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 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!”





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:

http://www.cnn.com/videos/us/2015/05/08/pkg-illinois-toddler-eye-cancer.wrex

or ABC News:

http://abcnews.go.com/Health/mom-catches-year-olds-eye-cancer-snapping-photo/story?id=30954695

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 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!”

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Focus on Archery

31 01 2015

When you hear of famous archers in history, you can almost visualize them in their garb of the time and with different types of bows.  Robin Hood in his green felt hat (doubt he had tights on) and a recurve bow.  William Tell in maybe a Swiss type lederhosen outfit and a crossbow.  Minamoto no Tametomo in a Kyodo obi and kumi bow.  Okay, maybe THAT one doesn’t ring a bell.  He was a famous samurai that legend says sank a ship with an arrow.   More contemporaries are:  Fred Bear, Katniss from “The Hunger Games” and Legolas ( the elf), from the “Lord of the Rings” series also.  Then there is this guy, Lars Anderson.  https://www.youtube.com/watch?v=BEG-ly9tQGk   That is some amazing skill right there.

Modern archers with a compound bow usually depend on being able to use a peep sight on the bow string up close to the eye.  It basically is a little round circle that you can “peep” through.  A front sight pin that extends a little further past the bow is aligned in the peep sight with the target.  Much like a rifle or pistol has a back sight and a front sight, both which have to be aligned with a target.  The human eye can only focus on one point at a time, so it is imperative with archery or firearms to concentrate on the front sight.  The back sight and the target are usually slightly blurred when you do so.

A problem occurs as we age though and we begin to lose our focusing ability up close.  After forty something years old, the crystalline lens in the eye begins to harden and cannot change shape as easily to focus on near  objects.  Sort of like an egg being fried and the protein in the egg yolk begins to change from runny to thick and then hard.  It’s not a muscle that is too weak and needs to be strengthened.  So that is why we ALL eventually have to have some help in the form of bifocals or even better, progressive lenses that can focus in all places (mis-labeled as “no-line bifocals” often times.)

So what do you do when the front sight pins of the bow begin to be more difficult to focus after forty?  The easiest way to compensate (there is a lot of compensating after 40) is to use what is called a “Verifier,” available from Specialty Archery. https://www.youtube.com/watch?v=x_s_lpHqHXo

It is a screw-in lens that is attached to the peep sight and allows for slight magnification to see the sight pins better.  I have not found out it if can be used in competitive archery or not yet but it’s not any different than wearing bifocal glasses to correct your vision so I wouldn’t think it would be against the rules.  It is not a scope to make the target magnified like a different product called a “Clarifier,” to be used with a scope and makes the target easier to see.

I recently prescribed a daily disposable bifocal soft lens to a forty year old competitive archer and he likes it for the time being.  He hasn’t ever worn glasses and still sees 20/20 far away.  He has been noticing it is not as smooth and easy to focus those sight pins quickly like it used to be.  I told him rifle and pistol shooters have the same problem after forty years old with open, iron sights.  The only thing you can do is either use some kind of scope or a peephole sight that extends the depth of focus of the eye.  Peepholes are fine for stationary, target shooting like Olympic shooters would do but are not practical for action shooting or even hunting.  This patient of mine wears the multifocal contact lens on his dominant eye and uses it just for shooting since he still reads fine without glasses…for now at least.   It focuses the sight pins better with a very slight blurring of the distance target but not bad within 50 yards.

So if you are over forty and not seeing those sight pins on your bow quite as well, good news!  There is hope for you in maybe more than one way.   Have your eyes examined for any uncorrected vision problem or eye disease first.  Unless you still want to blame your poor shooting on your eyes or your eye doctor.

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 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!”

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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!”





SnackPak 4 Kids and Transitions Lenses Special

17 07 2014

SnackPak 4 Kids is feeding hungry school age kids this summer and we want to help.   We support this program and we would like to team up for July and August 2014 to help them out.  If a patient brings in a 16 oz (small) jar of peanut butter or a box of Pop Tarts for SnackPak (or better yet Both!) and buys a Transitions lens add-on to their spectacle lenses, we will give them 50% off that price of the Transitions‘ add on cost(about a $45 dollar savings).   A collection container is by our front door.

Even if you do not buy any eyewear, you are welcome to drop off your donation of peanut butter or PopTarts at our office.  

It’s not the kid’s fault that they go hungry.   Studies are showing when the kids are not going hungry, they do better in school.  If they can get through school with a good education and not drop out, perhaps the generational poverty cycle can be broken.

If you have any questions about our offer, you can contact our office at 935-2020 or information about the SnackPak program in Dumas at SnackPak 4 Kids Dumas.  Thanks for your support of SnackPak 4 Kids and Dumas Vision Source.

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The following information is from SnackPak 4 Kids website (http://snackpak4kids.org/history)

“It began with 10 hungry students at Will Rogers Elementary School in Amarillo.  Bushland couple Dyron and Kelly Howell had discovered that Amarillo was the largest city west of Dallas without a weekend backpack program. And yet more than 3,200 children in the Amarillo Independent School District relied only on the meals served to them at school for their weekly food. That meant hundreds of children spent their nights and weekends hungry.

Determined to find some way to address this need, the Howells assembled ten bags of food that could be prepared without adult supervision—juice boxes, peanut butter, sandwich snack crackers, breakfast cereal, Pop-Tarts, fruit cups and more. On Friday, September 3, 2010, the first ten Snack Pak 4 Kids recipients were given those bags, which contained enough food to get them through the weekend. The Howells prepared the bags again the next week, and got others involved. Soon the number of children grew, and then the program expanded to other schools. Teachers began seeing academic improvement, better concentration, and higher attendance among SP4K recipients.
As of early 2014, the program has grown to serve 5,200 students in 30 school districts, Amarillo, Booker, Borger, Bushland, Canadian, Clarendon, Clayton NM, Dalhart, Dimmitt, Dumas, Friona, Fritch, Happy, Hereford, Highland Park, Lockney, Panhandle, Pampa, Perryton, River Road, Spearman, San Antonio, Stratford, Sunray, Tahoka, Texhoma, Texline, Tulia, White Deer, and Wildorado.

Every week, hundreds of volunteers pack 14 regular, nutritious items into plastic bags and deliver these bags to participating schools.  At the schools, officials discreetly place these bags in students’ backpacks on Fridays. Students receiving the bags have each been identified by school staff members (counselors, nurses, teachers or principals) as living in a “food-insecure” household—which means these families don’t always know the source of their next meal. The SP4K program feeds each elementary student and any siblings at home not old enough to attend school.

Our new Snack Shak program currently provides food to middle school and high school students, and is expanding quickly.”

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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.

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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!”





“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 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!”





Oooh baby, baaby…

14 03 2014

Baby baaaby…baby, baaaby….Push it.  Push it good.  Oooh…Baby baaaby.   Yup, got my grove on (in my mind). Who remembers the group Salt N Pepa?  Yes, I’m going back to the 80’s…girls with big hair, Miami Vice,  OP shorts, Member Only jackets…glad that era is over. Almost as bad as the disco 70’s.  But I digress.

Babies.  Just how do we check babies and those little kids eyes?

Well, it’s not easy.  It helps to be quick, creative and sometimes a goof ball to get their attention and help them not be scared.

When we check little children’s eyes, we are looking for three main things:

1. Clear vision in each eye

2. The eyes are aligned straight ahead

3. The ocular health is normal.

While we often can’t be as detailed in the exam data as an adult, we get what information we can.

To determine if the child is seeing clearly, we shine a light streak at the pupils which gives us a red reflection, much like that of a bad photograph where someone’s pupil has got a red reflex.  By moving the light streak in different directions, we can use that red reflex to determine the refractive power of the eye and thus what power of glasses they would need.  If they are old enough to sit for it, a computerized machine called an auto-refractor can read the approximate power of the eye within seconds.  This gives us a second opinion from the manual method.  So if the child is handicapped, won’t speak or too young to respond to questions, we can determine very closely what the refractive status of the eyes are without them saying a word.  When the two readings are close, especially with the help of eye drops that make the focusing system of the eye relax, we can be assured the refractive status of the eye is determined accurately.  That is how we know often times if a child is trying to fake a vision problem.

We usually use pictures instead of letters if they are old enough to speak to help determine what their visual acuity is on the eye chart.  A spinning hand held drum with alternating black and white lines can be used also to get a gross screening of what an infant is capable of seeing.

To determine if the eyes are straight, we cover and uncover the eyes back and forth to see if the covered eye moves to look at a target when the eye is uncovered.  This is called the “Cover Test.”   We also can shine a flashlight toward the eyes and look at the reflection off of the corneal surface and compare it to the pupil location and with the other eye reflection to look for symmetry.  If the reflection differs in one eye, it usually because one is turned a certain direction.  We also use a 3D picture the child looks at with special polarized glasses that makes the picture seem to be floating in the air if they have good stereopsis or depth perception.  If there is an eye turn, usually their depth perception is weak.

Finally, to determine the eye health, we look inside the eye as much as possible.  We try to utilize eye drops that make the pupil dilate and increases the view inside with our special equipment.  At the very least, a good bright red reflection should be coming out of the child’s pupils from the light.  If there is not a good red reflection or especially a white color coming from the pupil, that could indicate a serious eye problem that should be checked immediately by an eye doctor.

I recommend an Optomap Retinal scan be performed on everyone, every year to help see a more complete view of the retina inside the eye.   Even retinal specialists can overlook small things that an Optomap can bring attention to.  It was developed by a Scottish engineer whose 5 year old son had a retinal detachment that was not seen by regular means until it was too late.  Many kids even as young as 2 or 3 years old can often have an Optomap picture taken to see almost the entire back of the eye at one time.

If there is a suspicious finding and the child is just too young or too uncooperative, they can be sedated slightly with medicine that makes them sleepy and just not care or even totally sedated if needed for a more thoroughly internal eye examination.

Since the nerves from the eye to the brain quit developing by age 7-8 years, we want to make sure children are seeing clearly well before that age.   Ideally, children should have an early childhood, wellness eye exam to look for any abnormalities that could affect the eyes development by ages 3-4.  Now with Obamacare, children under the age of 18 are mandated to be covered by a yearly vision exam as a routine procedure.  Check with your insurance provider for specifics.

Don’t assume those big, bright baby eyes are seeing perfectly.  Often the problems are subtle and hard to tell they have a problem.  The child certainly doesn’t know any difference.   We need to correct those problems as early in life as possible so they can develop clear, comfortable,  binocular vision at all distances they are looking at by age 7 or 8. Especially when they look at your old high school yearbook and laugh at your big hair and Madonna outfit.

Don’t gamble with your children’s eyes.  Start checking their eyes by 3-4 years old.  Schedule your kids for an eye exam today.

 

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!”