I have recently started relying upon my glasses a little more.  My prescription is pretty small and I have only noticed in the past year or so, after I hit 40.    I usually choose the same type of rectangular frame and my prescription hasn’t changed in the past 2 years.  Just look at my collection – other than the difference in color, basically the same shape.

I usually wear my glasses for about an hour or two a week.  Not too often in the past, but, lately, more than that.  My usual go-to pair was this pair of Ray Ban above or the Fendi below. Same rectangular shape.

So, our clinic is upgrading our lenses to the new Zeiss lens and I chose a new pair of glasses to go with the new lens.  I got the pair back and it was SO clear.  Like viewing in HDTV clear when I had been watching an old cathode ray tube TV.  I loved them.

Then I decided I was tired of getting the same shape frame over and over, so I decided to try something totally different – round.  And, when those glasses came back a week later, I just didn’t like my vision in them.

Until I experienced this, I think I never truly understood what a patient meant when they said their vision was “too clear”.  But, that’s exactly what I felt.  I couldn’t quite put my finger on it, but it just wasn’t the same as the other pair I had just gotten.  Same prescription, same lab making the lens.  Only thing that was different was the shape of my glasses.  So, I asked my optician her thoughts and the first question she asked me

  1.  Are you switching back and forth between your two different pairs?

    Well, yeah, of course.  Turns, out that’s the wrong thing to do.  Being a newbie to wearing glasses, I had not given myself time to adapt to the new frame, so I asked our optician to give some advice about adapting to new lenses.

 

Hi, I’m the Optician for Honolulu Eye Clinic.

So you’ve finished the eye exam, and for the first time in your life, the doctor says you need to wear prescription eye glasses. You’ve never worn glasses before so you talk about lens options with the local optician, select a gorgeous new frame and finalize the order details. The optician calls you two weeks later when the glasses are ready. You try them on and your eyes widen in awe as you look around and suddenly see everything in sharp detail and crystal clarity. But after a few seconds of looking around, you start to feel a little funny. Objects almost look too sharp and after looking around and around through the lenses, you start to feel a little dizzy and feel a headache coming on. You look up at the optician in alarm and say, I cant wear these!!!

 

STOP. Take a deep breath.

 

This is a NORMAL experience, referred to as the adaptation period. Nearly all first-time glasses wearers experience initial dizziness and a sort of “off-balance” feeling. This is the time when the brain needs a chance to get adjusted to what the eyes are now seeing in crystal clarity. This is very common, and sometimes it takes a few minutes, a few days, or even a few weeks, before you can fully enjoy your new glasses. So don’t be discouraged! Take breaks when you experience dizziness, but do your best to put them back on and wear them as much as you can.

 

HEC Tips:

WEAR YOUR GLASSES. This seems like a no-brainer, but wearing the glasses every day for one or two weeks will give you the best chance at getting used to the new prescription. If dizziness or the “off-balance” feeling is the issue, practice wearing them in a safe environment, such as when you get home and are doing chores or watching TV. Be extra careful if you are wearing them while driving and walking down flights of stairs.  

 

KEEP YOUR HEAD MOVEMENTS NATURAL. Often times, first time wearers stop moving their head as they normally would and move their eyes only. Let your eyes and head work together, turning your head towards something you want to look at rather than just moving your eyes. This will usually help to reduce headaches and dizziness.

 

CLEAN YOUR LENSES. Smudges on the lenses are distracting to anyone wearing glasses, but especially to a first-time wearer who is adjusting to a new prescription. Keep your lenses clean with a small drop of liquid soap and water, and wipe the lenses dry with your Honolulu Eye Clinic microfiber cleaning cloth.

 

Even patients who have been wearing glasses for years can go through an adaptation period. Changes in prescription, slight changes in the inner curves of the lens, or even changing into a different frame style can create the need for an adaptation period. If this happens to you, TRY NOT TO WEAR YOUR OLD GLASSES. Resist the urge to switch to an older pair during the adaptation period. We understand that you may feel more comfortable wearing the old prescription, but wearing the old glasses will not give you a chance to adjust to the new pair. Even switching back and forth from old to new can prolong the adaptation period.

 

Wearing your glasses full-time for one or two weeks is typically the best way to adapt to your new prescription, however, if after that time you still experience headaches and dizziness, call your eye doctor  to schedule an appointment. It may be possible that a correction to your lenses or the prescription may need to be made. 

 

I thought I’d do a year end wrap up of our most popular frames for 2016.  2016 saw the resurgence of the round frame and I think we’ll see more of that in 2017.  We also saw more matte frames as well.  Though of course, classic frames likes aviators always do well.  So, in no particular order…

1.   Silhouette

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This is Kevin, our wacky optician.  He lives in these frames and you can just barely even see them on his face. These frames are so light you’ll hardly feel them on your face.  There’s a reason that half my family wears these.

2.  Ray Ban Aviators

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These classic suns will just never go out of style.

 

 

3.  Red Tomato

These are new kids frames that we just started carrying in 2016.  I noticed a patient of mine had them on and they were so cute and just had a great built up nose bridge for little ones.  They don’t smash on to the face the way Miraflex does.  They are very well made and come in cute colors.

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Red Tomato glasses on the bottom. An adult sized frame on top of the blocks for reference to judge how small these glasses can get!

4.  Tom Ford

We started carrying these back in 2015 and they have continued to gain in popularity.  I love the beautiful, neutral colors that complement any skin color.  Plus, James Bond wore them, so what’s not to love about Daniel Craig?

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5. Maui Jim

We live in Hawaii, so it’s no surprise that Maui Jim frames are some of our best sellers. Their polarized lenses are excellent.

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6.  Crocs

These are also new kid frames and they are just so cute and well made and come in a variety of fun colors.

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7.  Roberto Cavalli

For those of you who like bling, bling, these frames are for you!  I love that the sides are AMAZING, but they don’t look ostentations from the front.

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8.  Dragon Vantage

These frames are truly perfect for the Hawaii lifestyle.  It’s a FLOATABLE frame built for “aquatic action”.  The lenses are made of polycarbonate, so if your surfboard tips up when you’re catching a wave, your eyes are protected.  So, all you surfers our there who say you can’t wear sunglasses, these are perfect.

 

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9.  Zenka

One of my patients was actually wearing these frames and I complimented her on them and her friend happened to be the rep. I love them.  They are French and incredibly boutique.  If you want something different than what everyone else buys from Costco, Lenscrafters, then these are your frames.  These really awesome part about these frames is that you can buy these clips that attach to the front, to change up the look.

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And, here I am modeling three different clips that go on the clear frame.

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And, here’s Ronnie, my clinic manager, selfie-taker expert, who is teaching me what I need to do.  She had me cracking up!

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10.  Oakley

Another kind of no-brainer for Hawaii.  Well made, well-constructed.  Nothing more needs to be said.  They make specialty frames for each and every different kind of sport.  I love my hot pink ones for running.

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red aloha rupa sig

 

This is probably one of the most common questions I get.  Even though my husband and I are ophthalmologists (eye surgeons), we still do a large number of glasses and contact lens prescriptions.

Here’s my son, Taj performing his first refraction with the phoropter when he was 1.5 years old. This picture was taken at the Children’s Discovery Center, our equipment in our office is much newer than this!

Taj adjusting the phoropter

Refraction is the term used to describe that process of fine tuning your glasses prescription when you sit behind the phoropter. Everyone gets so nervous when we ask “Better 1 or 2”.  They don’t want to get the answer wrong.  And, the thing is there is no wrong answer.  Your glasses prescription is individualized to suit your needs.  And, most optical shops (like ours) can always redo the lenses for free for three months if you end up getting the glasses and they just don’t seem to work for you, even after giving them a couple weeks.  So, that should take the pressure off.

So, you did it – finished the dreaded “1 or 2” test and your doctor hands you a prescription.  It’s like an ancient language – what does it all mean??? OD, OS, Sphere, Cylinder, Axis, Add??

 

OD and OS

First, OD and OS.  OD stands for oculus dextrous, for those of you who took Latin in high school, which means right eye.  OS stands for oculus sinister, for left eye and OU stands for oculus unitas or both eyes

 

Sphere (Sph)

This refers to the spherical lens necessary to sharpen your vision to 20/20 (if possible for you).  The number is the amount, measured in diopters, needed to correct nearsightedness or farsightedness.  In this example, this patient has a minus in front of the number because he is myopic or nearsighted.  This patient can see near, but not far. Whether the number is plus or minus, the higher the number, the stronger the prescription.

This patient’s eye is a little longer than normal, so the light focuses in front of the retina instead of on it.

Myopic eye diagram

 

A minus spherical lens, or a concave lens, helps focus it onto the retina.

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Here’s another prescription with a plus number in the sphere column, meaning this patient is hyperopic, or farsighted.  That means this person can see far away, but not up close (that’s only for adults).  Though, that’s not entirely accurate – most kids are hyperopic.  As their eyeball elongates, they outgrow this farsightedness – but, their vision is never affected by it because their eye is so flexible it’s able to focus past the farsightedness, giving them 20/20 vision.

This patient is a child and her eye is a little shorter than is normal, so light comes to focus behind the retina.

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A plus spherical lens, or convex lens, helps focus the light onto the retina.

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Cylinder (Cyl)

There are two types of lenses in glasses prescriptions – sphere and cylinder.  Cylindrical lenses are used for correcting astigmatism.  Sometimes new patients come to me and say, “I have…..ASTIGMATISM” (que the scary music).  It’s almost as if it’s a terrible disease (which it’s not).  Astigmatism just means the front of your eye, or the cornea, is shaped more like an egg or football, instead of being perfectly spherical like a ball.

Most people have some astigmatism.  For people with astigmatism, it means that images are slightly stretched horizontally or vertically, like a fun house mirror.  This number can be minus or plus, but practices tend to stick to one sign.  In our office, all our prescriptions are written using minus cylinder.  If you don’t have a number in this column, it means you don’t have any astigmatism.

Axis

Axis refers to the direction or position in which the cylindrical lens is pointed to correct the astigmatism.  It’s measured in degrees.  If your prescription doesn’t have a cylinder number, then it won’t have an axis number either.  Remember high school geometry?  That’s what the axis refers to, just like your old protractor.  Do they still use protractors in high school?  Probably not, I bet there’s some app for that now.

cyl axis

Add

This number is also measured in Diopters and refers to the extra magnifying power needed to help you see up close if you are presbyopic.  Presbyopia is the condition which affects most individuals over the age of 40.  You probably know the signs if you fall into this age group – reading, using your phone, all starts to get a little harder and you have to hold things far away for them to be clear.  That’ presbyopia. If you wear bifocals or progressive glasses, then there will be a number in this column.  Add power is always a plus number and it can range from as low as +0.75 to +4.00 (in rare cases), though the normal add powers are between +1.25-+3.00.

Prism

My patients will have a number in this column.  This is for correcting eye misalignments (strabismus) and reducing double vision.  Depending upon the type of strabismus (eye drift up, out, in or down), the prism will be oriented in different directions to counter the eye misalignment.  Most people do not need prism in their glasses.

And, we’ll close with my favorite pic from the Cat in the Hat – it’s actually very accurate!

 

Why do my child’s glasses keep getting stronger? This is one of the most common questions I encounter in my practice.  I see a patient after they have failed their vision screening exam at their pediatrician’s office and diagnose them with nearsightedness.  The following year, their myopia is worse and the glasses prescription has to be increased.  The year after, same thing happens.  I always reassure parents,”‘This is normal.  Expect the prescription to increase every year until they hit college age”.  But, of course, as a parent, it’s worrisome.   Parents always ask me about TV/video games/foods they can eat, anything that could help “strengthen” their children’s eyes.  Before, I would have to tell them that nothing could be done, it was just genetics.  But, not so anymore!

But, first, let’s just review what is myopia?  Myopia is what most people often call nearsightedness  – you can see up close, but not far away.

 

Myopia is the most common refractive error in kids, and it’s on the rise. My son is obsessed with asking if my husband is nearsighted or farsighted after we read this page in the Cat in the Hat book at bedtime.

 

For myopes, the light rays from the outside world are focused just in front of the retina.  It can be because the eye is a little longer than usual (axial myopia), sometimes for adults, it’s because there is a cataract refracting the light differently.  But, let’s stick to the kids for this discussion.

Myopic eye diagram

So, it makes sense if one parent is myopic, then the child has a good chance of becoming myopic as well.  Eye size is inherited just as hair color, height, etc.  My boys don’t wear glasses for real (though they are modeling them in the picture above), but I should qualify this as a YET.  I am not nearsighted, nor is anyone in my immediate family, however, my husband’s side is a different story.  So, there certainly is a good chance that they may require glasses in the future.

Now, here’s a little throwback to high school physics.  For nearsighted individuals, the lens shape (concave) helps to focus the light on to the retina.

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Now, to the good stuff?  What can be done?  Two new studies have come out which have had some very promising results in terms of decreasing the progression of nearsightedness in kids.

1.  Increase Time Outdoors

One study examined 2000 children in Australia and specifically looked at the type of activities children were doing.  They then followed-up the kids 5- 6 years later to figure out which activities seemed to make a child more nearsighted.

  • Time spent indoors
  • Time spent doing near work (reading, homework, iphone, etc).
  • Family history of nearsightedness

So, what does this mean.  Being outdoors in the sunlight, is protective.  Kids who spent 1-2 hours/day outdoors, were on average a whole diopter less nearsighted than their peers who did not.  That would mean -3.00 prescription instead of a -4.00 prescription. And, the more time kids spent indoors on devices made their myopia worse.

But time spent doing near work, in and of itself, did not cause nearsightedness.  So, the belief that too much time spent on the iPad/iphone will cause a child to need glasses is incorrect.  I am asked this leading question at least daily by parents “Using the iPhone or playing video games is bad for the eyes, right?”  .  They look at me hopefully, expecting me to dispense a lecture to the kids of the dangers of said devices.  But, unfortunately, it’s just not true.  Now, what I do tell them, is that first and foremost, too much time spent on these devices is not great for their brain.  A policy statement issued  by the American Academy of Pediatrics warned about the dangers of attention problems, sleep difficulties and obesity from too much time spent on media devices.  However, there have been no conclusive studies which link media devices with eye or vision problems.  BUT, when kids are playing on these devices, it does make it more difficult to get them outdoors, in the protective UV light and that can make them more nearsighted. So, is it the bright light or the UV light that’s protective?  Well, studies in animals seem to indicate that it might just be bright light which is helpful, though it’s still too early to draw conclusions.  However, I still recommend that kids should always wear protective hats, sunglasses and clothing when outdoors, especially here in Hawaii.

Being myopic is not just a pain for children to wear glasses, it can also have serious consequences in terms of the health of a child’s eye.  People who are myopic have longer eyes than individuals who are not.  That predisposes them to having retinal tears and detachments if their prescription is higher than -6.00 D.   It’s basically because the same amount of retina is being stretched more in a myopic eye than in a normal eye.  This can leads to areas of thinning or tears which can cause retinal detachments.

 

2.  Atropine 0.01%

Another important study assessed the effectiveness of a dilute version of a dilating drop – atropine – in delaying the progression of nearsightedness.  Studies have been done with different strengths of this drop in the past, but as you may know from going to the ophthalmologist, even when dilute, dilating drops can cause side effects, like blurry vision and sensitivity to sunlight.  But, this study looked atropine 0.01%, which is 1/100th the strength we use in the clinic.  When administered daily to kids, it slowed their nearsightedness and also decreased the elongation of their eyeball.  Therefore, they were less at risk for those dangerous retinal tears or detachments.  I now offer these drops to a high select group of patients who have nearsightedness which is worsening quickly.

Schools in China are already applying the outdoor time in an effort to decrease their incidence of nearsightedness.  And, for those kids for whom this preventative treatment is not enough, then there is hope with the atropine drop.  As more studies come out, the research will be even better in helping us slow nearsightedness in our kids.

 

Some of you may have noticed I haven’t been posting as much as I normally do.  Those of you who have seen me in person lately know that’s because I’m pregnant!  Actually, now, 37 weeks pregnant and the older I get, each pregnancy gets a little harder.  Though I have gained the least amount of weight of all my pregnancies, I’m still tired and that has left little room for blogging, after work, taking care of two kids and managing our practice.  However, it did remind me that most women are unaware of how pregnancy can actually affect their eyes, so I thought the topic did deserve a post.

Pregnancy is obviously characterized by 40 weeks of hormones from your placenta which now affect the rest of your body.  These hormones can cause physiologic and pathologic changes in Mom and baby.  Also, as a pregnant woman, certain medications are contraindicated if you do develop an eye condition and I wanted to review some of the more common ones.

Common Eye Conditions:

1.  Viral conjunctivitis, or pink eye.  This is characterized by tearing, redness and discharge.  It often spreads from one eye to the other.  You should wash your hands frequently and it is highly contagious the first 5 days of infection. Supportive measures such as cold compresses and artificial tears are the best.  Antibiotic drops are useless against viruses, so no need to take them.

2.  Allergic conjunctivitis – this one drives me crazy, especially in Hawaii during mango season.  You’ll get the same red, watery eyes, but also accompanied by itching and sneezing.  Unfortunately, it’s not recommended to use allergy drops such as Patanol, Pataday or Lastacaft during pregnancy.  So, supportive measures such as cold compresses and artificial tears are the best option during pregnancy.

3.  Dry eyes -Many women experience dry eyes pregnancy due to the hormonal changes.  Symptoms include light sensitivity, feeling like there’s sand in the eyes and even tearing.

Tips

  • Take frequent breaks when reading
  • Use preservative free artificial tears (sensing the theme here? artificial tears are GOOD during pregnancy!).  And, remember – Visine is NOT an artificial tear!

4.  Change in glasses and contact lenses prescription.

You may notice that you don’t seem to be seeing as well with your current glasses or contact lens prescription when pregnant.  Everything becomes fluid filled when you’re pregnant, even your eye structures.  This fluid changes your glasses and contact lens prescription.  Women complain “I can’t see at night”.  Pregnancy can also cause more nearsightedness (myopia) and astigmatism which is temporary.  I always advise pregnant patients not to change their prescriptions when pregnant, because it may not be accurate.  Wait at least few weeks post-partum before getting a new prescription.  If you are nursing, I would wait around 6 months (until you are no longer exclusively breast feeding) to get your new prescription for the highest accuracy.

5.  NO LASIK!!

This goes hand in hand with the recommendation that laser vision correction is NOT recommended during pregnancy or immediately post-partum.  If your prescription is changing, then your doctor cannot be sure of the calculations necessary to give you a good surgical outcome.  Also, the mild sedatives which are given before LASIK and the steroid drops given post-operatively are not allowed during pregnancy.

 

 

 

 

There are also abnormal eye problems that can occur during pregnancy that you should ‘watch’ out for (i know that was a weak one!).

  • High blood pressure
  • Retinal problems
  • Blood vessel clots
  • Worsening of diabetes
  • Worsening of tumors

1.  Eclampsia – This is very severe high blood pressure after the 20th week of gestation.

It usually occurs with your first child and causes swelling in your legs and problems with kidneys.  It can cause seizures, headaches, stomach pain andvominting as well as vision abnormalities.  This is why your OB will always ask you about headaches or blurry vision.  You might see lightning flashes, blacking out of part of your vision, double vision or it just might be blurry.  Let your OB know right away if you experience any of the above symptoms.  Typically the eyes improve when the medical condition is treated and usually the baby must be delivered to stop eclampsia.

2.  Glaucoma

Some patients have glaucoma and then later become pregnant.  Most of the glaucoma drops are contraindicated in pregnancy because they can induce preterm labor and decrease the baby’s heart rate.  If you have to use drops, then practice punctal occlusion.  That’s when you place the drops in the eye and then hold pressure at the inner corner to minimize the systemic absorption of the drop. 

 

 

 

 

 

 

 

3.  Gestational diabetes

This is the one I’m blessed with.  I didn’t have it for my first two boys, but now that I’m over 35 years old, my risk increased and I was diagnosed with diabetes.  It has nothing to do with weight gain during pregnancy (I’ve only gained 14 pounds during the entire 37 weeks of pregnancy) or fitness level.  Most people are really surprised to learn that I have gestational diabetes.  Gestational diabetes is when your blood sugar levels become elevated during pregnancy in women who have never had diabetes before. Gestational diabetes starts when the mother’s body is not able to make and use all the insulin it needs during pregnancy. If you have gestational diabetes, you should see your ophthalmologist every trimester to assess for bleeding in the retina.  However, your risk for developing retinopathy is much lower if you were diagnosed with gestational diabetes than if you had a diagnosis of diabetes prior to getting pregnant.  If you had diabetes (Type I or Type 2) before becoming pregnant, than your risk of bleeding in your eyes is higher during pregnancy.   However, the good news is that most long term studies have shown that progression of retinopathy reverses after delivery and that there are no long term changes.

4.  Blood clots in your eyes

As you advance in pregnancy, the blood becomes more viscous and thick.  Clots can form in your legs, lungs and even eyes.  Sudden, profound, painless vision loss must be reported immediately to your OB and ophthalmologist because this could be a “mini-stroke” in your eye or artery occlusion.

5. Central serous chorioretinopathy

This is relatively rare, but I just saw a patient who was in her first trimester who had central serous chorioretinopathy.  Basically, this is a blister of fluid which builds up in the center most part of your retina, called the macula.  Usually these occur in Type A personality (you know, OCD, stressed out, perfectionistic type ) males in their 30’s and 40’s.  It’s induced by stress, hormones, and steroids.  However, those same hormones in pregnancy can cause CSCR in pregnancy.  Patients experience blurry vision, sudden onset of dim vision, waviness in your vision, decreased color vision, and the feeling that things look smaller in one eye than another.  Definitely see your opthhalmologist for any changes in your vision during pregnancy.

 

 

 

 

 

 

 

 

 

 

Please forgive any typos – I am posting this from the hospital bed where I am in labor!  Finishing this post is helping distract me from the pain of contractions!!

© 2011 Honolulu Eye Doctor & Mom Suffusion theme by Sayontan Sinha