News

Can I sleep in my contacts?

The short answer is “no”. Here’s a recent article that serves as a good reminder that sleeping in your contact lenses is a bad idea. Why? A few reasons. The biggest reason that sleeping in your contacts is a bad idea is because you can get a corneal infection. Check out this post from a few months ago when Today show host Craig Melvin had to wear glasses for the first time on air after developing a contact lens-related infection.

Our tear film is constantly defending our eyes against bacteria that are everywhere. When you sleep in your contacts you provide those little microbes a chance to set up shop and start growing in your cornea without having to worry about being washed away by your tears and blinks.

How can I tell if I have an eye infection after sleeping in contacts?

When these bacteria are able to start growing on the surface of your cornea, it is described by eye doctors as a “corneal infiltrate”. Think of it like a small ulcer. The symptoms of this type of eye infection include pain (it can be severe), eye redness, excessive tearing, and the feeling that something is stuck in your eye. If left untreated a corneal ulcer can develop, which can literally eat through your cornea. Even when treated a corneal ulcer will often leave behind a vision-limiting corneal scar. If you suspect you have an eye infection related to your contact lenses it is imperative that you see an eye doctor, either an optometrist or ophthalmologist, immediately. They can diagnose this infection as part of an eye exam and prescribe the appropriate antibiotic drops. Your eye doctor will keep a close eye (no pun intended!) on you over the next few days to make sure the eye is healing.

Are contacts bad for my eyes?

No. Contacts are a great optical solution for people who do not want to wear glasses and aren’t eligible for cataract surgery. However, in addition to the infection concerns detailed above, they can cause other problems. These other problems are often related to the contacts precluding an adequate amount of oxygen from reaching the cornea, despite the fact that nowadays contacts are manufactured to be highly oxygen permeable. CLARE (contact-lens-induced acute red eye) and limbal stem cell deficiency are two such problems associated with long-term contact lens use. Many of these problems can be prevented by wearing properly fitting contact lenses. Dr. Potthoff works closely with Traverse City optometrists to make sure they are wearing the right contact lenses.

Can a contact go behind my eye? Can you transplant a whole eye?

Check out this interesting article about eyes: http://mentalfloss.com/article/563242/parts-of-the-eye-facts

The article addresses some common misconceptions, such as “Can a contact get lost behind my eye”….spoiler alert, the answer is no. Contacts can move away from where they are designed to sit (the cornea) and become lodged in the conjunctival fornix, this is the little pouch of tissue formed under your eyelid. If you feel like a contact is stuck in your eye, dry using some lubricating drops and look under your upper eyelid.

Another good tidbit, that we are happy to see explained in the lay press, is that the length of your eye has a lot to do with determining your refractive error (glasses prescription) and ultimately how well you can see without glasses. Near-sighted people typically have eyes on the longer side, while far-sighted people often have shorter eyes. This is an important metric for a cataract surgeon to know when performing cataract surgery because eyes of various lengths can behave differently during surgery.

Perhaps the most interesting point in the article was the final one (Dr. Potthoff hadn’t even heard about this!)….a team of researchers in Pittsburgh is hoping to transplant whole eyes by 2026! That seems like an ambitious (but no doubt worthy) goal given the amazingly complex connections that the optic nerve makes with the brain, but hopefully they can do it!

Eye Care Technology

Optical Coherence Tomography (OCT)

This is a non-invasive imaging test similar to ultrasound but instead of sound waves, it uses light waves to take pictures of a cross-section of your retina and optic nerve. Your ophthalmologist can see each layer of your retina and measure its thickness. This helps in the treatment of glaucoma and retinal diseases such as age-related macular degeneration (AMD) and diabetic eye disease. 

Color Fundus Photography

Eye doctors can actually capture photos of the back of the eye using a specialized camera called a fundus or retina camera. This type of camera has an intricate microscope attached to be able to photograph the interior surface of the eye including the retina, optic nerve, and macula (the part of the retina where your best vision is created). Being able to see the back of the eye in this way helps with the diagnosis of diabetic retinopathy, macular degeneration, macular edema, and retinal detachment, among other conditions.

Visual Field Testing (Perimetry)

Eye care professionals like Dr. Potthoff in Traverse City can use this to test peripheral vision. We have one in our office, an automated perimetry machine (called the Octopus) that measures your responses to objects in different areas of your field of vision. In this way, it can detect blind spots and other visual field defects. It’s very helpful in detecting early signs of diseases of the eye, especially glaucoma.

Ophthalmic Biometry

Need cataract surgery in Traverse City? Your eye surgeon will use ophthalmic biometry prior to eye surgery to measure your eyes. This gives your ophthalmologist crucial information about the shape and size of your eyes which will then determine what size and type of lenses will be right for you. Ultrasound biometry used to be utilized but it involved direct contact with the cornea and the use of anesthetics. It could be uncomfortable for the patient and inaccurate. The machine that we use is called the Lenstar, and it is the most advanced technology available!

YAG Laser

After cataract surgery your cataract can never come back, but sometimes the membrane that holds the implant lens in place can eventually become hazy and may cause blurry vision. If this happens, Dr. Potthoff can perform a YAG laser capsulotomy which utilizes a laser to create a small opening in the membrane while leaving the implanted lens untouched. This procedure is painless, takes only a few minutes to perform, and is done right here in our office in Traverse City. Most importantly, it restores your clear vision!

Can an eye explode? Woman blinded at the Ryder Cup

What happened to that woman’s exploded eye at the Ryder Cup?

You may have heard about the recent tragedy involving a woman being blinded in one eye after it was directly struck by a golf ball hit by Brooks Koepka at the Ryder Cup in Paris last week. At some point the word “exploded” was used in describing what happened to the eye, and now every major news outlet is using this description. Given that it sounds like the woman also suffered an orbital fracture from the impact, it must have been quite a severe injury.

The more correct medical term would be “rupture”. And yes, an eye can rupture. In the field we call this injury a “ruptured globe”, and it is a surgical emergency that needs to be fixed by an ophthalmologist right away. Without getting in to too much detail, an eye exposed to the outside world is at a high risk for infection and further loss of the intraocular contents. Surgical repair is aimed at closing the wound and re-establishing the integrity of the eyeball. Subsequent surgeries are often required.

How can an eye rupture?

Ruptured globes are caused by trauma, either blunt or penetrating. The woman at the Ryder Cup would fall into the category of blunt trauma as it wasn’t a sharp, piercing injury that caused the injury. In contrast, penetrating trauma usually involves a sharp object, like a small projectile (think metal grinding accident) or something like a pencil (I’ve seen it). When an eye ruptures from blunt trauma it typically does so at the limbus and/or behind where the eye muscles attach to the white part of the eye, the sclera.

This is perhaps a good time to mention that the loss of an eye from an injury is almost always a freak accident. No mechanism of injury surprises me anymore. I’ve seen ruptured globes from sticks, pencils, and nails. I’ve seen eyes ruptured from cell phones (yes, a cell phone) and the corner of a nightstand (more than once). Just this year I’ve repaired ruptured eyes injured by a nailgun and also a firework. The takeaway is that you should always wear safety glasses or sunglasses when performing at-risk activities. Earlier today I drove by a road worker pulverizing asphalt without safety glasses… With that said, it’s impossible to prevent all injuries, especially such freaky ones.

What should I do if I think my eye is injured?

The most common symptoms of a ruptured globe (exploded eye) are a sudden loss of vision and onset of pain. It is rare for a patient to note any fluid coming out or onto their cheek, the amount of fluid in the front of the eye is very small. One of the more telling signs of a ruptured eye is a severely misshapen pupil. An irregular pupil is caused by a rupture injury whereby the iris (colored part of the eye) follows the flow of fluid and ends up plugging the wound. The least gory picture I could find is below, courtesy of the Cornea Academy via Twitter. If you ever suffer an injury and think you may have ruptured your eye it is important to see an eye doctor right away.

Will that French woman ever be able to see again?

I don’t know any more about her particular case than you, but based on the media reports it doesn’t sound like it. I say this because of the reports that she “lost her eye” and is now blind. This would suggest that the eye was removed, or enucleated. If the eye was incredibly damaged with minimal discernible anatomy at the initial surgery, thus suggesting no hope of ever having vision again, then the surgeon may have made the decision to remove the eye. This would be in part to prevent sympathetic ophthalmia (Google it). Going forward, one of the most important things for this woman to do is adhere to “monocular precautions”, which essentially means wearing glasses with a polycarbonate lens all the time, even if she doesn’t need them optically. This is basically like having a pair of safety glasses on all the time to prevent what would be another devastating freak accident. Also, using common sense and not engaging in high-risk activities should go without saying.

 

Today show host Craig Melvin’s Eye – What Happened To It?

Why is Craig Melvin wearing glasses?

This morning I was watching the Today show with my wife and kids before heading off to work. I was interested to see their segment regarding Today show co-anchor Craig Melvin’s recent eye issues. The segment started with discussing Craig’s choice of various trendy glasses frames as voted on by his Instagram followers. It then delved into why, exactly, Craig was wearing glasses in the first place….apparently this was his first time ever wearing glasses on air!

It turns out that over the last couple of days Craig’s left eye became red and painful. He wisely sought the advice of a nearby eye doctor. The ophthalmologist he saw diagnosed him with a corneal ulcer, in this case it was a contact lens-related corneal ulcer.

 

What is a corneal ulcer?

A corneal ulcer occurs when the top layer of the cornea, the epithelium (think of it like the cornea’s skin), is broken and the underlying tissue starts to degrade. Often this allows an infection to take hold. It’s like an abscess forming in your cornea! While some ulcers are sterile and aren’t related to infection, many are the result of either bacterial, viral, or fungal infection. Contact lens wearers in particular are susceptible to developing corneal ulcers and infections (sometimes called corneal infiltrates). Despite all of the advances in modern contact lens technology, contacts can still block oxygen from getting to the cornea and weaken it’s structure. This allows an infection to get started. This is often the result of poor contact lens hygiene.

 

How to avoid a contact lens-related corneal ulcer?

Good contact lens hygiene is key. This includes always washing your hands before handling your contacts. It’s also very important to change to a new pair of contact lens at the specified interval for your particular type. Cleaning and storing your contacts overnight according to the directions is also super important. Changing out your contact lens case at regular intervals can also help prevent an infection from growing in the case, which can then spread to the eye. If you are a contact lens wearer and notice one of your eyes becoming red and painful and possibly blurry, make sure to see a local eye doctor immediately. With prompt diagnosis and treatment these corneal ulcers can be readily treated, but left alone they can cause devastating eye problems, including blindness!

 

How is a corneal ulcer treated?

Depending on the location and severity of the corneal ulcer at diagnosis your eye doctor may choose to culture it. This means they take a sample of the infection and send it to a lab to see what type of infection is growing. This helps to tailor the therapy to the particular infection. Depending on the diagnosis, your eye doctor will likely prescribe antibiotic eye drops to treat the infection. These drops often need to be used very frequently (for example every hour) to initially treat the infection. In some cases your eye doctor may also recommend pills to be taken orally as well. These corneal ulcers require very close follow-up, in many cases the patient needs to be seen every day for a few days to make sure things are heading in the right direction.

Macular degeneration – what is it?

Macular degeneration is a disease of the retina that occurs when the central portion of the retina, called the macula, is damaged. The macula is responsible for processing central vision in the eye. It controls how we recognize faces or colors, our ability to read, drive a car, and see fine details. It’s super important that we see an ophthalmologist like Dr. Potthoff to watch for the early signs of this progressive eye disease.

Since macular degeneration affects people as they age, it’s often called age-related macular degeneration or AMD (sometimes ARMD). There are two types of AMD, but the most common form is called dry AMD. In fact, 8 out of 10 people with AMD suffer from the dry form. Parts of the macula get thinner with age and tiny clumps of protein can grow and can cause you to slowly lose your central vision.

 

The other form of macular degeneration, wet AMD, is less common but more serious. With this form, new abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids causing scarring of the macula. You lose your vision much faster with wet macular degeneration which, again, is why seeing an eye doctor regularly as you age is crucial. There is no cure for it but the progression can be slowed down if detected early.

I found, in my research about AMD, that there are a couple of interesting diagnostic tests that are sometimes used.  One is called the Amsler grid test and is fairly rudimentary and the other, called optical coherence tomography (OCT) is pretty high-tech. The Amsler grid is a simple test that utilizes a grid with a dot in the middle. You hold the grid 14-16 inches from your eyes and cover one eye. Focusing only on the dot in the middle, you note if any of the lines appear wavy or blurred, if all boxes look square and the same size or not, or if there are any holes or dark areas. This would help to indicate if you have any central vision issues or not.

 

 

Here at Potthoff Eye Care & Surgery in Traverse City we have a state-of-the-art OCT imaging device. Optical coherence tomography is similar to ultrasound, except it uses light waves instead of sound waves to produce high resolution images of any tissues that can be penetrated by light, including our eyes! With this technology an eye doctor can see each distinctive layer of your retina. It’s used not just to diagnose AMD, but also to aid in the treatment of glaucoma and diabetic eye disease.

As I mentioned before, there is no cure for macular degeneration, but there are injections of medication that can help slow or stop the leaking of the abnormal blood vessels. Injections in the eye? That doesn’t sound like fun but it’s not as bad as it sounds (easy for me to say, right!). An ophthalmologist uses numbing eye drops prior to the injection too minimize pain. It’s quick and I’m told you really only feel a bit of pressure. That’s good to know because it’s worth keeping your vision from deteriorating due to wet macular degeneration!

There are a number of things that increase your risk of getting age-related macular degeneration and one of them, of course, is age. Once you are 50 years and older your risk increases. Other risks include being overweight, eating foods high in saturated fats such as meat, cheese and butter, smoking, being caucasian, and having a family history of macular degeneration.

There’s no way to treat dry AMD but research shows that some nutritional supplements can help slow it down. Those supplements include Vitamin C, Vitamin E, Lutein, Zinc and Copper. We all remember our moms telling us to eat our carrots because they are good for our eyes. Well, it turns out, that is actually true in more ways than one! Carrots, along with foods like corn, peaches, beans, spinach, lettuce, orange juice, and many other foods contain zeaxanthin.  Zeaxanthin is one of the two primary xanthophyll carotenoids contained within the retina, and specifically within the central macula. So, eat your fruits and veggies just like mom told you to when you were a kid, they really are good for your eyes!!!