Dry Eye Relief Reinforced

There are estimates of 16 million dry eye patients in the United States that report symptoms to eye care professionals.  For these patients, good news in the form of Xiidra could not have come sooner.  Manufactured by Shire, Xiidra, aka lifitigrast opthhalmic solution,  a lymphocyte function-associated antigen 1 antagonist, was approved by the FDA for dry eye disease, on July 11, 2016.  

This is exciting news in the world of dry eye treatment.  Since 2005 Restasis, aka cyclosporine ophthalmic emulsion, (Allergan) was the only prescription solution available in the US to our dry eye patients.  Twelve years in the making, Xiidra is a new alternative to patients sensitive to Restasis, and who do not get complete relief from punctal plugs or frequently used artificial tears and other lubricants.

The drug’s safety and efficacy were assessed in more than 2,500 patients in four separate, randomized controlled studies. The results of the studies found that patients treated with Xiidra demonstrated improvement in their signs and symptoms of dry eye compared with patients treated with placebo.

Since FDA approval I have seen patients benefiting from Xiidra use.  When used twice daily, relief is felt two weeks after medication is started.  The only side effect that has been reported by the studies and my patients is a transient metallic taste after the drop is placed in the eye.  This fades with time and is less notable after persistent medication use.  

I am excited to see my patients using Xiidra long term and fighting the chronic inflammatory nature of the dry eye disease.  Currently first month supply is provided for free by the manufacturer given doctor's prescription.  Ask our office about your dry eye relief.

Cataract surgery linked to reduced mortality by 30%

Researchers evaluated the association between cataract surgery and mortality in a 5% random sample of U.S. Medicare beneficiaries. Overall, those who had cataract surgery lived longer.

Data was collected over a 10-year period from a cohort of more than 1.5 million patients.  This is the largest study of its kind making the results more valid since the sample size was so high.  Patients who had cataract surgery had a nearly 30% less mortality compared with those who did not have cataract surgery.

The association between extended life span and cataract surgery was significant outside of differences in systemic health problems like hypertension, high cholesterol and diabetis.  The association was strongest in women, in 80 to 84 year olds, and in those living in Western states.

The authors of this study hypothesize that cataract surgery improves a patient’s ability to care for themselves and remain physically and socially active, thus prolonging their life.

New Glasses Promise a Solution to Color Blindness

About 10 per cent of the population is color blind and simply can't perceive as many colors as those with normal vision. There has never been any way to correct the condition but now, a U.S. company claims they have created glasses that can open up a world of color to users. But some eye experts remain skeptical. Color blindness, or colour vision deficiency, as doctors call it, is more than just a nuisance. Most with the condition can't distinguish red from green and have trouble with aspects of everyday life. They can't become pilots, firefighters, electricians, police officers or take part in several other professions. An estimated 2.6 million Canadians are color blind, most of them men, because of a missing or mutated gene on their X-chromosome. There are different forms of the condition, but most people with a moderate form of red/green color blindness can correctly identify just five crayons from a standard box of 24. Now, the inventors of a brand of glasses called EnChroma say they have found a fix that is helping to bring the color back into users' lives. The EnChroma glasses don't work for every form of color blindness; in fact the company says they are effective in approximately 80 per cent of cases. But they say their glasses make colors appear brighter and more saturated. Users report that they can distinguish certain colors faster and more accurately. The company says the solution was discovered accidentally, when glasses provided to surgeons to help them distinguish tissue from blood during laser surgery also seemed to fix color vision. Devyn Vasseur is color blind and says the first time he tried the EnChroma glasses, he couldn't believe his eyes. "I looked up and I was like, Wow. Experiencing all these colors as an adult for the first time is indescribable," he says. Thanks to a series of testimonial videos showing people trying on the glasses for the first time, sales have exploded for the glasses, which cost about $400 a pair. "This year alone, we have sold over 10,000 pairs of eyewear," says Donald McPherson, the co-founder of EnChroma. But some ophthalmologists are skeptical, including Dr. Sam Markowitz of the Canadian Ophthalmological Society and Toronto Western Hospital, who says other products claiming to fix color blindness have come and gone. He would like to see hard research that show the glasses actually increase the number of colors users can see. "I would prefer to see validated color testing," he said. EnChroma says it's planning to do that and is also expanding into contact lenses that color-correct too. For more information, please visit: http://www.ctvnews.ca/sci-tech/new-glasses-promise-a-solution-to-colour-blindness-1.2669188 

Be EYEware on Halloween night

 

While they may be the perfect finishing touch on a costume, non-prescription cosmetic contact lenses can wreak havoc on your vision. Below are four ways that over-the-counter decorative contact lenses can seriously harm your eyes:

Corneal abrasion

Over-the-counter lenses are not fitted and sized for the person wearing the contacts, so they can easily scrape the outer layer of the eye. The resulting corneal abrasions can cause redness, light sensitivity, discharge, pain, plus the feeling that something is lodged in the eye.

Corneal ulcer

Costume contact lenses can literally create an eye sore called a corneal ulcer, with symptoms similar to corneal abrasions. The ulcers sometimes appear as a white dot on the iris, the colored part of the eye, and may require treatment with medicated eye drops. When the ulcers heal, they can scar over and permanently and adversely affect vision.

 

Infection

 

Both corneal abrasions and ulcers create openings in the eye, making them more vulnerable to bacteria, viruses and amoebas. All of these organisms can cause serious eye infections known as keratitis. A 2011 study found that wearing cosmetic contact lenses increased the risk of keratitis by more than 16 times. Some infections, such as herpes simplex, can be recurring and difficult to eradicate, while a number of bacteria have become resistant to common antibiotic eye drops.  

 

Scarring

 

In the most extreme cases, complications from wearing costume contact lenses may end in blindness or require surgery. For instance, extensive scarring from an infection can distort the cornea or make it opaque, requiring a corneal transplant to restore vision. 

If You Use Your Computer or Mobile Device At Least 7 hours a Day, You Have Dry Eyes

MORE SCREEN TIME EQUALS DRY EYES

Office workers who spend long hours looking at computer screens have changes in their tear fluid similar to people with the disease known as dry eye, according to a study from Japan.

The protein MUC5AC, secreted by cells in the upper eyelid, makes up part of the normally occurring mucus layer, or “tear film,” that keeps the eye moist. But study participants with the most screen time had MUC5AC levels nearing those of people with diagnosed dry eye.  Dr. Uchino, an ophthalmologist at the School of Medicine at Keio University in Tokyo, told Reuters Health: “When we stare at computers, our blinking times decreased compared to reading a book at the table”.  People staring at screens also tend to open their eyelids wider than while doing other tasks, and the extra exposed surface area in addition to infrequent blinking can accelerate tear evaporation and is associated with dry eye disease, he said.

Dry eye may be chronic for some but can be managed with over the counter or prescription eye drops. 

Past research suggests that up to 5 million men and women over age 50 in the United States suffer from dry eye disease, the researchers write in their report. In Japan, tens of millions of people report some dry eye symptoms, often associated with computer work, they add.

 In the study above, 7 percent of men and 14 percent of women were diagnosed with ‘dry eye disease,’ meaning they reported symptoms of eye problems like irritation, burning or blurred vision and had poor quality or quantity of tear film, according to the tests.  Overall, participants looked at screens for work for just over 8 hours a day and had an average of about 6.8 nanograms of MUC5AC per milligram of protein in each eye.

However, people who worked with computer screens for more than 7 hours per day had an average of 5.9 ng/mg of MUC5AC, compared to 9.6 ng/mg for people who spent fewer than 5 hours daily with screens.  Similarly, people with definite dry eye disease had an average of 3.5 ng/mg of MUC5AC compared to 8.2 ng/mg for people without the disease.

“Mucin is one of the most important components of the tear film,” said Dr. Yuichi Hori, who was not a part of the new study. “Mucins (like MUC5AC) function to hold water on the ocular surface of the epithelia that synthesize them, hence, they are major players in maintenance of the tear film on the ocular surface,” Hori told Reuters Health by email.  Concentration of the protein was also lower for people with symptoms of eye strain than for people without symptoms, according to the results published in JAMA Ophthalmology.

HELP RELIEVE SYMPTOMS

People with dry eyes at work tend to be less productive and are more likely to be depressed, according to previous studies, Uchino said. Office workers who are worried about dry eye can make some simple changes to decrease their risk, Uchino said.“The exposed ocular surface area can be decreased by placing the terminal at a lower height, with the screen tilted upward,” Uchino said.

Doctors also recommend using a humidifier at the office and avoiding being in the direct path of the wind from an air conditioner, he said. “We advise the office workers suffering from ocular fatigue and dry eye symptoms that they should blink more frequently in an intended manner during (screen use), and that they should use artificial tears,” Hori said.

Adopted by Dr. Kurteeva from Reuters Health and  JAMA Ophthalmology, June 5, 2014.

Study: cataract patients who undergo surgery live longer

Study: cataract patients who undergo surgery live longer

A new study has found that people with cataract-related vision loss who undergo surgery for the condition have a 40% lower long-term mortality risk than those who opt not to have surgery, the American Academy of Ophthalmology (AAO) said in a press release about a recently published study in its journal.
Researchers evaluated a total of 354 cataract patients aged 49 years and older enrolled in the Blue Mountains Eye Study between 1997 and 2007. Some had undergone cataract surgery while others had not. Subjects were evaluated five and 10 years after baseline exams.
The association between correction of cataract-related visual impairment and reduced mortality risk is not clearly understood, but plausible factors may include improvements in physical and emotional well-being, optimism, greater confidence associated with independent living after vision improvement, as well as greater ability to comply with prescription medications, AAO said. The study acknowledged that participants with cataract-related visual impairment who did not have cataract surgery could have had other health problems preventing them from undergoing surgery, and that these other health problems could partly explain the poorer survival among non-surgical participants.

My practice focuses on diagnosis, evaluation and treatment of cataracts.  If you or your family member need an evaluation, feel free to call our office and schedule a consultation at (949) 650-1863.

Kids! Get outdoors and get rid of glasses!

There has been additional evidence that the more time children spend outside the better chance they have to stay out of glasses.  Majority of school age children need to wear glasses to correct nearsightedness or myopia.  Myopia gets worse during the teenage growth spurt.  It is imperative for elementary school children to have at least an hour of outdoor playtime.  A review of scientific literature found a significant protective association between increasing time spent outdoors and prevalent myopia in nearly 10 000 children and adolescents aged ≤20 years.  Each increase in hours per week of time spent outdoors was associated with a 2% reduced odds of myopia (nearsightedness).  An increase in 7 hours of time spent outdoors per week (1 hr/d) equates to less nearsightedness.

 There are a myriad of possible mechanisms by which spending time outdoors may protect against the development and progression of myopia (nearsightedness). They include increased release of retinal dopamine in response to sunlight (dopamine inhibits axial elongation in experimental myopia,and the protective effect can be blocked by the dopamine antagonist spiperone), increased light intensity outdoors (leading to pupil constriction, increasing depth of focus, decreasing blur, and slowing of eye growth), and the low accommodative demand (focusing) for distance vision. 

Bright light has been shown to be protective of myopia in animal experiments using ultraviolet-free light.  Based on that evidence, one might support an old myth not to read in poorly lit rooms.  More focusing power is required to read in poorly lit rooms and it is the focusing muscle (ciliary body) if placed in overdrive will lead to development of nearsightedness.

Because there is no protective association between indoor sports and myopia, unlike outdoor sports, it suggests that physical activity may be a surrogate for outdoor activity. This is supported by a cohort study with 2 years of follow-up in 156 university students where physical activity time was higher in nonmyopes and associated with hyperopic refraction (0.175 D per hour of physical activity per day; P = 0.015) after adjustment for potential confounders, although there were no differences in objectively measured physical fitness levels between myopes and nonmyopes (P = 0.321).

Get your kids outside and take advantage of the great summer weather!  Just don't forget the sunglasses!