We left off with our story with…

…63 year-old gelatin sitting in its clear-plastic-lined glass bowl.

The years have gone by and slowly transformed this once great, jiggling substance into something – a little more complicated.

(You could always accelerate the process by breaking the bowl (blunt trauma) or with the rare surgical complication).

What we would see in this now vintage gel are little pools of liquid suspended and surrounded by what’s left of the intact gelatin.

This creates a major shift (increase) in the overall tension inside the bowl – and perhaps this story.

A lot of us have floaters.

Indeed, some of us develop deep, intense, border-line-passionate relationships with these little strings, loops, spiders, specks, etc. that float around in our visual fields.

While I enjoy a good history, I am most interested in your brand new flashes, floaters, and/or any weird stuff you see in your visual field.

Brand new floaters can mean a bunch of different things – ranging from the blinding to the benign — though not in that particular order.

Floaters and their associated phenomenon...

(spots, lights, waves, lightening flashes, pin points, dots, spider-webby looking, circular string-like things that float around and sometimes appear to be little animals flying around that are not actually there)…

…are NEVER painful…

Which means that when they appear, it is more likely that the average bear will just sit on it.

I know that sounds hard to believe.

Who in their right mind would/could ignore the fly that isn’t really there, but won’t go away – for months!??

And yes, most of us see “stuff” floating around in our vision from time to time. Usually shadows of particles inside the eye or in our tears.

Most of that kind of debris is normal and intermittent. And the visual system is adept at adapting.

Floaters and flashes are all about the vitreous – and/or the retina.

——

So we have the vitreous in a new state of tension.

This tension causes the whole complex to enter a process of slow (or potentially sudden) collapse.

Gradually or again, suddenly, the gelatin detaches from the sides of the bowl.

It can happen all at once or only in small or medium sections.

Most of the time this (gradual or sudden) separation does not take the “plastic lining” with it. In other words, usually the vitreous will separate “cleanly” from the retina.

To have the retina “go along for the ride” requires really bad luck.

(Occasionally, depending on where the vitreous separation occurs, the overall tension will wrinkle the macula very slightly – causing distortion in vision. But that is less common).

In the “clean type” of separation or pure vitreous detachment/separation, many see and report the sudden onset of floaters and/or light flashes.

In the “bad-luck-version”, where the retina rips, tears or detaches, many see and report the sudden onset of floaters and/or light flashes…

There in lies the dilemma.

Same symptoms, yet totally different on the “worry-scale”.

Vitreous detachments or separations are:

Common,

Generally benign,

And they settle down over time.

We just watch things carefully in the short-term because we know that the process occurs over a few months.

Normally floaters will gradually settle into the bottom of the eye ball, and out of the visual access after about 8-12 months.

The bad luck scenarios (Retinal breaks, tears, or detachments) are rare, but much more ominous and sight threatening.

When we find one of these, it will usually gets you an immediate appointment with the retina surgeon.

How do we find them?

We dilate the pupils and examine the retina carefully. Often, I can actually to see what you are seeing!

Retinal breaks, holes, and tears are hard to miss.

And occasionally I find holes and/or small breaks on routine exam – absent any symptoms!

Basically, the faster we identify what it is — the faster we can get you where you need to be.

But speed can mean the difference between a little painless laser treatment and full-blown visit to the OR.

If it happens to you:

Don’t panic

Call the office or email me,

Dr. L

PS. Here’s a short video about the anatomy.

The following are answers to a few questions I received from a patient about UV.

Regarding UV and cataracts…How much more of problem is it at 6,000′ Tahoe, 9,000′ Tuolumne Meadows, or 14,000′ Mt. Whitney?

First off, lets talk briefly about the The Eye Problems Associated With UV and HEV

NOTE: HEV = High-energy visible (HEV) radiation, or blue light. Although HEV rays have longer wavelengths (400–500 nm) and lower energy than UV rays, they penetrate deeply into the eye and can cause retinal damage.

Various eye problems have been associated with overexposure to UV radiation. As an example, UVB rays are thought to help cause pingueculae and pterygia. These growths on the eye’s surface can become unsightly and cause corneal problems as well as distorted vision.

In high short-term doses, UVB rays also can cause “Snow blindness” or photokeratitis, a painful inflammation of the cornea. Severe photokeratitis, can cause temporary vision loss usually lasting 24-48 hours. The risk for snow blindness is greatest at high altitudes, but it can occur anywhere there is snow if you don’t protect your eyes with UV-blocking sunglasses.

Because the cornea seems to absorb 100 percent of UVB rays, this type of UV is unlikely to be the culprit in cataracts and macular degeneration, which instead are linked to UVA exposure.

(BTW: UVC rays are totally absorbed by the Earth’s ozone layer, so not an issue here – yet).

According to a European study published in the October 2008 issue of Archives of Ophthalmology, HEV radiation — is associated with the development of macular degeneration.

Risks of eye damage from UV and HEV exposure change from day to day and depend on a number of factors, including:

• Geographic location: UV levels are greater in tropical areas near the earth’s equator. The farther you are from the equator, the smaller your risk.
• Altitude: UV levels are greater at higher altitudes.
• Time of day: UV and HEV levels are greater when the sun is high in the sky, typically from 10 a.m. to 2 p.m.
• Medications: Certain medications, such as tetracycline, sulfa drugs, birth control pills, diuretics and tranquilizers, can increase your body’s sensitivity to UV and HEV radiation.
• Setting: UV and HEV levels are greater in wide open spaces, especially when highly reflective surfaces are present, like snow and sand.

Which leads perfectly well into the next question:

Is there more UV reflected from snow and water?

UV exposure can nearly double when UV rays are reflected from the snow. See above regarding “Snow Blindness”.

And there is less risk of UV exposure in urban settings, where tall buildings shade the streets.

Surprisingly, cloud cover doesn’t affect UV levels significantly. Your risk of UV exposure can be quite high even on hazy or overcast days. This is because UV is invisible radiation, not visible light, and can penetrate clouds.

We were hiking in the snow at about 10,000′ yesterday. We had dark glasses. How about the dog, he
wouldn’t wear shades?!

Unfortunately, the same applies to dogs.  While canines and most mammals don’t have well developed maculas – their risk for macular degeneration is…well…low.

But these creatures definitely get cataracts and as you can imagine, many pet owners opt to have these lenses emoved.

Perhaps, the more forward thinking pet owners out there will seek the services of places like the this:

For years, boaters, fishermen, and skiers have used polarized sunglasses to reduce reflected glare from the water surrounding them.

But now that many others who spend time outdoors have discovered the benefits of polarized lenses, the popularity of these types of sunglasses has soared.

How Do Polarized Lenses Work?

Light reflected from surfaces like a flat road or smooth water is generally horizontally polarized. This horizontally polarized light is blocked by the vertically oriented polarizers in the lenses.

This results in a reduction in annoying and sometimes dangerous glare.

For the 3D effect, one lens has polarizers in one direction, while the other polarizes light from the opposite direction.

For more on this, click here.

Hi Folks,

This came from last week’s email broadcast.

The research says that antioxidants reduce your risk of cataracts and macular degeneration.

Specific antioxidants can have additional benefits:

Vitamin A protects against blindness.

Vitamin C may play a role in preventing or alleviating glaucoma.

As many of you know (because I often recommend it!), essential fatty acids appear to help the eye in a variety of ways, from dry eye relief to guarding against macular damage. Not to mention that most people report softer skin and thicker hair/nails.

These foods pretty much guarantee you get enough eye-protecting nutrients:

* Vitamin A: cod liver oil, liver, carrots, sweet potatoes, butternut squash.
* Lutein and zeaxanthin: spinach, kale, collard greens.
* Vitamin C: sweet peppers (red or green), kale, strawberries, broccoli, oranges, cantaloupe.
* Bioflavonoids: citrus fruits, cherries, grapes, plums.
* Vitamin E: sunflower seeds, almonds, hazelnuts.
* Selenium: brazil nuts, yeast, seafood.
* Zinc: oysters, hamburgers, wheat, nuts.
* Fatty acids: cold-water fish (salmon, mackerel, trout, and sardines – yum!!).

In general, you should eat plenty of green, leafy vegetables, two servings of fish per week, some nuts and some yellow or orange fruits and vegetables.

Oh, and the ‘Carb’ thing?

In 2007, study findings suggested that eating too many “bad carbs” such as refined white flour may increase your risk of developing macular degeneration. The idea is that blood sugar spikes caused by such high-glycemic-index-carbs could negatively affect the eyes.

Researchers suggested that people instead consume healthier carbs, such as whole grains, high-fiber fruits and vegetables.

So there you go…

Best regards,

Dr. Lewis

I’ve been on a long search for a reliable in-house, contact lens ordering system to make life easier for you.

I wanted convenience, security, and ease of use so that you get all the benefits of ordering online – including price.

But also the peace of mind from knowing that we are behind each and every order.

Here’s a fully functional sneak preview…its not fancy, but it works.

Use this link to get started now:

https://secure.yourlens.com/web/backdoor.asp?DID=11624

Here’s what we have so far…

When its time to order (or reorder) your disposable lens supply, go to our website, log-in (or create) your account – and just follow the instructions from there (or watch the video).

(Note: If we’ve ordered or shipped to you before – you may find that your information is already there – safe and secure). As it turns out, I went shopping around for a system only to return to a company we’d been using all the time. This is a breakdown of what you get:

No hassling with strangers.

Again, we needed to make sure that we had a system that was safe and secure.


After all, its a big online universe out there.

And by the way, this practically eliminates prescription verification because we do it for you.

Did I mention price?

This system allows us to match the prices of the leading and most popular online retailers.

And you still have access to all the usual manufacturer rebates.

That’s right, competitive pricing, the advantages of online ordering without service headaches.

Plus, you can sign up for auto-ship, and lock-in pricing until your prescription expires.

To get started all you need to do is go to this link and remember to
CALL US if you have any questions.

 https://secure.yourlens.com/web/backdoor.asp?DID=11624

Dr. Lewis » Continue reading “Contact Lens Ordering Made Simple”

Macular degeneration, often called AMD or ARMD (age-related macular degeneration), is the leading cause of vision loss and blindness in Americans aged 65 and older.

AMD is a degeneration of the macula, central part of the retina responsible for the sharp vision needed to read or drive.

It is estimated that 2 million americans had advanced age-related macular degeneration. That number is expected to rise to almost 3 million by 2020.

Macular degeneration is diagnosed as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area where they are not supposed to be.

The dry form is more common than the wet, with about 85-90 percent of AMD patients diagnosed with dry AMD. The wet form of the disease usually leads to more serious vision loss.

Dry AMD is an early stage of the disease and may result from the aging and thinning of the macula, depositing of pigment in the macula or a combination of the two processes.

Gradual central vision loss may occur with dry macular degeneration but is not nearly as severe as wet AMD symptoms.

No FDA-approved treatment or prevention has been available for dry macular degeneration. until now:

http://www.boston.com/news/health/blog/2009/02/vitamin_b_folic.html

Wet Macular Degeneration (neovascular). In about 10 percent of cases, dry AMD progresses to the more advanced and damaging form of the eye disease. With wet macular degeneration, new blood vessels grow (neovascularization) beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive retinal cells, which die off and create blind spots in central vision.

We often detect early signs of macular degeneration before symptoms occur – usually accomplished through a retinal exam.

The American Academy of Ophthalmology notes that findings regarding AMD and risk factors have been contradictory, depending on the study. The only risk factors consistently found in studies to be associated with the eye disease are aging and smoking.