Omega 3 fish oil is discussed all over the place now and is now being added to lots of foods as a supplement along with other products we use to help our bodies receive the essential fatty acids we need in our diets.  We get plenty of Omega 6′s with the typical “American Diet”, but not enough Omega 3′s as found in fish, nuts, and/or certain seeds.  Omega 3′s aren’t produced or made by our bodies, but rather need to be ingested through diet for our bodies to receive the recommended amount for healthy living.  Omega 3′s are good for our hearts, central nervous system, skin, hair, and even the tear film for our eyes! 

A lot of people suffer from a condition known as Keratoconjunctivitis Sicca, which is also known as Dry Eye.  Sometimes patients have symptoms of dry eye which include a burning sensation, scratchy/gritty feeling, excessive tearing, and/or intermittent blurry vision.  However, initially most patients don’t have any of these before mentioned symptoms until advanced forms of the condition develop leading to damaged tissue from chronic dry eye conditions.   Women tend to be affected the most by dry eye especially older women as the hormone testosterone is responsible for stimulating tear production.  Low levels of testerone  are found in women, but even lower levels are found in menopausal-aged women who produce even less, if any, levels of hormones like estrogen, progesterone and testosterone. 

My first line of treatment for these affected patients involves a natural approach to treatment which involves taking 4 capsules (2000 mg) of ProOmega daily along with a Rx artificial tear known as FreshKote or Systane high performance.  This combination of rewetting the eyes with artificial tear drops 4-8x per day along with ingesting the ProOmega fish oil through diet works externally and internally (respectively) to relieve and resolve the damaging affects of dry eye.  In 4-6 weeks, the dry eye patient usually shows significant improvements as healing takes place and any prior symptoms become nonexistent.  If dry eye doesn’t improve, we introduce  topical medications to the eye that are anti-inflammatory drugs.  Inflammation is the main reason behind dry eye which is why ProOmega is formulated a certain way to help combat the inflammatory component of the condition. 

Eicosapentaenoic (EPA) and Docosahexaenoic (DPA) acids are the main omega 3′s found in foods that have these fatty acids.  These essential fatty acids aren’t made by our bodies, but are rather taken in through diet only, which is why they are known as “essential” fatty acids.  EPA actually has a natural, anti-inflammatory ability to its molecular structure besides the omega 3 benefit that DPA offers.  This is why ProOmega has a heavier concentration of EPA vs DPA.  This formulation helps attack and resolve dry eye that would otherwise debilitate vision and the general health of our eyes and body.  Over the course of 4-6 weeks of using the recommended dosage of ProOmega, one should notice a subtle improvement in the quality of their vision and less problems with symptoms as the supplement works internally to repair and resolve dry eye.

If you think you maybe suffering from dry eye, please call an eye care professional to be examined and assessed for dry eye so that treatment can begin sooner than later as this is a slow, debilitating condition that millions of people suffer from; especially women.

This month’s topic touches on refractive errors.  What is a refractive error?  It has do with how light refracts or focuses when entering the eye.  The optics of the eye are made up of our tear film, cornea, and “natural” lens in the eye.  This combination of curved refractive surfaces and content within these areas of the eye give us the ability to refract and focus light!  In a perfect world the light would refract all to one point in the back of the eye where the retina exists.   This allows our brains to process the light bouncing off what it is we’re looking at to give us a retinal image  The physical limits of our visual system is 20/10 vision, but very few people are capable of appreciating such fine detail when it comes to our “focal” vision.  This is due in part to the optic limitations of the eye besides how spread apart our “rods and cones” are in the retinal tissue of the eye.  the retina is responsible for transmitting light into an electrical signal to the brain in order for us to appreciate light, color, shape, depth, motion, etc.  Aberration is the term used to describe refractive errors or blurriness to vision as a result of light not focusing to one main focal point in the eye.  The following are categories for different aberrations.

Lower Order Aberrations:  these aberrations make-up a significant amount of traditionally measured and corrected refractive errors.  Farsightedness, nearsightedness, and astigmatism make-up lower order aberrations.  Up until recently, this was all we could measure and correct in traditional glasses and contact lenses.  Roughly 80% of most patient’s refractive errors come from lower order aberrations.

Higher Order Aberrations:  These aberrations make-up the other 20% of most patient’s refractive errors.  For the longest time we had to ignore these aberrations because we didn’t have the technology to measure them as we do with lower order aberrations since they consist of a fraction of what was otherwise corrected with glasses and contacts.  It consists of aberrations known as Trefoil, Spherical, Coma, and Oblique Astigmatism aberrations.

Now with advancements in technology, we can finally measure these higher order aberrations with the lower order aberrations in order to give a patient a full 100% refractive error correction.  We use an instrument called an aberrometer that measures how all light enters and leaves the eye for our focusing needs.  This is the same technology utilized in a Custom LASIK procedure!  Well now this same technology can be used to make refined, customized spectacle and sunwear prescriptions.  Eventually contact lenses will enter the market starting with gas permeable lenses and who knows maybe even soft lenses.

This new technology is allowing the patient to appreciate “high definition” vision everywhere they look with these new lenses!  One of my patients wasn’t bothered by their HD T.V.’s current pixel resolution, but now notices the pixels in his T.V. because of the refined, sound vision he gets from his new “HD” glasses.  Hopefully this doesn’t cause him to have to go out an get a newer, higher resolution HD T.V., but the point is that now his vision is even “cleaner” and more customized to the optical make-up of his eyes than ever before.

We at Carlsson Family Eye Center offer this cutting edge technology in refractive correction and encourage you to learn more about the new iZon lenses and how it gives the patient the “WOW” in vision correction.  This lens is offered to most patients and is even available for our RK patient’s that have never had sound vision after having surgery and is why this refractive surgical procedure has since been discontinued.  This lens is now offered in single vision, progressives (“no line bifocals”), tinted sunwear, transitions, and even polarized!  It is a high index lens with an anti-glare and scratch coating package included!  Please learn more about the iZon lens through your favorite search engine and see what HD lenses are all about!

The last topic we discussed regarded Strabismus and the different types of Strabismus: Constant, Intermittent, and Alternating Strabismus.  Today, I’ll be talking about how we as behavioral optometrists can use lenses and prism to help resolve strabismus along with vision therapy. 

Lenses:  We all know to some degree that lenses are used in glasses to help us to see better whether your nearsighted, farsighted, and/or astigmatic.  Well lenses can also be used to help alter the posture of one’s eyes (“how straight the eyes are”).  For instance, plus power used to correct farsightedness can also be used to relax posture.  In other words, allow a strabismic patient that has their eyes turning in change to straightening out and not turn in while wearing glasses.  Minus lenses used to correct nearsightedness can also be used to help bring the eyes in or “a flexing” posture.  In other words, when one’s eye is too relaxed or positioned outward, these lenses can be used to help the eyes converge (come in) to again straighten out the eyes.

Prism:  Prism is used to bend light in a certain direction, I won’t go into the optics of it, but basically it can be used to alter the direction of light.  In strabismic patients we use prism to relax the demand on their binocular system to maintain fusion or use your eyes together as a team (binocularity).  For instance, when one’s eye is turned out as in exotropia (a form of strabismus) we can use what we call base in prism to shift the light and resultant image out to where the eye likes to be thus giving the brain an opportunity to view the same target of regard or image at the same time out of both eyes.   As a result, it then becomes easier for a strabismic patient to fuse or bring the images together to form one; creating binocularity!  Base out prism is used to correct strabismic patients that have their eyes turn in aka esotropia.  Vertical prism such as base up and down are used to correct a strabismic patient that has an eye that is turned up or down.  Either way, prism is used to eliminate double vision as a result of strabismis and encourage binocularity.  When I use the term “base”  think of the base of a prism and then when I say base up, down, out or in, that refers to the direction the base is in when placed in front of the patient to use in their glasses.  Please take note that the glasses would not look like there was literally prism in them as cosmetically that would look a little weird (; It’s actually a measurement for the lab to cut the lenses a certain way in order to create the prismatic affect.

Vision Therapy:  Vision therapy involves doing exercises or activities in an attempt to develop awareness of binocualrity by teaching the patient what to see and feel when using their eyes correctly for functional binocularity!  We use prism and lenses to manipulate light and challenge the patient to establish and sustain binocualrity.  Vision therapy usually involves 1 hour sessions in office once or twice a week followed with homework for the patient to do every night at home in order to build those skills; practice makes perfect! 

All in all, lenses, prism, and vision therapy is a credible and equal approach to treatment of strabismus.  I encourage you to read more about vision therapy and the success stories that come about from doing it.  Surgery isn’t always the answer when it comes to strabismus and this is definitely a less invasive and/or traumatic approach to treatment vs. surgery.  Strabismis surgery is usually repeated in roughly 50% of cases so please consider vision therapy before surgery as an alternative to treatment since it could be the best decision you have ever made regarding you and/or your child’s vision.

Strabismus is a condition where a patient lacks binocularity or binocular fusion as a result of the eyes not “teaming together” correctly.  An example is when you notice someone that has one eye fixated on you while your talking to them while the other eye is looking in a totally different direction whether it be up, down, left, or right.  Some people refer this as being a “lazy eye”, but that is not necessarily the case.   Amblyopia or “lazy eye” is a condition in which the eye is not capable of seeing 20/20 no matter how good the prescription is for the eye and there is no pathology or disease entity to explain the vision loss.  These types of eyes can be rehabilitated to sometimes 20/20 along with functional binocular vision with the use of vision therapy.  Only a constant strabismus (eye affected is always turned away) can cause a true lazy eye or amblyopia.  In other words different forms of strabismus exist which are as follows.  A constants strabismus, and intermittent strabismus and even an alternating starbismus.  I will define all three  accordingly:

Constant Strabismus:  One of the patient’s eyes is always turned in, out, up, and/or down.

Intermittent Strabismus:  One of the patient’s eyes sometimes deviates in one of the previously mentioned directions.  This especially occurs when the patient is fatigued or tired.

Alternating Strabismus:  This is when the patient’s eyes take turns alternating the deviation present between the eyes.  In other words, one minute the right eye is deviated and then the next minute the left eye is deviated. 

My next blog will be a continuation about this topic but I’ll be discussing ways of treating this condition.  If this is noted with your child, have them see an eye care professional immediately as a sudden onset could indicate neurological complications, while a congenital or gradual onset should be treated also right away for a more favorable prognosis.  However, strabismus surgery isn’t necessarily the answer, but vision therapy is the answer for a lot of these affected patients.

80% of what children learn before 12 years of age is through their vision.  This fact explains the importance of having your child’s vision checked on an annual basis besides having your child’s vision checked as a toddler.   Only 4% of vision problems are detected through vision screenings at school and at the pediatrician’s offices when 25% of children have a vision problem.  A simple comprehensive eye exam with dilation is recommended to rule-out any refractive errors, ocualr pathologies, and binocular vision disorders.  Our eyes reveal a lot about our general health and help reveal systemic diseases and/or autoimmune disorders that can otherwise go undetected until far later when the condition has worsened. 

Some states have all ready passed laws that mandate eye exams for children before starting school.  This is a great thing since it helps us rule-out right away if vision is hindering the ability for a child to learn with the rest of his or her peers.  For instance, a lot of these kids are mislabeled with ADD/ADHD for instance when all they needed was a pair of glasses or a little vision therapy.  This would save our education system millions of dollars in unnecessary “IEP’s” and special needs therapy at school since all it was to begin with was a vision problem.

The message here is to take your children and even yourself to an eye care professional to rule-out any vision problems let alone any systemic conditions that might be going on that you were unaware of at that time.  Preventive medicine is a great concept, which can save you a lot of money in medical bills in the long run let alone one’s life when catching a potentially life threatening disease in its early stages.

Amblyopia (lazy eye) is the leading cause of preventitive blindness in children.  There are different forms of amblyopia that exist.

1. Refractive Amblyopia-  This is usually due to a high refractive error in one vs. the other (anisometropia) or sometimes both (isoametropic) if the refractive error is high in both eyes.

2. Strabismic Amblyopia- This is due to an obvious constant eye turn.  This is what most people think of when they think about lazy eye.  In other words the person involved has one of their eyes turned in, out, up, or down while the other eye is looking at you or whatever target the person is fixated on.

3. Form Deprivation Amblyopia-  This is a form of amblyopia that is a result of something interferring with the normal refraction of light in the eye.  Examples include a congenital droopy eyelid (ptosis) or congenital cataracts that interfers with the normal retinal image processing of the brain’s visual cortex.

All three types of amblyopia are treatable if caught early in the patient’s development.  In other words the onset of amblyopia is from 1-8 years of age, but if the condition is caught early in a patient’s life than the prognosis is much more favorable than when trying to treat the condition later on in life as an adult.  The reason for this is due to the plasticity of the brain at an early age.  In other words it’s a lot easier to teach a “new dog new tricks vs. an old dog new tricks” as the saying goes.  This means a child’s brain has a much easier time relearning things than if you try later on in life due to this critical development period of the brain that exists between 1-8 years of age.  

I encourage all parents to get their children’s eyes checked at 2-3 years of age in order to catch it early and treat it.   This way the condition is caught early enough before it becomes a “bad habit” in order to salvage single clear comfortable binocular vision.

Only 4% of children are detected to have a vision problem with school and pediatrician visual screenings.  When actually 25% of children actually have a vision problem. 

The message here is to have an eye care professional perform a comprehensive eye exam on your child at 2-3 years of age so that these potential visual conditions are caught early and treated before they become a real problem with the child’s ability to learn and perform daily functions.

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