SUNGLASSES | READERS | GOGGLES | EYEWEAR

Eye Drops for Reading

Gary Edwards, M.D. — Thu, 13 Jan 2022 14:53:49 +0000

I predict a low acceptance of Vuity (pilocarpine drops). There are several reasons. Many years ago ophthalmologists used strengths of pilocarpine from 1 to 6 % to treat glaucoma. Then, medicines like Timolol, Xalatan, Cosopt and others came along and pilocarpine was dropped like a hot potato by most ophthalmologists.
Why? Pilocarpine constricts the pupil giving it an “angry” and “elderly” look. It also causes the ciliary muscle inside the eye to contract giving “brow ache” similar to what some people experience when going outdoors on a very bright day.

Atropine drops were called “bella donna”, which means “beautiful lady”, because they dilate the pupil. The dilated pupil is regarded as a sign of youth and beauty. In today’s beauty-conscious world, I don’t see a lot of people running out to constrict their pupils just so they don’t need reading glasses as much.

One reason that we have pupils that can dilate and constrict is to vary the amount of light coming into the eyes. When we drive through a dark tunnel in the day time our pupils dilate to let in more light. When we go to the beach on a bright day, the pupils constrict to reduce the light entering the eyes. With pilocarpine the pupil stays constricted. I predict an insert warning about driving when using Vuity drops.

One more reason that Vuity won’t be popular is the cost is almost $1000 per year. That will buy a lot of reading glasses. When Pfizer found that its pulmonary hypertension drug, sildenafil, caused erections in men, they quickly patented it as Viagra and made a fortune charging up to $90 per pill. Now that it has gone off patent and become generic it can be had for about $4.00 per pill.

Most modern glaucoma meds cost $10 or $15 per month for a bottle of drops. Pilocarpine has been in use for over one hundred years and until recently, has always been inexpensive. Now Allergan is charging $80 for a bottle of weak strength pilocarpine touting its use for improving reading.

Lastly, modern frames are seen as fashion accessories. One can get high quality progressive lenses and see far and near with no bifocal line in the lenses.

It’s just a thought.

The Truth about Eye Protection against Covid-19

Gary Edwards, M.D. — Tue, 27 Oct 2020 20:18:43 +0000

To Wear or Not to Wear Eye Protection – That is the Question

It was March 2020 when the USA SARS-CoV-2 epidemic was just getting underway. Dr. Fauci, spokesman for the pandemic response team of the U.S. government, downplayed the need for masks saying, “There is no reason to be walking around with a mask.”

Not long afterwards, he changed his statement and said masks were recommended. His explanation for this message change was that the government feared a mask shortage and did not want medical personnel to not have masks available due to the public acquiring all of them and creating a worse shortage than all ready existed.

Might I need eye protection against covid-19 in this pandemic? So far, we have not seen recommendations about eye protection forthcoming from the CDC, NIH or the federal government. This article is strictly my own opinion as a retired ophthalmologist and not medical advice for anyone.

Do They Know Something We Don 't?

When we see pictures of front-line, medical workers, in their fight against covid-19, one thing we notice is that most, if not all of them, have some sort of eye protection. This might be a plastic face shield. It might be goggles. It might be shielded glasses. So what does this mean for the rest of us? I submit that it is a good indication, that for more complete protection, you and I should be using eye protection against covid-19 as well.

Invasion of the Virus

There is universal agreement that covid-19 is spread mainly by inhaling the virus which has been exhaled by an infected person. Other conceivable methods of spread are hand-to-mouth, hand-to-nose, hand-to-eye, sexual contact and air-to-eyes. That last possibility is what we are discussing here.

We all know that the corona virus is transmitted by way of our mouths and noses, right? This is true as far as it goes. How about our other exposed mucus membrane; namely, our eyes? That’s right; our eyes are covered with a very thin membrane we call the conjunctiva. One could think of it as a thin, wet “Saran Wrap” sort of membrane covering the eye surface.

The coronavirus invades cells within the respiratory tract (lungs). It gains entry to these cells by attaching itself to a protein on the outside of the cell called angiotensin converting enzyme 2 or ACE2. Think of this like a home invader who has a key that fits the lock to your front door. The spikes on the coronavirus are the keys and the ACE2 protein is the lock on the door.

Can Virus Get in My Eye?

Recent studies showed that this ACE2 is present in the human conjunctiva and on the cornea. In theory, the virus could use the eye surface to get an initial foothold for entry into the human body.

Another study even found the virus present in the actual eye tissue of a previously infected covid-19 patient who had undergone glaucoma surgery.

Does this mean we should have eye protection against covid-19? Let’s look some more.

Down the Tear Hole

One of the properties of the eye’s anatomy is that in the inner corner of each eyelid is a tiny hole called the lacrimal punctum. This hole is where the tears, that we produce, drain. From each of the four puncta there is a tube eventually leading to the inner area of the nose. From the back of the nose the tears go to the throat. Anyone who has ever used eye drops can remember getting a delayed, funny taste in their mouth as the chemical in the drop stimulates the taste buds after draining into the back of the throat. These virus-containing tears are exposed to the air that we breathe in, giving potential entry into our lungs.

One of the more recent findings about covid-19 is that it can be spread as an aerosol. This is not the same as droplets. Droplet borne is the property of the virus being transported, balloon-like, in droplets that humans exhale during sneezing, coughing, breathing, talking and singing. These droplets usually fall to the ground within six feet or so from their origin, due to gravity.

Aerosol borne means that the virus particles can be suspended in the air for long periods of time and travel much farther than the six feet of “social distancing” we are told about. This would be analogous to smoke particles in a smoky room. An aerosol particle is small (1 to 5 μm) (microns). For reference, a microscopic human red blood cell is 7 microns in diameter.

Aerosols have the property of remaining suspended in the air instead of falling to the ground, something like smoke or dust particles that can be seen in the projector light in a dark theater. Aerosolized coronavirus particles can be inhaled but they can also land directly on the eye surface. In theory, the virus particles could then be washed down the lacrimal puncta and then into the throat and even the respiratory system.

So, Do Glasses Help?

To date, we do not have studies showing that there is a significant risk of catching covid-19 from eye exposure. There are studies showing that there is a lower incidence when eye protection is worn, just as there is a lower incidence from wearing a mask and practicing social distancing. A recent medical journal article from China suggested that people who wore glasses were less likely to get covid-19 than those without.

This could be because the glasses prevented touching of the eyes or the virus was less likely to land on the eyes from the air. In the Chinese study a small number of records of inpatients with covid-19 was examined. From more than 200 patients, just over 5% wore glasses for nearsightedness. In the general population about 30% wear glasses for myopia. The implication is that maybe glasses offer a protective effect from getting covid-19.

Compared to the amount of air we inhale and exhale, the amount of air making passive contact with our eye surface is much less. However, studies have shown that most people touch their hands to their faces and eyes many times during the day. If one is wearing glasses, goggles, face shields or other eye protection gear, he is much less likely to be touching his eyes. Whether preventing touching of the eyes, or direct landing of air borne virus on the eye, the implication is that eye protection against covid-19 may help.

Virus Load

One of the characteristics of viral infection is the concept of dose dependency. This means that if one virus particle lands on one lung cell, probably the body will have enough immunity to kill it and remain unaffected. If a billion virus particles land on a lot of lung cells in a vulnerable individual, the viruses will possibly overwhelm the immune system and the person will become a covid-19 victim. If a trillion virus particles end up in the lungs it might lead to an overwhelming covid-19 infection and even cause loss of life.

These values are conceptual and not based on scientific study data. The quantity of virus needed to create significant sickness varies with the health and immune status of the person infected. We know that young people with strong immune systems are less likely to become significantly ill than elderly people with weak immune systems.

Types of Eye Protection against Covid-19 V irus

Goggles – The cheapest and easiest might be simple protective goggles such as are worn when we hammer a nail or work around dangerous equipment. These may be used alone or over prescription glasses. When used with a face mask these offer good eye protection against covid-19.

Eyeglasses – Ordinary eyeglasses, either prescription or non-prescription, would be another choice but would not offer as much eye protection against covid-19 as a full goggle would.

Face Shield – A face shield offers a barrier for the whole face and eyes. It reduces the chance of bringing one’s hands to his face and eyes but, of course, leaves some exposure around the edges below and on the sides. When worn with a face mask this offers good eye protection against covid-19.

Full Face Respirator – A full face respirator mask, “gas mask”, serves to protect the whole face, nose, mouth and eyes. It is expensive and makes conversation difficult to understand. These have filters to keep out substances such as dust, gas, and even viruses (using N95 filters). Their valves allow exhalation. This probably represents the best eye protection against covid-19 of the choices shown.

My Personal Choice

Early in 2020, when I first heard that the pandemic was starting in China, I ordered a 3M full face mask in case a worst case scenario should develop in the USA. Unfortunately it has. Now, I routinely wear this complete mask whenever it is necessary to go to public places like the grocery store or the pharmacy.

So, What's the Answer?

Right now, there is no conclusive data to show that the general public should be wearing eye protection in addition to face masks. However, there are hints that maybe we should be wearing eye protection. If you’ve ever watched a movie (think “Contagion”) where the hazmat team comes to the rescue, they are always covered from head to toe to avoid any possibility of virus spreading not only by inhalation but also by landing on some part of the body including the eyes.

Like most things in life whether to wear eye protection against covid-19, during the pandemic, comes down to “risk-reward”. How likely are you to get infected through your eyes if you don’t wear eye protection? We do not know. How much bother is it to wear eye protection? It varies with the person. There are people who would not wear a seat belt when driving if it were not mandated. There are still people not wearing a mask even when it is mandated. I submit that if one wants to be as safe as possible then, in addition to a face mask, social distancing, crowd avoidance and hand washing, we should add wearing some sort of eye protection. It cannot hurt.

7 Awesome Steps on How to Use an Amsler Grid

Gary Edwards, M.D. — Wed, 02 Sep 2020 23:07:14 +0000

Let’s learn how to use an Amsler grid. It’s simple. The Amsler grid is one of those health checks that anyone can do on themselves, easily. It is possible to detect an early vision problem while it is still treatable by your ophthalmologist. Of course everyone should see his or her eye doctor routinely whether it is an optometrist or an ophthalmologist. The frequency of visits is up to your doctor but there are guidelines which vary depending on age and specific circumstances.

In 1945 a Swiss ophthalmologist named Dr. Amsler came up with the idea of viewing a piece of graph paper with a dot in the center to detect eye problems. In line with the medical tradition of naming things after their inventors, the powers-that-be called this invention, the Amsler grid. The Amsler grid is useful screening tool for detecting and following problems with the central part of your vision in the back of the eye.

Eye Health Conditions Detectable

There are many conditions that can produce abnormalities in your view of the square boxes of the graph paper.
These include:

macular degeneration
This is a deterioration of the eye tissue in the very center of one’s vision. It is often described as “dry” or “wet”.
central serous chorioretinopathy
This is a “blister” that forms under the retina. It is associated with stress, male gender and increased cortisols.
macular pucker
This is a wrinkling of the lining of the retina. It sometimes presents as seeing straight lines as having curves in them.
diabetic eye problems
This is catch all for many problems that diabetes can effect inside the eyes. Some of these are fluid leaking, bleeding and scar tissue forming.
and others
This includes more disorders that can be seen by clicking the link.

An Easy Test

The importance of your detecting these abnormalities in the way we see the Amsler grid is that the earlier they are detected, the more chance there is of a successful treatment.

The test is super easy and takes less than 30 seconds to screen both eyes.

Please remember this is NOT a substitute for a professional eye exam. If your Amsler screening seems normal there can STILL be problems that only your eye doctor can detect. So get that regular eye doctor check up.

To get your free downloadable Amsler grid with instructions on how to use an Amsler grid, click HERE.

Instructions on How to Use an Amsler Grid

1. Print and cut out your Amsler grid and mount it somewhere.

2. Use the same amount of room light as you would to read.

3. If you need glasses to read, then wear them.

4. Keep back from your Amsler grid about 14 to 16 inches.

5. Cover your left eye with your hand and look with the right eye.

6. Look at the center dot. If you can’t see the dot, try to look at the center of the graph paper where the dot would be if you could see it.

7. Repeat by covering the right eye with your hand and look with the left eye.

Q. What do I look for?

1. Are any lines blurred, distorted or wavy?

2. Are all the little boxes square and the same size?

3. Are there any areas that are missing or dark?

4. Can you see all the corners and sides at the same time,looking at the dot?

Q. What do I do if I find something?

1. Contact an eye doctor right away.

2. Print two copies of the Amsler grid, one for right eye and one for left eye.

3. Mark the copies showing areas where you noted the issues. Bring to doctor.

Q. Is this an eye exam?

1. No, of course not. It is an easy to use screening to help detect a possibly treatable problem in your eyes.

Why Glasses Are Expensive

Gary Edwards, M.D. — Wed, 02 Sep 2020 20:08:53 +0000

Most of the eyewear industry today is run by one giant monopoly, based in Italy. This huge optical concern can charge whatever the market will bear with very little competition. The excellent value aviators shown in the image are available here.
Starting with FDR in the 1930s and going onward for forty years, the US government opposed giant mergers that would result in monopolies. The business and political climate started changing in the 1970s. Giant mergers and giant corporations became more and more acceptable. Now, one rarely hears of any governmental opposition to mergers and acquisitions that result in monopolies or enormous conglomerates.

A Brief History

This is the case with the giant Italian optical firm whose name is very well known. This company has pursued a policy of acquisitions that has resulted in almost all famous brand frames and designer sunglasses being owned by them. They even own the big name, eye wear outlets such as Lens Crafters, Sun Glass Huts, Pearl Vision and many others.

With competition gone, they can act like the famous diamond concern and charge whatever the market will bear.

Meanwhile, the world’s largest optical lens company, based in France, had been acquiring almost all successful optical lens manufacturers in a similar way to the Italian company, gobbling up its competitors.

In the fall of 2018, the coup de grace to most competition occurred when these two companies merged. Now the worldwide sales and distribution of sunglasses, eyewear and optical lenses were dominated by one enormous behemoth, employing 150,000 people and mainly controlled by the family that owned the giant Italian eyewear company.

Meanwhile in Shenzhen, China

At the same time that all this was happening, manufacturing of eye wear and sunglasses was shifting to China. This has occurred to the point that the vast majority of the world’s eyewear and sunglasses is manufactured in China. This includes much of the eyewear and sunglasses produced and sold under the famous brand names.

This is where the informed consumer’s opportunity lies. The sunglass purchaser can get non-branded eye wear made with the same manufacturing skills and using the same materials as the famous-branded, designer glasses – BUT, at much lower prices.

What are the Alternatives

The value-priced, polarized, aviator sunglasses shown in the image are available here. One source of value-priced, quality eyewear is EYE MD^® Eyewear. Another is eyewearglasses.com. They offer you sunglasses, reading glasses, computer glasses and plano (no power) glasses.

The offerings with polycarbonate lenses are extremely impact resistant. They also greatly reduce ultraviolet exposure to your precious eyes and in the case of readers and computer glasses, many, also reduce blue light exposure.

Click HERE for Los Angeles Times article about this issue.

The Safest Lenses for Glasses

Gary Edwards, M.D. — Sun, 16 Aug 2020 21:11:25 +0000

Polycarbonate lenses are very strong plastic lenses. Eye care specialists universally recommend them for children’s eyewear. So, why not recommend them for adult eyewear? Well, I do and the reason is simple. Your sunglass lenses sit only a half inch or so from your eyes. Who wants something there that, if hit, could break and severely injure your eyes? This is why manufacturers make protective eyewear, S.W.A.T police eyewear, and military eyewear with polycarbonate lenses.
To learn more about the safety glasses shown in the image, click here.

What Are the Negatives of Polycarb Lenses?

It is easy to scratch a polycarbonate lens. That is why they are pretty much universally treated with a scratch resistant coating. The secret to not scratching your lenses, is to never place them with the lenses contacting the surface where they will rest. Always put them down with the temples (legs) down. Secondly, never rub your glasses with a random towel, shirt tail, necktie or cloth. To clean them, use non-residue soap and running water and gently clean them with your clean fingers. Blot them dry with a lint-free towel. This not only protects the polycarbonate but also the various layers of coatings such as anti-reflective (AR), scratch-resistant, tint and polarization coatings.

In high power glasses, there can be problems with polycarbonate. Two of these issues are edge thickness and chromatic aberration (seeing a rainbow fringe at the edge of objects). In adults needing high powers it can be problematic, so a sacrifice in safety is made and high index lenses are used. These reduce edge thickness and help eliminate the rainbow fringes.

Sunglasses and Readers

The advantage that over-the-counter sunglasses and readers have is that they offer plano (zero) power lenses and low power reading and computer eyewear. There is no issue with lens edge thickness or chromatic aberration at these powers.

In today’s world of modern plastics, I see no reason for anyone to wear glass lenses that sit only half inch from our most precious organ, our eyes. Sometimes glass lenses are called something else such as “crystal”. While it is true that they have passed a “drop ball test”, they are still glass. We all know what happens to glass if it is hit hard enough.

By using polycarbonate lenses you are wearing the safest and healthiest sunglasses, readers and blue-blocking eye wear available.