hard as normal to do it if their eye is using it’s near focusing ability (accommodation) to help the patient’s far vision.  It does that subconsciously like an auto-focus camera.  The eye should only “focus” or tense up when looking at objects within arm’s reach for the most part.  Uncorrected farsightedness (hyperopia) makes the eye, without even thinking about it; try harder to keep the vision clear while looking far away.  That constant, unneeded focusing causes strain and ultimately headaches in the frontal region of the head or around the eyes usually by the early or late afternoon after focusing the eyes more than average.  Basic single vision glasses worn all the time will typically resolve the headaches even though the vision of the patient has been clear anyway up until this point.  The eyes are just working too hard and the extra muscle tension causes the headache.  So farsighted glasses correction is more for comfort than to help the vision in many cases.

2. Uncorrected near vision after 40 years old

After the dreaded big 4-0, (typically 43 years old) the focusing system of the eye that helps to see up close begins to weaken.  The lens in the eye becomes stiffer and less flexible, which causes the automatic focusing of the eye to strain even more to make your near work activities harder and harder to see.  It’s not a weakening muscle, it’s simply the lens not able to flex anymore very well, like a piece of old rubber that doesn’t flex very well.    At this point, we need extra help to see up close clearly and comfortably.  Whether we need a prescription or not for the far away vision and more power for up close, then at that point a multi-focal lens with multiple focusing powers is recommended so people can see at all distances.  When patients that are 40 years old or over seem to get headaches after reading or other near vision work, quite often this is a sign they need a multifocal lens such as a progressive lens or a bifocal.  This is like using a tool to take the load off the eyes and make them focus better and not to have to strain to see.  If you get headaches after reading or looking up close and your arms seem too short anymore, more than likely you need help with the focusing in the form of a multi-focal lens.  Glasses or contacts can help.

3. Binocular vision disorders

The eyes are separate organs that work as a team (think of a pair of horses yoked together) to give clear, comfortable, binocular single vision.  When the coordination of the two eyes is not optimal, they have to work harder than normal , if they can, to keep the eyes aligned exactly in the same direction in order to not see double.  Imagine someone that slouches or is pigeon toed is told to “straighten up” and they have to exert more muscle effort to get the back or feet lined up straight.  The eyes can do the same thing and it causes a lot of muscle strain and possibly a headache.  Sometimes an eye that turns inward, outward or is higher or lower than the other is not easy to discern.  The uncoordination of the eyes is possibly caused by uncorrected vision but also could be caused by a genetic muscle or nerve problem or even by a medical condition such as diabetes, hypertension or even a stroke.  If basic glasses with or without a bifocal doesn’t’ help, then prism power can sometimes help.   A prism bends light so the muscles don’t have to work so hard to see one picture.

4. Medical eye problems

The most common medical eye problem  that can cause a headache from a more uncommon type of glaucoma called acute angle closure glaucoma.  When the drainage system of the eye is narrow, it can be difficult or even impossible for the inner eye fluid (aqueous humor) to drain properly.  This makes the fluid pressure inside the eye to increase rapidly and often times there is signs of a red eye, blurred vision and a severe headache over the eyebrow to the point of nausea.  There are treatments to relieve the condition.

Inflammation inside the eyeball itself, usually related to an auto-immune condition such as rheumatoid arthritis, can cause pain in and around the eye that can be construed as a headache.  Rarely a corneal abrasion or a bacterial ulcer on the eye’s surface can cause inflammation and pain enough to cause a frontal headache.

5. Eyewear and lens problems

Eyeglasses are precision made devices that must have very exact measurements in order for the brain to see clearly and comfortably at all distances.  If the frame is crooked on the face, it can cause eye strain and eventually a headache.  The same goes for a lens that is not centered in front of the pupillary axes.  Even what the material the lens is made out of can sometimes cause subtle distortion that could cause a headache.

6.  Sinus headaches

Having personal experience in this area, I can attest that these can be extremely painful.  When the air spaces in the bones of the skull that surround the eye called sinuses get inflamed  from infection or irritation from allergens,  the tissues expand and gets congested.  That causes a pressure feeling around and between the eyes but even on the side of the temples and down to the jaw.   It can cause the eye to feel like it’s going to pop out it hurts so badly.  Often times a patient will wake up with sinus pain due to sleeping on one side causing fluid to build up and congest the sinus passages more.  Increased water intake, decongestants (Sudafed), mucous thinning medicines (Mucinex) and sometimes antibiotics and nasal steroid inhalers when needed, can generally help but long term treatments may be needed such as nasal saline rinses, antihistamines, and immunotherapy (allergy shots).  Cysts (fluid filled bubbles) can develop and block off the drainage of sinuses at times building up pressure and pain and are not easily seen on CT or MRI scans.  Frequent severe headaches that are not getting better should be evaluated by an ENT (ear, nose and throat specialist) or neurologist (specialist of the brain and nervous system) if sinus and brain imaging with CT or MRI scans did not reveal any problems.

7. Tension headaches

Tension headaches generally happen later in the day but can happen at any time due to the stress load, work ergonomics (how your body is positioned at work) or anxiety the patient is suffering from, whether they realize it or not.  They tend to make the head hurt like a tight band around the head or start in both temples and work backwards.  They usually happen while at work or school in the afternoons but can wake up a person due to neck or back vertebrae misalignment.  Sleeping wrong on a pillow can cause muscle tightness and a resulting headache.   Resting and using pain reliever medicine usually makes tension headaches better.  Children can often get headaches from internalizing anxiety from bullying, domestic abuse or the stress caused by fighting or divorcing parents.  A child’s home life can impact them severely.

8. Migraines (vascular) headaches

Not all headaches are migraines as some people mistakenly believe.  A migraine headache is generally a severe headache on one side of the head that is preceded by some sort of visual distortion such as spots or wavy lines.   The pain is so severe a patient may experience nausea or dizziness and is usually sensitive to light and sounds.  Over the counter medications generally don’t help very much except for some that have caffeine and so migraine sufferers usually have to lie down and rest in quiet, dark locations until it gets better.  They can happen at any time and can be brought on by menstrual cycles or even certain foods.  Sometimes the cause is never found.  They tend to happen in women more than men.  There are prescription medicines that can help prevent or thwart migraine attacks.   Migraines are considered a diagnosis of exclusion however.  Your doctor needs to be fully confident that all other causes of headaches including tumors and aneurysms have been completely ruled out and excluded before they can be called a true migraine headache.  The International Headache Society has listed specific signs and symptoms that must be present or not present to officially classify your headache as a migraine.   I recommend keeping a journal of your headaches:   date and time when they happen, what you ate and drank that day, associations that made it worse such as reading or computer use, medicines used, menstrual cycles, etc… that might help isolate any specific triggers.

9.  Severe Medical Problems

Very rarely, a very serious medical problem can cause headaches.  The main serious medical problems causing headaches would include:

·         Hypoglycemia (low blood sugar)   Usually happen with poor diet, get a feeling of weakness, shakiness, moodiness and breaking out in a sweat and nausea.

·         Hypertension (high blood pressure)   Usually start at the base of the back of the skull where the head and neck meet, have ringing in the ears, sometimes dizziness.

·         Aneurysm (small area of ballooning outward of blood vessel)  Usually a quick forming, stabbing pain that is incredibly painful.  Often described as the worst headache ever.

·         Benign increased intracranial pressure (higher than normal fluid pressure in the brain and spinal cord caused by poor drainage or reabsorption of fluid)   Often related to females that are considered overweight and over 30-40 years.  Rarely, some people have smaller than average drain openings (foramens) in the skull that keeps fluid from circulating well.

·         Inflammation of cranial arteries – usually hurts on one side of temple, vision decrease in one eye, over 60 years old. It is not normal for someone over 60 years old to have frequent headaches unless they have a long history of them.

·         Poor blood circulation from a blood clot or stroke – usually sudden, associated with numbness or paralysis of facial muscles or limbs, eyelid drooping, sudden loss of vision.

·         Brain tumor – usually very gradual onset of headaches and other symptoms such as vision or hearing loss, behavior changes, depression, and can feel like general sinus pressure in some cases.

If you are experiencing frequent headaches, please see your medical physician for a medical evaluation and a reputable eye doctor for an comprehensive eye and vision examination to find the source and make sure it’s not serious.

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.


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 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.

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 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!”

“So What is the Right Answer, One….or Two?”

16 05 2014

Apparently, for some people going to the eye doctor to have their vision checked is a stressful experience.  It’s not that dreaded air puff test even.  Or even having the eyes dilated with eye drops.  It’s the refraction process where we determine the prescription for glasses.  You know, where the doctor puts up that big pair of glasses that the doctor flips different lenses and says, “Which is better, one….or two?

I think it’s probably harder for some when they are  afraid of getting something wrong.  Perhaps a little high-strung,  Type A personality or someone with some OCD tendencies that needs perfection so it’s hard to commit to an exact answer.   And engineers.  Not there is anything wrong with being a perfectionist, I appreciate things being in order and perfect as possible.  But it’s not anything to stress yourself over because there are multiple double checks to make sure everything is perfect as possible.

You see, when we say “which is better?” we are adding one step more power in the number one lens and one step power less in the number two lens.  Much like if your radio was on 92.5 FM and you went to 92.4 or 92.6 to see which sounded more clear.  We bracket back and forth until the power is just right.  So we start from a certain prescription, either your old prescription or from a computerized reading of what the prescription power is and refine it with your help by adding more or less power  until there is no change ideally.  Sometimes the answer keeps going back and forth and so by that we also have reached our endpoint.  Then looking at the vision from the old glasses and it’s prescription, the preliminary prescription reading and the final refraction reading, we can make sure it makes sense to prescribe exactly what you need to see 20/20 or hopefully even better than that.  So don’t get worked up about getting something wrong or saying the wrong answer.

So the correct answer is ideally……SAME.

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 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!”