Good Morning America reports that the American Academy of Ophthalmology states 90% of patients achieve 20/20 vision following laser vision correction. What the AAO report does not address is that 20/20 does not mean that the patients have a good quality of visual acuity. The Good Morning America Video (video at the end) interviews both satisfied and unsatisfied patients. Some patients complain of a worsening of their dry eye symptoms, halos or shadows, glare or starbursting, poor night vision, reduced contrast or simply uncorrectable blurry vision. The vast majority of the patients that have had LASIK or PRK are happy with the result. However, laser vision correction is not reversible and some of the resultant problems from refractive surgery are not resolvable.
Options available to patients that are not happy with their surgical result, of course depend on the symptom. Some of the options available to patients are:
Post Surgical Contact Lenses
These special contact lenses are available as soft contacts, as gas permeable lenses and as a combination soft/gas permeable. Post refractive surgery contact lenses are usually used when a patients vision can not be corrected by additional surgery, glasses or regular contact lenses because their corneal surface has become slightly irregular or distorted. The symptoms may include, blurry vision, halos and shadows.
Dry Eye Syndrome
The most common complaint following refractive surgery is dry eyes. Most often the dryness improves two to six months following surgery. Ocular dryness can also cause blurry vision. Should the dryness not improve there are numerous solutions to improve patient comfort and it is worth seeking help from an eye doctor that is familiar with treating dry eye syndrome.
Glare and Poor Night Vision
Often glare, halos and night vision problems are due to large pupils and/or uncorrected refractive error. Night driving glasses will usually help patients that are still a little nearsighted following refractive surgery. Treating the glare is little more difficult. Glare often improves with time, however a medication called Alphagan has been known to improve night glare symptoms by causing the pupil to constrict slightly. Alphagan may contribute to the ocular dryness, however.
Know Your Vision Correction Options
LASIK and PRK are good procedures and can greatly improve one’s quality of life. Prior to taking the refractive surgery plunge patients should thoroughly research their options. In an upcoming article I’ll cover the alternatives to refractive surgery.
At Total Eye Care we offer all of the refractive surgery and non surgical vision correction options available and we pride ourselves on giving our patients an objective opinion of all of their choices. It is important for our patients to be well educated on the pros and cons of each option so that they can make an informed decision.
Check out the video below from the Good Morning America’s investigation on LASIK, it offers a balanced report on refractive surgery.
In December 2009 we covered the results of a recent study Myopia Increasing Rapidly in The US Population. Recently National Public Radio’s Medical Detectives interviewed, Dr Susan Vitale, principle author of the study “1994-2004 National Health and Nutrition Examination Survey” and Dr. Don Mutti, an expert in myopia. It’s a good listen and only a little over 3 minutes.
With myopia increasing at such a rapid rate in our population will it be long before the use of orthokeratology to slow the progression of myopia in our children becomes the standard of care?
Photo courtesy of Flickr user Pink Sherbet Photography, D Sharon Pruitt
The rate of nearsightedness in the US has increased by over 66% in the past 30 years says a study published in the December 2009 issue of Archives of Ophthalmology
A 66% increase in myopia is a huge change over a 30 year period. The new study tried to simulate the testing methods of the original 1972 study on nearsightedness in the US population. The 1971-1972 National Health and Nutrition Examination Survey found that 25% of the US population between the ages of 12 and 54 were nearsighted vs the 1994-2004 National Health and Nutrition Examination Survey’s finding of 41.6%. Increased nearsightedness was noted regardless of age, sex, race or education.
The authors concluded that it would be beneficial to identify behavioral risk factors that cause increased myopia. If risk factors for increasing myopia are identified we may be able to slow the progression.
The big question is “what caused this increased nearsightedness in the US population”? As eye doctors we are often asked what causes nearsightedness and the usual answer is that that we believe nearsightedness is a combination of genetics and environmental influences. In the last 30 years our society has become much more near centric. People spend hours glued to their computer monitors at work and home. Kids spend more time at near now then ever before with computer games, hand held games etc.
Numerous recent studies have shown that orthokeratology contact lenses can greatly slow the progression of nearsightedness
Finding ways to slow or halt the progression of myopia has been a longstanding subject of study in eyecare. The process of using special contact lenses to reshape the front part of a patient’s eye to prevent the progression of nearsightedness and to allow the patient to see without glasses is called orthokeratology. There are a number of different names for orthokeratology, orthoK, corneal molding, corneal reshaping and corneal refractive therapy are some of the most common names.
Almost a year ago the study, Controlling Astigmatism & Nearsightedness in Developing Youth (CANDY) showed that orthokeratology contact lenses reduced the progression of nearsightedness in kids between 9 and 16. The authors of the CANDY study found that the amount myopia in children that did not wear the overnight Corneal Refractive Therapy lenses increased at a rate of .37D per year while those children wearing the lenses progressed at only .03 diopters per year.
Another study, Corneal Reshaping and Myopia Progression published in the British Journal of Ophthalmology, conducted at the Ohio State University College of Optometry found that the eyes of the children wearing overnight orthokeratology lenses increased in length at a markedly slower rate than the studies’ non ortho-K lens wearers.
Lastly, the study Stabilization of Myopia by Accelerated Reshaping Technique (SMART) is in the first of its five years and this past summer released preliminary results showing that again, orthokeratology lenses appear to markedly slowing the progession of nearsightedness in children.
While the rate of nearsightedness in the US population has increased significantly in the last 30 years it is comforting to know that there are safe and effective methods of slowing the progression of myopia. Download a PDF of the study Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999-2004
Image courtesy of Flickr member Foxtongue.
Posted in children, contact lens, orthokeratology, Refractive issues
Tagged corneal refractive therapy, corneal reshaping, myopia, national health and nutrition examinatin survey, nearsighted, ortho-K, orthokeratology, prevention, survey
That is the opinion of The National Commission on Vision & Health, in a new report entitled “Building a Comprehensive Vision Care System“, found that 25% of school age children have undiagnosed vision problems and that correcting this must become a national health care priority.
Some of the vision problems cited in the literature review included undiagnosed nearsightedness, farsightedness, amblyopia, retinoblastoma, congenital defects, and strabismus. The report went on to state that a vision screening was not a substitute for an eye exam and that eye exams from an optometrist or ophthalmologist were a very effective way to detect vision problems in children.
In 2004 The Vision council of America estimated that the rate of undetected vision problems in children to be 25%. The 2010 National Health Objective 28-4 to reduce blindness and visual impairment in children and adolescents has experienced little progress in it’s goal to reduce childhood blindness.
In 2002 the American Public Health Association (APHA) issued a statement supporting regular eye exams in children to improve the detection rate of vision problems instead of regular screenings. APHA recommended eye exams at age 6 mos, 2 years and 4 years. A failure of the current screening program is the lack of follow through for children when problems are detected. “Most forms of vision loss in children are preventable. Improving the access to eye care for children should be as important as are our current childhood vaccination programs” said Dr. Richard Driscoll.
Sixteen states do not require any vision assessment prior to a child entering school. The remaining states require some for of vision assessment prior to a child entering school, however only five states require a follow up examination to the screening. Screenings are clearly not effective if the results are not acted upon. Only three states, Illinois, Kentucky and Missouri have legislated mandatory eye exams prior to a child entering school.
Cost was found to be an issue with getting visual assessments for children. Uninsured children did not receive a well child visit 54% of the time. Often a well child visit includes a visual assessment.
The recommendations of the study to improve access to eye care for children included funding national campaigns to educate the public regarding the need to seek care for their child, setting up national standards to be adopted by all states, assure adequate vision coverage by all public and private insurers.
For more articles written on The Eye Doc Blog on vision problems in children see
Computer glasses can not only help reduce eyestrain but they also reduce neck pain at your desk. Numerous factors need to be addressed to maximize your comfort and effectiveness while working at the computer. Computer related eyestrain is especially common for those approaching their 50s and above.
When working at our computer we often find ourselves raising our chin to make the monitor clear. This puts our neck in a very bad, uncomfortable position. Everyone that experiences neck pain should see their eye doctor about computer glasses. A few minutes to read a quick email is not a problem, however the longer you spend in this position the worse it is for your eyes, your posture and your neck. Computer glasses place your monitor in the proper focus allowing you to look directly at the monitor while still allowing you to view reading material at a normal reading distance.
Another important consideration while working at the computer is your blinking. When we work at the computer we become so engrossed in what we are doing that our blink rate goes down which increases the symptoms of dry eye syndrome. The video below gives a good summary of computer vision syndrome and computer glasses.
Assessing the visual needs of your child with an eye exam is the first step in protecting your child’s vision. It is equally important to select lenses that will not only make them see well but also protect their eyes.
Polycarbonate or Trivex lenses are the only lens types that have the potential to reduce—not increase—the risk of serious eye injury. Polycarbonate and Lexan are used in bullet-proof windshields, safety glasses, helicopter canopies and many other hi performance applications. Other lens types, including glass and regular plastic (CR-39) will break into pieces upon impact. Often the impact from an object does less damage to the victim than the broken eyeglass lenses.
Both polycarbonate and Trivex are thin, lightweight and highly impact resistant. Kids can do crazy things and accidents can happen, therefore polycarbonate and Trivex are not just recommended for sports but should be used to protect their eyes everyday.
Trivex is highly scratch resistant making it the best option for children. Polycarbonate is much softer and therefore less scratch resistant, however it is slightly less expensive. Both lens materials naturally block 100% of UV light without any additional coatings. The optical qualities of Trivex are much better than those of polycarbonate, therefore there is less distortion and reflection from an ophthalmic lens made of Trivex. Both lens materials are available in Transitions (get darker outside, lighter inside) and accept an antireflective coating, which prevents reflections, making the lenses look transparent.
Technorati Tags: eye, children, amblyopia
The first year of the Stabilization of Myopia by Accelerated Reshaping Technique (SMART) Study has produced some encouraging results in a recent announcement. According to Dr. Robert L. Davis, co principal investigator of the SMART trial, “The net effect of this contact lens fitting philosophy is to change the cornea shape for the sole purpose of reducing the amount of myopia as measured by change in refraction” . “The results of the SMART Study so far are very exciting,” said Dr. Davis. “The outcomes of this study may revolutionize how we manage young nearsighted patients from this point forward”.
The SMART Trial involves 300 patients between the ages of 8 and 14. The goal of the study is to see if having patients where overnight orthokeratology or corneal molding lenses will stop or slow the progression of nearsightedness. The SMART Trial is the largest of its kind. Other studies have also shown that preventing nearsightedness with ortho-K contact lenses is possible, such the CANDY Study. A study from Ohio State Unversity suggested that wearing Ortho-K lenses overnight actually prevented the eye from becoming longer. The SMART Trial has just completed the first year of the five year study. We will continue to keep an eye on this potientially ground breaking study.
Study from Ohio State University Confirms Prior Studies Myopia Slowed With Contacts
In February, here in The Eye Doc Blog, we reported that The CANDY Study showed that OrthoKeratology contact lenses markedly slowed the progression of nearsightedness in children. The results of The CANDY study have now been confirmed in the British Journal of Ophthalmology, the new study, Corneal Reshaping and Myopia Progression, showed that children wearing corneal reshaping lenses, also known as ortho-K or orthokeratology lenses significantly reduced the rate of change of the length of the children’s eyes. The study participants wore the lenses for two years and ranged in refractive error from -0.75 to -4.00. The study concluded that previous reports of slowed eye growth following corneal refractive therapy were confirmed.
Read more about Orthokeratology and Corneal Refractive Therapy at Total Eye Care. Also view a video from ABC News about Ortho-K.
The archive summary of the study is available here.
I came across this video on orthokeratology . I believe it is from 2002, however it is still very relevant and the information still applies to how ortho-k is a safe, viable, non-surgical option to vision correction. Studies have also shown that overnight ortho-k may prevent or slow the progression of nearsightedness in children.
A new study found that first person action games improved the vision of adult video game players. Two groups of patients were tested. The first group of patients played Call of Duty and experienced a significant increase in their ability to distinguish different shades of gray (contrast sensitivity function). The second group used The Sims, which was similar in it’s graphic detail however it is a non action game that does not require precise visual activities such as aiming.
Contrast sensitivity function is a measure of visual acuity (the chart on the wall that uses progressively smaller numbers is another, more common method, shown to the right) uses different shades of gray to evaluate a person’s vision rather than how small of a letter a person can read (the latter is called Snellen visual acuity. Contrast sensitivity is a much more precise way of evaluating a person’s visual acuity and is more often used in clinical research.
The exciting part of this study is that it has been previously thought that it was difficult to improve the vision in adults. This study paves the way for possible new treatments of amblyopia in children and the hope of retraining patients that may have lost vision due to some retinal conditions. The study showed that not all games are created equal in producing this affect and advised caution in recommending games to recommend to patients. The entire study was published online by the journal Nature Neuroscience.