• Patients who already wear Transitions VI lenses, but are still bothered by glare.
• Patients who spend a lot of time outdoors.
• Patients who want crisper vision and better contrast outdoors.
• Patients who enjoy utilizing the latest technology.

Do these lenses take the place of my sunglasses?

No.  Vantage lenses do not fully darken in the car, behind the windshield.  Your sunglasses will perform better for that purpose.  Sunglasses are still your best bet for prolonged outdoor activities.  Keep in mind that you DO NOT want to wear regular ophthalmic frames with Transitions lenses when playing outdoor sports.  They are not designed to take impact like sports eye wear.

Can I get Transitions Vantage lenses for my prescription?

Vantage is available as of May 1st in grey in both polycarbonate and basic plastic materials.  Trivex and high index plastic will be available options in June 2012.  Single vision and progressive lenses are eligible for the technology. 

• A - Asymmetry.  Normal moles or freckles are typically symmetrical in appearance.  If you draw an imaginary line down the middle of the mole, both sides should be mirror images.
• B - Border.  The edges of a melanoma lesion can be scalloped or notched instead of smooth or even.
• C - Color.  If a freckle has multiple colors, and is not one uniform color, it is suspicious.
• D - Diameter.  Melanomas are usually larger than 1/4 inch in diameter.
• E - Evolving.  Any change in size, shape, color, or elevation is a warning.  Also, new crusting, itching or bleeding should be of concern.

• Wear sunglasses!  Most people avoid applying sunscreen on the eyelids or skin around the eyes due to potential irritation.  UV coated lenses with a large frame or wrapped design will give you the best protection.
• Wear a hat with a large brim to shade your face and eyes from the sun.
• Wear protective clothing, including long-sleeved shirts and long pants whenever possible.  Special clothing with built-in SPF is available for extra protection.
  
• Wear sunscreen.  You should apply SPF 15 with UVA/UVB coverage EVERY DAY.  For prolonged outdoor exposure, use SPF 30 or higher.  You will need to re-apply every 2 hours or after swimming.
  
• Avoid the sun between 10am and 4pm when the light is at its strongest.
• DO NOT use tanning beds!!!  According to the Skin Cancer Foundation, just 4 trips to the tanning salon per year increase your risk for melanoma by 11% and increase your risk for basal cell and squamous cell carcinoma by 15%!  If you want a sun-kissed glow, use self-tanning products.     

• corneal scratches (abrasions)
  
• inflammation of the iris (iritis or uveitis)
• bleeding in the anterior chamber of the eye
• traumatic cataract
• blow-out fracture of the bones lining the eye socket
• swollen retina
• bruising and/or cuts of the eyelid  (contusions and lacerations)

Prevent Blindness America states that 90% of eye injuries can be prevented with the proper eyewear.  Typically, polycarbonate lenses are used because they are up to 10 times stronger than traditional plastic.  They are also impact resistant and offer UV protection.  The type of frame you should purchase depends on the sport. 

What types of safety eyewear are recommended?

The American Society for Testing and Materials (ASTM) sets standards and makes recommendations for the proper safety eyewear for each sport. 

• Baseball/Softball - For batting, a helmet with attached face guard (ASTM Standard F910).  Fielding requires separate protection (ASTM Standard F803)
• Basketball - ASTM Standard F803 for Basketball
• Racquetball - ASTM Standard F803 for Racquetball
• Paintball - ASTM Standard F1776
  
• Football - Polycarbonate eye shield attached to helmet-mounted wire face mask

If you don't see your sport listed above, see the following link for a more extensive list:  www.aoa.org/x7679.xml

style="font-size: 13px;">Lastly, DO NOT let your child play sports in their prescription eye glasses.  They are not designed to protect your eyes from injury, and in many cases, they make injuries WORSE!

• 6 in 10 Americans believe that when left untreated, presbyopia leads to permanent blindness.
• 18% believe that taking vitamins can cure presbyopia
• 19% think that performing eye exercises can treat presbyopia

• The need to hold things further away from your face in order to see them  (Eye doctors refer to this as "Short Arm Syndrome".)
• The need for better lighting when reading
• Headaches or eyestrain with prolonged reading or computer work
• End-of-day fatigue
• BLURRED NEAR VISION!!!

What causes presbyopia? 

Many people mistakenly believe that the muscles that control focusing ability become weak with age.  With that logic, it is easy to understand why you might think that eye exercises would strengthen the muscles and restore focusing ability, right?  Unfortunately, the problem is not with the focusing muscles, but with the crystalline lens inside the eye.  The lens flexes and changes shape in order to focus from distance to near.  As children, our eyes could do this beautifully!  But, the crystalline lens grows like an onion over time, and it becomes so large that it is rigid and inflexible at a certain point (usually around age 40).  No amount of eye exercises (or vitamin supplements) can overcome this inflexibility. 

Our website's EyeMaginations page has a great overview of presbyopia.  After clicking the link below, select "I Agree", then click on the "Refractive Errors" icon and select "Presbyopia Description".

EyeMaginations Presbyopia Demonstration

What are the treatments for presbyopia?

• Reading glasses - Prescription reading glasses have better optical quality and are customized to your eyes as compared to one size fits all over-the-counter readers.  Both will be blurry when trying to look at distant objects, so you will have to remove them or slide them down your nose for that purpose.
  
• Progressive addition lenses (progressives) - These lenses offer clear distance, intermediate, and near vision.  Many patients prefer to wear them because you do not have to take them on and off.  They offer a more convenient option for vision correction.
• Contact lenses - Multifocal contact lenses provide an option for patients who want to limit the use of spectacles.  You can wear contact lenses that enable you to read items both near and at a distance.  Monovision is another, well-established method of contact lens use that utilizes one eye as the distance eye and one as the near eye.
  
• Clear lens exchange - This is a surgical option for correcting both near and distance vision.  It is the same procedure that is done to remove cataracts, but in this case, patients choose to have an implant for vision correction purposes.
  

The Bottom Line

Presbyopia is a completely normal part of the aging of the eye.  While it can be extremely frustrating, there are many options for correcting your near vision so that you maintain the use of your vision.  You can continue to enjoy everyday activities with proper correction.  Be sure to let me know what issues you are having with your vision so that I can make the right recommendations during your annual exam. 

• Drivers - eliminating glare from windshields and asphalt improves visibility.
• Fishermen - by eliminating the surface glare from water, polarized lenses help you to see well-below the surface.
• Marksmen - polarized lenses help to increase contrast between the target and background.
• Snow sports enthusiasts - snow is a highly reflective surface.
• Golfers - contrary to rumor that polarized lenses make it difficult to read the greens, they actually eliminate glare reflecting off the grass.  Some of the world's best golfers wear polarized lenses.  See the Kaenon Polarized blog:  blog.kaenon.com/category/golf-sports/
  
• Everyone - I personally would not wear a non-polarized pair of sunglasses, because I love the enhanced contrast and lack of glare that I get when I wear my polarized lenses.  

What color options are available in polarized lenses?

1. I have weekly or monthly disposable lenses, so I don't have to clean them.
2. It's okay to store your lenses in saline.
3. I use the "No Rub" solution, so I just put my lenses in the case overnight.
4. I don't rub my lenses until just before I insert them in the morning, after they've soaked overnight.
5. I use water to rinse my contact lenses.
6. I use Visine to rinse my lenses when I run out of solution.
7. Solution is expensive, so I just re-use what's already in my lens case.  Or, I add a little solution to what is already in there.
   

Why They're Wrong:

1. Just because you don't keep your lenses for a long period of time doesn't mean they don't develop build-up every time you wear them.  Your tear film contains protein, lipid, and other debris (make-up, allergens, and dirt that accumulate throughout the day).  All of that debris ends up on the surface of your contact lenses, causing blurred vision, discomfort, and the potential for inflammatory or infectious eye disease.  Of course, you have to clean your lenses!
2. I hear this more often than I would like.  Patients find that saline solution is much less expensive than Multipurpose Disinfecting Solution (MPDS), and they figure it is the same.  WRONG!  Saline solution is a fine rinsing agent.  It is great for gas permeable contact lens wearers in place of water, for example.  Saline DOES NOT clean or disinfect contact lenses.  If you use it in place of MPDS, you are wearing dirty lenses.
   
3. "No Rub" solutions are no longer available.  Why?  They don't work.  Check the label on your current bottle of MPDS.  The directions clearly state to rub your lenses on both sides, then rinse, then store them in fresh solution overnight.  Manually rubbing your lenses removes the build-up from the lens surface.  Once the lens is clean, it can be chemically disinfected by the MPDS overnight.  Check out the image below.   
4. MPDS systems are designed to work in a particular sequence.  The Rub & Rinse noted above is followed by overnight disinfection.  Many of the solutions available today are quite sophisticated.  They often incorporate moisturizing agents to improve lens comfort.  While the lenses are soaking and disinfecting overnight, the moisturizing agent is busy creating a layer of moisture around the contact lens.  When you rub your lenses after this process, you are effectively rubbing away the moisture.
   
5. NEVER, under any circumstances, rinse your contact lenses in water.  I'm talking to you, too, gas permeable wearers!  Soft contact lenses have never been approved for rinsing with water, and the newer gas permeable lenses are not designed for it, either.  Why?  Our drinking water contains parasites, bacteria, and harsh minerals that can contaminate and destroy delicate contact lens materials.  Not only will your lenses be cloudy and uncomfortable, but you can also develop nasty infections if you use water when cleaning, rinsing, or storing them.
6. Substituting Visine, or any other eye drop NOT designed for use with contact lenses can cause big problems.  Many of the drops that "get the red out" of your eyes can actually cause pupillary dilation if used in large doses (like what happens when you wear a lens that has soaked overnight in the stuff), so it can blur your vision and cause light sensitivity.  Also, many over-the-counter eye drops are loaded with preservatives that leach into the lenses, which can lead to corneal toxicity and contact lens irritation.   
7. Re-using or "topping-off" solution is what led to serious fungal eye infections with Renu MoistureLoc in 2006.  That particular product was subsequently pulled from the market, but it has since been determined that topping off solution led to fungal contamination of the contact lens case, and the lenses themselves.  A contact lens case is a moist, dark, warm environment that is friendly to fungi, bacteria, and other parasites.  The only way to make it a hostile environment is by the addition of chemical disinfecting agents (like the ones found in your MPDS).  They work very well in the short-term to kill bugs that want to grow in your contact lens case, but they become less effective over time.  The only way to ensure that your lenses aren't being contaminated is to dump out your used solution in the morning, rinse the case with MPDS, and let it air dry.  Place fresh solution in the case when you remove your contacts the next evening.

Age-related Macular Degeneration, or AMD, is a disease of the eye that results in central vision loss and distortion.  Sufferers do not lose peripheral vision, but they have difficulty with detailed vision.  In the worst cases, patients with AMD have total central vision loss.


What causes AMD?

The macula is the part of the retina that is responsible for our central vision.  In the most common form of macular degeneration, known as Dry AMD, deposits called drusen form in the macula.  The drusen interfere with the normal function of the photoreceptors (rods and cones) that help us interpret light images.  The macular tissue atrophies, or wears away, and it results in vision loss.

Approximately 10% of the time, Dry AMD progresses to Wet AMD.  Wet AMD is the more severe form of the disease.  Abnormal blood vessels grow under the macula and often leak.  Both the blood vessels and the fluid that leaks from them raise the delicate macular tissue and cause visual distortion.  The macula is quickly and more severely damaged when Wet AMD occurs.

We have a couple of great video clips on our website's EyeMaginations page.  Click on Macular Conditions to see both pictures of the disease and simulations of how AMD affects your sight.  www.arboreyecenter.com/Eyemaginations.html

What are the Risk Factors for AMD?

• Age - AMD is the leading cause of new cases of blindness in people over age 55.
• Race - Caucasians of European descent are 3 times more likely to develop AMD than other races.
• Gender - Females are at greater risk for developing the disease.
• Family History - Those with immediate family members who have AMD can be up to 50% more likely to develop the disease themselves. 
  
• Smoking - Take note that this is the only preventable risk factor for macular degeneration.  It can double your risk for developing AMD, and some scientists think it can actually cause AMD.

Are Treatments Available?

There are treatment options for Wet AMD.  They include: 

1. Injections - medications that block the formation of abnormal blood vessels are injected directly into the eye.  Frequent injections have been shown to improve vision for some patients and prevent further damage in others.
   
2. Photodynamic Therapy (PDT) - a drug which attaches itself to abnormal macular vessels is injected into your arm.  Once the drug reaches the eye, it is activated by a light shined into the eye.  This destroys the abnormal vessels and slows the progression of the disease.
3. Laser eye surgery - the high intensity of the laser destroys abnormal blood vessels.  It helps to slow the progression of the disease, but it can also damage normal retinal tissue and cause further vision loss.

There are currently no treatments available for advanced stages of Dry AMD.  This is unfortunate since it is the most common form of the disease.  There are, however, several clinical trials in progress which may lead to future treatments.  Also, the Age-Related Eye Disease Study, or AREDS, showed that taking a high dose of antioxidants and zinc can reduce the risk of those with moderate AMD from progressing to advanced AMD.  This can prevent the vision loss associated with advanced AMD.  The AREDS supplements include:  500 milligrams (mg) of vitamin C, 400 International Units (IU)of vitamin E, 15 mg of beta-carotene (equivalent to 25,000 IU's of vitamin A), 80 mg of zinc oxide, and two milligrams of cupric oxide.  ***It is important to note that smokers should avoid beta carotene due to an increased risk for lung cancer.

The Bottom Line

If you have any of the risk factors for AMD, you should have an annual eye exam, including dilation.  Retinal signs of AMD can be detected during that visit.  If you have early signs of AMD (not moderate or advanced), your eye doctor can recommend an eye supplement.  If you have moderate or advanced Dry AMD, the AREDS formulation is recommended.  If Wet AMD develops, you should be referred to a retina specialist who can provide you with one of the treatments mentioned above.  

"What if I don't have signs of AMD?"  Congratulations!  You can reduce your risk for developing it by:

• wearing sunglasses
• eating leafy, green vegetables
• NOT smoking!!!
• taking a supplement with lutein, zeaxanthin, and omega-3 fatty acids