Monday, October 31, 2011

Restasis and Tylenol

It's a very typical day at Skyvision Centers: we've written several new prescriptions for Restasis for people with dry eye. We know that they will start to feel better in a couple of weeks, and then we'll have to answer this question: "Do I have to keep taking my Restasis? Why? I feel great!" Happens every time!!

Well, that's the exact feel great! In fact, you feel great BECAUSE you are taking your Restasis. Dry eye is a chronic problem, one that needs to have on-going treatment. When Restasis is the right medicine to use it's important to understand just how and why Restasis works. It takes a while for Restasis to decrease the inflammation that causes lots of dry eye; that's why it can be several weeks before you feel better. Then, after the inflammation is controlled it's necessary to keep taking the Restasis in order to prevent the same inflammation from making your eyes hurt again!

Dr. White likes to say that Restasis is not a typical American medicine. It takes a while for it to kick in. Not like Tylenol for a headache. You have a headache, you take a Tylenol and you feel great. You don't have to keep taking the Tylenol to keep the headache away, but you DO have to keep taking your Restasis in order to keep comfortable eyes!

Tuesday, October 25, 2011

Dr. White's LASIK Anniversary

It's been 12 years since Dr. White had LASIK surgery on his eyes! Happy Anniversary, Dr. White!

"LASIK is one of the nicest things I've ever done for myself," he says. "My friend Dr. Dave Hardten (who taught me how to do LASIK!) did my surgery 12 years ago. What a difference!"

Dr. White had worn Gas Permeable (hard) contact lenses for almost 30 years before his LASIK. "I broke 12 pairs of glasses in 12 months playing basketball in Jr. High and my Dad, who made glasses for a living, strongly 'suggested' I try contacts. They got me through all of my sports, including playing football in college."

Like many people who have had LASIK, Dr. White is now wearing reading glasses. He had his surgery at age 39 so he knew that his years of no glasses at all would be short. "I only need to wear my reading glasses in the morning and at night, so I'm STILL glasses-free in the office every day!"

Did you know that the VISX laser is the most widely used LASIK laser in the U.S.? Dr. White actually performed the very first VISX laser LASIK in Cleveland all the way back in 1994!! Dr. White uses the  Intralase femto-second laser to creat the LASIK flap for a complete laser operation. Come visit us in Westlake and see if you are a candidate for LASIK. Talk to the doc who has been using the VISX laser longer than anyone else in Cleveland and ask him how HIS eyes are doing!!

Sunday, October 2, 2011

Let's Talk About Tears!

Before we get to the topic of how to treat Dry Eye let's take a couple of minutes to learn about tears. We have two kinds of tears lubricating the front of our eyes. We have our reflex, or emotional tears. These tears are created by the lacrimal gland that sits up and above our eyes. The lacrimal gland  makes the tears that we cry when we watch a sad movie, or if something gets in our eye.

It's the tears that lubricate our eyes from minute to minute that we are more interested in when we are talking about dry eye. These tears are made by different types of microscopic glands on the surface of our eyes, as well as deep within our eyelids. These tiny glands can be affected by all kinds of medical problems like arthritis, lupus, and the hormonal changes that come with getting older.

Normal tears consist of three different, separate substances. We  have mucin which is created by the goblet cells on the front surface of our eyes. We also have a salt water or aqueous component created by the glands of moll and zeiss. Lastly, we have an oily substance called meibum which is created by the tiny glands that sit just inside our eyelashes on the upper and lower eyelids. These three substances are mixed together, kind of like Italian salad dressing, to form a lubricating layer between our eye and the air.

Shake up a bottle of salad dressing and let it sit for a minute or two. Notice how there is a little bit more oil on the top surface, a thicker middle layer that is a mixture of everything in the salad dressing, and then a layer on the bottom that is really thick. This is a good way to visualize our tears. We have more mucin close to the eye, a mixture or emulsion of mucin and aqueous in the thicker middle, and then a layer which is mostly oil sitting on the surface and preventing evaporation of our tears.

When our tears are healthy we have just the right amount, and we have just the right proportion of the three different components. We start to have problems with dry eye when we either have too few tears, or when the three components do not mix well. Next, we'll talk about the different types of dry. See you soon!

Dry Eye 101

" My eyes hurt!"
 "My eyes feel like they're burning up!"
 "It seems like my eyes are always red."
 "When I'm reading at night or working on the computer my eyes get really tired. My vision starts to get blurry."
 "I tear all the time. My friends always want to know what's wrong."
 "It feels like there's something in my eye all the time."

 And of course, the obvious, "my eyes are dry!"

 These are the kinds of things that patients say when they come to the eye doctor and have a problem with dry eye. Sometimes it's hard for your eye doctor or the staff in the office to figure out that what you are really complaining about is that your eyes are dry. This really isn't as much of a problem Skyvision because we have become experts at treating dry!  In fact, Dr. White lectures all over the country, teaching other eye doctors how to diagnose and treat dry eye.

 Your tears are actually an emulsion, a complex mixture of three different parts: salt water, mucin, and oil. Tears are actually like the vinaigrette you put on your salad. Your tears work best when the three parts are mixed just right, just like salad dressing! You need just enough of the three parts, and the proportions of the ingredients have to be just right, too.

 In general there are two types of tear problems that can lead to the symptoms of dry eye. We call them "quantity" and "quality". If the microscopic glands in your eyes are not producing enough tears, if your tear "quantity" is too low, you can have any of the symptoms above caused by dryness. This is actually pretty easy to understand -- not enough tears equals a dry eye.

 The "quality" part of dry eye is a little more difficult to get a handle on. If you have too little of any of the components that make up your tears, your tears just may not work well enough. In addition, even if you have the right amount of each component, if any of the three parts (mucin, salt water, and oil) is not working well enough, the entire mix may be ineffective. In other words, you may have plenty of tears, but they may just do not work well enough. Kind of like trying to put out a fire with kerosene-- its wet, but it won't put out the fire. Sometimes it even makes the fire worse. You, too, have a dry eye.

 So if any of the statements at the top sound like you, perhaps it's time to come visit us at Skyvision Centers. We are experts in the diagnosis and treatment of all kinds of dry eye!