Friday, December 28, 2012

Types of Cataracts

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil.

Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic retinopathy combined, according to Prevent Blindness America (PBA).

Today, cataracts affect more than 22 million Americans age 40 and older. And as the U.S. population ages, more than 30 million Americans are expected to have cataracts by the year 2020, PBA says.

Types of cataracts include:

A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract.

A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging.

A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.

No one knows for sure why the eye's lens changes as we age, forming cataracts. But researchers worldwide have identified factors that may cause cataracts or are associated with cataract development. Besides advancing age, cataract risk factors include:

If you think you have a cataract, see an eye doctor for an exam to find out for sure.

By Gretchyn Bailey

Thursday, December 27, 2012

Hey! My Arms Shrunk!

We know what you're thinking...who shrunk my arms? It's happening a lot around the office at Skyvision Centers, too. We're all getting a little older  around here and it seems like there are a bunch of reading glasses lying around everywhere now. As a matter of fact, the only person in the office who can't seem to find Dr. White's readers is DR. WHITE!

Why do we start to have trouble reading when we get older? To answer that we have to go all the way back to age 2 or so. Almost all of us is born a little farsighted or hyperopic. We focus our eyes to overcome this little bit of farsightedness using the same muscles that we use to focus on objects up close. This muscular process is called ACCOMMODATION. When we look at things up close three things happen: our eyes come closer together, our pupils get smaller, and the lens inside our eyes gets fatter. We have massive powers of accommodation at age two and then we gradually lose those powers as wel get older.

The medical term for "Over 40 Eyes" is PRESBYOPIA. When we lose enough of our power of accommodation that we can no longer see things up close we become presbyopic. Of course your kids will just say you got old! Here's a LINK to the Eyemaginations video on presbyopia.

So what can we do? Well, there are a bunch of options, actually. If your eyes are health you can just buy reading glasses at the pharmacy. You might have a different prescription in each of your eyes, and if so your Skyvision Centers eye doctor can prescribe a pair of reading glasses that are specific to you. Many of us need to wear glasses to see things far away--a pair of bifocals takes care of the up-close problem. Bifocal contact lenses are available, and you can even correct your vision with something called MONOVISION, with one eye corrected for near and one eye corrected for far vision.

Whew! That's a lot of options! Don't worry...we'll have lots of answers for you in future posts, and of course,  you can go to the SkyVisionCenters101 YouTube channel see several "Dr. Whiteboard" videos about bifocals!

Thursday, December 20, 2012

Visual Field Testing

During a routine eye exam, some eye doctors may want to determine through visual field testing the full horizontal and vertical range of what you are able to see peripherally. This range is commonly referred to as "side vision."

Visual field tests assess the potential presence of blind spots (scotomas), which could indicate eye diseases. A blind spot in the field of vision can be linked to a variety of specific eye diseases, depending on the size and shape of the scotoma.

Many eye and brain disorders can cause peripheral vision loss and visual field abnormalities.

For example, optic nerve damage caused by glaucoma creates a very specific visual field defect. Other eye problems associated with blind spots and other visual field defects include optic nerve damage (optic neuropathy) from disease or damage to the light-sensitive inner lining of the eye (retina).

Brain abnormalities such as those caused by strokes or tumors can affect the visual field. In fact, the location of the stroke or tumor in the brain can frequently be determined by the size, shape and site of the visual field defect.

Types of Visual Field Tests

Confrontation visual field testing typically is used as a screening visual field test. One eye is covered, while the other eye fixates on a target object, such as the doctor's open eye, while the doctor stands or sits directly in front of you. You then are asked to describe what you see on the far edges or periphery of your field of view.

If an eye disease is suspected, you may need to undergo more comprehensive, formal types of visual field testing to evaluate the quality of your central and peripheral vision.

The picture to the right shows a patient who doing visual field testing with a Humphrey Field Analyzer (HFA), which uses automated perimetry to measure responses to visual stimuli appearing in central and side vision. (image by Zeiss)     By Marilyn Haddrill; contributions and review by Charles Slonim, MD

Wednesday, December 19, 2012

Detection and Treatment of Refractive Errors

Your eye doctor determines the type and degree of refractive error you have by performing a test called a refraction.

This can be be done with a computerized instrument (automated refraction) or with a mechanical instrument called a phoropter that allows your eye doctor to show you one lens at a time (manual refraction).

Often, an automated refraction will be performed by a member of the doctor's staff, and then the eye care practitioner will refine and verify the results with a manual refraction.

An eye care practitioner performs a manual refraction. Your refraction may reveal that you have more than one type of refractive error. For example, your blurred vision may be due to both nearsighted and astigmatism.

Your eye doctor will use the results of your refraction to determine your eyeglasses prescription. A refraction, however, does not provide sufficient information to write a contact lens prescription, which requires a contact lens fitting.

Eyeglass lenses and contact lenses are fabricated with precise curves to refract light to the degree necessary to compensate for refractive errors and bring light to a sharp focus on the retina.

Vision correction surgeries such as LASIK aim to correct refractive errors by changing the shape of the cornea, so that light rays are bent into a more accurate point of focus.

by Gary Heiting, OD

Tuesday, December 18, 2012

Thoughts From Dr. White on Newtown, CT

Dr. White has a blog where he sometimes shares his thoughts on life and stuff. Here is what he wrote this weekend about the tragedy in Newtown, CT.

I’m the words guy. There’s no word here. You’ve probably heard or seen this before. In every language, as far as I know, there is a word that describes the state of having lost a family member. Widow or widower, orphan.
There is no word in any language that I know that so names a parent who has lost a child. Think about that. This is such an unnatural state, so upside down, that the a signature trait that defines us as a species (complex language) is silent. All of the various languages that reflect countless cultures both current and long gone, and not a single word that immediately conjures an image as accurately as “orphan” for those who have buried their offspring.
Not a single word.
We are now in the middle of the Christmas holiday season in the Christian world. The suburban version includes various and sundry versions of the “Christmas Party”. Beth and I attended two last night. I had, oh, 50 or so distinct conversations. 50 little “Groundhog Day” chats catching everyone up on my own children. For my part I asked only one question: “how are your kids?” I imagine something more similar than different everywhere in the world when parents gather.
“How are the kids?”
Randy and I attended a really moving CrossFit event yesterday, one in which a really significant sum was raised to aid the family of a handicapped child (kudos to CrossFit Cleveland). We met a couple of brand new Moms with first borns velcro’d or strapped or otherwise attached in parenthood 1.0. I’m one of the “wise old men” of the local CF scene (hey, when did THAT happen?), and I shared with these young Moms my view that the arrival of your first child is the single biggest life-changing moment one can experience. I always say that, and the young Moms and Dads always shake weary heads and sleepy eyes in agreement, and I silently pray as I speak that the words I’ve spoken will ring ever true, for I know in my heart that I am lying to these children holding their children.
The single biggest life-changing moment one can experience is to learn that you have lost your child.
You know someone who has heard this news; we all do. They are never the same. They will never be the same. I meet people in their 80′s who lose a child in their 60′s and honestly, it looks the same. It’s unnatural. It’s not the way it’s supposed to happen, no matter how it happens. It’s so upside down that we have no word for the survivors.
I know that I am lying to these young parents because I once stood on the edge of this abyss. Stood so close that if I let myself lean just a little bit I could look over the edge, see the blackness, the emptiness, the cold. Nothing, and I really do mean nothing, has affected me ever in my life as profoundly as that one quick look, that one peek that I just couldn’t keep myself from taking at what life would be like if I’d lost my child. I can’t shake it. It’s been years and I can’t shake it. It informs everything about my life, how I live my life, how I find the good in most everything, the fact that I was not plunged into the abyss. I did not lose my child. My child lived.
There is really no lesson here, Dear Friends. No teachable moment today, just a most sincere hope and prayer for each and every parent among you that you will never stand at the edge of that abyss, let alone be plunged into its depths. Just the most sincere hope that there will continue to be a word that describes you throughout your life, as my wife Beth and I have thankfully continued to be blessed. Indeed, there is a word in every language in the history of our species to describe those so blessed, a name for each of us.
Mom or Dad.

Friday, December 14, 2012

Visual Acuity Testing

Visual acuity tests are used to evaluate eyesight. Several types of visual acuity tests may be used.

The Snellen test checks your ability to see at distances. It uses a wall chart that has several rows of letters. The letters on the top row are the largest; those on the bottom row are the smallest. See a picture of a Snellen chart .

You will stand or sit 20 ft (6 m) from the chart and be asked to cover one eye and then read the smallest row of letters you can see on the chart. If you are unable to cover your eye, an eye patch will be placed over your eye.

Each eye is tested separately. You may be given a different chart or asked to read a row backward to make sure that you did not memorize the sequence of letters from the previous test.

If you wear glasses or contacts, you may be asked to repeat the test on each eye while wearing them.

Let your health professional know if you have trouble reading the letters on one side of the row, or if some letters disappear while you are looking at other letters. You may have a visual field problem, and visual field tests may be needed.

The E chart tests the vision of children and people who cannot read. The E chart is similar to the Snellen chart in that there are several rows, but all of the rows contain only the letter E in different positions. The top row is the largest and the bottom row of Es is the smallest. You will be asked to point in the same direction as the lines of the E. Similar charts use the letter C or pictures. These charts are also available in a handheld card. See a picture of an E chart .

The Near test uses a small card (Jaeger chart) containing a few short lines or paragraphs of printed text to test your near vision. The size of the print gradually gets smaller. You will be asked to hold the card about 14 in. (36 cm) from your face and read aloud the paragraph containing the smallest print you can comfortably read. Both eyes are tested together, with and without corrective lenses. This test is routinely done after age 40, because near vision tends to decline as you age (presbyopia).

If you cannot read any of the letters or print on these charts because of poor vision, your visual acuity will be tested by other techniques, such as counting fingers, detecting hand movements, or distinguishing the direction or perception of light sources (such as room light or a penlight held up close to the face).

Visual acuity tests usually take about 5 to 10 minutes. They may be performed by a nurse, a medical assistant, an ophthalmologist, an optometrist, a teacher, or some other trained person. Testing may be done at a doctor's office, school, workplace, health fair, or elsewhere.

Tuesday, December 11, 2012

Vision Tests

Have You Wondered What All The Different Vision Tests Are For?

Vision tests check many different functions of the eye. The tests measure your ability to see details at near and far distances, check for gaps or defects in your field of vision, and evaluate your ability to see different colors.

Visual acuity tests are the most common tests used to evaluate eyesight. They measure the eye's ability to see details at near and far distances. The tests usually involve reading letters or looking at symbols of different sizes on an eye chart. Usually, each eye is tested by itself. And then both eyes may be tested together, with and without corrective lenses (if you wear them). Several types of visual acuity tests may be used.

Refraction is a test that measures the eyes' need for corrective lenses (refractive error). It is usually done after a visual acuity test. Refractive errors, such as nearsightedness or farsightedness, occur when light rays entering the eye can't focus exactly on the nerve layer (retina) at the back of the eye. This causes blurred vision. Refraction is done as a routine part of an eye examination for people who already wear glasses or contact lenses, but it will also be done if the results of the other visual acuity tests show that your eyesight is below normal and can be corrected by glasses.

Visual field tests are used to check for gaps in your side (peripheral) vision. Your complete visual field is the entire area seen when your gaze is fixed in one direction. The complete visual field is seen by both eyes at the same time, and it includes the central visual field-which detects the highest degree of detail-and the peripheral visual fields.

Color vision tests check your ability to distinguish colors. It is used to screen for color blindness in people with suspected retinal or optic nerve disease or who have a family history of color blindness. The color vision test is also used to screen applicants for jobs in fields where color perception is essential, such as law enforcement, the military, or electronics. Color vision tests only detect a problem-further testing is needed to identify what is causing the problem.

More information regarding these different tests to come . . . .

Monday, December 10, 2012

Snow Blindness

Well, if you live in Cleveland you KNOW why we're putting this post up!    We are known to have  some pretty crazy weather around here.  Quite a few of our patients will notice how bright it is when the sun is out and the snow is on the ground, and some of them were worried about Snow Blindness. So what, exactly, IS snow blindness, anyway?

Ultraviolet light in high doses is actually toxic to many parts of the eye. The cornea, the window to the eye, is especially affected by exposure to these high doses. In fact, welder's flash is actually an ultraviolet "burn" to the cornea. There is lots of UV light in sunlight. On snowy landscapes when the sun is out the UV light is not only transmitted directly into the eye from above, but it is reflected and CONCENTRATED or focused by the snow crystals on the ground.

Snow blindness is a kind of UV damage to the cornea. That's why you always see pictures of mountaneers wearing sunglasses with side shields, or very dark goggles.Same thing for skiers, if they are being smart about eye protection!

Can you get snow blindness here in Cleveland just from your daily activities? Well, probably not. At least not unless you are a park ranger in our Emerald Necklace of Metroparks!

Thursday, December 6, 2012

I Have Flashing Lights And I See Bugs!

 One of the most common symptoms patients share with us usually go something like this: "HELP! I'm seeing black things flying around in front of me and no one else can see them." Or "there's lightening in my house!" Flashing lights and dark floaters are things that bring patients in to see us every day.

The most common cause of "Flashes and Floaters" is changes in the vitreous jelly, the jell that fills the center of the eye. The vitreous is very important for the development of the eye until we reach the age of 2. After that it's just there to cause mischief! One of the mischievious things it does is shrink. In the beginning stages of this shrinking the microcsopic protein skeleton that makes the vitreous a jell collapses on itself and you get bits of protein debris...FLOATERS!

In time the vitreous shrinks to the point where it starts to separate from the inside of the eye. When this happens the vitreous tugs on the retina. It doesn't matter what you do to the retina it will give off a sensation of light. So, when the vitreous contracts and puts some pulling on the retina you get a FLASH!

The danger, of course, is that when the vitreous pulls itself off the retina it can take a piece of the retina with it, causing a hole or a tear. That's why it's important to call your Skyvision Centers eye doctor and come in for a visit if you have new FLASHES AND FLOATERS!

Monday, December 3, 2012

SkyVision Center's Holiday Time 2012 - Were You Naughty or Nice?

We love the holidays here at SkyVision!

 Dr. White starts with his much awaited holiday bowtie collection!   
                                        Today's tie is very dashing Dr. White!  

As you enter SkyVision, Santa looks to find your wish on his list of gifts he needs to get.  

Were you naughty or nice? 

Coming or going through SkyVision you are reminded of the holiday greetings  . . . . .

we wish for each and every one of you!

Happy Holidays from the staff at SkyVision!

Thursday, November 29, 2012

November is Diabetic Eye Disease Awareness Month

An Article from the Lebanon Journal, Lebanon PA   Nov 2012

An estimated 25 million Americans currently have diabetes, according to the United States Centers for Disease Control and Prevention. Unfortunately, rising rates of diabetes have contributed to a sharp increase in diabetic eye diseases and blindness. To raise awareness about this serious threat to healthy vision, the Pennsylvania Academy of Ophthalmology is urging all diabetic patients in Pennsylvania to obtain regular eye exams during November, Diabetic Eye Disease Awareness Month.

The most common diabetic eye disease is diabetic retinopathy, which affects 40 to 45 percent of Americans with diabetes according to the National Eye Institute. Diabetic retinopathy damages the delicate blood vessels inside the retina at the back of the eye. Damaged blood vessels in the retina may leak extra fluid and small amounts of blood or fat deposits into the eye. As the disease progresses, abnormal blood vessels can grow on the surface of the retina or optic nerve, which can lead to blindness. Diabetic patients are also at an increased risk for cataracts and glaucoma.

Diabetic eye diseases typically have no early symptoms, so regular eye exams with an ophthalmologist - an eye medical doctor - are paramount to help monitor eye health and preserve diabetic patients' vision. Once diagnosed, an ophthalmologist can help slow the progression of the disease.

Too often, diabetic eye disease progresses into blindness because patients don't get their annual eye health screenings. Early detection and treatment is critical to reduce and delay severe vision loss in diabetics.

To maintain healthy vision with diabetes, ophthalmic professionals recommend the following EyeSmart tips:

Get a comprehensive dilated eye examination at least once a year.

Control your blood sugar.

Maintain healthy blood pressure and cholesterol levels.

Exercise regularly.

Quit smoking, or never start.

As diabetic retinopathy progresses, symptoms may include specks or spots floating in the visual field, blurred central vision, vision that changes from blurry to clear, poor night vision, and vision loss. Treatments to slow the progression of diabetic retinopathy include injectable and oral medications, laser surgery and vitrectomy surgery.

Wednesday, November 28, 2012

Hiding in Plain Sight - An interesting Article from The New York Times

Gray Matter    

Hiding in Plain Sight


Published: November 17, 2012     New York Times    Sunday Edition

How do you make something disappear? Easy ? bend all the light around it.

A Real-Life Invisibility Cloak . . . .

IMAGINE yourself at a magic show. The magician brings out a tiger and coaxes it into a large, colorful box on the stage. He closes the lid, says a few mysterious words and then — poof — opens the side panel, revealing the inside of the box to be empty. The tiger is gone. Cue applause.

Morgan Blair

  We know, of course, that tigers are not apt to vanish into thin air; we know that such magic tricks are more trick than magic. But how is it possible that our eyes can be deceived so easily?

The answer has much to do with the way our sense of sight works. As we look around a room, our eyes detect the light that bounces off nearby people or objects, and our brains interpret the images formed from the patterns of light received. We can even figure out what material something is made of based on the way it reflects and transmits light: metal is opaque and typically very reflective; plastic, which is more dull and often translucent, absorbs some of the light and reflects the rest in all directions. Our brains, then, turn these signals from reflections into breathtakingly complex pictures of the world around us. And it all happens faster than the blink of an eye. Indeed, after every blink of an eye.

Such lightning-fast cognitions are possible partly because the brain makes certain automatic assumptions: it figures that light has traveled in a straight line from the object to our eyes. Remarkably, in that built-in assumption is the recipe for a bit of magic that humans (and mythical humans) have sought, from the time of Plato to the age of Harry Potter: invisibility.

The trick involves the ability to bend and distort light as it travels through space — in other words, to make it do what the brain assumes it won’t. In some ways, it’s the same sleight of hand that the magician uses with the tiger. He uses a mirror angled in such a way that when we think we’re looking into an empty box, we’re actually seeing the reflection from the bottom of the box and assuming it’s the back. Since we don’t expect that the light reaching our eyes has swerved, making a 90-degree turn along the way, our eyes “tell” us the tiger has vanished. (In reality, he’s hiding comfortably in the box.)

Now we’ve found a way to one-up this neat trick with science: changing the trajectory of light without using mirrors. We do it with the science of materials — designing a “cloak” that can make light curve around an object, and then emerge just as if it had passed in a straight line through space. (Think of it like water flowing past a rock in a stream.)

The phenomenon is indeed supernatural. That’s because nature doesn’t appear to offer any materials that can accomplish this feat. The reason is that light has both electric and magnetic components — and to make it swerve around an object, one has to redirect both of these very different components and have them sync up immediately after the detour. That’s impossible to do with metals, fabrics or any other traditional materials.

But research findings over the past decade have shown us how to develop artificially structured “metamaterials” — in which tiny electrical circuits serve as the building blocks in much the same way that atoms and molecules provide the structure of natural substances. By changing the geometry and other parameters of those circuits, we can give these materials properties beyond what nature offers, letting us simultaneously manipulate both the electric and magnetic aspects of light in striking harmony.

This year, with one such metamaterial, we built the world’s first invisibility cloak capable of managing both components of light.

There is a catch, admittedly. Our cloak works only on microwaves, not on visible light. And humans don’t “see” microwaves in the first place, making the idea of invisibility seem, well, a little extraneous.

Still, even if we mortals don’t see them, many essential devices do. Nearly every time you walk through security at an airport, your body is scanned with microwaves. Also, your cellphone, iPad and other devices make a similar kind of virtual eye contact with one another. So, even in the microwave realm, cloaking can potentially be used to remove obstacles from the paths of direct microwave communications (or hide things we don’t want detected).

More important, microwaves are part of the same electromagnetic spectrum as visible light. In principle, if cloaks can be made to work at microwave frequencies, they might one day be made to work at visible wavelengths.

This will be far more difficult: the wavelengths of visible light are more than 10,000 times smaller than those of microwaves, meaning that the corresponding metamaterials would have to be equally reduced in size.

What excites scientists and Harry Potter fans alike, though, is that our microwave cloak proves there’s no theoretical limitation that would prevent someone from building a visible-light cloak.

There are some tricky technological barriers to work out. But in this case, at least, not seeing is believing.

David R. Smith is a professor of electrical and computer engineering at Duke University, where Nathan Landy is a graduate student.

Tuesday, November 27, 2012

Time To Plan For Ski Season! All new Zeal by Maui Jim are here!

We know...we was just 67 degrees in Cleveland a couple of weeks ago! Crazy, huh?! Even so, winter is just around the corner and it's time to get ready for ski season. It's very important to think about UV protection on the slopes, just like it's important to protect your eyes on the beach and on the water.

When you are skiing or snowboarding you are exposed to UV light from the sun above, but you are also getting bathed in UV rays that are reflected UP off the snow! That's why snow blindness, basically a UV burn on the front of your eyes, is such a big problem.

How about polarization? At Skyvision Centers we think polarization is a personal choice. On very bright days it can help to cut down on glare and reflections, but sometimes it actually makes it harder to pick out obstacles (think moguls! ) on those gray, flat light days.

We have a great selection of Oakley, Adidas and Ed Hardy and the all new Zeal by Maui Jim ski goggles in our Westlake, Ohio office, and we can order any hard to find lens/goggle combo.  Now is the time to be thinking about protecting your eyes whether you are skiing or boarding!  How about a new pair for a Christmas gift?

Wednesday, November 21, 2012

Dr. White's Thanksgiving Musings

Thanksgiving is my favorite Holiday …because there’s nothing to advertise. There’s nothing to buy. Ever since giving gifts to Indians went out of style Thanksgiving is no longer one of our gift–giving holidays. That’s a good thing!

No, Thanksgiving is the last of the pure holidays. Nothing commercial, nothing to promote, nothing but an opportunity to do just what it sounds like: give thanks. Think about it, there’s exactly one Thanksgiving holiday song. “Over the River and through the Woods” and all that. There’s pretty much only one industry that depends on this day, the turkey industry. Pretty small potatoes, that. Thanksgiving pretty much equals going home.

Think for a moment about your Thanksgiving, this year and in years past. There’s an awful lot of sameness about it, isn’t there? The years of the gatherings all blend together because this is the one holiday where we go out of our way to do those same things year after year. Same meal; same pies; same games; same traditions. For as long as it can be, same people.

My earliest Thanksgiving memories actually revolve around football. In New England the Thanksgiving day football game represents the peak of the high school football season. Most high schools played a game against some decades–old rival, some of these rivalries extending back to before World War II. It was always cold. Man, it was always so cold. I had my first cup of coffee at a Southbridge versus Bartlett Thanksgiving Day football game at Bartlett; they ran out of hot chocolate before halftime. The games themselves were huge, played by heroes too large to describe. No dream was bigger for my Pop Warner football teammates than to be a part of the Southbridge–Bartlett Thanksgiving game someday. I played in one as a freshman before we moved. Three more Thanksgiving Day games in Rhode Island, Lincoln versus Shea, rounded out my playing days, but every other year for two more decades Thanksgiving day started with two hours bundled up in the stands watching the game.

Then we ate! You remember what you had for Thanksgiving at age 10 and 15, 20 and 25 because you had the same thing EVERY YEAR! Each and every family has its traditions. Turkey, of course, but it was really the fixins that set each family apart. Ours was a pretty standard table, much more proletariat then patrician no matter how well-off the family might have been. Mashed potatoes, green bean casserole, creamed onions and corn, with the simplest bread stuffing bursting out of the bird. It’s funny how a Thanksgiving Day tradition can highlight the differences between families, too. My wife Beth’s family got all of their turkey day fixings from the local farms, everything fresh and homemade. Neither way was better or worse, and that’s really part of the point. It’s Thanksgiving, and it’s always enough…always good.

Even the changes that eventually come, the evolution of any particular family’s Thanksgiving day traditions, represent a call to home. When our oldest, Danny, went to college a couple years ago we decided to bring our family Thanksgiving celebration home, to our house. The kids returned to their own home and visits with their childhood friends, just like we had done for so many years in our “ancestral” homes. Thanksgiving is all about the coming together. The gifting is in the giving of your time, your presence to the rest of family gathered. Even stuff that comes in from the outside like the annual Detroit Lions massacre is about the coming together with everyone gathered around the television set in various stages of repose or food coma.

Yup, Thanksgiving is my favorite holiday. Nothing fancy, nothing to buy, as little pressure as there can possibly be on an American holiday. All about home. All about family. All about being thankful for both. As cold as it may be outside it’s always warm in the house. There’s football, some kind of football, even if I don’t get to go to a traditional New England rivalry game. Each year is enough of the same that it, too, will blend in with all that came before.

And did I mention the pies?

Tuesday, November 20, 2012

What are Styes and Chalazia?

WebMD Medical Reference from Healthwise

What are styes and chalazia?

Styes and chalazia are lumps in or along the edge of an eyelid. They may be painful or annoying, but they are rarely serious. Most will go away on their own without treatment.

A stye is an infection that causes a tender red lump on the eyelid. Most styes occur along the edge of the eyelid. When a stye occurs inside the eyelid, it is called an internal hordeolum (say "hor-dee-OH-lum").

A chalazion (say "kuh-LAY-zee-on") is a lump in the eyelid. Chalazia (plural) may look like styes, but they are usually larger and may not hurt.

Styes and chalazia may be related to blepharitis, a common problem that causes inflammation of the eyelids.

What causes a stye or chalazion?

Styes are caused by a bacterial infection. Usually the bacteria grow in the root (follicle) of an eyelash. An internal hordeolum is caused by infection in one of the tiny oil glands inside the eyelid.

A chalazion forms when an oil gland in the eyelid becomes blocked. If an internal hordeolum doesn't drain and heal, it can turn into a chalazion.

What are the symptoms?

A stye usually starts as a red bump that looks like a pimple along the edge of the eyelid.

As the stye grows, the eyelid becomes swollen and painful, and the eye may water.

Most styes swell for about 3 days before they break open and drain.

Styes usually heal in about a week.

A chalazion starts as a firm lump or cyst under the skin of the eyelid.

Unlike styes, chalazia often don't hurt.

Chalazia grow more slowly than styes. If a chalazion gets large enough, it may affect your vision.

The inflammation and swelling may spread to the area surrounding the eye.

Chalazia often go away in a few months without treatment.

How is a stye or chalazion diagnosed?

The SkyVision doctors can diagnose these problems by closely examining the eyelid. It may be hard to tell the difference between a stye and a chalazion. If there is a hard lump inside the eyelid, the doctor will probably diagnose it as a chalazion.

How are they treated?

Home treatment is all that is needed for most styes and chalazia.

Apply warm, wet compresses for 5 to 10 minutes, 3 to 6 times a day. This usually helps the area heal faster. It may also help open a blocked pore so that it can drain and start to heal.

Use an over-the-counter treatment. Try an ointment, solution, or medicated pads.

Let the stye or chalazion open on its own. Don't squeeze or open it.

Don't wear eye makeup or contact lenses until the area has healed.

If a stye is not getting better with home treatment, talk to one of the SkyVision docs. You may need a prescription for antibiotic eye ointment or eyedrops. You may need to take antibiotic pills if infection has spread to the eyelid or eye.
If a stye or chalazion gets very large, the doctor may need to pierce (lance) it so it can drain and heal. Do not try to lance it yourself.

How can you prevent styes and chalazia?

Don't rub your eyes. This can irritate your eyes and let in bacteria. If you need to touch your eyes, wash your hands first.

Protect your eyes from dust and air pollution when you can. For example, wear safety glasses when you do dusty chores like raking or mowing the lawn.

Replace eye makeup, especially mascara, at least every 6 months. Bacteria can grow in makeup.

If you get styes or chalazia often, wash your eyelids regularly with a little bit of baby shampoo mixed in warm water.

Treat any inflammation or infection of the eyelid promptly.     This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Friday, November 16, 2012

The Continuing Education Tailgate!

SkyVision Centers had a Tailgate last night at The Surgery Center! 45 local eye doctors came out, some of them dressed in their finest Browns and Buckeye gear for our fourth Continuing Education seminar presentation. Connie and the Surgery Center staff had classic football tailgate fare on hand to feed our guests.
Our invited speaker was Jeff Peres, President and CEO of the patient education company Eyemaginations. Jeff laid out the rationale for going the extra mile to make sure that your patients are as well-informed as possible. Not only does this make their care better and keep their eyes healthier, but Eyemaginations has some research that shows a higher degree of loyalty of doctors of all kinds who make special efforts to educate their patients. SkyVision Centers has used the entire collection of Eyemagination videos in our office and as part of our "at home" educational program since our founding. We are excited to offer the latest iPad programs in the first quarter of 2013!

Dr. White presented part 2 of his series on developing a protocol for seeing patients who have Glaucoma.  The SkyVision protocol puts the interests of the patient first in an attempt to simultaneously provide the best possible outcomes in the most efficient and cost-conscious way. After showing the attendees how Drs. White, Schlegel, and Kaye take care of Glaucoma Dr. White asked for a voluteer from the audience to develpop a protocol for their office. Dr. Jim Kershaw raised his hand and Dr. White offered a couple of pearls for Dr. Kershaw to consider!

We are already planning our Winter Symposium, dreaming about what kind of surprise we will serve up for the local community of eye docs!

Wednesday, November 14, 2012

iStent: A New Glaucoma Surgery

Dr. White spent some of his time at AAO looking at new technologies for the care of Glaucoma. He has been saying for some time that multiple forces in medicine and in the economics of medicine are pushing toward Glaucoma becoming a surgical disease. Here is one of the new technologies he found:

"Glaucoma is a progressive disease that causes damage to the optic nerve.  At this time the only thing we can do is lower the eye pressure in order to stop any further damage. The vast majority of American Glaucoma patients control their pressure through the use of eyedrops. Part of the problem with this is remembering to take your eyedrops, and it's important to take your eyedrops properly. A new twist on medical care is having difficulty either paying for your medication, or getting your insurance to pay for the medication your doctor thinks is the right one for you.

Traditional glaucoma surgery is very effective, but there are a number of complications that can occur after even successful surgery. Ophthalmologists who care for Glaucoma have been on the lookout for new, better, safer Glaucoma surgeries for many years. The Glaukos company has invented a surgery using a micro-drain called the iStent for use as part of cataract surgery.

Briefly, the iStent is inserted in the natural drainage system of the eye to increase the outflow of the natural fluid in the eye and lower the eye pressure. The procedure looks very cool! I'm really looking forward to getting the special training so that I can add this to my standard surgeries. I think it will be great to not only improve people's vision with cataract surgery but also to be able to reduce their dependence on medications."

We will keep you up to date on the progress of the iStent at SkyVision.

Tuesday, November 13, 2012

Where does Dr. White do his Cataract Surgeries?

Although we have a very large, very beautiful main office in Westlake ( see pictures on our website) we don't have enough room to do our surgeries right there.  So where does Dr. White do cataract surgery, especially surgery using all of the new Lifestyle implants? Well, glad you asked! 

For more than 16 years Dr. White has been doing lots of his surgeries at a simply fantastic outpatient center called The Surgery Center in Berea, OH. You can find their website here.  The Surgery Center has been run since it opened by a woman who is simply the best surgical administrator in America,  Barb Draves!   Barb was part of the original team who opened the center some 27 years ago, and it has grown into one of the busiest outpatient surgery centers in the whole country. 

So why there?   Why choose THIS particular outpatient center to use for our most exciting, premium cataract surgeries? In a word it all comes down to excellent patient care. The entire staff at The Surgery Center is fully dedicated to providing not only the very best care possible but also to give our Skyvision patients the best experience possible. Just like in our office at Skyvision Centers! 

One of the most common comments we hear from our patients after their cataract surgeries at The Surgery Center is "the staff is so wonderful there!".  
We couldn't be happier with the care our patients get at The Surgery Center, and we know you will be happy there if you need to have surgery!

Monday, November 12, 2012

From AAO: "Meaningful Use"

Dr. White was busy over the weekend! We'll spread his thoughts and experiences out over the next few days:

"Every convention is always filled with surprises. The not-so-good one this year was learning as we were all arriving that Medicare would be drastically reducing what it pays for patients to enjoy the miraculous effects of cataract surgery. That's really a bummer because it is the first effort to discover how low medical insurance can go before doctors stop treating patients because of cost.

Good surprises happen, too! I was visiting the company that makes our Electronic Medical Record (EMR), a company called SRS Software. SRS is a great company that has built an EMR around a very simple, but very important idea: an EMR should not interfere with the Doctor/Patient relationship. Radical stuff, huh? The SRS software allows doctors to continue to use whatever type of patient flow they have always enjoyed without adding all kinds of time to both the visit and the doctor's administrative burdens.

There is a government requirement that all EMR's demonstrate "Meaningful Use", a term that is defined in Washington by people who do not practice medicine. In its first few versions Meaningful Use was going to be a terrible burden on doctors and their practices, especially specialists like eye doctors. Through the efforts of SRS and other companies the final rules are somewhat less of a burden in general, but without creative thinking on the part of the makers of the EMR software it still looked like it was going to make things harder and slower in the office. Everything still pointed to a new paperwork hassle for docs and patients.

Here's where the pleasant surprise comes in: SRS stuck to their core philosophy and engineered a solution that looks like a winner! I was stunned when it was demonstrated to me. What looked like it would take at least an extra 10-15:00 for every patient every time they came in now looks like a one-time 5:00 entry and just a couple minutes each time thereafter. Believe me, knowing how good all to the staff at SkyVision is, and how much they care about providing a great experience for every patient, I just know they are going to make it look like "normal" in a very short time!

This is really fantastic news, and it was a really pleasant surprise, too! Stand by for SkyVision Centers to become fully on-board with Meaningful Use thanks to the fantastic work of everyone at SRS Software."

That sounds like something to get excited about!

Friday, November 9, 2012

"No-Touch" Laser Vision Correction

It's day one at the AAO! What's Dr. White been up to?

"Friday and Saturday are called 'Sub-Specialty Days' at AAO. These are highly specialized meetings where the leaders in the more specialized areas of eye surgery convene to really concentrate on that smaller slice of eye care. As I usually do, I am attending the Refractive Surgery meetings, and I might drop by the Cornea meeting for a bit, too.

The most interesting talk so far has been given by the very famous Dr. Lindstrom on doing Laser Vision Correction without using any type of flap or physical manipulation of the surface of the cornea. Dr. Lindstrom was specifically talking about late enhancements of prior LASIK cases, but it applies very well to patients who have had Advanced IOL Cataract Surgery, too.

Briefly, the laser that we use to do the treatment itself can also be used to prepare the cornea for laser. The epithelium, or "skin" of the cornea, is removed using the laser itself, and then the refractive treatment follows almost immediately. This helps to protect a previous LASIK flap, and after cataract surgery it will probably result in faster, more comfortable healing.

The fact that I have already learned something that we will be able to apply to our SkyVision Center patients before lunch is a very positive sign that this is going to be a very productive AAO!"

Exciting things are coming out of Chicago already! Keep us posted Dr. White.

Thursday, November 8, 2012

Blogging and Tweeting: Dr. White at the AAO

Dr. White is attending the largest meeting of eye doctors in the world, the American Academy of Ophthalmology (AAO) meeting in Chicago. He's our Social Media guru, and he promised to keep us up to date on the happenings at the meeting.

Dr. White:
"I'm here with a couple of very specific goals in mind. Ophthalmology was dealt a serious blow, and all of our older patients will suffer because of the changes in how Medicare will be paying for cataract surgery. In a time when more and more people will need this surgery, when we already have a shortage of eye surgeons on the horizon, these changes will probably hasten the premature retirement of eye surgeons who will decide it's not worth it to soldier on. I will be talking with the representatives of the AAO and trying to make sure that we will be able to weather this storm at SkyVision. I'm sure there will be lots and lots of discussion about Medicare and cataract surgery.

Glaucoma is on my mind for this meeting. This disease of the optic nerve is going to be more common. Medicines like eye drops have been the mainstay of treatment, but there are several very promising surgical solutions that are being introduced this weekend. I have been telling our staff that Glaucoma will soon become a primarily surgical disease.

Lastly, with our aging population we know that there will be more people with visual handicaps that can't be helped with traditional medical, surgical, or optical means. As a profession we need to be better prepared for this coming problem. I will be exploring the world of low-vision rehabilitation this weekend."

So there you have it! You can also keep up with Dr. White on his Twitter feed @DarrellWhite. We'll report the "hashtag" to look for if you want to search for other docs attending, too. Looks like lots of stuff to come...See What's Next (R)!!

Wednesday, November 7, 2012

What is a Photoreceptor?

How do we see? How do our eyes actually translate light into something that our brains can "see"? It all starts in the retina, the thin film of tissue that lines the inside of our eyes. Everything in the front of the eye, the cornea and the lens, focus light on the retina. It's then the job of the PHOTORECEPTORS to turn that focused light into electrical energy.

Maybe you remember something about this from high school biology class! There are two types of photoreceptors, the RODS and the CONES. People who have normal color vision actually have 3 separate types of cones; we'll chat about this sometime when we talk about color blindness.

There are cones scattered throughout the retina but the vast majority of them are in the very center of the retina, the area called the macula. In the middle of the macula is the fovea and here there are nothing but cones. As you move outward from the fovea and leave the macula you enter a part of the retina that is covered almost totally with rod photoreceptors.

Cone photoreceptors are sensitive to subtle differences in light intensity and wavelength. It is this sensitivity to wavelength that allows us to see color. Different cones are activated by different wavelengths giving us our sense of color. Subtle differences in light intensity drive our sharp central vision. Cone photoreceptors are most active in bright light and do not work well in the dark. That's why you have to look just to the side of a star to see it at night!

Rods are the photoreceptors for side vision and vision at night. They are very sensitive to low levels of light, and they also "fire" when there is some evidence of movement. Some night vision problems are caused by diseases of the rods. Complex chemical reactions occur when either a rod or a cone is "excited" by the energy in light, and these reactions create the electrical impulses that eventually become sight!

Tuesday, November 6, 2012

RevitalVision: How Did Dr. White Do?

He finished! Dr. White has completed a 25 session "Low Myopia" RevitalVision program after being switched over from the Sport program. How did it go? Well, Dr. White can now see a full line better on the eye chart without wearing his glasses in each of his eyes! His right eye went from 20/40 to 20/30 in the right eye, and from 20/30 to almost 20/20 in the left eye.

"I'm not wearing my glasses to drive during the day anymore," said Dr. White. "I'm watching TV without my glasses, too!"

RevitalVision is a computer training program that actually increases the ability of your brain to see better. Our eyes gather and focus images which are then transported to the back of our brains. It's there, in the brain, that we actually see. The RevitalVision program increases the processing speed of the visual information, recruits additional visual pathways, and increases contrast sensitivity to allow you to see better.

There are specific programs for Low Myopia, Sports Vision, Post-Cataract and Post-LASIK, as well as an FDA approved program for Amblyopia or "lazy eye".   Ask us about this amazing, exciting non-surgical way to improve your vision!

Wednesday, October 31, 2012

Hurricane Sandy Visits SkyVision

People roll their eyes when we say things like "we have a very visual job", but when big storms hit our part of Cleveland it's never more true. SkyVision Centers, along with all of the businesses in the Crocker Park area of Westlake, lost its power on Monday night. We didn't get it back until sometime very early in the morning today. As luck would have it our phones were still kaput until just after noon. All is well and everything is up and running now, even our phones!

As much as any specialty, eye doctors are literally stopped cold without electricity. Not just those who have computerized medical records, but ALL eye doctors. If you think about it that makes a lot of sense. All of the instruments that our doctors use are electric in some way, shape or form. Even the lowly flashlights need to be plugged in to get charged.

We are fortunate to have highly qualified emergency room physicians in the Greater Cleveland area, and most of the hospitals have generators if there is an emergency that must be attended to immediately. Dr. White likes to say that SkyVision is open and available for eye emergencies 363 days of the year, we just never know which day will turn out to be #364 or #365. For us this year one of them was November 30th!

We are back and running strong today. Happy Halloween! Let's hope none of the Hobgoblins gives you such a fright that you need to see an eye doc, but if you DO...

Monday, October 29, 2012

Advanced Lens Implants Last Forever!

More and more of our SkyVision patients are choosing Advanced Lifestyle intraocular lens implants (IOL's) for their cataract surgeries. Not only are they getting better and better vision, but following their surgeries they can see almost everything they need to see WITHOUT ANY GLASSES!! We have also noticed a trend toward people opting to have their surgies at a younger age so that they can enjoy their improved, glasses-free vision for a longer time.

This of course has prompted people to start to ask how long will their implants last? It turns out that the new, advanced IOL's that help people to see better without glasses last just as long as the Basic High-Tech implants we have been using for decades. Dr. White is fond of saying that "[your] lens implants will outlive you by several thousand years!"

If you have a cataract and need to have surgery you don't have to worry about your IOL "wearing out". They pretty much last forever! The two questions you need to ask yourself remain the same as they've always been. When do I want to see better? Do I want to be freer from the need to wear glasses after my cataract surgery?

If the answers are "now" and "yes" you can rest assurred that your IOL's will likely last forever!

Friday, October 26, 2012

Halloween Contact Lenses? BE CAREFUL!!

Every year we see someone in the SkyVision Centers office who bought decorative contact lenses as part of their Halloween costume. This is pretty cool, adding a cool "eye" to your costume, but the people we see after Halloween are folks who bought their contact lenses at the same place they bought their costume, NOT from an eye doctor of any kind. Some of these people have never worn contact lenses before, and no one taught them how to take care of their lenses.

Contact lenses are WONDERFUL, and we are big fans of contacts in general. There are some really important safety rules with contact lenses, though, and buying contacts from a costume store can be dangerous. Here is a video from the American Academy of Ophthalmology about these dangers.

Be smart. If you wear contact lenses take good care of your eyes. If you don't wear contacts and have never had a formal contact lens fitting, don't choose this weekend to all of a sudden buy a pair for Halloween. We want your Halloween to be filled with only treats!

HAPPY HALLOWEEN from all of us at SkyVision!

Monday, October 22, 2012

The Chronic Dry Eye Five

How do you know that you need to make a special visit to your Skyvision Centers eye doctor when you think you have dry eye, even if you are not due for an appointment? Here are 5 questions to ask yourself:

1) Are you using artificial tears multiple times a day?
2) Have you been using them on your own without an eye doctor's guidance for several months?
3) Have you tried 2 or more types?
4) Are dry eyes affecting your use of the computer? Reading? Driving? Wearing contacts?
5) Are you unsatisfied with the relief you're getting from the dry eye treament you've chosen?

Dry Eye Syndrome (DES) is incredibly common. In fact, people search the internet for information on DES rougly 5X as frequently as they search for information on LASIK! If you have not had a DES consultation at Skyvision Centers and you answered "Yes" to two or more of the above questions call us (or download our free Smarphone app and email) for a consultation.

You don't have to suffer from chronic DES!

Thursday, October 18, 2012

BMO Harris Vice President Justine Fedak loves her glasses

October 2012

Justine Fedak shows off a few of her 30 pairs of glasses.

A Few of her Glasses - A Gallery

So, I wear glasses. All the time.

I started wearing them 20 years ago. I distinctly remember my eye doctor suggesting that I wear them to drive, and to “try and get used to them.” At first, they were uncomfortable and I felt a little queasy. My father jokingly called me “four eyes.” I briefly investigated switching to contacts.

But then, I began to embrace my bespectacled self. The glasses were my shield. My armor. My look. Now, my glasses define me wherever I go.

My name really isn’t something anyone remembers. I find myself having to repeat “Justine” after I’m called Julie, Joanne, Jennifer, Jasmine or Christine. But nobody ever forgets my glasses. I always hear the same thing, “oh, I remember meeting you” and “those” glasses.

Yes, those glasses.

Those glasses are actually 30 different pairs. Looking back, it’s hard to believe that I wore the same pair for 10 years. But I really did; I didn’t think about them as a possible accessory, because people didn’t accessorize with glasses in the ’90s. They were actually a functional tool to improve your vision. Imagine that.

Now that they are more popular, people’s comments have evolved: “Do you really need those glasses to see?” Or, “Are those lenses real?” as they move their faces closer to mine. These days, glasses aren’t really for seeing. They’re a hipster accessory; a proclamation of coolness.

But my love of glasses is about more than fashion. They actually help me meet people — you can’t imagine how many comments I get from strangers. It typically starts with a compliment like, “I really love your glasses.” I say thank you and smile, and the follow-up varies from asking about the brand and where I bought them and goes as far as, “Can I try them on?” (For the record, I’m happy to hand them to strangers, give my opinion about how they look and often take their picture with their phone so they can see for themselves.)

Another unexpected benefit of my glasses is they are a fountain of youth. With all the twenty-somethings wearing glasses because they’re trendy, my oversized glasses (which I always thought made me look like Candice Bergen in the late ’70s) are now a youthful statement.

I’m sometimes still asked why I don’t try contacts — typically by people who are a little older. They tell me I’d be more comfortable and look better. I defend my glasses with fervor. “I love my glasses,” I say. “They are me.”

My glasses create connections. They invite friendships. They’re more than an accessory — they change people’s perceptions of themselves. They offer wearers the chance to reinvent themselves. They build confidence. They protect me.

The glasses that made me “four eyes” 20 years ago are now my unmistakable personal brand. When they slide down my nose and I push them up, touching them reminds me they are there and what they mean to me. I feel good.

And now that I’m in my 40s, when I’m reading I’ve noticed I sometimes see better with them off. I recall laughing at my grandfather taking his glasses off to read. And I think of how many special moments my glasses provide me and how — in a world where we are all striving to be perfect — I’m grateful my eyes aren’t perfect. Except when I wear my glasses.

Justine Fedak donated her fee for writing this column to the Noah’s Arc Foundation

Skyvision Centers has an extensive collection of eyeglasses for all ages and personalities!

Wednesday, October 17, 2012

Advanced Care for Pink Eye: An Update

We recently wrote about a new diagnostic tool to help determine if Pink Eye, or Conjunctivitis, is caused by a particular virus. The AdenoPlus test for adenovirus is now part of our acute red eye protocol at SkyVision Centers and has been for 6 weeks. Here's what we have found:

1) Approximately 50% of infection-caused Pink Eye is caused by the adenovirus.
2) Treating viral conjunctivitis with both and anti-inflammatory medicine AND an antiviral decreases the time it takes for patients to feel better.
3) We have been surprised to find positive test results in eyes that we would otherwise not have diagnosed as viral Pink Eye. This has increased our ability to accurately and promptly treat our patients.
4) Positive tests have occurred as long as 3 weeks after the beginning of symptoms; we wonder if the AdenoPlus test will also bring a new understanding about the length of time someone can remain contagious.
5) We have been able to decrease the amount of antibiotics we have been prescribing for Pink Eye.

New Test For Pink Eye at Skyvision

In combination with our cutting edge Dry Eye diagnostic protocols using the TearLab tear osmolarity test, SkyVision now has the most advanced protocols available to diagnose and treat a patient who comes to the office with a Red Eye. We are committed to seeking out any and all new discoveries in order to remain on the cutting edge of this, and all eye diseases!