News

What Is 20/20 Vision?

Have you ever gone to the eye doctor (an optometrist or ophthalmologist) and been told that you have 20/20 vision? Have you ever wondered what 20/20 vision actually means?

20/20 is a notation of visual acuity in what is called Snellen acuity. It is tested by having a patient read individual black letters of various sizes on a white background. The top number in the Snellen acuity is the distance at which the chart is viewed (historically 20 feet); however, new digital acuity systems can be calibrated to various testing distances. The bottom number of the Snellen acuity refers to the distance from which those letters can be read by a person with “normal” vision. For instance, someone with 20/200 vision can read letters at 20 feet that someone with “normal” vision can read from 200 feet. 20/200 happens to be the threshold to determine someone is “legally blind” if that is the best they can see in their better-seeing eye.

Is It Possible To See Better Than 20/20?

Yes, some people can actually read the 20/10 line on the vision chart! This means their vision is twice as “good” as someone with 20/20 vision; they can read letters at 20 feet that a person with “normal” or “average” vision can only read at 10 feet. A disproportionate number of professional athletes, especially MLB professional baseball players, have vision that is better than 20/20.

Why Don’t I Have 20/20 Vision?

There are countless reasons someone may not be able to see 20/20, but I don’t consider age one of them! Too often I have patients in their 70s, 80s, or 90s say “I can’t see well because I’m old”. Not true! Last year I did cataract surgery on a 96-year-old gentleman and he was able to see 20/20 afterwards! Now there is some truth to the above sentiments, because age is the biggest risk factor for eye diseases including cataracts, glaucoma, and macular degeneration. These are all reasons an eye might not be able to see 20/20.

Firework Eye Injuries

10,000 Reasons to Leave Fireworks to the Professionals

Every year, about 10,000 people are rushed to the emergency department for fireworks injuries. Ophthalmologists – physicians and eye doctors who specialize in medical and surgical eye care – treat thousands of patients who suffer a range of fireworks-related injuries, from cuts and bruises to damaged corneas, retinas, and ruptured eyeballs. Traverse City is no exception, last year Dr. Potthoff cared for a man who suffered a devastating eye injury from a firework. Many people believe that consumer fireworks are safe. But here’s the explosive truth: Most injuries are caused by legal fireworks parents buy for their children, such as sparklers, firecrackers, bottle rockets, and Roman candles. To help reduce the number of potentially blinding fireworks accidents this holiday, Potthoff Eye Care & Surgery and the American Academy of Ophthalmology are sharing these tips:

• Wear protective eyewear when igniting fireworks: Ophthalmologists recommend that every household have at least one pair of ANSI-approved protective eyewear. Stop by any hardware store and pick up some safety glasses for the entire family. 
• Don’t pick up duds and misfires: When a lit firework didn’t explode, Javonte McNair, 14, walked over and picked it up. The “dud” exploded, severing his hand and blasting hot debris into his eye, causing severe damage to his cornea. Keep a hose and buckets of water on hand for duds and misfires. Soak the dud from a distance with a hose or a bucket of water. Pick it up with a shovel and fully submerge it in a bucket of water to ensure it’s safe for disposal.
• Keep a safe distance: Bystanders are injured by fireworks as often as the operator. Stacy Young was 100 yards away when an illegal firework sent shrapnel into her skull. Ophthalmologists couldn’t save her eye. It had to be removed. 
• Supervise children closely: Sparklers seem like harmless fun for the kids, but they are responsible for about 1,400 eye injuries each year. Even those tiny poppers or snappers can pose dangers. A ricocheting popper burned parts of five-year-old Nolan Haney’s eye and eyelid.
• Celebrate with the pros: The Fourth can be complete without using consumer fireworks. The Academy advises that the safest way to view fireworks is to watch a professional show.

“Consumer fireworks are a treasured part of Fourth of July celebrations, so it’s easy to forget the dangers they can pose, particularly to the eyes,” said Dianna L. Seldomridge, M.D., a clinical spokesperson for the American Academy of Ophthalmology. “Please, take our advice. We don’t want to see you in the ER this Fourth of July.”

If you experience a fireworks eye injury, ophthalmologists urge you to minimize the damage to the eye:

• Seek medical attention immediately
• Do not rub the eye. Rubbing may make the injury worse
• Do not attempt to rinse the eye
• Do not apply pressure to the eye
• Do not remove objects from the eye
• Do not apply ointments or take pain medications before seeking medical help

To learn more ways to keep your eyes healthy, visit the American Academy of Ophthalmology’s EyeSmart^® website.

Ophthalmologists Urge Eye Protection for Recreational and Professional Sports

New research shows that about 30,000 people in the U.S. go to emergency departments each year with sports-related eye injuries, a substantially higher estimate than previously reported. This April during Sports Eye Safety Month, Potthoff Eye Care & Surgery in Traverse City, MI and the American Academy of Ophthalmology remind the public that the right protective eyewear is the best defense against eye injury.

Three sports accounted for almost half of all trips to the emergency room: basketball, baseball, and air/paintball guns. Sports-related injuries can range from corneal abrasions and bruises on the lids to more serious, vision-threatening internal injuries, such as a retinal detachment and internal bleeding.

Ophthalmologists — physicians who specialize in medical and surgical eye care — continue to remind the public that most sports-related eye injuries are avoidable.

Here are some tips for both the professional athlete and the Little League star to stay safe: 

• Athletes should wear sports eye protection that meets requirements set by appropriate organizations.
• Parents should make sure that children wear eye protection. Most often, those who sustain sports-related eye injuries are 18 years old or younger.
• Eye protection can weaken with age and may no longer provide adequate protection. Consider replacing when damaged or yellowed.
• For basketball, racquet sports, soccer and field hockey, wear protective eyewear with polycarbonate lenses.
• Athletes who wear contacts or glasses should also wear appropriate protective eyewear. Contacts offer no protection and glasses do not provide enough defense.
• Professional athletes should also wear sports goggles that meet national standards.

“I’ve treated many patients with eye trauma because of an unintentional blow to the face,” said Rahul N. Khurana, M.D., clinical spokesperson for the American Academy of Ophthalmology. “Athletes often engage in these seemingly safe, yet rugged, high-impact sports with zero awareness about the potential risk factors. This is why eye protection is critical and can greatly reduce the number of emergency room visits treated each year.”

To learn more ways to keep your eyes healthy, visit the American Academy of Ophthalmology’s EyeSmart^® website.

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Stephen Curry’s Eye Condition: What Is Keratoconus?

What is keratoconus?

Steph Curry, the star of the NBA’s Golden State Warriors basketball team recently told the press that he has keratoconus. Keratoconus is a progressive eye disease that involves the cornea, the very front part of the eye that light rays first pass through when entering the eye (it’s the part that really hurts if you scratch it and get a corneal abrasion). Corneas are ideally round or spherical, but in keratoconus there is progressive thinning in certain areas of the cornea that cause the cornea to weaken and lose its spherical shape. This results in light not being focused as well and causes blurry vision. The only way to know if you have keratoconus is to visit an eye doctor.

Much has been made in the media since Steph Curry’s announcement that he has keratoconus, but I think some perspective is in order. Like most diseases there is an entire spectrum of pathology. Severe keratoconus is extremely visually debilitating, and often requires a corneal transplant to fix. At the other end of the spectrum is mild or early keratoconus, which I suspect better describes Steph’s eye condition. I say this because he simply wouldn’t be able to see, let alone play NBA basketball if he had untreated keratoconus that was anything but mild. I certainly don’t mean to make light of his eye condition as it is indeed serious and progressive, but the claims that he became one of the best three-point shooters in history while not being able to see are a bit overblown.

How is keratoconus treated?

Steph Curry serves as a good example that in early keratoconus the vision can often be improved with contact lenses. The contacts may either be your standard soft contact lenses or hard contacts, also known as rigid gas permeables (RGPs). Contacts ride on the cornea and serve to mask it’s irregular shape, thus creating sharp vision. Historically, when a keratoconus patient could no longer achieve acceptable visual acuity with contact lenses, a corneal transplant was required. Fortunately, today we have corneal collagen cross-linking (CXL) to help stabilize and possibly reverse keratoconus before a patient requires a corneal transplant. CXL works by saturating the cornea with a chemical (riboflavin) that is then activated with ultraviolet light; the end result is the cornea becomes “stiffer” and less prone to progressively lose its shape. CXL has been used for years in Europe with great results, and was recently approved by the FDA for use here in the US. CXL will no doubt save many patients from requiring a corneal transplant.

Can I have LASIK if I have keratoconus?

No. Keratoconus is a contraindication to having LASIK because the cornea is already weak, and during LASIK corneal tissue is lasered away to bring the eye into focus without glasses. By removing corneal tissue LASIK weakens the cornea. This isn’t an issue for the vast majority of people, but in patients with keratoconus it is a bad idea to further weaken any already weak cornea. This could lead to post-LASIK ectasia, which is similar to keratoconus as the cornea starts to lose its spherical shape and causes blurred vision. With all that said, it may still be possible to have refractive surgery (so you don’t need glasses) if you have keratoconus. Some eye surgeons are performing corneal collagen cross-linking prior to PRK (similar to LASIK but with less weakening) in the right candidates.

Lumify Eye Drops

Last year Bausch & Lomb released Lumify eye drops, marketed to help reduce eye redness and give the appearance of whiter and “brighter” eyes. Lumify is available over-the-counter so they do not require a prescription from your eye doctor. Here in Traverse City, MI I have seen them on the shelves at Rite Aid and Walgreens, a small bottle of Lumify eye drops sells for between $10 and $20.

How Does Lumify Work?

The active ingredient in Lumify is a drug called brimonidine. Brimonidine is an alpha-2 adrenergic agonist; this means that it causes constriction of blood vessels. By constricting blood vessels on the surface of the eye in the conjunctiva, it can create the appearance of whiter eyes.

Interestingly, brimonidine has long been used by ophthalmologists and optometrists to lower eye pressure, usually in the treatment of glaucoma. For this indication a much higher concentration of brimonidine is used. Brimonidine is also sometimes given to prevent eye pressure increases following laser eye surgery procedures, such as a YAG capsulotomy to clear a film that can form following cataract surgery.

The studies of Lumify show that it is too low a concentration to meaningful alter eye pressure, so don’t worry about Lumify making your eye pressure go too low (which is nearly impossible anyway in the absence of surgery or trauma to an eye).

Is Lumify safe?

Yes, when used as directed. Given the extensive history we have in using brimonidine to treat glaucoma, eye doctors know that it is generally well-tolerated even at much higher concentrations than are found in Lumify. Of course, some patients will be allergic to any medication and Lumify is no exception. If you notice your eyes getting more red and becoming itchy following the use of Lumify, it is best to stop using the drops until you can be evaluated by an ophthalmologist or optometrist.

Alzheimer’s Disease: Can It Be Detected With An Eye Exam?

Recent news stories have highlighted some exciting news from ophthalmology studies looking to see if Alzheimer’s disease can be diagnosed using information obtained from a non-invasive eye test performed as part of an eye exam.

The studies have evaluated the retina and optic nerve tissues in the back of the eye. These tissues are readily imaged by equipment found in an eye doctor’s office. The light signals detected by the retina are transmitted to the brain by the optic nerve, which is technically an extension of brain tissue. Researchers evaluated the correlation between the thickness of retinal tissue and also the density of blood vessels in the tissue using optical coherence tomography (OCT) scans and the presence of Alzheimer’s disease. The study found a less dense network of retinal blood vessels in individuals already diagnosed with Alzheimer’s disease.

This is exciting news. The thought is that these microvascular changes noted in the back of the eye may be a surrogate for similar blood vessel changes happening in the brain during the development of Alzheimer’s disease. Furthermore, if these types of changes could allow earlier diagnosis of Alzheimer’s, they could help doctors identify patients best suited for new therapies aimed at slowing or preventing the development of Alzheimer’s.

Of course, it will be years before these findings are validated and the appropriate imaging devices and algorithms are rolled out for use in the general public. For instance, while Dr. Potthoff has an OCT machine in his Traverse City MI office, it would need a database and appropriate algorithms to segment the right parts of the OCT eye scan and compare the measurements to normative databases of both people with and without Alzheimer’s disease to provide useful clinical information. With that said, it’s only a matter of time before we are able to diagnose more and more neurological diseases by imaging and examining a patient’s eyes.

What Causes A Black Eye?

Bernie Sanders and Arod recently seen with black eyes

Well it depends on if you’re asking about mechanism or the pathophysiology underlying the appearance of a black eye. Regarding the latter, a black eye is simply a bruise of the skin the near the eye. And a bruise is simply the result of an impact or trauma that causes rupture of underlying blood vessels in the skin. This, in turn, can lead to a collection of blood under the skin, or a hematoma. Eyelid skin and skin around the eye and orbit is very fragile and thin, so even minor trauma can sometimes result in a dramatic appearance of a black eye.

Regarding mechanism, trauma (either intentional or inadvertent) is the most common cause. The current news cycle reminds us of this…with stories of Bernie Sanders sustaining a black eye following a periocular trauma sustained from hitting the edge of a shower door, to the more drama-laden reports of Alex Rodriquez (Arod) getting a black eye from new fiance Jennifer Lopez (J Lo) after reports of a cheating scandal. Two pretty timely examples of black eyes related to both accidental and perhaps intentional trauma.

Another common cause of a periocular hematoma is post-surgical. When an eye surgeon performs even minor eyelid procedures it is not uncommon for a rather large bruise (periocular hematoma) to develop following the injection of just a small amount of numbing medicine in the eyelid skin. It’s also not uncommon for eye doctors to see black eyes form under the eye after surgery performed on the upper eyelids. Being on blood thinners can cause the hematoma to become larger. Invariably black eyes will get better on their own over the coming days and weeks. Ice can help limit the formation of a black eye by serving to constrict the local blood vessels that were initially ruptured.

Eye Strain: Why Do My Eyes Hurt?

As an eye doctor in Traverse City, I often see patients who tell me their eyes “hurt” or that they have “eye strain”. My job is to figure out what they actually mean. Eye strain can mean a variety of things, and a thorough exam with an eye doctor can help figure out what is going on and how to treat it. For instance, it may simply be that your glasses or contacts are no longer the correct power and you are squinting all the time!

The most common scenario for someone presenting with complaints of eye strain is that their eyes hurt or get blurry after doing something for an extended amount of time. The most common activities are looking at a smartphone, reading a book, or using a computer. When we perform focused tasks, we don’t blink as much. This can lead to the surface of the eyes getting dry (dry eye), which is often perceived as grittiness, burning, or eye strain.

To prevent or treat dry eye you can try a number of strategies. You may have heard of the 20-20-20 rule, which states that while performing a focused task, every 20 minutes you should stop and look at an object at least 20 feet away for 20 seconds. This can help reduce eye strain. Additionally, pay attention to your environment. For instance, make sure a fan or vent isn’t blowing directly on you. Using artificial tears or ointment a few times throughout the day can also go a long way towards preventing and/or treating dry eye. If these solutions don’t work, your next step should be to visit an eye doctor near you.

Check out this great article for more tips related to preventing eye strain: https://www.aao.org/eye-health/diseases/what-is-eye-strain