Learn How We Can Help You See Again

Low vision describes a visual impairment that decreases your vision, either with a reduced field of view or with low visual acuity. This type of vision loss cannot be corrected fully with prescription eyewear, medication, or surgery. And because low vision implies that you still have some remaining sight – it is not the same as blindness.

However, even though people with low vision maintain some level of sight, this condition can drastically lower independence and quality of life. Normal daily tasks, such as reading, writing, driving, and watching TV, may become difficult. For someone who is used to being independent, low vision can therefore be very frustrating and spiral into depression. Fortunately, there are a number of low vision devices, technologies, and techniques that can help people with low vision to see again. Our low vision doctors are knowledgeable about many types of low vision assistance, and we strive to maximize vision for every patient. We want you or your loved one to see and enjoy life to its fullest!

What causes low vision?

The primary causes of low vision are eye diseases, such as cataracts, glaucoma, macular degeneration, diabetic retinopathy, and retinitis pigmentosa. Other conditions that can lead to low vision are brain injury, eye injury, and genetics.

What is a low vision eye exam?

Our eye doctor will perform a specialized low vision eye exam to assess the quantity and type of remaining vision. We will use advanced diagnostics, such as OCT scans and Visual Field testing, to ensure highly accurate results. If you have an ocular disease, we will keep close watch on it to check for any changes. Sometimes a change in your ocular condition indicates the need for a different treatment to prevent further vision loss.

Based on the results of your low vision eye exam, we will recommend the most helpful low vision aids and strategies to enhance quality of life.

What are low vision aids?

Low vision devices are tools that can be used to make the most of your sight and improve daily function. Typically, they are categorized as either electronic, optical, or non-optical. Each type targets a different visual task or circumstances. Therefore, our low vision doctor may recommend a variety of devices for each patient.

Some examples of low vision aids include:

• Handheld magnifiers
• Spectacle-mounted magnifiers, can be used with one or two eyes
• Stand magnifiers, particularly useful if you are not able to hold your hands steady
• Bioptic telescopes – in a range of lens powers
• Devices to reduce glare and enhance visual contrast
• Technologies that use non-visual cues (sound and feel) to assist with identification
• Computer programs and glasses

Is it possible to drive with low vision?

Low vision driving is associated with many risks. For example, you may not be able to see road signs and traffic lights clearly. However, losing the ability to drive can be devastating, which is why we will strive to fit you with a low vision driving aid to help keep you on the road – driving safely. A selection of bioptics and telescopic glasses are available to magnify everything you need to see while behind the wheel. Depending upon your individual eye condition, low vision driving aids may be able to sharpen your sight to 20/40 vision!

See For Yourself How Our Low Vision Doctor Can Help!

Many people who have suffered vision loss are skeptical about the effects of low vision devices. However, a recent study published in Acta Ophthalmologica explored the impact of low vision aids on a group of seniors (average age 82 years) with vision loss. The study showed that while 16% of these people could still read without any aids, this number soared to 94% once they were fit with a suitable low vision device. In addition, their reading speed rose from 20 words per minute to 72 words per minute!

Instead of sitting around and wondering whether or not low vision assistance can really improve your quality of life, we invite you to book a low vision eye exam with our Rancho Mirage eye doctor. We want you to see all the benefits with your own eyes!

We invite you to take a look around our new site to get to know our practice and learn about eye and vision health. You will find a wealth of information about our optometrists, our staff and our services, as well as facts and advice about how to take care of your eyes and protect your vision.

Learn about our Practice specialties including comprehensive eye exams, contact lens fittings and the treatment of eye diseases. Our website also offers you a convenient way to find our hours, address and map, schedule an appointment online, order contact lenses or contact us to ask us any questions you have about eye care and our Practice.

Have a look around our online office and schedule a visit to meet us in person. We are here to partner with you and your family for a lifetime of healthy eyes and vision. We look forward to seeing you!

Conjunctivitis, also called pink eye, is one of the most frequently seen eye diseases, especially in kids. It can be caused by viruses, bacteria or even allergies to pollen, chlorine in swimming pools, and ingredients in cosmetics, or other irritants, which touch the eyes. Some forms of conjunctivitis might be quite transmittable and quickly spread in school and at the office.

Conjunctivitis is seen when the conjunctiva, or thin transparent layer of tissue covering the white part of the eye, becomes inflamed. You can identify conjunctivitis if you notice eye redness, discharge, itching or swollen eyelids and a crusty discharge surrounding the eyes early in the day. Pink eye infections can be divided into three main types: viral, allergic and bacterial conjunctivitis.

The viral type is usually a result of a similar virus to that which produces the recognizable red, watery eyes, sore throat and runny nose of the common cold. The red, itchy, watery eyes caused by viral pink eye are likely to last from a week to two and then will clear up on their own. You may however, be able to reduce some of the discomfort by using soothing drops or compresses. Viral pink eye is transmittable until it is completely cleared up, so in the meantime maintain excellent hygiene, remove eye discharge and try to avoid using communal pillowcases or towels. If your son or daughter has viral conjunctivitis, he or she will have to be kept home from school for three days to a week until symptoms disappear.

A bacterial infection such as Staphylococcus or Streptococcus is usually treated with antibiotic eye drops or cream. One should notice an improvement within just a few days of antibiotic drops, but be sure to adhere to the full prescription dosage to prevent pink eye from recurring.

Allergic pink eye is not contagious. It is usually a result of a known allergy such as hay fever or pet allergies that sets off an allergic reaction in their eyes. First of all, to treat allergic pink eye, you should eliminate the irritant. Use cool compresses and artificial tears to relieve discomfort in mild cases. When the infection is more severe, your eye doctor might prescribe a medication such as an anti-inflammatory or antihistamine. In cases of chronic allergic pink eye, topical steroid eye drops could be used.

Pink eye should always be diagnosed by a qualified eye doctor in order to identify the type and best course of treatment. Never treat yourself! Keep in mind the sooner you begin treatment, the lower chance you have of giving pink eye to loved ones or prolonging your discomfort.

 

A recent study published in the journal of Forensic Sciences (2017) examined over 300 decorative, non corrective contact lenses obtained without a prescription. What they found was shocking:

• 60% of the counterfeit lenses tested positive for microbial contamination
• 27% of the unapproved lenses tested positive for microbial contamination
• 3% of authentic contact lenses were positive for microbial contamination
• 48% of the non prescribed brands tested had at least one nonsterile sample
• of the bacterial isolated both Bacillus cereus and Pseudomonas aeruginosa pose considerable health risk for ocular tissues and a common cause of microbial keratitis & corneal uclers

FDA requires prescriptions for all contact lens products and yet each year thousands of consumers obtain contact lenses through channels that evade regulatory authority. These contact lenses (often worn for cosmesis) have been shown to have up to 20 times higher levels of microbial contamination than those obtained through normal channels. In addition consumers who obtain these often do not have proper disinfection, proper monitoring and proper instruction on usage.

The bottom line is patients that purchase contact lenses that are counterfeit and unapproved are putting themselves at risk of ocular infections including microbial keratitis, conjunctivitis and possible blindness.

The organisms isolated were as follows: Pseudomonas, Strenotrophomonas, Bacillus Altitudinis, Bacillus thuringiensis, Enterobacter species, Klebsiella pneumoniae, Pseudomona monteilii, Micrococcus luteus, Herbaspirillum, Rhodococcus baikonurensis, Pseudomonas fluorescens A, Delftia acidovorans, Pseudomonas veronii, Achromobacter denitrificans, Elizabethkingia species, Bacillus fusiformis, Bacillus cereus, Bacillus simplex, Ochrobactrum anthropi, Rhizobium species, Brevendimonas, Spingopyxis terra, Aquabacterium Species.

Source: Land et al, J Forensic Sci, 2017 doi: 10.1111/1556-4029.13553 available online at: onlinelibrary.wiley.com

Starting August 21st at approximately 9:07am, maximizing at 10:24am and finishing at 11:48am a solar eclipse will occur. Here in the desert it won’t be a total eclipse but about 70% (69%)of the sun will be obscured. Because of the infrequency of this natural phenomena and because of the publicity involved it is important to be aware of the risk of solar retinopathy with improper viewing.

Solar Retinopathy:

Solar retinopathy (also known as, photic retinopathy, foveomacular retinitis,solarretinitis, and eclipse retinopathy) refers to a photochemical toxicity and resultant injury to retinal tissues, commonly occurring at the fovea where the eye’s sharpest vision is.

The initial exposure can present immediately following exposure or as increasing symptoms four to six weeks after the incident. The damage is done as an oxidative process at the level of the retinal pigment epithelium (RPE) and subsequently the outer retina.

There is currently no treatment for solar retinopathy. Patients present with blurry vision, central or para-central scotomas (vision loss) and photophobia (light sensitivity).

How this occurs:

The wavelengths of light that are most damaging are those that can pass through the cornea and lens. Those include the longer waves of the UV-A, the visible light and the near infra-red light. This high intensity radiation is absorbed by the pigment in the RPE layer and an oxidative process damages it. The layer above it called the outer retina is also damaged. Since the RPE layer is a support layer for the retina; long term damage comes from loss of this support layer.Typically damage to the outer retinal occurs immediately in more advanced cases and more slowly in less involved cases.

Prognosis:

Generally patients with solar retinopathy that present with 20/50 to 20/70 visual acuity have a better prognosis and those will less damage of the retinal pigment epithelium also have a better long term outcome. Vision can improve for up to a year although it’s not uncommon to have fairly normal vision with paracentral scotomas (small areas of vision loss). Chronic solar retinopathy occurs when vision progressively gets worse after one year.

The best treatment is avoidance:

To ensure a save viewing experience wear ISO (international Standards Association) 12312-2 certified eclipse glasses. In America there are 5 manufacturers. They are Rainbow, Symphony, American Paper Optics, Thousand Oaks Optical and TSE-17. The eclipse glasses will be marked to ensure safety.

• don’t wear if scratched
• don’t wear if warped
• don’t wear if they’re knock-off or not certified to ISO standards (these will be listed on the KMIR website)
• there will be no totality here in the desert so you cannot watch the eclipse without risk of damaging the eyes with no protection
• regular sunglasses do not offer protection. Eclipse glasses absorb up to 1000 times as much solar radiation

The last total eclipse visible in the US was in 1979. The next total eclipse visible in parts of the US will be April 8, 2024.

Sources:

timeanddate.com

Solar Retinopathy: Etiology, Diagnosis and Treatment, Chen et al, Retinal Physician October 1, 2013

2017 Solar Eclipse Public Service Announcement

Understanding Stroke Basics

Approximately 800,000 people suffer a stroke every year. It is the most common disability among adults. There are two basic types of strokes: an ischemic stroke (when a blood clot blocks a blood vessel) and hemorrhagic stroke (when a blood vessel ruptures or leaks). Some stroke patients have preceding symptoms called transient ischemic attacks (TIA) which are temporary interruptions of the blood supply to the brain. TIA’s are important as they can occur hours, days or even weeks before a full stroke. Symptoms may include temporary episodes of weakness, numbness, paralysis of the face, arm, leg (especially on one side), loss of balance and or co-ordination. Also included in this list is transient or permanent double vision, loss of visual field or improper eyelid closure.

Diplopia – double vision

Recent onset intermittent or persistent double vision is a common complication. It’s confusing for patients since adaptation by head turn or suppression has not yet occurred. To solve this problem a temporary prismatic correction (called a Fresnel lens) can be used or the patient can patch or occlude the eye with the limited gaze. Post stroke range of motion in the affected eye can be improved with exercise. Most cases of vertical double vision are only stable in one field of gaze and therefore even if a vertical prism correction is prescribed the patients need to perform a head tilt or learn to turn their head to the corrected orientation to avoid double vision. The majority of resolution of diplopia and adaptation occurs in the first 3 months therefore it’s important that patient seek care in that timeframe in order to avoid deeply imbedded suppression (the brain turning the image from one eye off)

In patients with neuro-related double vision damage to the brain pathways can occur and the best solution may be to alternately patch eyes.

Hemianopsia – loss of vision in one half the visual field

Behind the optic nerve the visual pathway is split with the left visual field going to one part of the brain and right visual field going to the other. Cerebral stroke most often involves loosing either the left or the right field (depending on where the stroke occurs). Recent onset hemianopsia field loss leaves a person disoriented and struggling to make it through daily living. They are often confused in busy visual environments such as a mall and they may bump into people or have the fear of falling off a curb. Usually the visual field loss is permanent so optical corrections try to compensate for the visual field loss. As a minimum two separate pairs of glasses are needed; one for distance and one for near. There are specifically designed lenses called SVAG (Side Vision Awareness Glasses) that expand the patients awareness of vision in the affected side.

Eyelid Paresis

Some patients develop ptosis (droopy eye) following stroke and blepharoparesis (the inability to close the eye). When this happens the cornea drys and can be damaged. To correct for this topical ointment, plugs and an eyelid weight are used to help close the eye and prevent damage. This often improves over time but not always and may require long term care.

Summary

Patients require specialized care following a stroke and can usually be helped. Often times a significant field loss can be present but the patient is unaware of this. Make sure a patient seeks care if they see double, have a droopy eyelid or problem closing the eye and if they report part of their field missing.

An allograft is a bone or tissue surgically transplanted from one human donor to another, which may sound frightening, but is actually safe and has been in use for quite some time. The most common tissues are amniotic tissues which are attained only during childbirth. The tissues are processed and preserved to maintain viability from the placenta of elective cesarean section after full-term pregnancy in medically cleared donors.

The amniotic membrane (or amnion) is the innermost layer of the placenta that lines the amniotic cavity. The membrane itself consists of a special combination of tissue layers, making amnion a unique membrane in the human body. These tissues are an abundant source of collagen, as well as other proteins and growth factors that are essential to support the body’s natural regenerative healing process as they promote epithelialization (the wound healing process). Amniotic tissues also facilitate epithelial cell migration, reinforce adhesion of basal epithelial cells, and prevent epithelial apoptosis (cell death). They are often described as “immune-privileged” because they rarely evoke an immune response in the human body.

Amniotic tissues are used for many eye conditions to reduce scarring and inflammation and to speed up healing. Below is a list of common ocular uses for amniotic allographs:

• Persistent corneal defects
• Corneal ulcers
• Ptyergium surgeries
• Conjunctival surface reconstruction
• Advanced dry eye and exposure keratitis
• Cicatricial entropion
• Chemical and thermal burns
• Neurotrophic corneal epithelial defects
• Stem cell deficient corneas
• Recurrent corneal erosion

Amniotic membrane works well as a bandage contact lens, allowing corneal epithelialization or healing beneath it. The specific proteins in the membrane also reduce scarring (a sight-saving benefit) in clear structures like the cornea.

Corneal allografts have been used for years to restore sight in patients with corneal disease such as keratoconus, herpetic eye disease or Fuchs’ dystrophy. New techniques allow more precise and controlled cell allograft so that only the unhealthy part of the cornea needs to be removed and replaced with a healthy allograft. Corneal allografts are obtained through deceased donors and tissue banks. Because of the importance of tissue matching (and supply and demand), the distribution is tightly controlled to ensure a fair and proper match.

 

Amniotic allografts are used for rapid recovery with minimal scarring; corneal allografts are used to replace damaged, scarred or diseased corneas. Thanks to modern laser technology, the host (patient) and allograft (corneal tissue to be transplanted) can be cut exactly to match minimizing or eliminating the need for aggressive suturing. This provides for improved optics and faster recovery following transplantation.

 

Dr. Evans is the founding owner of Evans Eye Care in Palm Desert and can be reached at (760) 674.8806 or online at www.evanseyecare.com.

During the past 20 years there have been numerous studies that show the contact lens

dropout rate is about 20%. The main reason in almost all studies is comfort which when studied further is mostly related to dryness. The incidence of dry eye increases with age in men and particularly in women. To help keep patients comfortable in lenses doctors first address the underlying dry eye. Regarding contact lenses there are newer options to help address the comfort/drying as well as improve visual outcomes. These can be broken down into subgroups as follows:

Material Changes

Silicone hydrogels: These lenses now account for more than 80% of new toric soft lenses prescribed. They are a popular option because silicone materials have been shown to decrease complications, such as hyperemia, dryness and discomfort. Silicone is naturally more oxygen permeable so these can prevent corneal neovascularization due to low oxygen at the cornea.

Non-Hema Materials: These lens materials although they are not standard soft nor silicone have improved wetting and less drying properties. A typical soft lens will dehydrate 6-8% during a normal 10 hour day. Newer materials loose only 2-3% of their typical hydration.

Modality

Changing from more prolonged wear to daily disposables creates less problem with accumulation of surface deposits. This enhances tear spreading over the corneal surface and improves wetability. It also reduces the risk of infection. Controlled studies have shown a high bacterial colonization rate in cases when ulcers and infectious keratitis is present. A daily replacement lens is not stored so it reduces the infection risk as well as reduces drying.

Expanded Parameters

Newer designs of lenses have a wider variety of both Multifocal (presbyopic) and astigmatism corrections. This shows maturity of the current market and an expansion of newer materials to better address both more difficult prescriptions or more specific tasks

Multifocal lenses which correct for astigmatism. In the past patient with astigmatism had little option but to wear reading glasses over their contact lenses. Today doctors have more freedom to incorporate both into a prescriptions.

Scleral lenses

With the advent of computerized lathing, newer rigid gas permeable materials and the knowledge gained through scanning laser topographers there has been a resurgence in the use of scleral lens designs. Scleral lenses have the advantage of vaulting the cornea. The lenses are much larger than standard soft or gas permeable lenses. This provides a tear film which in effect bathes the cornea in tears. That principal allows the lenses to be used for both diseased corneas such as dry eye, keratoconus and other specialty designs but also for regular astigmatism. Scleral lenses used to be quite uncomfortable but research on new designs have shown them to be comparable to soft lenses in comfort. The highly polished surfaces give more stable vision correction for patients with astigmatism.

Gas Permeable

Reverse Geometry lenses: These new lenses have oblate (thinking dipping down like a bowl) versus prolate (think curved like a cone) surfaces. They fit remarkably well for patients that have had corneal surgery such as lasik, Radial Keratotomy, and Photo-refractive keratotomy. In these cases the vision improvement can be quite remarkable as the lenses really replace small optic zones with larger improved optic zones.

Semi-scleral lenses: These lenses are bigger than normal gas permeable lenses but smaller than Scleral lenses. They correct really well for irregular corneal surfaces as well as edge to edge astigmatism. Like Scleral lenses they are also very comfortable.

With newer approaches and solutions contact lens wearers can successfully continue on much later in life and for more varied vision environments.

A recent study (November 2014) released by the Centers for Disease Control and Prevention showed in 2010 there were an estimated 988,000 visits to doctors’ offices, outpatient clinics, and emergency departments for keratitis and contact lens related eye conditions. The total cost was estimated to be $175 million. There was over 250,000 hours of clinician time spent seeing these patients for contact lens related microcrobial keratitis. They also estimated the cost of a doctor’s visit for keratitis is $151.00 on average; each emergency room visit costs an average of $587.00 Neither of these fees includes the cost of medications to treat the eye infections.

In the majority of cases (76%) an anti-microbial prescription was prescribed and by far the biggest single risk factor was contact lens wear.“Among the estimated 38 million contact lens wearers in the United States, poor storage case hygiene, infrequent storage case replacement, and overnight lens wear are established preventable risk factors for microbial keratitis, contact lens-related inflammation and other eye complications”

This study, if anything, under represents the incidence of infectious keratitis as it captured few optometric offices. Optometrists provide over 70% of eye care in America. The prescribed prescriptions recorded were only those covered by insurance not those filled by private pay. Lastly, visits for contact lens related corneal problems do not all involved microbial keratitis. Others may involve erosions, abrasions or foreign bodies.

To prevent complications patients should follow these recommendations:

Wash hands with soap and water and dry well before handling lensesRemove contact lenses nightly and before swimmingRub and rinse contacts in disinfecting solution each time removedReplace contact lens cases every monthRub and rinse the contact lens case with contact solution, dry the case and keep it upside down with the caps off dailyDo not “top off” solution in the lens caseReplace the lens on schedule (do not extend the recommended replacement schedule)Avoid sleeping in your contact lensHave backup glasses with a current prescription available

Remember, when an eye is sore, red, inflamed or irritated, remove the contact lenses, and see an eye doctor. Eye infections can cause permanent vision loss. The sooner treatment is started the faster the recovery and the better the outcome.