We have been using a new gas permeable rigid lens called the SoClear lens. It is a scleral lens, which means it has a very large diameter = 13.0 to 15.0 mm. These large diameter rigid lenses work very well for patients with corneal dystrophies such as Keratoconus and pellucid marginal degeneration. The lens completely vaults the cornea and rests on the white of the eye (sclera). Patients with irregular corneas who have had problems in the past with contact lenses find these lenses work almost miraculously well.
These large lenses are a bit time consuming to fit because multiple diagnostic lenses must be applied to the eyes to determine the proper lens fit. The "bowl" of the lens must be filled with saline and orange dye (fluorescein) to evaluate the lens/cornea relationship. Patients with irregular corneas almost always have normal peripheral corneas/ scleras, and these lenses "fit" on that area of the eye. Sceleral contact lenses such as SoClear are the best bet for providing good vision on irregular corneas.
Tuesday, October 19, 2010
Wednesday, August 25, 2010
You Can’t Hide From the B-scan
It is fairly common to encounter patients with dense cataracts that do not allow the doctor a very good view of the posterior structures of the eye. These structures include the optic nerve and retina. In our office we use the ScanMate Ultrasound B-unit from DGH to better evaluate the retina and optic nerve when we cannot directly view these structures with standard exam techniques.
Retinal detachments are easily picked up with the B-scan. This instrument is invaluable when the doctor cannot get a good peripheral view of the retina due to cataracts.
Even when the view of posterior eye structures is unimpeded, B-scan can come in handy. Buried drusen in the optic nerve can cause visual field loss. A B-scan can confirm that what appears to be buried drusen really is, and not a more serious optic nerve problem.
The B-scan experience is very comfortable for the patient. We obtain data through a closed eye, so no “goopy stuff” needs to be applied to the open eye when using the probe to obtain an image.
Retinal detachments are easily picked up with the B-scan. This instrument is invaluable when the doctor cannot get a good peripheral view of the retina due to cataracts.
Even when the view of posterior eye structures is unimpeded, B-scan can come in handy. Buried drusen in the optic nerve can cause visual field loss. A B-scan can confirm that what appears to be buried drusen really is, and not a more serious optic nerve problem.
The B-scan experience is very comfortable for the patient. We obtain data through a closed eye, so no “goopy stuff” needs to be applied to the open eye when using the probe to obtain an image.
Monday, August 16, 2010
Not - So - Peripheral Vision
At my office, we do a visual field screening test with almost every standard eye examination. This is sometimes incorrectly referred to as a “peripheral vision test”. My Humphrey-Zeiss automated visual fields tester can measure the visual field out to the far periphery, but during the screening mode it only tests the central 30° of the visual field. The vast majority of the neurological disorders we are looking for will be picked up in this 30° central test.
Two main disorders we are looking for are brain tumors and strokes. Both of these disorders can cause a visual field loss because they disrupt the “wiring” in the visual pathway in the brain. The visual cortex, or “seeing” part of the brain, is located at the very back of the cranium. The “wires” in the visual pathway that connect the retina in the eyes to the visual cortex travel through the parietal and temporal lobes of the brain. The “wires” responsible for the left half of our visual field travel in the right side of the brain, and those for the right half of the visual field travel in the left side of the brain. Therefore, any disruption of the wires (from, say, a stroke or a tumor) on the left side of the brain can cause a visual field loss on the right. Problems on the right side of the brain will manifest in the left half of the visual field. When visual fields are screened, careful attention is paid looking for field loss present in both eyes symmetrically on either the left or right half of the field.
Two main disorders we are looking for are brain tumors and strokes. Both of these disorders can cause a visual field loss because they disrupt the “wiring” in the visual pathway in the brain. The visual cortex, or “seeing” part of the brain, is located at the very back of the cranium. The “wires” in the visual pathway that connect the retina in the eyes to the visual cortex travel through the parietal and temporal lobes of the brain. The “wires” responsible for the left half of our visual field travel in the right side of the brain, and those for the right half of the visual field travel in the left side of the brain. Therefore, any disruption of the wires (from, say, a stroke or a tumor) on the left side of the brain can cause a visual field loss on the right. Problems on the right side of the brain will manifest in the left half of the visual field. When visual fields are screened, careful attention is paid looking for field loss present in both eyes symmetrically on either the left or right half of the field.
Wednesday, August 4, 2010
It's Good to Be Thick (In Some Places):
Eye pressure is nearly always measured during a comprehensive eye examination. It is an important measurement because high fluid pressure in the eye can cause the gradual death of the optic nerve. This disease process often leads to visual field loss and sometimes central acuity loss, and is known as glaucoma. Other risk factors exist for glaucoma other than high eye pressure. One important risk factor is central corneal thickness.
When eye pressure is measured, the cornea is flattened (applanated) from its normal convex shape to a flat (Plano) state. This flattening is achieved with a puff of air (non-contact tonometry) or with a probe (Goldmann tonometry). The amount of force required to flatten (applanat) the cornea is measured and converted to a fluid pressure in millimeters of mercury. Typical normal eye pressure runs from 8 to 21 millimeters of mercury. When the cornea is flattened, the calculations used to convert the force required to flatten it to fluid pressure, assume that the cornea is “average” thickness. Average is about 550 microns thick centrally.
I was taught in optometry school 30 years ago that almost all corneas are average thickness. We now know that this is not true. Since thin corneas are a contraindication for some refractive surgeries (i.e. LASIK), many practioners have ultrasound–A units that measure central corneal thickness quickly and easily. In my office, use of my ultrasound–A unit (pachymeter) has shown a wide variance among patient’s corneal thickness. It is not unusual to see thick corners (580 microns and higher) or thin corneas (520 microns and lower). Since it is easier to flatten a thin cornea, most experts’ feel that a patients true eye pressure is actually higher than that measured if the patient has a thin cornea. Patients with thick corneas probably have lower pressure than that measured.
Thin corneas are an independent risk factor for glaucoma. Irrespective of a patient’s true pressure, the theory goes that patients with thin corneas probably have other structures in the eye that are thinner than normal, which may be more easily damaged by fluid pressure. I always tell patients it’s good to be thick in some places. The cornea is definitely one of those places.
When eye pressure is measured, the cornea is flattened (applanated) from its normal convex shape to a flat (Plano) state. This flattening is achieved with a puff of air (non-contact tonometry) or with a probe (Goldmann tonometry). The amount of force required to flatten (applanat) the cornea is measured and converted to a fluid pressure in millimeters of mercury. Typical normal eye pressure runs from 8 to 21 millimeters of mercury. When the cornea is flattened, the calculations used to convert the force required to flatten it to fluid pressure, assume that the cornea is “average” thickness. Average is about 550 microns thick centrally.
I was taught in optometry school 30 years ago that almost all corneas are average thickness. We now know that this is not true. Since thin corneas are a contraindication for some refractive surgeries (i.e. LASIK), many practioners have ultrasound–A units that measure central corneal thickness quickly and easily. In my office, use of my ultrasound–A unit (pachymeter) has shown a wide variance among patient’s corneal thickness. It is not unusual to see thick corners (580 microns and higher) or thin corneas (520 microns and lower). Since it is easier to flatten a thin cornea, most experts’ feel that a patients true eye pressure is actually higher than that measured if the patient has a thin cornea. Patients with thick corneas probably have lower pressure than that measured.
Thin corneas are an independent risk factor for glaucoma. Irrespective of a patient’s true pressure, the theory goes that patients with thin corneas probably have other structures in the eye that are thinner than normal, which may be more easily damaged by fluid pressure. I always tell patients it’s good to be thick in some places. The cornea is definitely one of those places.
Tuesday, June 29, 2010
A Goji Berry a Day Keeps the Cataract Doctor Away
There are only two protective pigments in the human lens and retina -Lutein and Zeaxanthin. These two are both yellow pigments. Research indicates that of the two pigments, Zeaxanthin is more important. In the macula (central retina) Zeaxanthin is found at a 2 to 1 ratio to Lutein centrally. Lutein is at a 2 to 1 ratio to Zeaxanthin in the less important peripheral macula. Both Lutein and Zeaxanthin protect the lens from cataract formation.
The P.O.L.A. study published in 2006 indicted that high levels of both Lutein and Zeaxanthin in the diet protect the macula from age-related macular degeneration. Only high levels of Zeaxanthin in the diet however, were shown to protect the lens from cataracts.
Zeaxanthin is less common than Lutein in foods we typically eat. A small amount of Zeaxanthin is found in green leafy vegetables such as kale, spinach, broccoli, and mustard and collard greens. A bit more is found in egg yolks. A better source of Zeaxanthin is found in orange (not green) peppers. The best source of Zeaxanthin in nature is goji berries (also known as wolf berries). These can be purchased in dried form and resemble dried cranberries in taste and appearance.
Since Zeaxanthin is an important protective yellow pigment for the eye, and is sometimes difficult to get in a normal diet, taking it in supplement form makes sense. At Dr. Steven Lutz and Associates, we recommend and sell EyePromise daily eye supplement, which contains 8mg of Zeaxanthin and EyePromise Z-10 which has 10mg Zeaxanthin in pure olive oil. Both supplements cost about 50 cents a day.
The P.O.L.A. study published in 2006 indicted that high levels of both Lutein and Zeaxanthin in the diet protect the macula from age-related macular degeneration. Only high levels of Zeaxanthin in the diet however, were shown to protect the lens from cataracts.
Zeaxanthin is less common than Lutein in foods we typically eat. A small amount of Zeaxanthin is found in green leafy vegetables such as kale, spinach, broccoli, and mustard and collard greens. A bit more is found in egg yolks. A better source of Zeaxanthin is found in orange (not green) peppers. The best source of Zeaxanthin in nature is goji berries (also known as wolf berries). These can be purchased in dried form and resemble dried cranberries in taste and appearance.
Since Zeaxanthin is an important protective yellow pigment for the eye, and is sometimes difficult to get in a normal diet, taking it in supplement form makes sense. At Dr. Steven Lutz and Associates, we recommend and sell EyePromise daily eye supplement, which contains 8mg of Zeaxanthin and EyePromise Z-10 which has 10mg Zeaxanthin in pure olive oil. Both supplements cost about 50 cents a day.
Tuesday, May 11, 2010
Digital Retinal Imaging is Superior
We have utilized digital retinal imaging at Dr. Steven Lutz and Associates, in Ann Arbor Michigan, for about six years. This technology makes viewing the central retina of the eye with high resolution a breeze. Digital retinal imaging is far superior to standard ophthalmoscopy examination technique when evaluating the central retina.
My retinal camera is the Zeiss Visucam. The superb German optics in this unit produces the finest retinal images available anywhere. When evaluating the retinal images in the exam room we utilize high resolution LCD flat screens. The doctor can show the patients their retina on the screen, and can better explain any areas of concern. The imaging system has a zoom feature, allowing the doctor to highly magnify any central retinal area he or she wishes to evaluate more closely. This zoom feature is a key advantage of digital systems over manual ophthalmoscopy.
Age – related macular degeneration (AMD) is a main cause of vision loss in older adults. The earliest signs of AMD are subtle pigmentary changes (and subtle white drusen in the central retina macula). I have found that these subtle pigmentary changes are much easier to see with digital imaging versus standard exam techniques.
My retinal camera is the Zeiss Visucam. The superb German optics in this unit produces the finest retinal images available anywhere. When evaluating the retinal images in the exam room we utilize high resolution LCD flat screens. The doctor can show the patients their retina on the screen, and can better explain any areas of concern. The imaging system has a zoom feature, allowing the doctor to highly magnify any central retinal area he or she wishes to evaluate more closely. This zoom feature is a key advantage of digital systems over manual ophthalmoscopy.
Age – related macular degeneration (AMD) is a main cause of vision loss in older adults. The earliest signs of AMD are subtle pigmentary changes (and subtle white drusen in the central retina macula). I have found that these subtle pigmentary changes are much easier to see with digital imaging versus standard exam techniques.
Thursday, May 6, 2010
Glaucoma - More Than Just Eye Pressure
During a comprehensive eye examination, it is customary to measure eye pressure. This pressure is called intra-ocular pressure (I.O.P.). Many patients dread the air- puff tonometry test, and refer to it as a “glaucoma test”. This is technically not correct, since eye pressure is only one component of a glaucoma diagnosis. In fact, it is possible for a patient to have normal eye pressure, but still have glaucoma. Glaucoma is the (usually) slow death of the optic nerve fiber layer (N.F.L.) usually, but not always, caused by high pressure.
In glaucoma, as the nerve layer slowly dies, it becomes thinner. A scanning laser, such as the Zeiss GDX or the Zeiss OCT, can measure this N.F.L. thickness. These lasers also compare patient results to a data base of people with the patient’s same age and race. These units also perform statistical analysis, showing the doctor how significant a particular deviation in N.F.L. thickness is from a normative data base.
At Dr. Steven Lutz and Associates, we measure eye pressure with both air-puff tonometry and Goldmann aplanation tonometry. We also utilize a Zeiss GDX scanning laser to better help us diagnose and treat glaucoma.
In glaucoma, as the nerve layer slowly dies, it becomes thinner. A scanning laser, such as the Zeiss GDX or the Zeiss OCT, can measure this N.F.L. thickness. These lasers also compare patient results to a data base of people with the patient’s same age and race. These units also perform statistical analysis, showing the doctor how significant a particular deviation in N.F.L. thickness is from a normative data base.
At Dr. Steven Lutz and Associates, we measure eye pressure with both air-puff tonometry and Goldmann aplanation tonometry. We also utilize a Zeiss GDX scanning laser to better help us diagnose and treat glaucoma.
Friday, April 30, 2010
It's Good To Be Yellow!
The light-sensitive tissue at the back of the eye is the retina. The very center of the retina (and the center of your visual field) is called the macula.
All of our 20/20 acuity is confined to the macular region, which is a very small part of the overall retinal area. Most of our vision is peripheral vision, which is 20/200-type acuity. We detect movement and larger objects with our peripheral vision, then point our macula at the movement or object to see it clearly. The macula is the most important part of the retina.
We all have two yellow pigments in our macular regions – Lutein & Zeaxanthin. These two yellow pigments act passively as an internal sunscreen, protecting the macula from UV radiation, and act actively as antioxidants, protecting the retina from oxidative stress from the blood.
We want to have high levels of yellow pigment in the macula. We get these yellow pigments from our diet. Foods such as kale, broccoli, spinach, collard greens, and mustard greens (green leafy vegetables) are high in yellow pigment. Other foods, such as whole eggs and corn, are also good sources.
At my Ann Arbor office, we now offer Macular Pigment Optical Density (MPOD) testing. This test is quick and easy to administer, and the results are immediately available for the doctor to analyze and discuss with you. Patients who have a low yellow pigment density are educated and counseled on nutrition (both food sources and supplements if indicated) and lifestyle changes (such as smoking cessation) that can increase a patient’s yellow pigment density in the macula.
The next time you go to see your optometrist for your eye care, ask your optometrist if they know why “it’s good to be yellow”!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
All of our 20/20 acuity is confined to the macular region, which is a very small part of the overall retinal area. Most of our vision is peripheral vision, which is 20/200-type acuity. We detect movement and larger objects with our peripheral vision, then point our macula at the movement or object to see it clearly. The macula is the most important part of the retina.
We all have two yellow pigments in our macular regions – Lutein & Zeaxanthin. These two yellow pigments act passively as an internal sunscreen, protecting the macula from UV radiation, and act actively as antioxidants, protecting the retina from oxidative stress from the blood.
We want to have high levels of yellow pigment in the macula. We get these yellow pigments from our diet. Foods such as kale, broccoli, spinach, collard greens, and mustard greens (green leafy vegetables) are high in yellow pigment. Other foods, such as whole eggs and corn, are also good sources.
At my Ann Arbor office, we now offer Macular Pigment Optical Density (MPOD) testing. This test is quick and easy to administer, and the results are immediately available for the doctor to analyze and discuss with you. Patients who have a low yellow pigment density are educated and counseled on nutrition (both food sources and supplements if indicated) and lifestyle changes (such as smoking cessation) that can increase a patient’s yellow pigment density in the macula.
The next time you go to see your optometrist for your eye care, ask your optometrist if they know why “it’s good to be yellow”!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, April 14, 2010
The Next Big Thing
I have been an optometrist for over 23 years. In that time, I have seen my fair share of irregular corneas. The most common form of irregular cornea is keratoconus, which is Latin for “cone-shaped cornea”.
Keratoconus is a genetically inherited corneal dystrophy in which the cornea is cone-shaped, usually below the papillary area. This type of eye generally requires a custom RGP contact lens (rigid gas permeable) to achieve good vision.
I personally have severe keratoconus in my left eye and moderate keratoconus in my right eye. I have struggled for the last 10 years to achieve good vision in my left eye due to the severity of the disease. Recently I was fit with a new sclera gas permeable contact lens called the Jupiter Lens. My vision is dramatically improved now in both eyes.
The Jupiter Lens has a very large diameter – 15.5 to 20.0 millimeters. It rests on the sclera (white part) of the eye, thereby vaulting the corneal irregularities. It has been a bit challenging for me to learn insertion of these large diameter contact lenses (my lenses are 18.2mm in diameter), but after one week, I am now an expert at getting them in. Removal of the lens is easy with a large suction removal device.
If you are a keratoconus sufferer and are struggling to achieve the best vision possible, discuss the Jupiter Lens with your optometrist at your next eye exam – it truly is the Next Big Thing!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Keratoconus is a genetically inherited corneal dystrophy in which the cornea is cone-shaped, usually below the papillary area. This type of eye generally requires a custom RGP contact lens (rigid gas permeable) to achieve good vision.
I personally have severe keratoconus in my left eye and moderate keratoconus in my right eye. I have struggled for the last 10 years to achieve good vision in my left eye due to the severity of the disease. Recently I was fit with a new sclera gas permeable contact lens called the Jupiter Lens. My vision is dramatically improved now in both eyes.
The Jupiter Lens has a very large diameter – 15.5 to 20.0 millimeters. It rests on the sclera (white part) of the eye, thereby vaulting the corneal irregularities. It has been a bit challenging for me to learn insertion of these large diameter contact lenses (my lenses are 18.2mm in diameter), but after one week, I am now an expert at getting them in. Removal of the lens is easy with a large suction removal device.
If you are a keratoconus sufferer and are struggling to achieve the best vision possible, discuss the Jupiter Lens with your optometrist at your next eye exam – it truly is the Next Big Thing!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, April 7, 2010
A New Medication for Dry Eye
Dry eye can be a mild irritant or a major inflammatory problem. Recently a new ocular drop has entered the marketplace to help treat dry eye – Azasite. Azasite helps with evaporative dry eye.
Dry eye can be thought of as having two main causes – lack of tear production (low tear volume) or normal tear volume that evaporates too quickly.
Oil glands in the eyelids (meibomian glands) produce oil that forms an “oil slick” on top of the tear layer of the eye to prevent rapid evaporation. These oil glands can become inflamed, causing low oil production and a quickly evaporating tear film.
Azasite is Azithromycin (an antibiotic) in drop form. This antibiotic has an anti-inflammatory side effect – it is the side effect of the drug that helps deal with dry eyes.
As the inflammation of the oil glands in the lids is reduced, the oil production is increased, and the tear layer evaporates more slowly, greatly reducing the dry eye symptoms.
The next time you go to see your optometrist for your eye exam or contact lens fitting, ask the doctor if Azasite would be a good option for you, and hopefully there will not be a dry eye in your house.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Dry eye can be thought of as having two main causes – lack of tear production (low tear volume) or normal tear volume that evaporates too quickly.
Oil glands in the eyelids (meibomian glands) produce oil that forms an “oil slick” on top of the tear layer of the eye to prevent rapid evaporation. These oil glands can become inflamed, causing low oil production and a quickly evaporating tear film.
Azasite is Azithromycin (an antibiotic) in drop form. This antibiotic has an anti-inflammatory side effect – it is the side effect of the drug that helps deal with dry eyes.
As the inflammation of the oil glands in the lids is reduced, the oil production is increased, and the tear layer evaporates more slowly, greatly reducing the dry eye symptoms.
The next time you go to see your optometrist for your eye exam or contact lens fitting, ask the doctor if Azasite would be a good option for you, and hopefully there will not be a dry eye in your house.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, March 31, 2010
Am I A Good Candidate For LASIK?
At my optometry practice here in Ann Arbor, I am asked by patients every day, "Am I a good LASIK candidate?" There are a variety of areas we look at to answer that question.
The first key area in determining candidacy for LASIK is stability of the eyeglass prescription. We like to see the prescription be stable for at least one year. We define stable as changing 0.25 units or less in a single year. It is generally rare for a person under the age of 21 to have a stable prescription.
A second area is corneal thickness. LASIK laser surgery thins the central cornea. Therefore, a cornea that is thinner than the average may not be a good LASIK candidate. We quickly and easily measure the central corneal thickness with Ultrasound.
A third key area is corneal surface quality. Corneas that are irregular or cone-shaped (Keratoconus) are definitely NOT good LASIK candidates. By using an instrument made by the Zeiss Corporation called a Corneal Topographer, we are able to map the shape of the cornea and measure the corneal surface quality.
Another important factor is eye wettability. Dry eyes can make a patient a poor LASIK candidate. LASIK usually makes the eye temporarily drier than usual. This can push a borderline dry eye into an inflamed, irritated dry eye with intermittently fuzzy vision. Careful tear film evaluations with various dyes are used to look for dry eye problems.
The factors discussed above are some, not all, of the key areas we will look at to determine if you are a good candidate for LASIK surgery. Good candidates generally have great surgical outcomes and are extremely satisfied with their experience.
The next time you go to see your optometrist for your eye care, ask if you are a good candidate for LASIK surgery.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
The first key area in determining candidacy for LASIK is stability of the eyeglass prescription. We like to see the prescription be stable for at least one year. We define stable as changing 0.25 units or less in a single year. It is generally rare for a person under the age of 21 to have a stable prescription.
A second area is corneal thickness. LASIK laser surgery thins the central cornea. Therefore, a cornea that is thinner than the average may not be a good LASIK candidate. We quickly and easily measure the central corneal thickness with Ultrasound.
A third key area is corneal surface quality. Corneas that are irregular or cone-shaped (Keratoconus) are definitely NOT good LASIK candidates. By using an instrument made by the Zeiss Corporation called a Corneal Topographer, we are able to map the shape of the cornea and measure the corneal surface quality.
Another important factor is eye wettability. Dry eyes can make a patient a poor LASIK candidate. LASIK usually makes the eye temporarily drier than usual. This can push a borderline dry eye into an inflamed, irritated dry eye with intermittently fuzzy vision. Careful tear film evaluations with various dyes are used to look for dry eye problems.
The factors discussed above are some, not all, of the key areas we will look at to determine if you are a good candidate for LASIK surgery. Good candidates generally have great surgical outcomes and are extremely satisfied with their experience.
The next time you go to see your optometrist for your eye care, ask if you are a good candidate for LASIK surgery.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Monday, March 8, 2010
Not a Dry Eye in the House (Hopefully!)
Dry Eye is a very common problem encountered daily in an eye care practice. It is often more than a minor annoyance - it is common to see extensive inflammation due to dry eye. We have a systematic approach to treat dry eye syndrome in my optometry practice.
The first step is to select the proper artificial tear for the patient. After a comprehensive evaluation of the patient's dry eyes, we usually start with a mild steroid drop combined with the artificial tear drops. There are dozens of artificial tears on the market. Which one I choose for my patient to try often depends on if the patients has evaporative dry or aqueous deficiency dry eye.
• Evaporative dry eye is caused by poor oil production in the oil glands (meibomian glands) in the eyelids.
• Aqueous deficiency dry eye is thought to be caused by a lack of tear production by the tear glands themselves.
For evaporative dry eyes, I like to use an artificial tear that contains some type of oil. This helps keep the "oil slick" on top of the tear film thicker, which helps prevent evaporation. A good example of this product is Soothe XP from Bausch and Lomb.
For aqueous deficiency dry eyes, I like a product with hyaluronic acid (H.A.). H.A. helps "glue" more to the eye, and often lasts for several hours per drop applied. A good example of this type of product would be Blink Tears from Abbott Medical Optics.
The next time you go to see your optometrist for your eye exam or contact lens fitting, ask the doctor if artificial tears would be a good option for you, and hopefully there will not be a dry eye in your house.
Steven Lutz, OD
Dr. Steven Lutz & Associates PC.
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
The first step is to select the proper artificial tear for the patient. After a comprehensive evaluation of the patient's dry eyes, we usually start with a mild steroid drop combined with the artificial tear drops. There are dozens of artificial tears on the market. Which one I choose for my patient to try often depends on if the patients has evaporative dry or aqueous deficiency dry eye.
• Evaporative dry eye is caused by poor oil production in the oil glands (meibomian glands) in the eyelids.
• Aqueous deficiency dry eye is thought to be caused by a lack of tear production by the tear glands themselves.
For evaporative dry eyes, I like to use an artificial tear that contains some type of oil. This helps keep the "oil slick" on top of the tear film thicker, which helps prevent evaporation. A good example of this product is Soothe XP from Bausch and Lomb.
For aqueous deficiency dry eyes, I like a product with hyaluronic acid (H.A.). H.A. helps "glue" more to the eye, and often lasts for several hours per drop applied. A good example of this type of product would be Blink Tears from Abbott Medical Optics.
The next time you go to see your optometrist for your eye exam or contact lens fitting, ask the doctor if artificial tears would be a good option for you, and hopefully there will not be a dry eye in your house.
Steven Lutz, OD
Dr. Steven Lutz & Associates PC.
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Friday, March 5, 2010
Thanks for Your Feedback!
Thanks for the comments on Dr. Beebe:
Dr Beebe is FANTASTIC!! My daughter loves coming to see her! She takes such good care of her! -Katrina E., Washtenaw, MI
We’re proud of our staff and we are glad to hear you like them too. We appreciate any and all patient feedback and comments. What you say matters the most, after all, our business is all about you and the health of your eyes.
Dr Beebe is FANTASTIC!! My daughter loves coming to see her! She takes such good care of her! -Katrina E., Washtenaw, MI
We’re proud of our staff and we are glad to hear you like them too. We appreciate any and all patient feedback and comments. What you say matters the most, after all, our business is all about you and the health of your eyes.
Wednesday, March 3, 2010
Gas Perm Bifocal Fittings Don't Have To Be Hard!
At my practice, Dr. Steven Lutz and Associates in Ann Arbor, MI, a large portion of our patients are contact lens wearers. Many of the patients we fit with contact lenses are multifocal (bifocal) wearers. Most of these patients wear soft contact lenses, but about 15% are gas permeable (rigid) lens wearers, sometimes called RGP's.
Because gas permeable contact lenses are completely customized, and have multiple variables that need to be manipulated to get the correct prescription, they have a reputation of being much more difficult to fit than a soft multifocal lens. This does not always have to be the case. If a few fundamental concepts are kept in mind, gas permeable multifocal contact lens fittings can be relatively straightforward.
I put bifocal gas perm wearers in two categories: those that the contact lens will center on the eye and those that the contact lens wants to ride up higher ("superior attached fit").
Lifestyle Corporation makes a multifocal contact lens that is designed to ride up on the eye, tucked under the upper lid. This design is my first choice for patients where the lens wants to ride up.
Art Optical Corporation in Grand Rapids, MI makes the Renovations gas permeable multifocal contact lens. This design is my first choice for centered-fit patients.
There are often clues in the eyelid and eye architecture that helps the doctor determine if a centered-fit lens or high-riding lens will be preferable. If the patient's upper lid covers much of the superior cornea (the upper lid hangs down a bit), this is often a good indicator for a high riding lens design. Patients with upper and lower lids that are quite far apart (large aperture) are usually better candidates for a centered-fit design. Diagnostic contact lenses are the key - we always put diagnostic contact lenses on the eyes to ultimately determine which design works best for each individual patient.
If you are an RGP contact lens wearer, make certain that your optometrist specializes in RGP contact lens fittings, so your next fitting doesn't have to be "Hard"!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Because gas permeable contact lenses are completely customized, and have multiple variables that need to be manipulated to get the correct prescription, they have a reputation of being much more difficult to fit than a soft multifocal lens. This does not always have to be the case. If a few fundamental concepts are kept in mind, gas permeable multifocal contact lens fittings can be relatively straightforward.
I put bifocal gas perm wearers in two categories: those that the contact lens will center on the eye and those that the contact lens wants to ride up higher ("superior attached fit").
Lifestyle Corporation makes a multifocal contact lens that is designed to ride up on the eye, tucked under the upper lid. This design is my first choice for patients where the lens wants to ride up.
Art Optical Corporation in Grand Rapids, MI makes the Renovations gas permeable multifocal contact lens. This design is my first choice for centered-fit patients.
There are often clues in the eyelid and eye architecture that helps the doctor determine if a centered-fit lens or high-riding lens will be preferable. If the patient's upper lid covers much of the superior cornea (the upper lid hangs down a bit), this is often a good indicator for a high riding lens design. Patients with upper and lower lids that are quite far apart (large aperture) are usually better candidates for a centered-fit design. Diagnostic contact lenses are the key - we always put diagnostic contact lenses on the eyes to ultimately determine which design works best for each individual patient.
If you are an RGP contact lens wearer, make certain that your optometrist specializes in RGP contact lens fittings, so your next fitting doesn't have to be "Hard"!
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, February 24, 2010
Uptight Eyelids Can Increase Astigmatic Contact Lens Success
Soft contact lenses that correct astigmatism are called “Toric” lenses. “Toric” comes from the root word “Toroid”. A toroidal surface in geometry is a surface with two curves at 90° angles to each other.
Toric soft contact lenses have two curves and two powers at right angles to each other. These powers must be rotationally stable on the eye for optimal vision. If the bottom of the contact lens rotates nasally (towards the nose) or temporally (away from the nose), your vision will be compromised. Rotational stability is of paramount importance with toric contact lenses.
Accordingly, soft toric lenses have multiple design features to create rotational stability. The most common design element to encourage this is prism ballasting (or peri-ballasting). Essentially, the bottom of the lens is thicker than the top. This causes the thicker bottom of the lens to ride down. Gravity may play a small role in stabilizing a prism ballast lens, but the main reason the thicker bottom of the lens rides down because the upper eyelid presses harder on the eye during a blink than the lower lid. This causes the thicker part of the lens to move away from the greater force of the upper lid. This is sometimes referred to as the “pumpkin seed effect”.
Often in patients with higher eyelids, standard prism ballast lenses are unstable rotationally. These patients often do better in regards to both vision and comfort with what I call a “double slab-off” toric contact lens. These lenses are thinner on the top and bottom, and are thicker in the middle. Thus the opposing forces of the upper and lower lids stabilize the lens on the eye.
During a contact lens fitting for patients with astigmatism, I usually place both a prism ballast contact lens design and a double slab-off design lens on the patient’s eye. Usually I will prescribe the lens that looks the most rotationally stable on the eye. Often “uptight” lids do best with double slab-off designs, and patients who have loose eyelids or eyes where the upper and lower lids are far apart (large apertures) tend to do better with a prism ballast design.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Toric soft contact lenses have two curves and two powers at right angles to each other. These powers must be rotationally stable on the eye for optimal vision. If the bottom of the contact lens rotates nasally (towards the nose) or temporally (away from the nose), your vision will be compromised. Rotational stability is of paramount importance with toric contact lenses.
Accordingly, soft toric lenses have multiple design features to create rotational stability. The most common design element to encourage this is prism ballasting (or peri-ballasting). Essentially, the bottom of the lens is thicker than the top. This causes the thicker bottom of the lens to ride down. Gravity may play a small role in stabilizing a prism ballast lens, but the main reason the thicker bottom of the lens rides down because the upper eyelid presses harder on the eye during a blink than the lower lid. This causes the thicker part of the lens to move away from the greater force of the upper lid. This is sometimes referred to as the “pumpkin seed effect”.
Often in patients with higher eyelids, standard prism ballast lenses are unstable rotationally. These patients often do better in regards to both vision and comfort with what I call a “double slab-off” toric contact lens. These lenses are thinner on the top and bottom, and are thicker in the middle. Thus the opposing forces of the upper and lower lids stabilize the lens on the eye.
During a contact lens fitting for patients with astigmatism, I usually place both a prism ballast contact lens design and a double slab-off design lens on the patient’s eye. Usually I will prescribe the lens that looks the most rotationally stable on the eye. Often “uptight” lids do best with double slab-off designs, and patients who have loose eyelids or eyes where the upper and lower lids are far apart (large apertures) tend to do better with a prism ballast design.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, February 17, 2010
All Aboard For Sharing
Several years ago, when I would babysit for my granddaughter, Savannah, she used to force me to watch Barney videotapes for hours on end. Her favorite tape was “All Aboard For Sharing”. I thought about this recently when I sat down to write my blog about multifocal (bifocal) contact lenses.
Soft multifocal contact lenses are all about sharing pupil space. A soft multifocal contact lens has a reading zone, a distance zone, and usually an intermediate zone, all centered within the pupil of the eye.
This is fundamentally different from a bifocal (lined) lens or a progressive (no-line) lens for your glasses. With glasses, by looking straight ahead, you fill both pupils of the eyes with far (distance) vision rays of light. To fill both pupils with near (reading) rays of light, you need to look down with your eyes and look through the lower portion of the glasses.
By having two independent areas of the lens, glasses are therefore better visually than multifocal contact lenses, which must place both far and near rays of light in the pupil simultaneously.
Glasses, of course, are not perfect. They are literally a “pain in the neck” if you are trying to view a computer screen placed straight ahead of you. You have to tilt your head back to adjust your line of sight so you are looking through a lower point in your lenses to get the proper corrective power in front of your pupil!
Multifocal contact lenses are much better in this situation. By looking straight ahead, the contact lens places the near vision correction on the retina. No head tilting needed!
When my patients come in for their eye exam, I always ask what situations they find themselves in on a daily basis. Glasses are a bit better for certain tasks, such as prolonged reading or long distance night driving, but most patients find (myself included!) they prefer multifocal contact lenses for most everyday tasks.
The next time you go to see your optometrist for your eye care, ask about the possibility of having a contact lens fitting for a multifocal contact lens, and see for yourself why a multifocal contact lens will have you “all aboard for sharing”.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Soft multifocal contact lenses are all about sharing pupil space. A soft multifocal contact lens has a reading zone, a distance zone, and usually an intermediate zone, all centered within the pupil of the eye.
This is fundamentally different from a bifocal (lined) lens or a progressive (no-line) lens for your glasses. With glasses, by looking straight ahead, you fill both pupils of the eyes with far (distance) vision rays of light. To fill both pupils with near (reading) rays of light, you need to look down with your eyes and look through the lower portion of the glasses.
By having two independent areas of the lens, glasses are therefore better visually than multifocal contact lenses, which must place both far and near rays of light in the pupil simultaneously.
Glasses, of course, are not perfect. They are literally a “pain in the neck” if you are trying to view a computer screen placed straight ahead of you. You have to tilt your head back to adjust your line of sight so you are looking through a lower point in your lenses to get the proper corrective power in front of your pupil!
Multifocal contact lenses are much better in this situation. By looking straight ahead, the contact lens places the near vision correction on the retina. No head tilting needed!
When my patients come in for their eye exam, I always ask what situations they find themselves in on a daily basis. Glasses are a bit better for certain tasks, such as prolonged reading or long distance night driving, but most patients find (myself included!) they prefer multifocal contact lenses for most everyday tasks.
The next time you go to see your optometrist for your eye care, ask about the possibility of having a contact lens fitting for a multifocal contact lens, and see for yourself why a multifocal contact lens will have you “all aboard for sharing”.
Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.
Wednesday, February 10, 2010
One Day (Single Use) Contact Lenses
My name is Dr. Steven Lutz. I am an optometrist in Ann Arbor, MI along with Dr. Lesley Beebe. My office is located inside the Lenscrafters at the Briarwood Mall.
I have a very large contact lens practice. During routine eye exams, I fit many patients with complex prescriptions, including patients that have astigmatism or presbyopia (the need for help with their reading, mostly in patients over the age of 40).
Of course, we also do contact lens fittings for many patients that have straightforward prescriptions for myopia (near-sightedness) and hyperopia (far-sightedness). Many more of these patients are being fit with one day contact lenses, as opposed to the traditional two week or monthly contact lens. These lenses are worn once and then thrown away - no cleaning, no storage, fresh lenses every day!
There are many advantages to these one day contact lenses:
1: No contact lens solution hassle or cost. This is a supremely easy way to wear contact lenses. Solution will cost a patient about $75 / year. This cost is eliminated with one day contacts.
2: Brand new lenses are very comfortable. As a contact lens ages, often the comfort and wettability goes downhill. Discuss the comfort of your current lenses with your doctor during your eye exam. A one day contact lens patient has new lens comfort every day.
3: Time-released artificial tears & advanced polymers. Many one day lenses have time-released artificial tears built in that deal with dry eye problems very well. Other one day designs have technology that binds water tightly to the contact lens polymer, keeping the lens moist all day long.
It is true that most one day contact lenses may cost a bit more for your year supply than traditional disposable contact lenses. However, when you factor in the savings gained by eliminating contact lens solution and the hefty rebates available from the manufacturers (most are between $80 to $100!), as well as the health benefits of a new lens every day, the cost of one day contact lenses is usually only $3 to $5 more a month! You may find the health benefits of a daily disposable lens outweigh the extra $3-$5 per month.
When talking with your eye doctor about your eye care, be sure to discuss all the benefits of one day contact lenses to see if these lenses are the right fit for you!
I have a very large contact lens practice. During routine eye exams, I fit many patients with complex prescriptions, including patients that have astigmatism or presbyopia (the need for help with their reading, mostly in patients over the age of 40).
Of course, we also do contact lens fittings for many patients that have straightforward prescriptions for myopia (near-sightedness) and hyperopia (far-sightedness). Many more of these patients are being fit with one day contact lenses, as opposed to the traditional two week or monthly contact lens. These lenses are worn once and then thrown away - no cleaning, no storage, fresh lenses every day!
There are many advantages to these one day contact lenses:
1: No contact lens solution hassle or cost. This is a supremely easy way to wear contact lenses. Solution will cost a patient about $75 / year. This cost is eliminated with one day contacts.
2: Brand new lenses are very comfortable. As a contact lens ages, often the comfort and wettability goes downhill. Discuss the comfort of your current lenses with your doctor during your eye exam. A one day contact lens patient has new lens comfort every day.
3: Time-released artificial tears & advanced polymers. Many one day lenses have time-released artificial tears built in that deal with dry eye problems very well. Other one day designs have technology that binds water tightly to the contact lens polymer, keeping the lens moist all day long.
It is true that most one day contact lenses may cost a bit more for your year supply than traditional disposable contact lenses. However, when you factor in the savings gained by eliminating contact lens solution and the hefty rebates available from the manufacturers (most are between $80 to $100!), as well as the health benefits of a new lens every day, the cost of one day contact lenses is usually only $3 to $5 more a month! You may find the health benefits of a daily disposable lens outweigh the extra $3-$5 per month.
When talking with your eye doctor about your eye care, be sure to discuss all the benefits of one day contact lenses to see if these lenses are the right fit for you!
Wednesday, February 3, 2010
Naturally Wettable Comfort - Lens Provides Astigmatic Patients with Comfort and Corneal Stability
Toric contact lens wearers demand two things from their contact lenses - great comfort and great vision. Contact lens practitioners demand a lens that can be predictably fit with a minimum of chair time. A wearing schedule that encourages patient compliance is a big plus also. Biofinity Toric, the latest new silicone hydrogel from CooperVision, meets all of these demands. It combines a great soft lens material, comfilcon A, with an excellent toric design.
I have been using Biofinity Toric in my office since early January 2009. I have fit more than 40 patients with this product, and I have been very impressed with this lens. I feel the Biofinity Toric is the best toric contact lens that has ever entered the marketplace.
Comfort
Biofinity Toric is made with the polymer comfilcon A. Comfilcon A is naturally wettable, has a low modulus, offers a high Dk (128), and it is approved for extended wear for up to six nights/seven days.
The polymer is inherently very wettable. Biofinity Toric has a low wetting angle, allowing water to spread out evenly on the lens surface. It does not require a wetting agent or surface treatment (plasma) to be hydrophilic and wet properly. CooperVision's Aquaform Comfort Science creates a naturally hydrophilic contact lens that retains water within the lens, which minimizes dehydration. Biofinity Toric, being naturally wetable, offers exceptional deposit resistance and comfort.
The low modulus means that Biofinity Toric is not stiff, but rather is quite soft and "spongy," also helping to deliver great comfort. The massive oxygen flow (DK = 128) ensures great end-of-day comfort for those extra-long wearing times that many patients experience.
Vision
Biofinity Toric is made with a toric design that provides remarkably crisp vision. CooperVision started with its tried-and-true horizontal iso-thickness design, found in Biomedics Toric, and fine-tuned it to perform with the newer material.
I've always had great success with the Biomedics Toric design, finding it very stable rotationally, but wished that I could have more oxygen delivered to the cornea. Obviously, the oxygen issue has been addressed, but I've found the Optimized Ballast Design of Biofinity Toric to be even more stable than the Biomedics lens, which produces improved visual acuity.
Quick fit/patient compliance
CooperVision also got the little things right with Biofinity Toric. The lens has a single orientation mark at 6 o'clock, and it is very easy to see. This sounds very basic, and it is, but its ease of visibility is a great time saver when fitting the patient. Also, the lens handles well, and it's easy to tell when the Biofinity Toric is inside-out.
I also like the fact that the lens is designed for monthly replacement. In my office, the best compliance, by far, is seen with one-day and one-month replacement products.
Biofinity Toric is currently available in plano to -6.00; cylinders of -0.75, -1.25, and -1.75; and axis of 10 to 180. Plus powers and a -2.25 cylinder will be available August 1.
Biofinity Toric has quickly become the "workhorse" soft toric contact lens in my office. Both the lens material and lens design are excellent. I encourage you to try Biofinity Toric in your practice. I think you will be very pleased with the results.
I have been using Biofinity Toric in my office since early January 2009. I have fit more than 40 patients with this product, and I have been very impressed with this lens. I feel the Biofinity Toric is the best toric contact lens that has ever entered the marketplace.
Comfort
Biofinity Toric is made with the polymer comfilcon A. Comfilcon A is naturally wettable, has a low modulus, offers a high Dk (128), and it is approved for extended wear for up to six nights/seven days.
The polymer is inherently very wettable. Biofinity Toric has a low wetting angle, allowing water to spread out evenly on the lens surface. It does not require a wetting agent or surface treatment (plasma) to be hydrophilic and wet properly. CooperVision's Aquaform Comfort Science creates a naturally hydrophilic contact lens that retains water within the lens, which minimizes dehydration. Biofinity Toric, being naturally wetable, offers exceptional deposit resistance and comfort.
The low modulus means that Biofinity Toric is not stiff, but rather is quite soft and "spongy," also helping to deliver great comfort. The massive oxygen flow (DK = 128) ensures great end-of-day comfort for those extra-long wearing times that many patients experience.
Vision
Biofinity Toric is made with a toric design that provides remarkably crisp vision. CooperVision started with its tried-and-true horizontal iso-thickness design, found in Biomedics Toric, and fine-tuned it to perform with the newer material.
I've always had great success with the Biomedics Toric design, finding it very stable rotationally, but wished that I could have more oxygen delivered to the cornea. Obviously, the oxygen issue has been addressed, but I've found the Optimized Ballast Design of Biofinity Toric to be even more stable than the Biomedics lens, which produces improved visual acuity.
Quick fit/patient compliance
CooperVision also got the little things right with Biofinity Toric. The lens has a single orientation mark at 6 o'clock, and it is very easy to see. This sounds very basic, and it is, but its ease of visibility is a great time saver when fitting the patient. Also, the lens handles well, and it's easy to tell when the Biofinity Toric is inside-out.
I also like the fact that the lens is designed for monthly replacement. In my office, the best compliance, by far, is seen with one-day and one-month replacement products.
Biofinity Toric is currently available in plano to -6.00; cylinders of -0.75, -1.25, and -1.75; and axis of 10 to 180. Plus powers and a -2.25 cylinder will be available August 1.
Biofinity Toric has quickly become the "workhorse" soft toric contact lens in my office. Both the lens material and lens design are excellent. I encourage you to try Biofinity Toric in your practice. I think you will be very pleased with the results.
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