I can't imagine the crickets that Huffington Post writer Amanda Chan must have faced when she pitched her recent article idea concerning contact lens safety to her editors.  Contact lens wearers are a notoriously tough crowd -- most people have a hard time listening to their doctor for advice on their contact lens wear, much less an article in a newspaper.  That's why I applaud the efforts of her article, What Every Contact Lens Wearer Needs to Know (But is Afraid to Ask), for asking contact lens wearers to question the safety of their daily practices.

Large Corneal Scar from contact lens complications.  This person will never see clearly again! Via

If you are a blog regular, you know that I can get on a major soap box about contact lens compliance.  But that is only because as an optometrist, I am constantly seeing the side effects that contact lens wear can cause.  Contact lens wear can cause permanent scar tissue, and in some cases permanent blindness!  Yet, most of us admit to treating contact lenses carelessly.

How many times in this past year have you stretched the wear time of your contact lens by a few days or weeks (if you say months, really be still my heart!).

How many times did you put the contact lens in your mouth to rehydrate it or run it under tap water?

How many times did you sleep in your lens when you know that you don't wear a lens approved for overnight wear?

And how many times did you toss your lenses into a case of multi-purpose contact lens solution without emptying the case from the night before, or even put them in fresh solution but without rubbing the lens or cleaning it in any way before tossing it in?

And we wonder why there is a 12.5 x greater risk of infection when you wear multiple-wear contact lenses when compared to the industry safety leader, daily disposable options?

I love daily disposable contact lenses because all of those major risk activities we just mentioned are negated when you wear the super-hydrated daily wear options.  No nightly wear needed--you just toss the lens in the trash (or on your nightstand for the next morning's trash) and pop in a fresh pair in the morning.  No cleaning; no risk of overwear.  It is just so easy.  But dailies only make up about 17 percent of American contact lens sales (compared to nearly 40% globally).  So if you don't wear daily lenses, make sure you are taking the steps necessary to keep your eyes healthy for years to come.  One infection can mean you can never wear contact lenses, or have quality vision!, ever again if the infection occurs in the wrong place on your cornea.  Is it really worth the risk of blindness?

Key take homes from my experience (and perfectly outlined by aforementioned article):

• Know your contact lenses.  Know how often you need to throw them away and if they are approved for overnight wear; and then follow the guidelines.  The FDA tests these lenses to get these guidelines; your doctor doesn't make them up!  But in some cases, your doctor may tell you that with your particular eyes, a certain lens is not safe for you and you may have even stricter contact lens wear guidelines.
• Know your solutions.  If you are using a "no-rub" solution, it doesn't mean that you just toss your lens in a case.  You have to read the fine-print!  A no-rub solution means you have to "power wash" your contact lens with a stream of fresh solution for 30 seconds before putting in the case with fresh solution.  If you properly are using a no-rub solution, you should use up an entire bottle within 2-3 weeks.  Best just to rub, right?
• Know how old your case is.  My oh my, have I seen some terrible looking cases.  Cases are petri dishes of bacteria-broth, and if you can actually see dirt on your case, don't put your contact lens in there.  It's a no-brainer.  I strongly recommend the every 3 month disposal of your case rule that Dr. Thau and Dr. Taylor describe in the article.

I'm a little late with my fashion week post, but better late than never.  Here's a glimpse of the eyewear top designers sent down the runway:

Just Cavalli goes futuristic in Milan.  Mirrored sunglasses continued to be a popular trend for designers.

Louis Vuitton frames with widened bridge evoke a sports goggle aesthetic.  It's hard to imagine these being popular mainstream, but definitely breaks the norm!

Burberry Prorsum in London.  While this frame shape can be challenging to wear, the graphic juxtaposition of white frame and dark lens is a definite bold statement.

Charlotte Ronson rehashes the geek chic look - oversize frames re-envisioned in clear plastics.  To me, this takes the trend way over the top, but that's what fashion week is all about.

Marc Jacobs sunglasses in dark plum, giving a harder to edge to the familiar round shape from last season that was seen more frequently in pastels.  I can imagine these darker jewel tones faring well on the market after we were bombarded with pastels and neons for the past few seasons.

Via

The medical landscape is constantly changing, and eye care providers have a new medication in their arsenal to fight glaucoma with the introduction of Simbrinza (Alcon).  Want a refresher on glaucoma? Simbrinza is a combination drop containing the carbonic anhydrase inhibitor brinzolamide with the alpha 2 adrenergic agonist brimonidine.  These medications individually have been used in glaucoma treatment for years, and with a combination of the two, the hope is that a patient will get the combined method-of-action effects of these two drugs with a lower frequency of daily dosing.

What You Need to Know:

Early FDA studies show Simbrinza to have a high efficacy in the lowering of IOP (intraocular pressure) with a reported 21-35% reduction.  The recommended dosage is 3 x a day for maximum effect.  Not surprisingly, side effects and contraindications are indicative of what we would find with each individual drug:

Most common side effects: blurred vision, eye irritation, unpleasant taste, dry mouth, and eye allergy

Price:  Around $100/ bottle for cash pay patients; coupon cards available through Alcon
      -- At this time I do not know the average copay with medical insurance to expect, but I will try to update this when I receive the information!

When Not to Use:

Like all CAIs, Simbrinza is not recommended for patients with known sulfa allergies, significant corneal endothelial loss (it can result in corneal edema in patients with conditions like Fuch's Dystrophy), or in conjunction with oral CAIs.

Like all alpha 2 adrenergic agonists, there is a risk of hypotension when combined with anti-hypertensives, an increased risk of side-effects when taken concurrently with MAO Inhibitors, and lethargy in children under 6 years of age (in as high as 50-83% of pediatric glaucoma patients! -- most specialists highly advise against pediatric dosing of this drug as a result).

The drug is Pregnancy Class C, meaning it is not advisable unless the benefits outweigh the potential risks.

Why This is Exciting News for our Industry

Any time we get new glaucoma medication, it is a step in the right direction.  Even though this particular drug only combines two existing therapies, combination drugs already on the market are so effective because they require less dosage for patients.  Imagine you were taking brimonidine and a CAI individually.  You have 2 different bottles to buy every month and as many as 6 drops to instill a day (up to 3 x a day each).  Then imagine getting just 1 bottle to keep track of for the month, and dosing half as often.  It may not seem like much of a difference, but studies routinely show that poor drop compliance is a huge reason glaucoma patients suffer progressive damage.  Glaucoma is a painless and symptomless disease, and remembering to put 6 drops in a day is probably not going to happen unless you are the most vigilant of patients.  By making your patient's drops easier to remember to take, and less of a drain on their day, you can make it easier for them to keep their pressure controlled every day of the year!

As an optometrist, I test children for color blindness on a routine basis, but many adults come in asking me if they might have a color vision problem too.   Have you ever wondered if your color vision is up to snuff?  No surprise, but there is an app for that.  

This well-done image tries to depict what a color blind person would see on a Ishihara Color Blindness test Protanope = no red receptors, Deuteranope - no green, and Tritanope = no blue via

Optometry jokes are the best

"There's a freckle in my eye!?"

A small choroidal nevus can be seen inferiorly in this photograph (it looks like a grey-green circle)

That's usually the response to seeing a retinal photograph that contains a freckle or choroidal nevus (as it is formally called).  With today's excellent imaging software, small freckles inside the ocular tissue are easier and easier to detect.  So if you have a nevus, what does this freckle mean to you?

Normal, benign choroidal nevi occur in as much as 7.9% of the population (though with new technology we may find this incidence is a little higher since it is easier than ever to spot faint, small nevi).  Melanoma inside the eye, conversely, are exceedingly rare, with only 6 in 1 million incidence rate. In neither a melanoma or a normal nevus will there be any visual effect (unless the melanoma is significantly advanced), so your doctor will only detect these lesions through dilation or retinal photography.  Just like any freckle, the most important thing you can do is protect it from UV exposure.   A normal freckle can turn into a malignant melanoma under certain conditions, and this malignant change has an incidence rate of 1 in over 8,000 freckles.  While exceedingly rare based on these numbers, it is best to protect yourself.  I always recommend sunglasses with 100% UV protection, but it is an absolute must for my patients with ocular nevi!

Can you find all the nevi in this person's retinal photo?  Hint (there are a total of 3).

What do I look for in detecting suspicious freckles?  Growth from year to year is a big risk factor, so I use retinal photographs to find any small changes in size or shape from year to year.  A freckle that is 3 x larger than the optic nerve is highly suspicious.  I also look for changes in thickness (if the blood vessels run over top of the freckle without changing their path, the freckle is flat!), coloration, and position inside the eye.  Freckles that are closer to the optic nerve are in a higher suspicion category.  Your nerve is the eye's highway to the brain, so we don't want any malignant changes occurring so close to this pathway.

Always remember, most of the internal ocular findings that your doctor evaluates at your annual eye examination have no real consequence to vision, so you wouldn't know anything was changing inside your eye just by judging vision alone.  Always best to get your eye evaluated regularly even if you don't need glasses or contact lenses!