Insights with Dr. C  

    Welcome to Insights with Dr. C.  Dr. Scott Caughell publishes a bi-monthly eye care column in the Times-Union newspaper which addresses common question related to taking care of your eyesight.

    Look for the column in the weekend edition of the Times-Union.  Submit questions to drc@warsawfamilyeyecare.com

    Below is an archive of previous topics that have been covered.  Scroll down to see the topics below.

1. #1 Introduction
2. #2 When should my child have his/her first eye exam?
3. #3 What is glaucoma and should I be worried about it?
4. #4  What should I do if I get a red or painful eye?
5. #5 Dry Eye
6. #6 Medical and Vision Insurance
7. #7 Computer Use and Your Eyes
8. #8 Tips for healthy eyes in the New Year
9. #9 Diabetes and the Eye
10. #10 Aren’t All Eyeglass Lenses Basically the Same?
11. #11 Progressive (no-line) Bifocals
12. #12 Have you considered contact lenses for your specific needs and lifestyle?

13. #13 Signs of Spring: Itchy Eyes and Sunglasses

14. #14 Why should I get my eyes dilated?

15. #15 Warning Signs for your Child’s Eyes

16. #16 What exactly is a Doctor of Optometry?

17. #17 Eyes, Children, and School

18. #18 Eye Quiz - Test your Eye-Q

19. #19 Eyes Ready for the Warm Weather?

20. #20 Eyes, Children, and School

21. #21 Eye Care Value in this Economy

22. #22 I Have a Cataract, Now What?

23. #23 Eye Strain, Tired Eyes, and Headaches

24. #24 Don’t take Floaters too lightly

25. #25 Using Medicare and Medical Insurance to Pay for Eye Exams

   Issue #1: Introduction

Welcome to the first INSIGHTS with Dr. C!  In this new column to the Times-Union, we hope to address some common questions and misconceptions related to the care of your most precious sense: your eyes.  There is no doubt that we are a visually dominated society and it is our goal to help you protect and best utilize what God has so wonderfully created.  Look forward to hearing from us at least twice a month.

First off it is important to realize that VISION is much more than seeing a small line on an eye chart.  Vision, which begins at the front of our eyes with our tear film and ends at the back of our brain, is an incredibly complex process.  It is my belief that the eye care professions have done a terrible job of educating the public about the importance of thorough eye exams and how poor visual function can impact our lives in more ways than one. 

Now I’d like to take a quick moment to preview a small sample of topics that will be covered in the future.  This will include when a child should have their first eye exam (hint: it starts at 6 months old!), children and learning, vision therapy, glaucoma and its treatments, the infantSEE program, why we dilate your eyes, what to do with red or infected eyes, why a contact lens wearer needs annual exams, reasons for buying quality frames and lenses (they are a medical device), diabetes and the eye, and other fun topics.  Other questions that will be addressed in the future can be asked by you, our readers, by emailing Dr. Caughell at drc@warsawfamilyeyecare.com.

Lastly:  The topics and advice offered in this column should not replace frequent examinations with your eye care professional.  If you have any recent onset of visual problems please see your eye doctor!  See you next time.    – Dr. C

   A quick word about the author: Dr. Scott Caughell. 

Dr. Caughell joined the practice of Dr. Tabitha Temple, optometrist, in July of 2007.  He has relocated to Warsaw and works at the office full time.  Dr. Caughell’s training is somewhat unique as he is one of only a few fellowship trained optometrists specializing in pediatrics and binocular vision.  This extra training took place after he graduated from Indiana University School of Optometry, earning his Doctor of Optometry with high honors.  During the fellowship he gained unique experience in advanced pediatric eye care and adult binocular vision.  This includes experience in pediatric eye diseases, lazy eyes/eye turns, binocular vision, double vision, post stroke care in adults, vision related learning difficulties, vision therapy, headaches, sports vision and more.  This is not to discount that he is fully trained in primary eye care and eye disease.   Please see the website at www.warsawfamilyeyecare .com for more information on Dr. Caughell and his colleagues at Dr. Temple’s office.

 Issue #2: When should my child have his/her first eye exam?

When should a child have their first eye exam and what are you looking for? 

As an eye doctor with specialized training in children’s vision I have been asked this question quite a few times.  I think the answer will shock quite a few parents and guardians.  It is also important to note that children’s eye exams should include a few extra tests not usually preformed with adults.  

 Unfortunately, since kids don’t know what is abnormal (for example if they have always seen blurry up close they will assume that is normal) they often will not tell parents that they are having vision problems.  Often I see parents experience feelings of guilt since their child’s eye problems could have been treated more easily if they were caught at a younger age.   Then I get the famous question, “So when should I have had Jimmy’s eyes checked?”

The official answer from the American Optometric Association is at 6 months old!  Yes, you heard it right, 6 months.  They also recommend exams at 3 and 5 years old and throughout school. 

Contrary to popular belief, a child does not need to be able to read letters to have a thorough eye exam.  I have in fact prescribed glasses to a 4 month old infant with amazing results.  The infant was not meeting developmental milestones, but soon after her large farsightedness was corrected she almost immediately got back on track.  Needless to say, mom was extremely happy!

During an infant exam we check the baby’s ability to see in a number of ways, look for eye turns, check their prescription, look for differences between the eyes that could cause a “lazy eye” in the future, and dilate the eyes to look for eye diseases such as tumors and inherited diseases.  It truly is a full eye exam.

A complete visual exam is also very important for school success.  The numbers are staggering.  Consider these facts:  learning is 80% visual, over 1 in 20 children have an eye problem that can not be seen on an eye chart screening, eye problems can cause symptoms similar to ADD/ADHD and learning disabilities, and is one of the main causes of headaches in children.  Please note that school screenings, while very important, cannot take the place of a full eye exam.  This is one of the main reasons that the state of Kentucky (and now Illinois) requires a full eye exam by an eye doctor before starting school.  I have seen children fall behind in school, get labeled learning disabled and undergo thousands of dollars of tutoring only to later discover it was a treatable eye problem the whole time.

No matter what eye doctor you choose for you child’s exam, the exam should always include tests of eye focusing, “eye teaming”, eye muscle testing, depth perception, and dilation of the pupils with eye drops to check the health of the eyes.  See our website for some recent stories that have been published by familiar authors at warsawfamilyeyecare.com. 

Now that you have all of the books and new clothes bought, you may think that your child is ready to learn.  My question to you is…are your child’s eyes ready to learn?  

Until next time….Dr. C.

Issue #3   What is glaucoma and should I be worried about it?

This is a common eye disease that usually generates a lot of questions.  The problem with glaucoma is that you may have it for years and not even know it.  It is currently estimated that well over a million Americans are living with undiagnosed glaucoma and it’s the second leading cause of irreversible blindness in the United States.  The term “silent thief” or similar phrases have been used to describe this disease and its slow onset.

Most people don’t notice glaucoma right away because it slowly takes away your side or “peripheral” vision.  For example, since most of us use 2 eyes you might not know that small changes are occurring to one or both of your eyes.  The reason regular eye exams are important is that they can discover early changes before vision is lost. Once you lose vision you cannot get it back.  The silver lining to this dreary cloud is that there has been great progress in treating glaucoma, especially if it is caught early.  In most cases, your eye doctor can prescribe eye drops to slow down or stop the progression of the disease.  Again, early detection is the key to treating glaucoma.

What causes glaucoma?  There are many different causes of glaucoma.  The most common is primary open angle glaucoma (POAG).  While a lot of work is being done on this disease, we know that high pressure inside the eye is one of the major factors.  High eye pressure slowly kills the cells in the back of our eye that carry signals back to the brain.  Over time, as more cells are lost, patients slowly lose their side vision; and, if it goes untreated, may end up with severe tunnel vision or total blindness.  Most of the medicines work by lowering the eye pressure.

Thorough eye exams can catch the disease long before any problems are noticed.  Doctors look at many factors including your eye pressure (blue light or air puff tests), how the nerve looks at the back of your eye, how thick the front of your eye is, if you have side vision problems, and recently how thick the actual nerves are at the back of your eye.  Things that increase your risks include: family history, race, age, high blood pressure, migraines, eye injuries, diabetes, and history of prescription steroid use (prednisone).  The best way to avoid any problems is with routine eye exams.

About our office and glaucoma.  Our office offers cutting edge glaucoma detection and management.   We recently acquired a GDx scanning laser that can actually measure the nerve fibers at the back of the eye!  All of our annual eye exams test for the risk factors of glaucoma, and further testing will be recommended if necessary.  Dr. Caughell practices at Dr. Temple’s office in Warsaw full time and is specially trained in pediatric eye care along with full scope primary eye care.  To learn more log on at www.warsawfamilyeyecare.com .  Questions for this column can be sent to drc@warsawfamilyeyecare.com

Until next time – Dr. C  

Issue #4  What should I do if I get a red or painful eye?

A:  This is an important question to be addressed.  Not all “red eyes” are pink-eye, nor will all “red eyes” harmlessly go away on their own.  While contact lens wearers are at a slightly higher risk for serious eye infections if good hygiene is not practiced, anyone can get a red eye that leads to permanent vision loss and scarring.  

Why should I go to my eye doctor for a red eye?

 As soon as many patients get a red eye many go to the store and get Visine to “get the red out”.  In the minds of eye professionals this is a big no-no.  These drops constrict the blood vessels and cover up your body’s warning sign that something is wrong.  They do not treat the problem that caused the redness in the first place.  If significant redness or pain develops I highly recommend you see your eye doctor.  While it may be something like a minor viral infection, it could be a bacterial or fungal infection that could cause permanent vision loss in less than 24 hours!  Only your eye doctor has the proper equipment and training to best diagnose and treat a red eye.

I’ve also had patients tell me that they used their friend’s eye drops when they got a red eye.  This is extremely dangerous.  For example, if your friend was given a steroid eye drop to treat their red eye and you use it to treat a red eye caused by certain viruses or bacteria you could make the infection MUCH worse with the drop.  This mistake alone could result in permanent vision loss.  It is also very important to follow your doctor’s directions and take the drops as often and as long as prescribed.

There are many serious and not so serious causes of red eyes.  These include but are not limited to: viral, bacterial, fungal, inflammation, cuts to the eye, foreign object in the eye, allergies, dryness, and systemic diseases.  It is important to find the proper cause because the red eye could be a sign of other problems in other areas of your body.  During my post doctoral training I worked at the Indiana University health center where it was easy to see 10-15 red eyes per day!  Not all of them were so harmless.  The proper diagnosis is also important because schools and other places may need to be warned if a highly contagious eye infection is found.  A true case of “pink eye” can shut down a school or workplace very quickly.

See you next time – Dr. C

Issue #5 Dry Eye

Q:  Are dry eyes normal and what can be done about it?

A:  Dry eye syndrome is one of the most common medical eye conditions.  Dry, irritated, and watery eyes are not a normal fact of life and there is no reason to continue to suffer if you have them.  Currently there is a large amount of research being conducted on this problematic condition and new treatments are coming out every year.  In this edition of “Insights” I will discuss what dry eye is, who is at risk, and what can be done to treat it.  One survey estimated that one out of five, or 59 million Americans, suffer from dry eye.

Dry Eye Syndrome is actually a diagnosed medical condition.  Symptoms include dryness, “gritty” feeling eyes, burning, tearing/watering, blurred vision, eye strain, and eye pain.  A lot of patients don’t realize how bad the dry eye affects them until after it’s treated and they feel better.

Dry eyes can be caused by not enough tears, poor tear quality, inflammation, or a combination of these things.  Your tear film is actually made up of three different layers secreted by three different types of glands around your eyes.  If even one of these three layers has problems, the tears will dry out too quickly and cause problems. 

Who is at risk?  There are a lot of risk factors for developing dry eye.  These include: aging (75% of adults over 65 have dry eye), women, arthritis, diabetes, prescription medications, contact lenses (many times a different lens will help), computer use, smoke, wind, and eye surgery.   As you can see, this includes a lot of individuals.

How is it treated?  A visit to your local eye doctor is the best place to start.  Your optometrist can figure out what the primary cause of your dry eyes is and address that specific issue.  It is important to note that dry eye exams are usually covered as an office visit by your medical insurance (not to be confused with vision insurance which fewer people have).  Treatment may be very simple, for instance just changing some habits or using artificial tears, or it may be more complex such as prescription medications and minor surgical procedures.  None of the treatments are very invasive or cause any loss of work and may help you avoid vision loss from severe dry eye in the future.  If you are using artificial tear drops more than a couple times a day, your dry eye is probably pretty significant.

The moral of the story is:  You don’t have to suffer from dry eye, there is help available!

Thank you for your time and I’ll see you in the next column!  Dr. C

Dr. Scott Caughell practices full time with Dr. Temple in Warsaw.  He provides a full spectrum of primary eye care with special emphasis and training in pediatric eye care.  Please visit the website at www.warsawfamilyeyecare.com or call 574-267-3515 to learn more about their services, view previous topics covered, or to ask Dr. Caughell a question related to eye care.

#6 Medical and Vision Insurance

Yes, Medical and Vision insurance can both be used at the Eye Doctor.

Medical and vision insurance is very confusing for many of our patients, and for good reason.  Optometry offices are one of very few professions that use more than one type of insurance for their services.  It’s important to note that the medical insurance that you use to see your family doctor can often be used to cover services at your eye doctor.  Medical savings cards and flex money can also be used for eye exams, glasses, and contact lenses.  Please read on for further explanation.

Most people think that they will always have to pay out of pocket if they don’t have vision insurance.  In many cases this is not true.  Vision insurance is only for routine eye exams or yearly health checks for people who don’t have any medical eye problems or only need glasses and contact lenses.  Medical insurance (often with a small copay) will cover almost all other reasons for seeing your eye doctor.

For example:  If you have dry eye, cataracts, headaches, diabetes, glaucoma, new flashes/floaters, a red or painful eye, or other similar problems your exam can likely be billed to your medical insurance.  This might include medicare, anthem, sagamore, cigna , and other similar carriers.  In these circumstances they will usually cover everything except the small fee associated with the glasses or contact lens prescription. 

There are many eye findings that cause an eye doctor to recommend yearly exams.  Using your medical insurance for the proper reasons can help you afford these important exams.  Again, don’t forget that medical insurance will not cover glasses or contact lenses but may help you pay for the eye exam.  If you are curious you may always contact our staff with a question, and don’t worry, we work very hard to keep our fees reasonable for our private pay patients.

Now that it’s the end of the year don’t forget to use your remaining flex money before you lose it.  A lot of patients have also met their yearly deductible at this time which further makes keeping your eyes healthy even easier…. and hey if you can’t find that special someone a great gift, what about some new sunglasses for the bright snowy days or a new glasses frame.  Similar to jewelry, this is something that other people will see on you every day. 

Don’t forget you can see previous topics on our website such as children’s exams, glaucoma, and dry eye online at warsawfamilyeyecare.com.  Just click on Insights with Dr. C on the left side. 

Until next time, have a great Christmas season! – Dr. C

#7. Computer Use and Your Eyes

I get this question a lot: “Does staring at a computer screen all day hurt your eyes?”  The answer isn’t a straight yes or no so stick with me as I try to explain.

Computer use is rampant both at work and at home for many of my patients.  If fact the problem is so common that it was given its own diagnosis: Computer Vision Syndrome or CVS. A lot of patients spend 6+ hours on a computer at work and 1 or more hours at home.  This can take a toll on our visual system for several reasons.  The two main ways that computer use affects our eyes is due to blinking our eyes less and the need for our eyes to constantly focus. 

As anyone in their late 40’s can attest, the older we are the less our eyes can focus up close.  Focusing or “accommodation” occurs to some degree anytime we look at something closer than 20 feet away.  The closer an object is to us, the harder our eyes work to focus.  This act of focusing is actually a very demanding task for our eyes and brains and the system can be fatigued by constantly looking at something up close like a computer screen.  Staring at a computer screen for hours is very artificial for our eyes and is something that they would prefer not to do!  This can affect people of all ages.

The second problem is that we don’t blink as much when we are looking at a computer screen or TV.    For example, a person may blink 15-20 times per minute normally, but only 7 times a minute while on a computer.   This can lead to quite a bit of discomfort from dry eye.

What can be done?  There are several things you can do to address these problems.  Your optometrist would be the best person to give you specific advice, but here are some things you can try.

A lot of patients benefit greatly from a pair of “computer” glasses.  Usually, the correct prescription for computer use is determined after your eye exam.  I’ve had a lot of patients thank me for prescribing such a setup where the top of the glasses are for computer distance and the lower part is set for up for reading and writing.  This can greatly benefit even younger patients in their 20’s, let alone our patients a little farther along in life.  It is important to note that everyone has a different focusing ability.

A couple of other  ideas are to: #1 Take a break and look across the room for a couple of minutes for every 15 minutes on the computer #2 Set your computer monitor below eye level, and #3 remind yourself to blink more frequently and consider using artificial tears.  (For more information about dry eye check out my previous article located on our website at warsawfamilyeyecare.com)

#8. Tips for healthy eyes in the New Year

Resolutions accompany the New Year for many of us.  Usually this includes things like losing weight, exercising, and treating others better.  I would encourage you to consider taking better care of your most important sense, your vision, throughout 2008.  Surveys have shown that second to dying, loss of sight is America’s largest health care fear.  The problem is the habits of Americans do not show this.

The American Optometric Association took a survey in 2006 on Americans’ knowledge about vision care.  Sadly, Americans received a grade of F in over half of the categories. It’s not hard to realize that most Americans see their dentists like clockwork twice a year, but many don’t see an eye doctor for years.  In this issue of “insights” I will list 6 tips for keeping your eyes healthy in the new year.

#1.  Get annual eye exams.  Most insurance companies realize the benefits of yearly eye exams by covering yearly comprehensive eye exams.  Even though you may be seeing fine, there could be systemic or eye diseases that your doctor can pick up before they cause irreversible damage.  I promise that going to the eye doctor is neither scary nor painful! 

#2.  Wear UV protecting sunglasses, prescription glasses, or contact lenses.  The eye health risks from the Sun’s UV rays are real and are present even during cloudy days.  UV damage leads to earlier cataracts, macular degeneration, and other complications.

#3.  Consider taking supplements that include antioxidants such as luetine and omega-3 fatty acids.  This can help reduce the risk of retinal disease and dry eye.  See your optometrist for specific recommendations.

#4.  See your optometrist quickly if you develop a red or painful eye, or if you see new floaters or flashes in your vision.  These common signs can lead to sight threatening vision loss in less than a day if not properly diagnosed.

#5.  Get your children thorough eye exams starting at 6 months old, then again at 3 years, 5 years, and every year while in school.  The states of Illinois, Kentucky, and Missouri have all passed mandatory full exams by an eye doctor before children enter school.  School screenings like we have in Indiana are not sufficient to pick up vision problems that could make learning and reading very difficult.  Optometrists with special training like myself perform many extra tests to make sure the eyes are working properly together.

#6.  ALWAYS wear eye protection for fast moving sports, construction projects, weed trimming, firearms, and other situations were the eye may be damaged.   Thousands of people permanently loose vision through sports injuries and other trauma each year.

Here’s to completing all those resolutions and keeping our eyes healthy!  - Dr. C

#9 Diabetes and the Eye

Q: Why is it important for a diabetic to have yearly dilated eye exams?

This is a great question that deserves a good answer.  The main reason is that diabetes is a leading cause of blindness in the USA.  This problem is becoming more and more severe with the increasing numbers of diabetics in the country.  Yearly dilated exams are a necessity for all diabetics whether you are Type I or Type II.  Often the first signs of diabetes are found by your eye doctor before you know you have it!  Read on to learn more.

Diabetes affects your eyes in 3 important ways.  This includes diabetic retinopathy, which is caused from leaky or new blood vessels, increased risk of early and more severe cataracts, and an increased risk of glaucoma.

Diabetic retinopathy is the largest concern.  Retinopathy simply means disease of the retina which is the layer of cells at the back of our eyes that we use to see.  Over time diabetes damages the small blood vessels that give the back of our eyes oxygen.  As the blood vessels get damaged from high sugar levels they begin to leak.  This leaking from the blood vessels not only starves the cells in the back of our eyes of oxygen and nutrients, but it also can cause swelling in the retina that damages the cells.

During the later stages of diabetic retinopathy new blood vessels may form that leak even more.  It is the swelling  from this leaking fluid that causes the severe vision loss in people with diabetes. Treatment can help some, but often will not completely restore crisp vision.  Treatment may include monitoring, laser surgery, injections, or invasive eye surgery.  Cataracts in diabetics are caused from swelling and shrinking of the lens that comes from high and low levels of blood sugar.  This is what causes the vision of diabetics to fluctuate if they do not control their sugar properly.  High sugar causes the lens to swell and makes patients more nearsighted.

What should you bring with you to your eye doctor?  There are several facts that your eye doctor will want to know.  This includes how long you have had diabetes, what medications you are on, if your vision has been fluctuating, what your last sugar readings were, what your last HbA1c level was (the 3 month average), if you have high blood pressure, and how your kidney function is. 

What should you do?  To put it simply; you should work with your physician to keep your blood sugar under control and make certain to get yearly dilated eye exams.  These exams are almost always covered by medical insurance even if you don’t have vision insurance.

For those that don’t have diabetes these are signs that you might have it: going to the bathroom frequently, always being thirsty and constantly drinking water, fluctuating blurry vision, weight loss, extreme hunger, and irritability.  If you experience these symptoms frequently you should see your doctor.

Diabetics I’ll see you at your yearly eye exam! – Dr. C

#10 Aren’t All Eyeglass Lenses Basically the Same?

I’m going to stray away from eye diseases and children’s vision issues this week and talk about glasses.  It seems like many patients are unaware of the differences between the lens options and how they can help them visually. 

Since glasses are a significant cost, it is important that you ask your eye doctor and the opticians any questions you may have before completing your prescription order.  I would say that choosing the right frames, lens material, and lens options is almost as important as the doctor’s prescription.  Many times patients will decline lens options that cost about as much as a dinner at a restaurant because they feel that the opticians or doctors are trying to “sell” them something that won’t really make a difference.  For most patients their glasses are worn every single day for a year or more.  What else that you spend money on affects you every day of your life?

I would also like to warn patients that “generic” lenses and products often sold by retail chains are not the same as name brand.  Using anti-reflective coatings as an example, most generic products are very hard to clean, scratch easily, and may even discolor.  Good anti-reflective coatings on the other hand almost always carry a 1-2 year scratch warranty.  Generally a good product will carry a warranty with it, make sure you ask.

It is also important to realize that a large part of the cost of lens upgrades goes to the regional or national labs that develop and produce these products.  Similar as it takes money for scientists to invent new drugs, so it also takes scientists to develop better lens designs and options. 

Let’s go over a few quick options. I will start with a couple and continue the explanations in my next column, or you can always read the patient handout available on our website for the complete list.

Anti-Reflective coatings (AR): AR coatings dramatically reduce glare.  The coating works by allowing more light to pass through the lens and is great for reducing glare from the sun and headlights at night, eyestrain and glare from computers and overhead lights, helping those with cataracts, light coming off the back of the lens, and better vision in low-light.  Another great benefit is that the lenses are much clearer and less “shiny” in appearance when people are looking at you.

High Index Lenses:  High index lenses bend more light per the same thickness compared to regular plastic frames.  Not only does this make the lenses thinner and lighter and allow you clearer vision, but also will not change the appearance of your eyes as much to onlookers.  High index is great for higher prescriptions and drill-mount frames where the lens connects directly to the frame.

In the next column I will talk about progressive (no-line) bifocals and how to best choose from the 100’s of different types of them.  See you then! 

#11.  The 411 on no-line (Progressive) Bifocals

Though many of us might not want to admit it, there comes a time when basically every one of us will need reading glasses or bifocals to see up close.  For most, this loss of focusing ability becomes problematic sometime just past 40 years old.  While it may be a frustrating necessity, there are many good options to correct this problem.

The most popular way to correct this is by using no-line or progressive bifocal lenses.  I would estimate that approximately 80% of our patients choose these over lined bifocals or straight reading glasses.  Alternatives to progressive bifocals are lined bifocals and trifocals and the increasingly more popular bifocal contact lenses.

What are the differences between the different types of progressive lenses?  Well, I’m glad you asked!  There are literally 100’s of different brands and models of progressive lenses.  Since there is a lot of science that goes into making the lenses there is a significant difference in quality when comparing premium progressives to generic ones.  It is important to communicate to your doctor and technician your specific visual needs when choosing your lenses.

For example: There are specific progressives for smaller and larger frames, computer users, golfers and those who need to clearly see their feet, those who need a wider near view, and some more adapted for those with high prescriptions.

What’s new in Progressives?  There have been significant advances in progressive lens design over the past 2 years.  Previously, the lenses were molded in plastic in a limited number of different powers.  Today’s premium progressives are custom made for each individual patient’s prescription using an ultra-precise computer controlled lathe.  This basically means instead of choosing the design that is “close” you have a lens that is “exact”.  Thus you get clearer vision, less distortion and “waviness”, and wider reading zones.

Getting used to wearing progressive lenses:  New wearers usually go through a “learning” period after getting their first pair of no-lines.  I often tell my patients to give your brain at least 2 weeks to get used to the lenses before you think something might be wrong with them.  Since the lenses get stronger the farther down you look, you have to get used to moving your eyes correctly to see objects at varying distances.  Also, patients must get used to pointing their heads at what they are looking at since progressives are usually a little blurry if you look out the sides of them.

 What are the benefits of no lines?  The main benefit I see is that they allow clear vision at all possible distances whereas a lined bifocal only provides clear vision at two different distances.  This is a big difference when it comes to computers and you car’s dashboard.  The second major benefit is cosmetic.  Since you can’t see the line no one will know that you are “old enough” to need a bifocal!

If you have any more questions about progressives, give us a call or stop in!  Until next time – Dr. C

#12  Have you considered contact lenses for your specific needs and lifestyle?

Contact lens technology has come a long way over the past few years.  Patients who haven’t been able to wear contact lenses in the past may be able to now.  Today’s contact lenses are more comfortable, healthier to wear, and offer better vision than ever before.  Please read on to learn about the current options in contact lenses including lenses for astigmatism, daily lenses, and bifocal lenses.

The most common type of contact lenses currently prescribed are 2 week or 1 month soft disposable lenses.  The newer lenses, made of silicone hydrogel, allow up to 10 times more oxygen to your eye than the older disposable lenses.  Not only are the lenses more resistant to drying out, but the higher oxygen greatly reduces the risk of eye infections and corneal swelling.  Often I refit patients who show sings of oxygen starvation into new lenses.  Another nice feature of the newer lenses is that several brands can be worn over night for periods of time (though I still discourage this in many patients). 

Patients with astigmatism also have much better lenses to choose from, including lenses made of the new soft high oxygen materials.  The newer astigmatism lenses offer much clearer and stable vision than those in the past, especially concerning the soft lenses.  If razor sharp vision is your #1 priority, the “harder” gas permeable lenses are still hard to beat.

Daily lenses are very popular for many patient groups.  These are soft lenses that are thrown away after 1 day of use.  This way there is no solution to deal with and you can take them out while lying in bed and throw them away.  Dailies are also great for part time wearers who usually wear glasses, but would like to wear contacts for sports, on the weekends, or for other occasions.  Great candidates for dailies also include allergy sufferers and patients who work around chemicals and dusty environments. 

Perhaps the latest breakthrough in soft and hard contact lenses are bifocal contact lenses for patients who are having difficulty seeing at near.  Previously the only option was monovision where one eye was corrected for near, the other one distance.  The problem with monovison is that it reduces depth perception and is less useful for intermediate distances.  Bifocal contact lenses focus near, intermediate, and far images on each eye so that both the eyes can work together more as God intended.  Many patients are very happy with their bifocal lenses even if they have never worn contacts before. 

One last advance that I would like to mention is the Synergeyes hybrid contact lens.  This lens has the superior vision of a hard lens with the comfort more like a soft lens.  These are great for patients who needed to wear hard lenses in the past for visual reasons but didn’t like the comfort.  Synergeyes lenses are available for single vision, astigmatism, bifocal lenses, and post-surgical patients.

Ask your Doctor of Optometry for the best options for your specific needs and lifestyle!

#13 Signs of Spring: Itchy Eyes and Sunglasses

These are two major signs of spring.  Along with the wonderful sunshine and blooming flowers comes itchy eyes and increased ultra-violet (UV) levels.  To make sure we get the most out of this great time of year let’s spend a few minutes addressing these issues.

UV rays from the sun (specifically UVA and UVB) not only give some of us nice tans, but they also wreak havoc on our eyes.  Over our lifetime, continued exposure to ultra-violet solar radiation plays an important role in several eye diseases.  The most common side effects of a lot of UV exposure include earlier and more severe cataracts and increased risk for macular degeneration.  Clearly these are two things that all of us would like to avoid getting!  The sun can also cause extra tissue to grow on the whites of our eyes, which are termed pingueculae.

The solution for UV damage to our eyes is pretty straight-forward.  A good pair of sunglasses or a pair of glasses or contacts with UV protection built into the material.  Make sure the sunglasses you buy block 100% of UVA and UVB (not all do, especially knock-offs).  Transitions lenses (lenses that darken in light) are another great option to add to your prescription lenses.  For people who fish or do other water or snow sports don’t forget polarized lenses to block out the glare.  It is also a great option for sunglasses when driving in the car.

Many offices like ours carry a nice selection of specialized sunglasses that can have prescription lenses and bifocals put into them.  Some examples include motorcycle sunglasses with removable foam inserts, fishing sunglasses, and others specific for other sports and activities such as tennis and golf.  While a nice pair of sunglasses may look cool, the major benefit is to your eye health!

Eye allergies (that fun itching, redness, and watering) are another reality of spring.  Millions of Americans unnecessarily suffer from allergy eyes because they don’t go and see their eye doctor for treatment.  Indiana is one of the worst states for allergies; at least that what it seems like!  In fact, many patients still have itchy eyes even though they take a systemic allergy medication like Claritin, Allegra, or Zyrtec.  The reason is that the mast cells in our eyes (the cells that release histamine and make us miserable) are different from those in our noses and throats.  Prescription eye drops like Pataday target those cells specifically that the other medicines don’t.  A discussion with your eye doctor may also reveal some other small changes that you could make to decrease your symptoms.  Don’t forget, an exam for eye allergies can be covered by your medical insurance even if you don’t have vision coverage.  

I look forward to seeing you all out and about this spring.  Hopefully with some sunglasses and clear eyes! 

#14 Why should I get my eyes dilated?

This question comes to me almost daily.  I strongly believe that a dilated eye exam is the only true way to evaluate a patient’s overall eye health and is perhaps the most important aspect of the eye exam.  Many people instantly remark how much they don’t like their eyes dilated.  Something like: “oh my eyes were dilated for a week last time and I could hardly make it home!”  In reality it is usually only a minor annoyance for a few hours and the benefits definitely outweigh the inconvenience.   

So why do I dilate almost every one of my patients (unless there are excellent reasons not to)?  The short answer is we only have 2 eyes and most of us would agree it  is our most important sense.  It’s interesting in surveys that people’s greatest fear secondary to losing their life is losing their vision.  Yet, people take their eyesight for granted and either don’t come in for routine exams or will flat out refuse to be dilated because they will be light sensitive for a few hours.

Basically, dilating or putting drops into your eyes to make your pupils (the black part) big lets me see the structures in the back of your eye much easier.  For example, if you were trying to watch a family of deer play in your back yard would it be easier to see them through a large window or a small key-hole?  I’m betting the large window would be your answer.  Your eyes are the same way; it is much easier to see through a large dilated pupil that a tiny black speck.

What are you looking for in the back of the eye?  Everything and anything to be exact!  Your optic nerve (the nerve that runs to your brain) is examined for signs of glaucoma and other diseases.  Even brain tumors can sometimes be discovered by looking at your optic nerve!  Your blood vessels are examined for specific eye diseases and signs of systemic diseases like diabetes, high blood pressure, and high cholesterol.  This is the only place in the body that these small blood vessels can be seen and problems seen in your eye could mean there are problems in the rest of your body.  Your macula or center vision is checked for signs of macular degeneration or other debilitating diseases.  Also the back of your eye is checked for signs of retinal holes, tears, or detachments.  There are literally thousands of eye diseases that can be detected and treated before serious vision loss occurs.  All are much easier to see with a dilated pupil.

So…next time your doctor wants to dilate your eyes say: “sure, I know it’s important and I appreciate you being thorough.”  Okay, maybe not, but at least it’s a start.  See you next time – Dr. C  

#15 Warning Signs for your Child’s Eyes.

This week I’m going to return back to my specialty.  As many of you know I have a passion for educating the public about the importance of pediatric vision care.  While many conditions will only be found by a full eye exam by an eye doctor, I am going to talk about some signs to watch for.  Remember, the American Optometric Association recommends that a child’s first eye exam (by an eye doctor) should take place at around 6 months of age.  After that, exams at 3 years, 5 years, and every year while in school.

It is estimated that 80% of learning takes place visually.  Thus, you can imagine if there is a visual problem a child could have significant developmental problems.  Many times it is nearly impossible for a parent to recognize these issues as a child will grow believing that their situation is normal.  With that said let’s talk about some things to look for.

A white pupil in pictures or bright light compared to the other eye is a cause for significant concern.  This could be a sign of anything from a high prescription to a rare but life threatening form of eye cancer.  A good dilated exam by your family optometrist can quickly calm any fears you may have.  Many times it’s just an artifact in a picture, but something that definitely needs checked out. 

An eye that turns in or out separate from the other eye also needs evaluated.  If the problem is not addressed within a certain time period, permanent vision loss can occur. Luckily if caught during childhood the problem is correctable.

A child that avoids reading or near tasks could be the sign of a focusing or eye teaming problem.  Also, some children will tilt their heads to one side or turn their head one direction if their eyes are not aligned or one eye is not seeing well.  Often, but definitely not always, a binocular vision problem can mimic disorders like ADD and learning disabilities.

Frequent headaches are not normal or common in children.  Let your family eye doctor and pediatrician/family physician know if this is occurring.  Headaches can be caused by minor things like sinus congestion or needing glasses, but can also be a sign of scarier medical problems.

Red eyes in your child should also be evaluated by an eye doctor.  Bacterial eye infections are much more common in children than adults.  It is important to differentiate a bacterial infection from highly contagious viral “pink eye.” Eye allergies can also be common if the child is seen rubbing their eyes frequently throughout the day.  An eye that waters a lot is also a cause for concern.  This could be a sign of blocked tear ducts or childhood glaucoma.

Clearly we all want the best for our children.  Luckily serious problems are rare but the signs should be evaluated.  I am a huge believer in preventative care and highly recommend yearly eye exams, visits to your medical doctor, and dental exams.  Even if money is tight at times the benefit clearly outweighs the costs of these visits.  It really gets expensive if many of these problems are not caught early!  Until next time – Dr. C

#16 What exactly is a Doctor of Optometry?

There are many common misconceptions regarding the title Optometrist or Doctor of Optometry.  I will admit the terminology is a bit confusing because I once had someone exclaim “Oh so you deliver babies?”   The easiest explanation is that an optometrist is an eye doctor.  Let’s take a quick moment to get a better handle of what your favorite eye doctor does.

                The American Optometric Association defines an optometrist this way:

“Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.”

Optometrists have extensive education and training relating to the eye and surrounding structures.  It is important to realize that vision is much more than just the function of the eye ball itself.  Actual vision takes place at the back of our brains and incorporates well over half of our brain cells!  The average doctor of optometry has 4 years of undergraduate (which must include credits in advanced biology, chemistry, physics, and calculus) and 4 years of optometry school.  Some ODs like myself (around 10%) have an additional year of post doctoral residency training to equal 9 years of education after high school.

Though many people think of glasses and contact lenses from optometrists, we are trained to diagnose and treat a large variety of eye conditions and diseases with prescription medication or other means.  This includes red eyes, diabetic eye exams, glaucoma treatment, uveitis, diagnosis of macular degeneration, eye turns, pre and post operative exams, and much more.  Optometrists are different from ophthalmologists in that they do not perform in the eye surgery.  Usually an optometrist will refer you to a trusted local ophthalmologist if you need cataract or other eye surgeries.  I would think of your optometrist as your family doctor for your eyes who takes care of most eye problems that arise and sends you to the most competent surgeon if the rare need presents.

Again don’t forget that optometrists can bill vision plans for routine check-ups, but if you have a medical eye condition your visit should be billed through your medical insurance.  Offices like ours have staff to file these visits for you.

Hopefully the topic is a little clearer than mud now.  You can imagine that if doctors like me spend 9 years training to take care of such a small little structure like you eye that vision is not something to take lightly!  Tune in next time when I’ll discuss MACULAR DEGENRATION and the new research involving the condition. 

Until next time – Dr. C

#17 Eyes, Children, and School

It’s that time of summer again when children are starting to realize that they will soon be heading back to school.  Some children are looking forward to it while others are quite sad.  To be sure, many parents are looking forward to another break from entertaining the kids!  The back to school sales and advertising will be in full effect and before we know it another year of learning will be under way.

            Many parents will go down their checklist of back to school items making sure that junior has what he needs to have a good start to the school year.  This might include new pencils and notebooks along with clothes and calculators.  Those items are all important, but many parents forget what is possibly the most important: an eye exam.  An undiagnosed vision problem can make learning extremely difficult for children.  Most of the time parents will be completely unaware that such a problem exists and their eyes can change greatly from year to year.  Let’s review a couple quick facts:

-           Over 85% of learning involves the visual system

-          Greater than 1 in 20 children have a focusing or eye teaming problem that will not be found on an eye chart

-          Many children are misdiagnosed with ADD or a learning disability when in reality it’s a vision problem

-          Eye screenings from the schools, family doctors, and others DO NOT take the place of a comprehensive eye exam from an eye doctor

-          Many eye conditions, if not treated early, can result in permanent vision loss

-          Eye exams are so important for school that the surrounding states of Illinois and Kentucky require a full eye exam before school.  Unfortunately, Indiana does not have such a requirement at this time.

-          Vision problems can make school and reading difficult and cause a child to avoid learning activities; just think of the lifelong impact of poor school performance on career and self esteem!  

It is important that you go to an eye doctor that tests the entire visual system, including the prescription, eye teaming, eye focusing, depth perception, and a dilated retinal exam.  I wish you all a smooth transition into the new school year!  Stay tuned for the next column on macular degeneration.  As the area’s only post-doctoral trained pediatric optometrist I felt the importance of vision and learning should be covered before the start of school! 

#18 Eye Quiz - Test your Eye - Q

Eye Quiz:  Are these statements true or false?

                I decided to make this week’s column a little more interactive.  Go down the list and choose true or false.  The answers will be at the bottom.  Good luck!

1.       T/F  Reading in the dark will hurt your eyes.

2.       T/F  An eye doctor can do a meaningful eye exam on a 6 month old infant.

3.       T/F  Wearing glasses will weaken your eyes and make you more dependent on them.

4.       T/F  Little Johnny is ruining his eyes by sitting too close to the TV.

5.       T/F  Headaches are normal in children.

6.       T/F  Taking specific vitamins and supplements can reduce your risk of developing and losing vision from macular degeneration.

7.       T/F   If a child passes a vision screening at school or at the pediatrician’s office they don’t need a full eye exam

8.       T/F  You could have Glaucoma and have no noticeable symptoms.

9.       T/F   If you have astigmatism you can’t wear contact lenses.

10.   T/F   If I can see well I don’t need an eye exam.

11.   T/F   Bonus!  Dr. Caughell is the best eye doctor in the state!

Answers Please

1.        False. Reading in the dark may make it harder to see but doesn’t hurt your eyes.

2.       True.  You can assess their eye health and even their prescription.  The American Optometric Association recommends the first eye exam at 6 months old.

3.       False.  I hear this all the time and it’s simply not true.  In fact, one study showed that not fully correcting your nearsightedness can make it progress faster.

4.       Sorry moms, but this is False as well.  It is helpful to get Johnny away from the video games at times though.

5.       False.  Maybe one every couple of months, but much more frequent than that needs a professional evaluation.

6.       True.  The AREDS I and now AREDS II NIH studies have shown significant benefits to those at risk and those that have macular degeneration.  Ask your doctor for specifics on what doses you need to be taking.

7.       False.  False. False.  These screenings, while helpful, can miss over 1/3 of vision problems that can make learning very difficult and even cause attention problems and headaches.  Please don’t make school even harder for your children.  There is a reason why surrounding states now mandate full eye exams by eye doctors before school.  Unfortunately Indiana does not have such requirements at this time.

8.       True.  You could have significant glaucoma damage and not know it because it comes on very slowly.  The problem is once the vision is lost it’s gone for good if not caught early and treated.

9.       False.  Except for extreme cases, there are plenty of great options in contacts for patients with astigmatism.

10.   FALSE.  Many eye problems are not symptomatic before it’s too late.  Prevention is the key to maintaining your most important sense.  Just recently we had a healthy young woman in with absolutely no problems or symptoms.  A dilated eye exam found a tumor in the back of her eye!  This routine exam very well could have saved her life.

11.   True? J  Well it’s nice to think anyways and hopefully it holds some truth!  I do take my job very seriously and have some unique training.  Some might even say I’m nice, but that’s speculation.  Also a good doctor has a good staff behind the scenes and I think it’s definitely true around here!

#19 Eyes Ready for the Warm Weather?

Now that the cold weather is finally on the way out and summer is around the corner are your eyes ready?  As the sun comes out it is interesting to see all your neighbors emerging from their homes like hibernating bears.  During this short column I would like to address eye allergies, sunglasses, and contact lens wear as we become more active outside again.

Kosciusco County is blessed with beautiful lakes and great outdoor activities.  Sometimes prescription glasses can be bothersome, especially with water sports, running, and cycling.  Many patients in this situation can greatly benefit from contact lens wear.  For example, daily disposable lenses (that are thrown away every day after use) are great options for our weekend warriors out there.  Bifocal contact lenses are also great options for those who need a little near help.  In fact our office just got the brand new AcuVue Oasys for Presbyopia bifocal contact lenses that are the most comfortable and wetable bifocal lenses to date.  These are best for those patients 50 and under.   

Eye allergies (that fun itching, redness, and watering) are another reality of spring.  Millions of Americans unnecessarily suffer from allergy eyes because they don’t go and see their eye doctor for treatment.  Indiana is one of the worst states for allergies; at least that what it seems like!  In fact, many patients still have itchy eyes even though they take a systemic allergy medication like Claritin, Allegra, or Zyrtec.  OTC eye drops are not nearly as safe or effective as prescription drops.  If it is driving you crazy, go see your eye doctor.  Most times this can be billed by your eye doctor as a medical office visit through your medical insurance.

UV rays from the sun (specifically UVA and UVB) not only give some of us nice tans, but they also wreak havoc on our eyes.  Over our lifetime, continued exposure to ultra-violet solar radiation plays an important role in several eye diseases.  The most common side effects of a lot of UV exposure include earlier and more severe cataracts and increased risk for macular degeneration.  Clearly these are two things that all of us would like to avoid getting!  The sun can also cause extra tissue to grow on the whites of our eyes, which are termed pingueculae.

Quality sunglasses, eyeglasses, and some contact lenses provide great protection against UV rays and you should be protected at all times outside.  It doesn’t make sense to protect your skin with sunscreen and not wear something that protects your eyes!  Many offices like ours carry normal and specialized sunglasses for specific needs.  Whether it be looking good with a pair of prescription Coach Sunglasses or a pair of high performance Rudy Project sunglasses, offices like ours have you covered for a fair cost.  As we Americans live longer, we need to do a better job of protecting our eye health!

#20 Insights

Eyes, Children, and School

It’s that time of summer again when children are starting to realize that they will soon be heading back to school.  Some children are looking forward to it while others are quite sad.  To be sure, many parents are looking forward to another break from entertaining the kids!  The back to school sales and advertising will be in full effect and before we know it another year of learning will be under way.

            Many parents will go down their checklist of back to school items making sure that junior has what he needs to have a good start to the school year.  This might include new pencils and notebooks along with clothes and calculators.  Those items are all important, but many parents forget what is possibly the most important: an eye exam.  An undiagnosed vision problem can make learning extremely difficult for children.  Most of the time parents will be completely unaware that such a problem exists and their eyes can change greatly from year to year.  Let’s review a couple quick facts:

-           Over 85% of learning involves the visual system

-          Greater than 1 in 20 children have a focusing or eye teaming problem that will not be found on an eye chart

-          Many children are misdiagnosed with ADD or a learning disability when in reality it’s a vision problem

-          Eye screenings from the schools, family doctors, and others DO NOT take the place of a comprehensive eye exam from an eye doctor

-          Many eye conditions, if not treated early, can result in permanent vision loss

-          Eye exams are so important for school that the surrounding states of Illinois and Kentucky require a full eye exam before school.  Unfortunately, Indiana does not have such a requirement at this time.

-          Vision problems can make school and reading difficult and cause a child to avoid learning activities; just think of the lifelong impact of poor school performance on career and self esteem!  

It is important that you go to an eye doctor that tests the entire visual system, including the prescription, eye teaming, eye focusing, depth perception, and a dilated retinal exam.  I wish you all a smooth transition into the new school year!  Stay tuned for the next column on macular degeneration.  As the area’s only post-doctoral trained pediatric optometrist I felt the importance of vision and learning should be covered before the start of school! 

#21 Eye Care Value in this Economy

Unfortunately the economy is still struggling and many hard working people are losing their vision and health benefits.  The benefits that many have come to rely on are disappearing at an alarming rate and I would like to pass some money saving ideas on to my column’s readers.  Luckily, eye care is already one of the best values in the health care field.  In fact a recent study showed that eye care fees have been steady while other heath costs have sky rocketed.

When it comes to eye health issues your family optometrist (eye doctor) is a great place to save some money.  If you have lost your health insurance I would recommend visiting your eye doctor for red eyes and other eye health matters before heading to the hospital.  You will receive timely and professional care by a doctor specializing in the eyes.  In fact, Dr. Temple and I are available for such emergencies after hours for our patients and your eye doctor may be as well.  As always, if you have medical insurance many eye doctors can file it for you. 

Medicare and/or Medicaid can also come in handy.  Many Medicare patients are not aware that most of their eye exam can be billed to Medicare.  You still may have to pay a little for the glasses part of the exam, but it would be much less than without.  Also those with headaches, itchy or dry eyes, diabetics, cataracts, glaucoma and other eye health related problems can bill their medical insurance as an office visit. 

Don’t assume that the big box or chain eye glass retailers are less expensive than your private home town eye doctor.  Patients are frequently caught off guard when they spent more for their optical products at a mass retailer than they would have here.  Also I would encourage you to look at the overall value rather that the upfront cost and realize that local offices keep much more money in the local community.  Just yesterday I heard an economist say that a dollar spent at a locally owned business has 3 times the benefit to the local area.  You must compare apples to apples because I know those TV ads are temping with crazy low prices.  A high quality product cannot be compared to a generic product.  I can’t tell you how many patients we have had come back for a higher quality experience and product.  Don’t forget about the included warranties that come from private doctors, we are invested in our communities and know we have to treat our neighbors the right way.  You use your eyes every day and depend on them for nearly every aspect of your life.

Health savings accounts and other tax deferred health plans.  Don’t forget these can be used for eye exams, glasses, and contact lenses.  Since the money is tax exempt it is like getting 10-25% off automatically!

Continue routine exams.  On the hit network show “The Doctors” a couple weeks ago they recommended three “must have” yearly exams.  One of the three was a yearly eye appointment which was great because none of “The Doctors” are eye doctors.  Eye problems that are not caught early can become visually devastating and much more expensive to treat.  Be it blurry vision or eye health your eye doctor is a great ally in today’s stressful times.

I wish you all the best.  Dr. C

#22 I Have a Cataract, Now What?

            Cataracts; if you live long enough you’ll probably get them.  Most patients used to cringe when their eye doctor told them they had a cataract.  The surgery used to be risky and landed you in the hospital quite frequently.  Well, the times they are a change’n.  Getting rid of those pesky cataracts is now a quick outpatient procedure in most cases.  There are also new options for how your vision is corrected once the cataract is removed.  I’ll discuss these options briefly and tell you what to do to improve your vision when the cataract is not ready to be removed.

            Cataracts form in the lenses of our eyes.  The lens sits right behind the colored iris of our eyes and helps correctly focus light onto the retina.  It resembles a sunflower seed in appearance and becomes less flexible over time leading all of us into bifocals.  Over time the lens becomes less clear and cloudier.  This clouding makes it difficult for light to get through and focus on the back of our eyes; eventually reducing our vision and usually changing our glasses prescription.

            Cataract surgery is the most commonly performed surgical procedure in the United States.  During the surgery, the old cloudy lens is removed and a new “plastic” lens is put in its place.  Today’s surgeries are remarkable in that commonly no stitches are used and recovery time is a matter of a few days.  Usually your family eye doctor will see you before and after the surgery to monitor the healing process.  The main advancements in the surgery now are the different types of lenses that you can have put into your eyes.

            Previously the replacement lenses were designed to correct your vision for distance only.  Now you can pay to upgrade to a bifocal implant, or if you have a lot of astigmatism, an astigmatism implant.  The bifocal lens implant is great for patients that would like to rely less on glasses for reading and other near work.  It is important to note that the bifocal implants have some minor drawbacks as well so it is best to talk it over with you family optometrist, who knows you best, before making a semi-permanent decision.       

#23 Eye Strain, Tired Eyes, and Headaches

Headaches and eye strain are complaints that I hear all the time from my patients.  In today’s world of computers, increasing near tasks, poor working environments, and sleep deprivation this problem is becoming even worse.  The sad thing is many patients have told me that no doctor has ever found a cause for these problems and they just continue to live with it.  If you ask me, life is too short to live with unnecessary discomfort.  These symptoms also need addressed because they can be signs of much more severe neurological causes.

These types of complaints are of great interest to me.  I spent much of my post doctoral training diagnosing and helping people with these issues which are many times overlooked in routine exams.  Many believe that just because they can see things clearly that it must not be an eye problem.  In fact, over 1/3 of vision problems will be missed by a simple eye chart screening.  Often I see patients that have seen numerous doctors of different specialties, have had MRIs and CTs, and are quite possibly on medication that does not seem to help.

So what causes these problems?  Well I’m glad you asked!

In my experience there are several main causes.  I will only address the most common and easiest to explain in this short space.  The most obvious is an uncorrected spectacle correction.  While uncorrected nearsightedness can be problematic, these symptoms are more common with uncorrected farsightedness and astigmatism.  Often these do not cause significantly blurred vision, but can cause significant eyestrain and headaches. 

A second major cause is from eye alignment issues.  Over 1 in 20 are believed to have a significant eye teaming issue.  I am not talking about eye turns, but cases where the eyes look straight but do not work together.  Most common is convergence insufficiency (see our website for more info) where the eyes do not move in enough when looking at near objects.  The eyes and surrounding muscles thus need to work twice as hard when reading or looking at a computer screen.  Symptoms vary from eyestrain and tired eyes to headaches and ADD-like behaviors.

The last cause I will mention is problems with focusing ability and focusing speed.  Accommodation is the term that is used to describe the process where the eye focuses on near objects.  This is what we lose as we get older and eventually need eye glasses.  Many people have problems with this system even when they are young and experience occasionally blurry vision (especially when looking from near to far or the opposite) and headaches.

Treatments include eyeglasses, reading glasses, prism glasses, and vision therapy.  Often vision therapy will treat these problems even when glasses will not.  People should realize that vision therapy is effective, valid, scientifically supported, and cost effective in the long term.  Unfortunately, misunderstanding and political battles between medical professions have discouraged people from trying this extremely powerful treatment option.   Again see our website and previous “Insights” articles for more information.

Don’t keep suffering.  Your eye doctor went through a lot of schooling to help you and is probably a real nice person to boot!

#24 Don’t take Floaters too lightly

                No those aren’t bugs flying around; those are floaters in your eyes!  Most of us will develop floaters in our eyes sometime during our lifetime.  They can be big or small and come in all different shapes.  Some are really annoying and stick around your central vision, while most settle down in the bottom of our eyes from gravity.

 It is important to realize that floaters can be a sign of serious vision threatening problems.  New floaters, especially large or numerous ones, should trigger a trip to your eye doctor.  While most of the time you will be given a clean bill of health from your eye doctor and educated about the cause, you may unfortunately have a serious problem like a retinal detachment, eye infection, or inner eye inflammation.  A dilated eye exam is almost always called for during these times.  Don’t worry; these visits should be covered by your medical insurance and are usually billed as an office visit. 

Most floaters are caused by changes in the vitreous or “jelly” in the back of our eyes.  As we get older the vitreous becomes more water-like and shrinks.  This process may cause strands to clump together or others to break free resulting in the classic floaters.  This same shrinking process can also pull on the fragile retina at the back of our eyes causing small tears or holes to form. 

A visit to your eye doctor should be quick because if you do have a retinal detachment it would need to be immediately repaired.  If you were unfortunate and didn’t have it repaired it could continue to pull loose and cause severe permanent vision loss.  One day you could have fine vision, and next it could be lights out!  Not something to take lightly.  I don’t mean to scare anyone because most of the time floaters are a benign occurrence, but vision is too precious to risk.  Amazingly, a couple weeks ago I diagnosed two patients with retinal detachments in two days who came in with recent floaters.  Luckily we caught it in time and surgery was successful at saving their vision. 

#25 Using Medicare and Medical Insurance to Pay for Eye Exams

As economic times get tough I wanted our readers to realize that many times medical insurances will cover most of the cost of an eye exam.  While I do believe that eye care is already one of the most affordable doctor visits around these days, it is nice to know that you may be able to pay even much less out of pocket.

It is important to realize that a comprehensive eye exam is really made up of 2 different parts.  These are the health exam and refraction.  The refraction is the (which is better 1 or 2) part of the exam used to determine your glasses or contact lens prescription.  The health part is basically everything else including the microscope and dilation.  While these two procedures are billed separately, both must happen to consider it a valid eye exam. 

Many medical insurances, including Medicare, will pay for the eye health part of the exam (after co-pay and considering deductibles) as long as there is a presenting medical issue.  This might include such things as headaches, dryness, glare, itchy eyes, cataract, diabetes, strong family history of eye diseases, lazy eye, and others.  Often we don’t know until the exam is done if blurry vision is due to a simpler prescription change or is caused by a medical issue such as dry eye or cataracts.  If an eye doctor has told you, for example, that you have an early cataract this can be billed as a medical eye exam. 

It is important to note that hardly any medical insurances pay for contact lens services or glasses.  It is also important to realize that a young healthy person who only needs new contacts or glasses probably will not be able to use medical insurance to pay for the exam.  This is why offices such as ours offer a discount for routine exams paid that day.  There are, however, an increasing number of medical insurance plans that include a yearly “well vision” or healthy eye check up in the benefits.  For example, there are several Blue Cross and Anthem plans in the Warsaw area that have a covered normal eye exam included.  If you are not sure call your HR person, or better yet, your insurance company and ask them if you have that benefit.  It is much better if you come to your appointment knowing what your specific coverage is. 

I mentioned the refraction part of the eye exam above for a reason. While some medical insurance will pay for the refraction part of the exam many, like Medicare, will not.  Luckily the refraction part of the exam is usually much less expensive than the required eye health check.