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!”





Don’t Get “Bob Costas Eye”!

12 02 2014

Don’t get “Bob Costas Eye”.

To tell you the truth, I have not been watching the Sochi Winter Olympics.  In fact, the Westminster Dog Show held my attention more.  But all the media attention on Bob Costas’ eye infection drew my interest to what was going on and so like a bad accident I had to look.  “Whoa! That’s a bad one, hope no one got hurt.”

I’m chuckling as I write this.   You may have seen the Direct TV ads that start with something like “When your cable goes out, you get bored….”, which leads to what seems like a never ending cascade of cause and effect events, like a small version of the legendary “Butterfly Effect.”  Usually ending up with the person who has cable TV trouble not doing well.

I can just picture a scenario like this:   “When you sleep in your contacts, you wake up seeing clearly.  When you wake up seeing clearly, you have more energy and motivation.  When you have more motivation, you perform your job a lot better.  When you perform your job a lot better, you get a promotion.  When you get a promotion, you get a raise.  When you get a raise, you think you can travel to exotic places like the Winter Olympics.  When you travel to exotic places like Sochi, you fly coach next to a big Ukranian man with a cold.  When you sit next to a big Ukranian man with a cold in an airplane, you get “Bob Costas Eye”.  Don’t get “Bob Costas Eye”!”   The morale of the story here would be:  Don’t sleep in your contacts to start with!

In Bob Costas’ case though, it looks like he has a case of a viral eye infection or what lay people would call “pink eye.” Epidemic keratoconjunctivitis or EKC for short is caused by a virus as opposed to bacteria.  Though sometimes similar, the two infections are more like a zebra and a horse.  They look and behave a little different and you treat them differently too.

Bob Costas probably got the infection in the trapped space of the airplane.  It is extremely contagious and usually spreads from one eye to the other.  When I say contagious, I don’t mean it is going to jump off someone else’s eye and into yours like a flea or something.  People think they need to be put in isolation sometimes.  It is normally spread by coughing and sneezing.  It is mostly an airborne virus.  It is a cold virus that settles in your eye.  That is why is spreads so fast at schools or in some small offices.   You can get it from the person that is sneezing two people behind you in line at the supermarket.   That being said, it can last on surfaces for hours also.  So you want to avoid touching things the other person has touched without washing their hands or sanitizing with Clorox wipe or other disinfectant. Definitely avoid sharing towels, pillows, computer keyboards or telephone and the like.

There are no current prescription drops to cure EKC.  It is a cold virus or adenovirus that causes the infection and just like the common cold, there is no cure.  You have to let your own body’s immune system get rid of the infection. Fortunately, just like taking “cold medicine” to help you feel better, there are some treatments we can do to help the infection resolve faster and make you feel better.

In the office, we can anesthetize the eye with some numbing drops and place some 5% Betadine disinfecting solution on the eye’s surface and eyelids to sterilize the surface and get rid of most of the live virus.  With the viral load reduced, the body’s immune system can overcome the infection easier and faster.  The viral particles cause a lot of inflammation, which is what causes the redness, swelling and pain.  We can help that with a non-steroidal and steroid eye drop to calm that down.  And the old standby treatment….chilled wet washcloths or cold packs wrapped with a wet washcloth.  Wet transfers the cold better to the tissue and helps reduce inflammation and pain.

There are no over the counter treatments or home remedies that are going to help a viral conjunctivitis or pink eye.   Instead of putting up with pain and irritation, make an appointment early and we can get you healed up and normal looking again much quicker.   The next time you wake up with the barn cat eye or the eye starts getting red and watering, just remember Bob Costas.

Don’t get “Bob Costas Eye”!

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!”





Water, water, everywhere….

14 08 2013

In one of my English classes in 9th grade, Mrs Mowery had us read the poem, The Rime of the Ancient Mariner, by Samuel Taylor Coleridge.  The famous quote I always remember is “Water, water, everywhere….but not a drop to drink.”   As you could imagine, it would be quite tormenting to be surrounded by seawater and having no drinking water.

For us “blind” people that depend on our contacts, it can almost be torture when our contacts get dry, blur our vision and burn.  Drops help but often for not long enough.  Very often there is eyelid disease and poor tear quality as the underlying cause.  In those cases, we try to address the underlying cause of dry eye.  However, that is not always easy and sometimes the eye just doesn’t produce the volume of fluid it used to.  Sometimes it’s just our environment with high evaporation rate due to low humidity, air movement and not blinking enough staring at computers.

There is now a revolutionary new material in contacts just now available in a daily, disposable lens called Dailies Total 1, made by Cibavision/Alcon.

focusdailies-focus-dailies-total-1-90-lenses-contact-lenses~7274230

The material is a totally new category of contact lens called “Water Gradient” technology.  Basically the outside surfaces are almost completely water with an inner core of plastic.  This gives the patient the benefit of extreme comfort with high oxygen delivery to the cornea to keep it healthy.   With the outer surface almost entirely water, the “lubricity” or coefficient of friction is almost zero.  This means almost there is almost no interaction of the eyelid with the contact lens.  I like to say it’s “slickery.”   Studies have shown 9 out of 10 can’t even feel it on the eye.*

LensCrossSection

Daily lenses give the patient the ultimate convenience since there is no cleaning or disinfecting the lenses with contact solutions, which often irritate and dry the eyes further.   Since they are always clean, they often offer the clearest vision as well.   Clean lenses also help keep the eyes healthy. Currently, Dailies Total 1 lenses are only available for nearsighted individuals.   Soon there will powers for farsighted patients, those with astigmatism and needing bifocals for reading. We would love for you to try some free trial lenses if you are a candidate when you come in for your next exam and get your feedback on this promising new technology.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist.    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.  Connect on Twitter @eyedocdumas  and like our Facebook business page:  Dumas Vision Source You also can visit our website www.visionsource-dumas.com for more information.   Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”





Cotton mouth anyone?

21 04 2013

Sometimes we get thirsty from time to time, especially in the dry Texas Panhandle.  But do you always have a mouth so dry you need to keep a mint or gum in your mouth?  People sometimes call a mouth so dry like that “Cotton mouth.”  We probably all have been that thirsty from time to time for various reasons.  When it occurs all the time though, it could be an indicator of a medical problem.

A person with dry eyes can have a dry mouth since the tear drainage is reduced.  Tears normally flow through a small hole in the nasal corner of the eyelid called the “puncta.”   From there a tube delivers the fluid over to the nasal passages and eventually into the throat.  If you don’t have enough tear volume, it can help dehydrate your mouth.

Several systemic medical problems can cause a severe, chronic dry mouth however:

  • Diabetes is well known for causing extreme thirst all the time.  It is usually accompanied by frequent urination,  increased appetite but losing weight without trying, fatigue and irritability and sudden vision changes, especially after eating.
  • Parkinson’s disease, HIV/AIDS, anxiety disorders and depression.   Stroke and Alzheimer’s disease may cause a perception of dry mouth, even though the salivary glands are functioning normally.
  • Medications of all kinds can lead to a chronic dry mouth.
  • Snoring and breathing with your mouth open also can contribute to the problem.
  • Smoking or chewing tobacco can increase dry mouth symptoms.
  • Sjogren’s syndrome

Sjogren’s syndrome is named after a Swedish doctor, Dr Henrik Sjogren, who in 1933 (pronounced “Show-grin”) observed a triad of symptoms of:   severe dry eyes, extreme dry mouth and arthritis.    Sjogren’s now has a primary form with just dry eyes and a dry mouth and a secondary form with dry eyes, dry mouth and arthritis.

Sjogren’s is an auto-immune disease where the body’s own immune attacks itself.  White blood cells attack the glands that produce moisture in the eyes and mouth.  There are blood tests to help confirm the disease but you may need to see a doctor that specializes in auto-immune diseases, such as a rheumatologist.   There are several treatments but no actual cure for this syndrome so far.

We can help with your chronic dry eyes.    Make an appointment today for a dry eye evaluation and treatment.

For more information about Sjogren’s, visit this link to the Sjogren’s Syndrome Foundation.

 

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 22 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Connect on Twitter @eyedocdumas  and like our Facebook business page:  Dumas Vision Source You also can visit our website www.visionsource-dumas.com for more information.  

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





Maybe It’s Not Your Contact Lens!

17 11 2011

At times contact lenses can be uncomfortable, especially in the climate of the Texas Panhandle.   Low humidity, wind, and lots of allergens do not make for an environment conducive to all day, comfortable contact lens wear.   A torn lens, a piece of lint or dust or lens coatings from using the same lens more than 1 month can definitely make a contact lens uncomfortable.  A thicker lens, a larger diameter or the improper curvature of the lens that doesn’t match the eye curvature can make the contact lenses uncomfortable.   Sometimes the contact lens is the problem.

However, more often than not, the source of discomfort is not the actual contact lens but your contact solution.  Most people use Multi-Purpose Solutions (MPS) such as Optifree PureMoist, Complete, Renu, etc…to disinfect their lenses since it is easy to use.    These MPS solutions all have preservatives (chemicals) that keep the solution from becoming contaminated.  These chemicals, while effective at that, are soaked up into the contact lenses and will slowly diffuse into the tear layer of your eyes during the course of the day while wearing them.  Often this results in from mild to severe irritation to the surface of the eye and inside of the eyelids in certain people.  Irritation to the eye results in dryness, foreign object sensation, redness, burning, blurry vision and sometimes itching and mucous production.  I have found MANY people use cheap, generic, store brands from the Bigmart stores to save money.   While they say they are comparable in how they work, the chemicals may not be as gentle as the name brand solutions.

The only way to know is for your eye doctor to look at your eye to determine what the exact nature of the problem is.  Switching to a preservative-free contact solution, such as Clearcare or Purilens,  is sometimes all that is needed to make contact lenses more comfortable.  The ideal scenario is to wear a daily disposable lens, such as Focus Dailies AquaComfort Plus, that involves using no contact lens solution at all.  No chemicals in the eye, no more problem!

So before you decide to stop wearing your lenses or try to ride out the discomfort, check with your eye doctor first to see if using a daily disposable contact lens or a trial run of a preservative free disinfection system may be the answer.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 21 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Connect on Twitter @eyedocdumas112727 and like our Facebook business page:  Dumas Vision Source You also can visit our website www.visionsource-dumas.com for more information.   Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”