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Dr. Mark Siegel, MD FAAO

Health, Sea Island Ophthalmology, eyes

Vitamin see: foods rich in vitamin C may help slow cataracts

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By Dr. Mark S. Siegel

What do grapefruit, broccoli and strawberries have in common?

They are foods loaded with vitamin C, which could help slow cataract progression, according to a British study.

Cataracts are a clouding of the eye’s lens that happens naturally with age. The condition is the leading cause of blindness in the world, according to the World Health Organization.

Researchers from King’s College London examined data from more than 1,000 pairs of female twins to see what factors may help keep cataracts at bay. They tracked intake of vitamin C and other nutrients from food and supplements. They also recorded how opaque the subjects’ lenses were at around age 60, with a follow-up on 324 sets of twins about 10 years later.

Women who reported consuming more vitamin C-rich foods had a 33 percent risk reduction of cataract progression over the decade, according to the study. Their lenses overall were more clear.

Although we cannot totally avoid developing cataracts, we may be able to delay their onset and keep them from worsening significantly by eating a diet rich in vitamin C. The researchers noted that the findings only pertain to vitamins consumed through food and not supplements.

Vitamin C is a powerful antioxidant. The fluid inside the eyeball is normally high in a compound similar to vitamin C, which helps prevent oxidation that results in a clouded lens. Scientists believe more vitamin C in the diet may increase the amount present around the lens, providing extra protection.

Because the study was done in twins, the team was also able to calculate how much of a role genetics versus environmental factors play in cataract progression. While environmental factors, such as diet, accounted for 65 percent, genetic factors only accounted for 35, indicating that diet and lifestyle may outweigh genetics.

The study, “Genetic and Dietary Factors Influencing the Progression of Nuclear Cataract“ will be published this June in Ophthalmology, the official journal of the American Academy of Ophthalmology.

Dropless Cataract Surgery: What are the potential risks?

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By Dr. Mark S. Siegel

Cataract surgery continues to evolve, with microincisional clear corneal incisions, femtosecond lasers, new imaging modalities, and improved lens implants. However, the published literature is having trouble keeping up with clinical practice. Despite the ongoing change, one concern remains constant: endophthalmitis (infection) prophylaxis. The use of perioperative povidone-iodine, a lid speculum, and drape with isolation of lids and lashes, and sterile preparation, is effective in limiting the incidence of endophthalmitis after cataract surgery.

The recent advent of “dropless” cataract surgery via transzonular ocular injections of TriMoxi or TriMoxiVanc, offers another option of infection prophylaxis. As some cataract surgeons consider adopting dropless cataract surgery it is important to balance the potential complications and risks involved with this technique.

These combinations of antibiotics and steroids are delivered to the anterior vitreous (jelly that fills the back of the eye) by injection through the zonules (tiny spider web-like ligaments that anchor the lens to the wall of the eye). This is intended to mitigate the need for post-operative topical drops. Drops can be costly, can irritate the surface of the eye, can be difficult for some patients to administer and can be burdensome to prescribers. Though post-operative drops are less than ideal, this new mode of dropless infection prophylaxis contains some inherent risks.

A clear concern is compounding errors. There have been reports of dilutional errors with intraocular antibiotics that have resulted in complications including macular swelling, retinal detachment, macular infarction, toxic anterior segment syndrome (severe inflammation) and a large outbreak of Fusarium endophthalmitis.

The pharmacokinetics of TriMoxi(+/-) Vanc is unclear when placed in the anterior vitreous. These antibiotics have the shortest half-life of current intravitreal antibiotics being used (1.7 hours). Vancomycin has a half-life of 25.1 hours. Routine topical antibiotics are able to produce concentrations inside the eye for a week post-operatively. While one European study showed decreased rates of endophthalmitis with injected antibiotics, all arms of the study used 6 days of topical postoperative antibiotics! The question remains: is the duration of coverage with injected antibiotics without topical antibiotics adequate?

Antibiotic resistance is another consideration when using TriMoxi. Emerging resistance has been identified. A recent review found resistance rates to moxifloxacin has increased from 21% in 1995 to 62% in 2014.

The use of prophylactic vancomycin in TriMoxiVanc during routine cataract surgery is controversial. The Centers for Disease Control issued guidelines in 1995 specifically discouraging the use of vancomycin in routine surgical prophylaxis because of increasing bacterial resistance. The risk of fueling the emerging resistance to vancomycin for an unproven practice is worrisome. Given that there are more than 3 million cataract surgeries performed in the United States each year, exposure of the ocular surface to low doses of vancomycin could result in an increase in vancomycin resistant bacteria.

Another unknown is the risk of steroid-induced ocular hypertension (elevated eye pressure) associated with TriMoxi(+/-) Vanc. It is well known that topical steroids can induce ocular hypertension, but drops are easily discontinued, whereas injected intraocular steroids are not. Currently there is a paucity of literature addressing transzonular triamcinolone (the steroid component in TriMoxi) and its associated ocular hypertension risk. Furthermore, the use of triamcinolone leaves patients with obscured vision and floaters for the first week or more. Patient complaints of foggy vision postoperatively have led some cataract surgeons to discontinue the product. Many randomized trials show that topical nonsteroidal anti-inflammatory drugs (NSAIDS) are superior to topical steroids in reducing post-operative macular swelling after cataract surgery. Thus, regardless of the intraocular steroid and antibiotic used, it is likely that a topical NSAID will need to be prescribed.

Technical and mechanical issues must be considered in addition to issues of bacterial resistance, compounding risks, steroid-induced elevated eye pressure, and post-operative foggy vision. In patients with lens zonular weakness (pseudoexfoliation), intraocular lens (IOL) decentration or dislocation may occur. The impact of this technique for premium IOL decentration could create significant visual disturbance. Since most patients using blood thinners do not discontinue this medication, there could be intraocular hemorrhage from inadvertent cannula contact with the iris ciliary muscle. Finally, very short eyes may not have the space to accommodate the injected volume of these antibiotic and steroid preparations.

Today’s cataract surgery is safer for the patient and shorter in duration than in decades past. Improvements in technology, techniques, and training have led to improved outcomes for our patients. Although the concept of dropless cataract surgery is clearly attractive, cataract surgeons should consider the serious issue of bacterial resistance and the unnecessary risk of the transzonular delivery of TriMoxi(+/-) Vanc. In an era of increasing cost-benefit analysis where physicians will be judged on outcomes and the allocation of limited healthcare resources, the value of dropless cataract surgery remains uncertain, risky and currently not the standard of care.

February is Age-Related Macular Degeneration Awareness Month

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By Dr. Mark S. Siegel

Macular degeneration is a major cause of irreversible vision loss in the United States and around the world. As many as 11 million Americans have some form of macular degeneration. To observe Age-Related Macular Degeneration (AMD) Awareness Month, Sea Island Ophthalmology is offering tips for prevention, early detection, and treatment of the condition.

Facts about Age-Related Macular Degeneration (AMD)

The number of people living with any form of macular degeneration is similar to that of those who have been diagnosed with all types of invasive cancers.

As many as 11 million people in the United States have some form of AMD. This number is expected to double by 2050.

AMD is the result of deterioration of a central area of the retina called the macula, which is the location of central vision. This deterioration can make vision become blurry or wavy. It can also result in a blind spot in the center of your vision.

Age is a major risk factor for developing AMD. Other risk factors include: a history of smoking, hypertension, and family history. AMD is more common among women and Caucasians but is seen among all races.

There are two types of AMD: dry (atrophic) and wet (neovascular or exudative). Most AMD starts as the dry type and in 10-20 percent of individuals, it progresses to the wet type.

Age-related macular degeneration is always bilateral (i.e., occurs in both eyes), but does not necessarily progress at the same pace in both eyes. It is therefore possible to experience the wet type in one eye and the dry type in the other.

Tips for Age-Related Macular Degeneration (AMD) Prevention and Treatment

If you have a family history of AMD, get a comprehensive dilated eye exam yearly after the age of 50.

AMD occurs less often in people who exercise, avoid smoking, and eat nutritious foods including green leafy vegetables and fish. If you already have AMD, adopting these habits may help you keep your vision longer.

Although some vision loss from AMD is irreversible, effective treatments can slow down progression or in some cases reverse vision deterioration.

Nutritional supplement formulations containing antioxidants and zinc (studied in the AREDS and AREDS2 clinical trials) have been shown to slow the disease in those who have intermediate AMD and those with advanced AMD in only one eye.

Anti-VEGF injections (medication specifically aimed at stopping the progression of the abnormal blood vessels that cause the vision loss) are an effective treatment for the wet or neovascular form of AMD and may control or reverse vision loss if administered shortly after the onset of vision loss. Early recognition of vision change, evaluation by an ophthalmologist, and starting proper medical treatment may be sight-saving.

Anti-Complement treatments and Stem cell therapies are promising treatments for the advanced dry form of AMD, which are being studied in multiple clinical trials.

January is Glaucoma Awareness Month

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By Dr. Mark S. Siegel

January is National Glaucoma Awareness Month, an important time to spread the word about this sight-stealing disease.

Currently, more than 3 million people in the United States have glaucoma. The National Eye Institute projects this number will reach 4.2 million by 2030, a 58 percent increase.

Glaucoma is called “the sneak thief of sight”. There are no symptoms and once vision is lost, it’s permanent. Nearly 40% of vision can be lost without a person noticing.

Glaucoma is the leading cause of preventable blindness. Moreover, among African American and Latino populations, glaucoma is more prevalent. Glaucoma is 6 to 8 times more common in African Americans than Caucasians.

And among Hispanics in older age groups, the risk of glaucoma is nearly as high as that for African-Americans. Also, siblings of persons diagnosed with glaucoma have a significantly increased risk of having glaucoma.

Over 3 million Americans, and over 60 million people worldwide, have glaucoma. Experts estimate that half of them don’t know they have it. Combined with our aging population, we can see an epidemic of blindness looming if we don’t raise awareness about the importance of regular eye examinations to preserve vision. The World Health Organization estimates that 4.5 million people worldwide are blind due to glaucoma.

What is Glaucoma?

Glaucoma is a group of eye diseases that gradually steal sight without warning. Although the most common forms primarily affect the middle-aged and the elderly, glaucoma can affect people of all ages.

Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain.

There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.

Types of Glaucoma

There are two main types of glaucoma: primary open-angle glaucoma (POAG), and angle-closure glaucoma. These are marked by an increase of intraocular pressure (IOP), or pressure inside the eye. When optic nerve damage has occurred despite a normal IOP, this is called normal tension glaucoma.

Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss.

Regular Eye Exams are Important

Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization. In the most common form, there are virtually no symptoms. Vision loss begins with peripheral or side vision, so if you have glaucoma, you may not notice anything until significant vision is lost.

The best way to protect your sight from glaucoma is to get a comprehensive eye examination. Then, if you have glaucoma, treatment can begin immediately.

Risk Factors

Are you at risk for glaucoma? Those at higher risk include people of African, Asian, and Hispanic descent. Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted. Regular eye exams are especially important for those at higher risk for glaucoma, and may help to prevent unnecessary vision loss.

Choose safe toys this holiday season

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By Dr. Mark S. Siegel

No one chooses gifts with the intent to harm, but some popular children’s toys can cause serious eye injuries. According to the U.S. Consumer Product Safety Commission, more than 265,000 toy-related injuries were treated in emergency rooms in 2012, and almost half of these injuries affect the head or face – including the eyes. Unfortunately, most of these injuries happen to children under age 15.

Give children the appropriate protective eyewear along with their new skis, snowboards, and sleds.
Give children the appropriate protective eyewear along with their new skis, snowboards, and sleds.

‘You’ll shoot your eye out’

Some propelling toys, like air soft guns, BB guns, paintball guns and darts can be particularly hazardous, with the potential to cause serious eye injuries such as corneal abrasion, ocular hyphema (bleeding inside the eye), traumatic cataract, increased intraocular pressure and even permanent vision loss.

Another dangerous toy category is those with laser components, which have increased in power and decreased in price over the years. Lasers can be especially hazardous when used in toys that are aimed, such as a laser gun. Blue light lasers are particularly dangerous, as they are more likely to cause retinal injury compared with green or red lasers. Studies show that exposure for even fractions of a second to high-powered blue handheld laser devices can cause serious eye injuries – including macular holes – which often require surgical intervention. In addition, the FDA warns that laser pointers are not toys and should only be used with adult supervision.

The good news is that following these toy safety tips can easily prevent most eye injuries:

Top Toy Safety Tips:

  • Avoid purchasing toys with sharp, protruding or projectile parts.
  • Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury.
  • Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J.
  • Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your ophthalmologist to learn about protective gear recommended for your child’s sport.
  • Check labels for age recommendations and be sure to select gifts that are appropriate for a child’s age and maturity.
  • Keep toys that are made for older children away from younger children.

If your child experiences an eye injury from a toy, seek immediate medical attention.

Are you a candidate for laser cataract surgery?

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By Dr. Mark S. Siegel

The femtosecond laser technology that brought new levels of safety, accuracy and predictability to LASIK surgery is also advancing cataract surgery. In our office, we call the procedure Refractive Laser-Assisted Cataract Surgery (ReLACS), but it also is known generally as laser cataract surgery.

In laser cataract surgery, an advanced femtosecond laser replaces or assists in the use of a hand-held surgical tool for the following steps in cataract surgery:

1 The corneal incision

2 The anterior capsulotomy

3 Lens and cataract fragmentation

4 Astigmatism correction at the time of surgery

Use of a laser can improve the precision, accuracy and reproducibility of each of these steps, potentially reducing risks and improving visual outcomes of cataract surgery.

The Corneal Incision

Traditional cataract surgery is one of the most frequently performed surgeries and also one of the most safe and effective, with predictable outcomes. It is highly dependent on surgeon skill, volume and experience.

Optical coherence tomography is an imaging technology that helps your cataract surgeon to plan the location and depth of incisions made during a laser-assisted cataract surgery procedure. OCT scans offer high-resolution and even cross-sectional images, to make the cataract surgery as precise as possible.
Optical coherence tomography is an imaging technology that helps your cataract surgeon to plan the location and depth of incisions made during a laser-assisted cataract surgery procedure. OCT scans offer high-resolution and even cross-sectional images, to make the cataract surgery as precise as possible.

The first step in cataract surgery is making an incision in the cornea. In manual cataract surgery, the eye surgeon uses a hand-held metal or diamond blade to create an incision in the area where the cornea meets the sclera. This incision allows the surgeon to gain access to the interior of the eye to break up and remove the cataract, which is a clouding of the eye’s natural lens that is located right behind the pupil. Next, an intraocular lens (IOL) is inserted and implanted, to replace the cloudy natural lens.

The corneal incision is made in a special way so it will self-seal when surgery is complete, without any need for stitches.

In laser cataract surgery, the surgeon creates a precise surgical plan for the corneal incision with a sophisticated 3-D image of the eye called an OCT (optical coherence tomography). The goal is to create an incision with a specific location, depth and length in all planes, and with the OCT image and a femtosecond laser it can be performed exactly without the variable of surgeon experience or patient cooperation.

This is important not only for accuracy but also for increasing the likelihood that the incision will be self-sealing at the end of the procedure, which reduces the risk of infection.

The Capsulotomy

A very thin, clear capsule surrounds the eye’s natural lens. In cataract surgery, the front portion of the capsule is removed in a step called an anterior capsulotomy, to gain access to the cataract.

It is very important that the remainder of the lens capsule that remains intact in the eye is not damaged during cataract surgery, because it must hold the artificial lens implant in place for the rest of the patient’s life.

In traditional cataract surgery, the surgeon creates an opening in the capsule with a small needle and then uses that same needle or a forceps to tear the capsule in a circular fashion.

In laser cataract surgery, the anterior capsulotomy is performed with a femtosecond laser. Studies have shown that capsulotomies performed with a laser have greater accuracy and reproducibility.

Studies also have shown that laser capsulotomies enable better centering of the intraocular lens, and IOL positioning is a significant factor in determining final visual outcomes.

Lens and Cataract Fragmentation

After the capsulotomy, the surgeon now has access to the cataract to remove it. In traditional cataract surgery, the ultrasonic device that breaks up the cataract is inserted into the incision. During this phacoemulsification procedure, the ultrasound energy can lead to heat buildup in the incision, which sometimes can burn the incision and negatively affect the visual outcome by actually inducing astigmatism.

An incision burn also has a higher chance of leaking and sometimes needs multiple sutures to close. The smaller the incision we use, the more this issue is important to consider.

The laser, on the other hand, softens the cataract as it breaks it up. By breaking up the cataract into smaller, softer pieces, less energy should be needed to remove the cataract, so there should be less chance of burning and distorting the incision.

Laser cataract surgery may also reduce the risk of capsule breakage. After the calculation of the proper implant power, there is no step more important for visual outcome than preservation of the capsule that the natural lens sat in. This capsule is as thin as cellophane wrap and it’s important that the portion that is left inside the eye after cataract surgery is undamaged, so it can hold the IOL in the proper position for clear,
undistorted vision.

The reduced phacoemulsification energy required in laser cataract surgery may also make the procedure safer to the inner eye, which reduces the chance of certain complications, such as corneal decompensation or retinal complications.

Astigmatism Correction at the Time of Cataract Surgery

To reduce the need for prescription eyeglasses or reading glasses after cataract surgery, it is important that little or no astigmatism is present after implantation of IOLs, especially presbyopia-correcting multifocal IOLs.

Astigmatism usually is caused by the cornea being more curved in one meridian than others (in other words, it’s shaped somewhat like a football). To reduce astigmatism, small incisions can be placed in the periphery of this more curved meridian; as the incisions heal, this meridian flattens slightly to give the cornea a rounder, more symmetrical shape (like a baseball).

This procedure is called limbal relaxing incisions (LRI) or astigmatic keratotomy (AK). Surgeons can perform LRI or AK manually with a diamond blade, and it is quite effective in reducing astigmatism.

During refractive laser-assisted cataract surgery, the OCT image can be used to plan laser LRI or AK incisions in a very precise location, length and depth. This increases the accuracy of the astigmatism-reducing procedure and increased the probability of good vision without glasses after cataract surgery.

This LenSx femtosecond laser system has laser data entry at left, a joy stick control and an OCT screen at right, which offers the surgeon all-important guidance during laser-assisted cataract procedures. (Images: Alcon)
This LenSx femtosecond laser system has laser data entry at left, a joy stick control and an OCT screen at right, which offers the surgeon all-important guidance during laser-assisted cataract procedures. (Images: Alcon)

Laser Cataract Surgery Systems Currently Available

A number of medical device companies worldwide manufacture systems for performing laser cataract surgery. There are four Systems that have attained FDA approval and are currently available for laser-assisted cataract surgery performed in the United States. We use the LenSx system in our practice.

• LenSx. The LenSx system (Alcon) was the first femtosecond laser system to gain FDA approval for cataract surgery performed in the U.S. The LenSx system is approved for corneal incisions, capsulotomies and lens (cataract) fragmentation and has been used in more than 400,000 cataract refractive procedures worldwide, according to Alcon

Cost of Laser Cataract Surgery

Refractive laser-assisted cataract surgery costs more than conventional options. Medicare or private health insurance does not cover extra costs of laser cataract surgery since the laser is used to treat astigmatism or is used in conjunction with advanced technology IOLs, which is not a covered service. You will pay extra out-of-pocket per eye for a laser-assisted procedure.

Conclusion

It is important to put this new technology into proper perspective. Manual cataract surgery is very effective and successful. People who do not want to invest out-of-pocket money in laser cataract surgery can still feel confident about the manual approach.

But if you want the best possible vision, laser cataract surgery is more precise, accurate and gentle. A more accurate and precise incision, capsulotomy and astigmatic correction may help you achieve your goal of less dependence on glasses after cataract surgery.

Cataract surgeons who use lasers say that their advantages are especially evident when it comes to advanced technology, premium implants such as presbyopia-correcting multifocal IOLs and toric IOLs for astigmatism. The advantages can include better lens placement and therefore more accurate visual outcomes.

To decide if laser cataract surgery is the best choice for you, ask your cataract surgeon for more information about this exciting technology during your preoperative exam and consultation.

Avoid an eye nightmare this Halloween!

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By Dr. Mark S. Siegel

If you want your Halloween look to include cat, zombie or glow-in-the-dark eyes, or if you’d like to use lenses to change your eye color or appearance, obtain prescription costume contact lenses from an eye care professional. It’s crucial that your lenses fit properly, and your individual prescription can only be determined by an eye exam.

Skipping this step and buying lenses online or over the counter can set you up for serious eye problems, infections or even permanent vision loss.

What are costume contact lenses?

Costume contact lenses – also known as cosmetic or decorative contact lenses – are any type of contact lenses that are meant to change the appearance of your eyes. They include colored contacts, fashion lenses and lenses that can make your eyes look like vampires, animals or other characters.

Websites often advertise colored contacts as if they were cosmetics, fashion accessories or toys. With whimsical packaging and names, their targets are often teens and young adults. The truth: claims such as “one size fits all” and “no need to see an eye specialist” are misleading. Non-prescription contact lens sales are illegal.

What’s wrong with costume contact lenses? 

Contact lenses should not be thought of as fashion accessories or makeup – they are medical devices that require a prescription from an eye care professional. The eyes are one of the most delicate and important parts of the body, so what you put in and on them must be medically safe and FDA-approved.

Many people buy these lenses to use as costume accessories to enhance their Halloween costumes, and shops as well as online retailers, actively market and advertise the lenses to innocent consumers unaware of the risks. These risks include dangerous infections that can lead to permanent vision loss and even require corneal transplants. This is why many ophthalmologists see a spike in patients coming to them with these types of injuries around Halloween.

What damage can costume contact lenses cause?

Non-prescription costume contacts can cause injuries such as cuts and open sores in the cornea, the protective clear layer in front of the iris and pupil. Corneal abrasions and corneal ulcers can cause potentially blinding painful bacterial infections (keratitis). These injuries can require serious eye surgeries such as corneal transplants, and in some cases lead to permanent vision loss.

One study found that wearing costume contact lenses increased the risk for developing keratitis – a potentially blinding infection that causes a corneal ulcer– by more than 16 times, compared to people who wear regular, corrective contacts. Unfortunately, 60 percent of patients who developed keratitis from wearing non-prescription costume contact lenses in this study suffered permanent vision loss.

Novelty products, like circle lenses, are not FDA-approved. Circle lenses can be particularly harmful, because the lens covers more of the eye than regular corrective lenses, which makes it very difficult for necessary oxygen to get through to the eye.

Why are circle lenses illegal?

Unlike regular, prescription contact lenses, circle lenses cover a bigger area of the eye, extending past the iris and onto the whites of the eye so that the iris appears bigger and the wearer has a “doe-eyed,” or Anime, look. In Korea, Japan, and other Asian countries there’s a subculture that seeks to mimic the “Ulzzang” look of Anime characters (cartoon figures).

Illegally sold circle lenses bypass several crucial safeguards, such as a lens fitting and instructions on how to properly clean contact lenses. And since the industry is unregulated, the lenses may not have been cleaned or disinfected properly before sale, again raising the risk of eye infections and vision damage.

How many injuries occur each year from costume contact lenses? 

There are no comprehensive studies yet that tells us how many injuries occur each year from wearing costume contact lenses. However, we know anecdotally amongst ophthalmologists that we continue to see injuries of this type each year despite FDA regulations. In addition, a 2010 study published in Pediatrics indicated that at least 13,500 emergency room cases each year are due to contact lens injuries in children and teens.

Why are stores and online retailers selling costume contact lenses without a prescription if it’s not safe?

Although the practice has been illegal since 2005, today cosmetic contact lenses are still sold in shops and via online retailers to customers who are unaware that wearing these devices can result in serious eye injuries. Federal law classifies all contact lenses as medical devices and restricts their distribution to licensed eye care professionals. Illegal sale of contact lenses can result in civil penalties of up to $16,000 per violation. If you see contact lenses being sold by retailers not requiring a prescription, you can report the retailer to the FDA through its MedWatch program.

So if your Halloween includes costume contact lenses, please see your eye care professional to avoid an eye horror! Have a safe and happy Halloween.

September is Healthy Aging Month!

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By Dr. Mark S. Siegel

There are over 76 million baby boomers today over the age of 50 and the first of the 82.1 million Generation X-ers are turning 50 in 2015. Aging is a process that brings many changes and baby boomers, as well as gen x-ers, share an interest in staying active, vibrant, and independent as long as possible.

Traveling, biking, boating, kayaking, hiking, learning new skills and many other exciting activities become very difficult without healthy vision. Taking steps to maintain healthy vision as we age is one of the most critical things we can do to ensure our activity options remain virtually limitless. Follow these tips for healthy vision all year and enjoy healthy aging for the years to come:

#1. Get a Comprehensive Dilated Eye Exam in September

Starting at the age of 40, getting an annual dilated eye exam with an ophthalmologist is the most important step you can take – even if you have no vision problems. So take the month of September to celebrate healthy aging by calling your ophthalmologist for a comprehensive dilated eye exam. A comprehensive eye exam isn’t the same as your basic eye exam for glasses or contacts. During a comprehensive dilated eye exam your eye doctor will check for signs of cataracts, age-related macular degeneration, glaucoma and diabetic retinopathy, along with other eye conditions. Early diagnosis and treatment helps to prevent vision loss and is instrumental in enjoying life into the ages.

#2. Protect Your Eyes with Sunglasses and a Hat

We know what the sun’s UV (ultraviolet) rays do to our skin, but we often forget they also have a damaging effect on our eyes – causing cataracts and contributing to the acceleration of macular degeneration. Although sunglasses with UV protection help to protect our eyes, wearing a wide-brimmed hat while enjoying outdoor activities will provide the extra protection to keep your eyes aging healthy and supporting your active lifestyle. And don’t forget – UV rays occur throughout the year so don’t put away the shades when the temperatures drop.

#3. Reduce Eye Strain with Breaks and More Sleep

Although eye strain isn’t a vision disease or disorder, it can cause headaches, fatigue and occasionally itchy eyes – which contributes to rubbing. Eye rubbing exacerbates dry eye syndrome and ocular irritation. In order to reduce eye strain, take breaks from reading, driving, and looking at screens by focusing your eyes on something else every 20 minutes for about 20 seconds. Another step we can take to reduce eye strain is to get enough sleep. Being overtired increases eye strain while a healthy evening dose of sleep can keep our eyes ready for another active day.

#4. Stop Smoking

Studies show that smoking increases the risk of developing vision problems including macular degeneration, cataracts, glaucoma, diabetic retinopathy and dry eyes. Taking the month of September to get help in kicking the habit could be one of the most important things you could ever do to ensure healthy aging for your body and your vision.

#5. Take Advantage of Fresh Fruits and Vegetables

Choosing a diet rich in fruits and vegetables can help keep your eyes healthy and disease free. Studies suggest that the antioxidants lutein and zeaxanthin may help lower the risk of eye conditions, such as cataracts and macular degeneration that can accompany aging. Lutein and zeaxanthin are found in fruits and vegetables with yellow and orange pigments, such as corn, squash, carrots, and citrus fruits. They are also found in dark green leafy vegetables, like kale, collard greens and spinach. This September (and into the fall) take advantage of harvest time and visit one of the many farmers’ markets in the area to purchase some fresh fruits and vegetables.

#6. Enjoy Exercise to Maintain a Healthy Weight

Many eye diseases are linked to high blood pressure, diabetes and high cholesterol levels. Exercise can help keep these problems at bay or limit their impact if they do occur. Recent studies have shown that people who exercise regularly were less likely to develop serious eye disease.

Is it time for you to have cataract surgery?

in Contributors/Dr. Mark Siegel, MD FAAO/Health by

By Dr. Mark S. Siegel

A cataract diagnosis does not typically mean that surgery is required immediately. Cataracts occur as part of the body’s natural aging process and may not change vision significantly in the early stages. Small cataract-related changes may be improved with prescription glasses. But as the cataracts continue to mature over time, they may cause vision loss that can interfere with activities of daily living.

Although the prospect of cataract surgery can be intimidating, the procedure itself is the most common elective surgery among Medicare beneficiaries in the United States. Multiple studies have demonstrated that cataract surgery can lead to improved quality of life, reduced risk of falling and fewer car crashes. In addition, one study found that those who had cataract surgery had a 40 percent lower long-term mortality risk than those who did not.

The following four questions can help you determine whether or not you’re ready for cataract surgery:

Are your cataracts impacting your daily or occupational activities?

Symptoms of cataracts include dim, blurry or yellowed vision and can even cause double vision in one eye. The lack of contrast and clarity can be difficult for those who need clear vision for work, driving or for those who enjoy hobbies like reading, cooking or sewing.

Are your cataracts affecting your ability to drive safely at night?

Cataracts can cause halos around lights and difficulty seeing in low-light settings, which can impact the ability to safely drive at night. Advanced cataracts can even cause enough vision loss to fail the vision test required for a driver’s license.

Are your cataracts interfering with the outdoor activities you enjoy?

Cataracts can also increase sensitivity to glare, which can be especially troublesome for those who enjoy skiing, surfing and a number of other outdoors activities. They can also cause visual differences from one eye to the other, which can affect the distance vision required for people who play golf, tennis and similar recreational activities.

Can you manage your cataracts in other ways?

Those who decide to put off cataract surgery can make the most of their vision with a few simple tools, such as incorporating brighter lighting and contrasting colors in the home. Polarized sunglasses and a wide-brimmed hat can reduce glare, while magnifying lenses can make reading easier.

If cataracts aren’t disrupting your life, you can probably wait and have surgery when they really start to bother you. But if you feel as though cataract-related blurred or dulled vision is slowing you down, the procedure can have a significant and beneficial impact. It’s best to discuss how cataracts are affecting your life and vision with your eye doctor.

June is Cataract Awareness Month!

in Dr. Mark Siegel, MD FAAO/Health by

By Dr. Mark S. Siegel

The American Academy of Ophthalmology has declared June as Cataract Awareness Month. Cataracts are the leading cause of treatable vision loss in the United States, and it is the leading cause of blindness in the world. There are 24 million Americans over the age of 40 who are affected by cataracts, so it seems fitting that an entire month should be dedicated to education and awareness.

In honor of Cataract Awareness Month, here are some common questions and answers about cataracts:

What is the treatment for cataracts? Even though cataracts are so prevalent, they are very successfully treated. Cataracts are a clouding of the human lens inside the eye, which prevents passage of light into the back part of the eye. The solution to cataracts is cataract surgery, which requires a surgeon to remove the deteriorated lens and replace it with an artificial lens called an intraocular lens or IOL. Over 3 million Americans undergo cataract surgery annually, making it one of the most common surgeries in the United States. In fact, the entire surgery lasts only about 20 minutes, and most people can resume normal activities after surgery fairly rapidly.

Is cataract removal safe? Cataract surgery is a twenty-minute miracle! Cataract surgery is one of the safest and most effective surgeries with a success rate well over 95 percent. Your eye surgeon will remove your clouded lens and replace it with an intraocular lens (IOL). Only a micro incision in the cornea is necessary to do this procedure, and it can be completed in about 20 minutes in an outpatient surgery center. We currently use phacoemulsification, an ultrasonic process that breaks up or emulsifies the cloudy lens and then vacuums it out. We currently have a wide variety of vision improving IOL’s that patients may choose to reduce their dependence upon eyeglasses, thereby improving their lifestyle.

Do cataracts only affect seniors? Cataracts can affect anyone! Although most people do not show symptoms of cataracts until at least the age of 40, cataracts can also affect young adults or even children. Heredity, disease, eye injury and smoking may cause cataracts to develop at an earlier age.

Can I prevent cataracts? There is no proven way to prevent age-related cataracts. However, choosing a healthy lifestyle can slow the progression of cataracts. Some ways to delay the progression of cataracts include avoiding smoking, reducing exposure to UV rays, eating healthy foods, and wearing proper eye protection to avoid eye injury.

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