Don't cry over ocular allergies; 3 simple weapons for combating pollen

Beautiful spring flowers are blooming - be sure to protect your eyes from the pollen!

Here are just 3 suggestions for helping to keep your eyes healthy and comfortable during allergy season. Other options may be available for some people - have a full comprehensive eye exam to determine what may particularly benefit you.

1. Prescription anti-allergy eyedrops. You may be a candidate for a prescription anti-allergy eye drop. Special tests can be done at your next eye exam that determine whether you have an allergic response under your eyelids, or if you have other signs such as redness that would benefit from certain medication.

2. Daily disposable contact lenses. If you wear contact lenses, consider a daily disposable contact lens. Many allergy sufferers love having a supply of daily disposable contact lenses during allergy season so that they can dispose of their contacts at the end of the day and not have any pollen or protein buildup to irritate their eyes. Ask the doctor at your next contact lens exam if you are a candidate for daily disposable contact lenses (not available in all prescriptions).

3. Safe over-the-counter eyedrops. Please stay away from the allergy eyedrops that say "Get the red out". These over-the-counter eyedrops contain certain ingredients called vasoconstrictors that cause the red blood vessels to temporarily get smaller. However, there is a rebound reaction, and prolonged use can cause more redness. Some safe anti-allergy eyedrops that are over-the-counter are called "Alaway" and "Zaditor".

These eyedrops contain an antihistamine and mast cell stabilizer, which safely help to decrease the allergic reaction.

You may also benefit from safe over-the-counter rewetting drops that are preservative free. These eyedrops come in single-use vials and they help dilute the allergen and wash out any irritants.

Did you know that rubbing your eyes due to allergies can actually cause more astigmatism and blurry vision?

See clearly during allergy season and protect your eyes with these simple anti-allergy suggestions! Don't forget to schedule your eye exam for a comprehensive check of your eyes!

Grab those shades!

Picture on the left: An iris melanoma, which has an incidence rate of about 4.7 people per million Americans. (photo courtesy of the Mayo clinic)

A good pair of sunglasses could save your life! Although rare, eye cancers can occur in adults due to UV light exposure from the sun. Also, prolonged exposure from a tanning bed, artificial lights, or other UV light sources may damage the eye. Therefore, please be sure to wear UV light protection whenever you are outdoors or exposed to UV light. Even if you are not looking at the light source, the beams may still penetrate around the outside structures of the eye and cause ocular complications.

Dr. Paull had an up-close and personal experience with this during her first year of practice. A 55 year-0ld male patient had a suspicious brown spot in his otherwise clear blue eyes, and Dr. Paull noticed that it had not been documented in any previous exams. He was sent to Duke for some special tests, and it was determined he had a rare iris melanoma that was growing very rapidly. It was quickly excised, before spreading to other areas of his body. He stated that he had been a lifeguard for many years of his life, and he often didn't wear sunglasses while out in the sun.

Thank goodness that large sunglasses are definitely in style. Keep those shades on and you are not only protecting yourself from cancers, but also from eye diseases like cataract and macular degeneration. Dr. Paull sees patients every day that have 'sun spots' or tiny raised areas on the outer part of their eye called pinguecula. These areas can cause irritation and can grow into larger structures called pterygium that may eventually blur vision.

Therefore, Dr. Paull wants to see all of her patients (young and old) to be sunglass models this spring! Grab your favorite pair of sunshades when enjoying this beautiful weather!

(more information may be found at: http://www.webmd.com/melanoma-skin-cancer/tc/eye-intraocular-melanoma-treatment-health-professional-information-nci-pdq-general-information#s2.1)

Goggles and glaucoma? What you need to know before purchasing your next pair of goggles.

Make sure your goggles fit properly before swimming! Studies have found that tight, small goggles can actually raise the pressure of your eye to dangerous levels. Did you know that the pressure exerted by certain small racing goggles can raise a person's eye pressure 13 mm? For example, if your normal eye pressure was 15, then when you were wearing the small goggles, your pressure would be 28! The average pressure is between 10-20mm, and if it raised above 21 for prolonged periods of time, optic nerve damage can result and glaucoma can develop. This leads to a gradual loss of peripheral vision and can eventually cause tunnel vision or blindness if not controlled.

The picture above shows several styles of goggles, of which the bottom left goggle is the safest. If in doubt, just bring an extra pair of your goggles in to our office and we can remove the front part and measure your pressure while you wear them in our exam room (see picture E)! Courtesy of Morgan et al, http://bjo.bmj.com/content/92/9/1218.full .

This is not intended to suggest that swimming with goggles can lead to blindness! However, for the serious swimmers, it is in their best interest to use large goggles that do not press too hard on the orbit of the eye. For example, in the above picture, the best goggle style was letter C - it has a continuous interface between the two eyes and the pressure exerted on the orbit was not clinically significant. However, stay away from goggles that look like the one pictured in letter A - that particular style raised eye pressure an average of 5mm. The goggles pictured in letter B and D only raised the pressure by about 1.5mm.

For more information, please read the interesting article published by Morgan et al. at: http://bjo.bmj.com/content/92/9/1218.full. In this study, the measurements had to be taken outside of the water. When under water, the pressure of the water could exert even more force on the orbit, potentially increasing the pressure more. However, there is some good news for swimmers! It is also estimated that 20 minutes of any aerobic exercise like swimming actually decreases eye pressure by about 4 mm.

Therefore, the moral of the story is to keep swimming! However, make sure you are wearing comfortable, nice large goggles. I found a good pair on Amazon.com (pictured below): http://www.amazon.com/Aqua-Sphere-Seal-Swim-Mask/dp/B000EORGXQ/ref=pd_sim_sg_4 .

Happy swimming!

Tinted glasses: More than just cosmetic

from Dr. Levy:

I had a patient this week who presented with a complaint that "everything looks green, especially when I'm reading off of white paper." As she was an elderly retiree, and reading was one of her few pastimes, this was especially troubling to her. Psychological studies have shown that a green color near the center of the visible spectrum of light wavelengths is supposed to be the most pleasing to the human eye, but it wasn't to this frustrated lady.

My first thought was that she may have had cataracts developing, as people will report their vision taking on a yellow, orange, or brown color as cataracts develop. Maybe if hers were turning yellow, it was such an intense yellow she may have perceived it as green. However, she had already had cataracts removed from both eyes several years ago, so that was not the case. I then wondered if her implanted lenses had some kind of green tint to them, maybe an ultraviolet blocker, but examination of the implanted lenses revealed them to be crystal clear, and ordinary implants.

My next thought was that maybe her maculas were starting to degenerate, and the blue, yellow, and red receptors were degenerating faster and earlier than the green receptors. I went along with that as a working hypothesis and tried to figure out how to solve her problem. Half from memory, and half from pulling up a color wheel on the internet, I identified the color opposite green, found that it was red, and asked one of the opticians if we had a pink or red colored tint sample that I could have her look through. We found a pink/brown combination lens, and then a pure pink lens, and held them up in front of her reading glasses. Immediately her hunched-up shoulders relaxed, she let out a sigh of relief, and said, "Yes. That's perfect!"

There is a small subfield of optometry know as Syntonics, that promotes the idea that colors, filters, and tinted lenses can affect how we perceive the world and how our visual systems function. While there isn't a lot of published scientific evidence to back it up, this appeared to be one case where we could solve a functional visual problem, with a simple tinted lens that would normally have been used for cosmetic purposes!

When you hear hoofbeats, sometimes it IS a zebra!

From Dr. Robert Levy

There's an old saying in medicine and healthcare: "If you hear hoofbeats, think horses, not zebras." What that means, is that when you listen to a patient's symptoms and complaints, you should think of the most obvious and common things it could be, and not the unusual or rare things that it could be.

But yesterday, I saw a zebra!

I had a 94-year-old patient who one week ago presented to the emergency room with a complaint of an extremely painful right eye. The emergency room doctor told her she probably got soap in her eye, and flushed it out, and recommended that she see an eye doctor the next day, and gave her the name of a well-regarded opthalmologist in her area. She went to that doctor the next day, still in pain, and he diagnosed a corneal erosion; the sloughing off of the top layer of the cornea. He bandaged the cornea with a bandage contact lens, gave her several drops to use (lubricants for comfort, and an antibiotic to prevent infection) and saw her back the next day. He told her she was significantly better the next day, and scheduled a follow-up for one week later. She came to see me two days before that scheduled one-week follow up, still in pain. I took a look at her cornea, and it was clean as a whistle! No sign of any abrasion or erosion, and nothing visibly wrong with the eye. But she was in so much pain she was literally crying. Further probing of her symptoms revealed that her teeth and jaws hurt when she ate, or chewed, or brushed her teeth, and she had pain in her forehead, and radiating back to her ear. At this point, I knew it was more than just her eye, and diagnosed trigeminal neuralgia.

The trigeminal nerves are one of the twelve pairs of cranial nerves that leave the brain and go directly to parts of the body; this one is called the "trigeminal nerve" because it has three branches - one that goes to the eye, one that goes to the upper jaw, and one that goes to the lower jaw. When she related her eating, chewing, and brushing complaints, I knew it had to be that. "Neuralgia" means nerve pain, and that is what she had. I referred her to a neurologist who will be able to treat her symptoms and finally give her some relief.

So the point of this story is not to pat myself on the back for coming up with a less-than-usual diagnosis, but to advise people to tell doctors ALL your symptoms, even if you don't think they're relevant. If she had mentioned the jaw and teeth involvement a week ago at the ER, or the next day in the corneal specialist's office, they may have been able to come up with the same diagnosis as well. But because she was going to "an eye doctor", she didn't think the teeth and jaw symptoms were important, and she only brought up the eye pain.

Today's optometrists are trained to diagnose far more than eye problems, as long as there is some ocular involvement that brings the patient into our office to begin with!

I look forward to receiving the neurologist's report, and to seeing the patient back when the neurologist discharges her, hopefully finally free of pain!

Dr. Levy's Jeapardy episode is fun to watch!

Dr. Levy claims that his buzzer wasn't working correctly during the first part of the Jeapardy episode. He was clicking 'too fast', and he was told during the commercial break that he actually had to wait before clicking in order for the computer to register his click! Perhaps that is true, or was it just rigged? Well, after he learned the secret, Dr. Levy raises his meager score of 0 to 7600, tying the champion! It gets more exciting, though, during Final Jeapardy, when the two contestants are tied and they battle the last question... For the first time in over 14 years, there is an unusual outcome to the game!

View the episode on youtube: http://www.youtube.com/watch?v=yVEMvybyhb8&NR=1

The myths and facts about Ted Williams' vision

From Dr. Robert Levy:

So Dr. Paull's recent entry about our 20/10 patient reminded me of the late great Red Sox player, Ted Williams, one of the greatest baseball hitters of all time. Williams was rumored to be able to see 20/3 (able to see from 20 feet away what a normal-sighted patient can see from three feet away); rumored to be able to see the seams on a baseball as they approached him at 90-100 miles-per-hour and tell by the spin of the seams whether the ball was going to be a fastball (straight pitch) or a breaking ball (curve ball or the like); was rumored to be able to read the label on a 78rpm record as it spun (records are what we had before compact discs and mp3s, for you young-uns).

While these make for amusing stories, Williams himself admitted that none of them were true. He DID in fact have 20/10 acuity, same as our star patient from the last blog entry, meaning he could see from 20 feet away what normal-sighted people could see from 10 feet away - but the other myths and legends were just that, myths and legends. Although as he entered the Marines as a pilot in World War 2, the ophthalmologist performing Williams' entry examination said his vision was on the order of a "1 in 100,000 occurrence."

Still, this remarkable vision was one contributing factor to his being one of the best hitters of all time, and to date, the last player to hit over .400 for an entire season. His lifetime batting average ranks among the best of all-time as well.

So he may not have been able to see the seams on a spinning baseball, or read the label on a spinning 78rpm record, but his actual visual acuity is still legendary.

Lions Club Helps Save Eyesight

The Lions Club of Brandermill-Midlothian-Woodlake has many fun-loving volunteers who serve the community. Besides helping to provide free eye exams and glasses for needy individuals, they help raise money for the blind and provide services for the hearing impaired. Taking time from their day, they enthusiastically serve the needs of our community with little or no recognition.


Bob and Alan (pictured above) are local Lions members who helped check the distance and near visual acuities in one station of the vision screening.

On Thursday, January 20th, 5 volunteers from the Lions Club assisted Dr. Paull in screening 41 home-schooled children for vision disorders. Although most children passed with good results, there were several children who needed additional attention. For example, one 7-year old boy was found to have normal 20/20 vision in his left eye, but 20/100 vision in his right eye. His mother had never known that he had much blurrier vision in his right eye because he had always compensated for it when both eyes were open. Thinking back, she did remember that he would often rub his right eye only when they were reading, but she never knew it was due to a vision disorder. Thankfully, his condition was caught early, during the critical period of vision development. He can receive correction for his right eye now so that he can develop the proper brain connections between his right and left eyes and develop proper 3-D vision.


Many thanks are given to the Lions Club volunteers for their tireless efforts to promote better vision health for both our community and others throughout the world. Did you know that over 12 million children have been screened by international Lions Club members? If you would like more information about joining a community club, please visit http://www.lionsclubs.org/EN/becoming-a-lion/index.php. You may also join a 'cyber club', whose participants meet online! Joining a club is not only great fun and fellowship for each member, but it helps many others in the community and abroad.

King of Vision

Congratulations to Greg L. - he is the King of Vision for our optometric practice! He even beats Dr. Paull and all the associates in the practice.

Greg told Dr. Paull that he had always had super vision with his contact lenses (he wears Air Optix Night & Day lenses). Dr. Paull looked at his high prescription (-8.00), and she knew that his uncorrected visual acuities were so bad that he couldn't even read the 20/400 "Big E". She did not really believe that he could have an 'eagle eye', due to his high nearsightedness. It is harder for him to see small letters because images are made even smaller with higher prescriptions for nearsightedness.

However, Greg surprised Dr. Paull by reading all 5 letters on the 20/10 line without a problem! Erynn, the optometric technician, was brought into the room to confirm that Greg could actually read a perfect 20/10. That means that what the average person could read 10 feet away, Greg can see it 20 feet away. That is almost impossible, because most people have distortions in the cornea, lens, and other media that the lightwaves pass through in order to be seen by the retina. Additionally, the neurological cells that are stimulated by the lightwaves must be small enough to distinguish the wavelengths from the small letters. Science has shown that if the eye was 'perfect' and if all the media was completely clear, then the best theoretically possible vision would be 20/8 because of the limit of the cells based on their size. Greg is one of the few in the world that has this near-perfect vision. Right now, there is no officially documented "Guinness Book of World Records" holder or best vision, but perhaps Greg should hold that title!

We will be checking our patients carefully this year, to see if anyone can come close to Greg's vision. If not, he will reign as King of Vision indefinitely!

Red eyes? Don't go grabbing just any eyedrop!

If you have red, irritated eyes, you may be tempted to grab the nearest bottle of Visine "Get the Red Out". These eyedrops contain a special ingredient which temporarily constricst the blood vessels, helping the eyes to whiten in most cases. However, there is a 'rebound reaction', and the blood vessels can return. Sometimes people become dependent on them, and if you read the small print on the bottle label, it might say "Overuse may cause more redness". Great!

Eye redness may be due to multiple factors. Sometimes staring at a computer screen all day can dry out the eye and cause redness. Eye fatigue, dryness, irritation, allergies, infection and contact lenses can all contribute to mild redness. It is best to have a thorough exam where your tear film can be evaluated and we can determine the cause and extent of your redness.

Some mild dry eye and redness problems can be solved with over-the-counter eyedrops. I have a few favorites, but it depends on each person as to which one works best for them. Some are formulated better for allergies, some are for severe dry eye, and some are for mild dry eye. There are also several prescription eye drops which help relieve more persistent cases of redness or dry eye.

If you have trouble with dry, irritated or red eyes, please do not settle for an eyedrop that might make things worse! Come in and see us for a thorough, personal exam to determine the best treatment for you!