Dr. Steven Suh has a new podcast called Healthy Eyes 101. This is a patient-centered health education program focused on the eyes. He will be interviewing ophthalmologists and optometrists to discuss various eye conditions and their latest treatments. If you would like to see the Dr. Suh’s Healthy Eyes 101 podcast website, please click on the logo.
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In this episode Dr. Steven Suh interviews Dr. Katie Wulff about a specialty gas-permeable contact lens called scleral lenses. Some people have abnormal corneal curvatures and irregularities which make it difficult for them to see even with glasses or soft contact lenses. Stephen Curry, an NBA star with the Golden State Warriors, wears scleral lenses because of his corneal condition called keratoconus.
Rigid gas-permeable contacts (RGP) and scleral contact lenses have a smooth, spherical, and hard surface which will neutralize these irregular “hills and valleys” on one’s cornea. The reason soft contact lenses do not work as well is because they “mold” onto these corneas and do not vault over them, thus replicating the abnormal curvature. Regular RGPs can be helpful in many cases but they have limitations. Scleral lenses do not sit on the cornea like RGPs but sit on the white part of the eye (sclera) so they are usually more comfortable.
Scleral contact lenses can help maximize vision in patients with these corneal conditions:
- Pellucid marginal degeneration
- Ectasia (abnormal corneal warpage and thinning) after LASIK surgery
- Corneal scarring
- Severe dry eyes
- After corneal transplants
- Corneal irregularities after radial keratotomy (RK)
Scleral lenses are much larger than standard rigid gas-permeable and soft lenses. Since they are customized for each patient’s eye, several visits are needed to ensure that the lens is fitting properly. Inserting these lenses onto the cornea may be much more difficult than other types of contacts. Because of their potential to restore sight in many of these patients, these specialty lenses can help delay or avoid the need for corneal cross-linking or corneal transplantation.
Here is another article on scleral lenses.
Dr. Suh interviews Dr. Beckman about a debilitating, corneal thinning condition called keratoconus.
The incidence is approximately 1 in 2,000 individuals.
The major risk factors include atopic disease, Down’s Syndrome, some family history, floppy eyelid syndrome, and chronic eye rubbing.
- Initially patients may be asymptomatic
- Blurred or distorted vision from increasing nearsightedness and/or astigmatism
- Increased sensitivity to bright light and glare, which can cause problems with night driving
- A need for frequent changes in eyeglass prescriptions
- Sudden worsening or clouding of vision
Keratoconus can be diagnosed in the late teenage years and can worsen as time goes on.
Corneal topography is the main tool for diagnosis.
- Early: glasses, soft contact lenses, gas-permeable contacts, then specialty contacts called scleral lenses
- Later stages: traditional treatment has been corneal transplantation
- May have long recovery time in terms of improved vision
- Need numerous post-operative visits
- Will need a lifetime of steroid eye drops to help avoid rejection of the corneal graft
- Minor trauma can be dangerous to a post-corneal transplant eye
- May need another transplant in the future
- Corneal cross-linking
- A relatively new, in-office procedure that can slow down the progression of the thinning and warping
- Cross-linking involves treating the cornea with eye drops containing riboflavin, a B-vitamin. After the cornea has been saturated with the riboflavin, the cornea is then treated with ultraviolet light.
- Procedure time is about one hour
- Eye drops are used for only a few weeks
- Goal is to treat keratoconus early with cross-linking to hopefully prevent, or at least delay, the need for a corneal transplant in the future
Cross-linking can also treat pellucid marginal degeneration and corneal thinning (or ectasia) after LASIK.
Here is the abstract for Dr. Beckman’s cross-linking article.
On this show Dr. Suh and Dr. Julia Geldis have a thorough conversation about contact lenses.
Contact lenses have some advantages over glasses. People with higher prescriptions find that they are more comfortable from a vision standpoint because contacts do not cause as much minification or enlargement of images as with glasses. They are usually preferable when playing sports and doing other physical activities.
Dr. Geldis is comfortable with children wearing contacts as young as eight years old as long as they are mature and can take good care of them. There is no maximum age when people have to discontinue wearing contact lenses as long as their eyes are healthy, and they do not have dry eyes or other conditions that make it unsafe to wear them.
Two main types of contact lenses
- Gas permeable lenses – can give better quality vision but may be harder to adapt to initially
- Soft contact lenses – easier to get used to; most popular type
- Different options: daily disposables; two-week disposables, one-month disposables; day-and-night extended wear (have to be careful when sleeping in any kind of lenses – increased risk of infections and inflammatory conditions)
Presbyopia and contact lenses – options for seeing up close when people get into their 40s
- Reading glasses over your contacts
- Monovision – dominant eye is set for distance vision and the non-dominant eye is set for near vision
- Multi-focal lenses – both eyes will be able to see distance and near because of different refractive zones in the lenses
It is not recommended that one wear contact lenses when swimming, showering, or sleeping.
At their appointment new contact lens wearers will be taught how to put them in, take them out, and care for them.
Eye infections and inflammation are more likely to occur when people overwear them or do not clean them properly. With regards to the contact lens cases, always dispose of the old disinfecting solution – do not top it off. Rinse the inside of the case with the solution and let it air dry. Change your case every 1-3 months.
Colored contacts and “costume” contacts (popular around Halloween) are all right to wear if they are prescribed by an eye care professional.
In this era of COVID-19, always practice good hygiene when handling the lenses. If you test positive or suspect that you have this virus, please do not wear your contacts and keep your hands away from your face!
Here is another resource to learn more about about contact lenses.
On this episode Dr. Suh interviews Dr. Ashley San Filippo about primary open-angle glaucoma (POAG), the most common type of glaucoma.
Glaucoma is a progressive disease of the optic nerve (the cable–like bundle of nerve fibers that transmits visual information from the eye to the brain) that may be associated with eye pressure build-up.
There are two main types of glaucoma: open-angle and angle-closure (or narrow-angle).
Nearly three million people are affected by glaucoma in the United States.
Risk factors for open-angle glaucoma: over age 40; family history; African or Hispanic heritage; have high eye pressure; had an eye injury; used long-term steroid medications; have corneas that are thin in the center; have diabetes.
Symptoms of POAG: there may be none! Initially it is a “silent” disease. This is why it is important to have your eyes examined periodically.
Peripheral (side) vision changes precede central vision loss as the disease progresses.
The diagnosis of POAG can be confirmed in the eye doctor’s office.
- High intraocular pressure (IOP) may or may not be present because some patients never have higher than normal IOP, which is somewhere between 10 and 22 mm Hg.
- The optic nerve head (disc) has a characteristic appearance indicative of glaucomatous damage.
- Loss of side vision as measured by a visual field test.
- Optical coherence tomography (OCT) is a non-invasive imaging technique used to visualize and quantify the thickness of the nerve fiber layer of the retina and provides information on optic nerve head topography.
- Corneal thickness measurement (pachymetry) – checking for thin corneas.
Ocular hypertension is higher than ”normal” eye pressure without the other signs of glaucoma. This is one of the biggest risk factors for developing glaucoma so it is important to have regular follow-up exams with your eye care specialist.
Treatment for POAG includes medicated eye drops, laser surgery, and traditional surgery. Usually eye doctors will start with eye drops. An in-office procedure called selective laser trabeculoplasty (SLT) has become a popular option as it can lower IOP and minimize your need for eye drops. Minimally invasive glaucoma surgeries (MIGS) may be performed in conjunction with cataract surgery and is used mainly for mild to moderate glaucoma. Traditional surgeries (trabeculectomy and tube shunt drainage surgeries) are reserved for more advanced disease.
Marijuana is not an effective treatment for glaucoma.
Patients with glaucoma or who are suspicious for having glaucoma should follow the advice of their eye physician in terms of frequency of visits to ensure that they are getting all the appropriate tests to follow any changes that may be occurring.
Dr. George Chioran and Dr. Suh will be discussing bumps in the eyelids that may be acute or chronic. Chalazia and hordeola (styes), can greatly affect people when they occur because of the pain and swelling that can be present. They will talk about risk factors and what you can do to prevent these. Dr. Chioran will also review the different types of treatments that can be done from home and in the office.
- Warm compresses can be used to get rid of or help prevent these bumps. We have them for sale in our office or you can buy a commercially available eye compress here.
- These eyelid scrubs are non-abrasive cleansers that can help remove debris and bacteria from around the eyelashes and lid margins that can cause blepharitis and, ultimately, styes.
- This is an article from the American Academy of Ophthalmology about chalazion and styes.
Apocrine and epidermal inclusion cysts are also common bumps that can appear on the eyelids. They will discuss the causes and treatments of these lesions.
In this episode Dr. Suh interviews Dr. Ken Beckman about all aspects of dry eye disease. They first delve into the common signs and symptoms. Dr. Beckman then discusses the special tests that can be performed at your eye doctor’s office to confirm which type of dry eye disease you may have. Lastly, he does a comprehensive review of the wide-ranging treatments that are available today.
Below are links to some more information about topics that we discuss on the episode.
- Tear osmolarity measures the salt concentration of human tears to aid in the diagnosis of dry eye disease.
- InflammaDry detects high levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with chronic dry eyes.
- Lipiscan is a high-definition oil gland imager that allows eye care professionals to assess meibomian gland structure.
- This is one of the brands of moist heat eye compresses that we sell in our office to help patients with evaporative dry eyes – the most common cause of dry eye disease.
- Lipiflow is a procedure performed in our office that heats and massages the eyelids to improve outflow of the natural oil from the glands that are so vital for a stable tear film layer.
- This is a nice summary article about the three prescription dry eye medications – cyclosporine-A (Cequa and Restasis) and lifitegrast (Xiidra).
- Punctal plugs, a quick, in-office procedure covered by insurance, are a nice adjunct to combat dry eyes.
- Autologous serum drops are eye drops made from a patient’s own blood plasma and serum.
- Scleral contact lenses can be worn to treat severe dry eyes. This is an old article but still relevant.
- This is a nice summary article on dry eyes from the American Academy of Ophthalmology
- Dr. Beckman was one of the lead authors in this landmark, peer-reviewed journal article that changed paradigms about dry eyes.
Since this is a show about eye health, this first episode introduces the basics. Dr. George Chioran and Dr. Suh discuss the different parts of the eye, refractive errors (nearsightedness, farsightedness, astigmatism, and presbyopia), and the differences in the roles among the various eye care professionals (ophthalmologists, optometrists, and opticians).
This is a brief trailer to introduce Healthy Eyes 101 – a podcast for patient-centered health education focused on the eyes. The host, Steven Suh, MD, will interview the brightest ophthalmologists and optometrists to educate you about various eye conditions and their most up-to-date treatments.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.