The Eye Practice

Contact Lenses fortunately over the years have had considerable technological advancement.  What is very sad though is that it seems the incidence of severe eye infections caused by them is on the increase.

The irony here is that because they have improved both practitioners and patients have slackened off in hygiene and compliance in replacement schedules.  WHAT ARE WE DOING!

Our vision is our most important sense.  At The Eye Practice we specialise in contact lenses and frequently treat conjunctivitis, dry eyes and allergic reactions to contact lens solutions.  Most of these complications are avoidable but the bizarre perception that contact lenses are somehow similar to putting on a pair of socks is just a frustrating process.

To get to The Eye Practice every day Dr Jim Kokkinakis walks through the Queen Victoria building and in full view of the unsuspecting public is a plasma screen advertising coloured contact lenses that can be purchased without a prescription.

This outrageous situation somehow sneaks through the legislative process in Australia because they are selling contact lenses without a power for vision.  Unfortunately the power of the lenses has nothing to do with its safety.  In the USA it is actually illegal to sell any type of contact lens without a prescription.  The loop hole that exists in Australia does not exist in the USA, yet unscrupulous retailers still try their luck on the unsuspecting public.  The following video highlights the dangers of purchasing contact lenses without a prescription.

Whether you are purchasing contact lenses from a retailer or over the internet make sure you have an up to date contact lens prescription that has been validated by an optometrist.  Your eyes are so precious. Please look after them.

Contact lenses are a specialty at The Eye Practice.  So much so that Dr Jim Kokkinakis is often invited to lecture to optometrists not only in Australia but around the world.

March was a particular busy time as Jim visited Bangkok to present twice on Contact Lenses, their advantages, possible complications and most importantly their solutions.

Amazingly Johnson & Johnson Vision Care, which sponsored this educational event has a purpose built presentation and training facility in Bangkok, which can be used to train optometrists not only from Bangkok but from other countries as well.

This particular cohort of optometrists were from Singapore.  The enthusiasm shown by this group of practitioners just proves what a vibrant profession Optometry is.  Even though legislation in Singapore does not allow optometrists to do procedures that our optometrists in Australia take for granted, their level of knowledge was nonetheless very advanced.

It is a credit to the Polytechnic School of Optometry in Singapore and their newly formed association.  Optometry in Singapore is certainly progressing in leaps and bounds.

This month Jim is off to the Gold Coast to present to Australian optometrists and again in May to Perth.  More on these presentations later.

Diabetes comes in two main types.  Type 1 and Type 2. 

Type 1 diabetes is quite frustrating for the affected person as they have to monitor their sugar level 6 - 8 times per day by taking blood samples.  This is done by pricking the finger with a needle.  What is tough is when children as young as 5 or 6 years of age have to do this every day and potentially for the rest of their lives.

In a previous post we discussed the use of a contact lens to monitor the pressure inside the eye to keep on top of a disease called glaucoma.  At Microsoft they are working together with specialized engineers to come up with a contact lens that can accurately measure sugar levels in the blood by continually monitoring sugar levels in the tear film.  Have a look at the following video.  Certainly it is a marketing video by Microsoft but the underlying message is fascinating.

Even though it is not well explained in the video, electronic circuitry will be implanted within the matrix of the contact lens, which will wirelessly send data to a synchronized computer for the patient to view, or to a medical facility that will monitor the patient.

One of the biggest issues in any medical management for a disease like diabetes is patient compliance with both monitoring and treatment.  Being accountable to your doctor, who I assume will SMS you if you are dropping off your treatment protocol is bound to be a great step forward to keeping people out of our hospital systems and leading dramatically improved and longer lives.

Who would have thought that a tiny bit of plastic that corrects blurry vision one day might be able to also measure blood sugar levels and the pressure inside the eye.

If this technology proves to be successful it is quite likely that other blood markers might be able to be measured, such as cholesterol and maybe even thyroid function and liver function. It is quite possible that the majority of the blood pathology industry could become obsolete in due course!

At The Eye Practice we have a feeling that in 10 years time we will be seeing technology implemented that we have not even dreamed about yet.

Conjunctivitis comes in many types.

We've mentioned before that we were going to have a closer examination of other types of conjunctivitis. This one is important for contact lens wearers, and those who have stitches (sutures) in their eye, or artificial eyes (prosthetics) and implants.

It's called Giant Papillary Conjunctivitis (GPC).  Primarily, the major population affected by GPC is contact lens wearers. Additionally, although it can happen to any contact lens wearer, the greatest affected group is?

Those who wear soft lenses, especially the silicon hydrogel variety.  Hard contact lens wearers rarely exhibit GPC.  In fact one of the treatments for GPC is to swap from soft contact lenses to the hard variety.

Essentially, GPC is a type of inflammation of the under-surface of the eyelid, which comes from constant blinking against the contact lens or foreign object. That surface, normally as smooth as silk, becomes irritated and rough, and forms papillae (bumps) all along the surface. The more you blink, the more it rubs, and the more it rubs, the more the whole eye gets irritated, causing the conjunctiva to get inflamed, hence – conjunctivitis.

Possible Causes

There are several possible causes of GPC –

·       constant rubbing of lenses against the eyelids (as described above)

·       allergic reaction to contact lens solution, drops, and cleansers

·       deposit build up on the lenses from extended wear, or improper cleaning techniques, or from wearing the lenses longer than they should be worn (like wearing 30 day disposable lenses for 60 days or 14 day contact lenses for 30 days.)

These causes will create an atmosphere of aggravation for the eyelid, causing papillae to form.

Symptoms

GPC is not contagious – but it looks and feels awful. Symptoms of GPC are similar to other conjunctivitis symptoms –

·       an itchy, gritty feeling in the affected eye

·       burning sensation in the affected eye

·       increased mucous output

·       redness

·       blurred vision from mucous sticking to the lens

– but with an exception...the bumps underneath the eyelid.

   

Treatments

The Eye Practice has a variety of treatments available, and we have a great deal of experience with different types of contact lenses, so that you might not have to give up wearing contact lenses at all. In fact, our specialty is contact lenses, so when you come in for treatment for GPC, we encourage you to follow our advice to the letter – we may be able to help you stay in your lenses or find ones that won't aggravate your GPC.

GPC can be very stubborn to settle down, so there are a variety of treatment approaches we use in order to get your vision and comfort back to optimal operation. Treatment options begin with stopping wearing your current lenses so that the inflammation can subside.It does not stop there though.  Judicious use of prescribed anti-inflammatory eye drops will really make the difference in bring the GPC to its knees.

Once the irritation heals, we can work with you to find the right lens system that will keep GPC at bay, and help you to build back up to enjoying the many advantages of contact lenses.

Call for an appointment on 9290 1899 for help. 

Keratoconus can be a very frightening diagnosis to get if your vision has recently deteriorated.  What is even scarier is that it can be hard to get some good news. 

Here is the bottom line - you do not go blind from keratoconus.

At The Eye Practice keratoconus is what we do.  After more than 20 years of treating patients with keratoconus we have a pretty good understanding of what to expect and exactly the appropriate treatment options at the appropriate time.

The best time for us to see a patient with keratoconus is usually when no one else has tried any treatment.  This by no way is trying to downgrade other practitioners, but the reality is keratoconus is absolutely unique with every individual. It is only after treating thousands of patients that an eye practitioner  will have a great understanding of what option to choose and at what time.

                                   

Our experience at The Eye Practice has revealed the following:

• NO ONE GOES BLIND FROM KERATOCONUS

• If an ophthalmologist or an optometrist has advised you that you cannot wear glasses, there is at least a 30% chance that this is not true.  How can this be?  Like anything, practice makes perfect.  Having seeing thousands of patients with keratoconus we have developed a skill in measuring glasses for keratoconus.  This does not mean everyone we see can wear glasses - it means of those that have been told they cannot wear glasses about 30% of the time we can find a very useful pair of glasses.  In these cases it is like winning the lottery!

• If you have failed in trying contact lenses elsewhere, we can fit you successfully 80% of the time.  Why such a dramatic difference?  Again it is about experience and options.  The average optometrist does not have any contact lens templates to try - At The Eye Practice we have over 50 different trial sets under 6 different categories.  Our specialty is keratoconus therefore we have invested in all possible options to give you every opportunity to succeed. 

• It is imperative to follow a process and not leap frog options. The process involves simple options followed by more complex ones.  Why would you want to try a complex option without having first tried a simple option?

• Referral to an experienced corneal surgeon is critical to a good result when surgical intervention is required.

• Only 5% of patients with keratoconus will require a corneal transplant.  Make sure you have failed in contact lenses before moving on to corneal transplantation.  This is because of two reasons:

1. A significant percentage will require contact lenses to see properly after corneal transplantation.
2. 50% of corneal transplants will fail by 15 years. Another corneal transplant can be done, but the second and third transplants will usually fail at an earlier time.

• Collagen cross-linking is very fashionable at the moment.  If you are over 30 years old and are offered this procedure make sure you have progressed in the disease as after 30 it is likely that keratoconus stabilises in most cases.  Crosslinking on average is better suited to some one under 25 years of age and has been documented as having progressed.

• Intacs or Kera Rings have been disappointing procedures.  Before trying them make sure an expert contact lens specialist has tried a number of options, as trying to fit contact lenses over the top of these devices is more complex - it can be done but maybe we have leapfrogged a simpler procedure in the past.

• Keratoconus is an inconvenience it is NOT A LIFE SENTENCE!

Call us on 9290 1899 or Book an Appointment Online Now.

Contact Lenses since the 1970’s have been popular corrective vision appliances. After glasses, contact lenses represent around 8% of the vision correction market in Australia.  In the USA it is over 20%.

Believe it or not approximately 50% of all people that begin wearing contact lenses will discontinue within one year. Most of the time this is because of discomfort.

According to expert optometrists it is quite clear that use of contact lenses and dry eye syndrome can be a troublesome cycle that seems to have no end in sight. On one hand the lens can protect the eye from dust and airborne irritants. On the other hand the lens can dehydrate and create a feeling of roughness and discomfort after a number of hours of wear.

    

Other contributing factors include incomplete eyelids closure, diseases that affect the eyelids (blepharitis) and insufficient tears due to deficiency in the tear-producing glands. It has also been shown that dry eye syndrome tends to occur more in females than in males. One of the explanations that has been given for this occurrence is that women go through more hormonal upheavals than men. A more recent survey has shown that aging increases the possibility of dry eye conditions in males and in females.

Dry eye conditions have baffled optometrists for ages. Most of time any treatment that is offered will be palliative (to try and suppress the irritation) but because the underlying cause is often unknown the dry eyes are only masked with symptoms often returning. 

One of the most popular methods in dealing with dry eyes is to instill artificial tears that top up the natural tears in the human eye. This artificial replacement helps to decrease the irritability and the dry feeling that accompanies the condition. Scratching the eyes due to the irritation is likely to result in a red eye effect due to inflammation. The artificial tears act to lubricate the eyes thus providing relief to the scratchy feeling which may act to give relief in the short term and sometimes in the long term. Wrap around sunglasses also help wearers of contact lenses to deal effectively with the problem of dry eye as they seal the moisture inside the eyes thus preventing their evaporation.  There are many treatments that need to be considered and tried, when it comes to contact lenses causing discomfort.

Other treatments will be discussed in more detail in later posts.  This is such an important topic that we are setting up a dedicated website to dry eyes called DryEyes.com.au - what else would we have called it?  We hope to have this up and running in a few months.

Another bizarre method of dealing with the dry eye syndrome is to administer allergens, which act to stimulate the production of more tears, which lowers the possibility of dry eye conditions. This is a homeopathic treatment, which even though has potential to stimulate tear production will also cause inflammation and significant potential for itchiness and irritation.  Do we think this is a good treatment - NO!

Before using any eye concoction or corrective measures with contact lenses it is important to consult with an expert optometrist to be sure that the measures or medication is safe and for the common good of the eye. Consulting with such professionals can be the saving step as they are likely to offer only the best treatments, which are long lasting and have lesser side effects to the user.

Even though contact lens wear can be tricky and it is unfortunate that so many people fail, the failure rate would be dramatically less if both the patient and the optometrist work together as a team. Contact lenses are a fantastic lifestyle enhancer and careful diligence maximizes their success rate.

Visit us at The Eye Practice, problem solving contact issues is what we do.  Call us on 92901899 or book an appointment on line.

Contact Lenses are normally just another form of vision correction.  You go to the optometrist with blurry vision and after glasses, contact lenses are the next most common form of vision correction that is chosen.

Contact lenses can have other functions, other than correcting vision blur.

They can change your eye colour from brown to blue. 

They also can protect your eye after being scratched, similar to a bandage.  By placing the contact lens on top of the injured eye (and normally adding antibiotic eye drops to protect the eye from infection) it buffers the eyelid from blinking on the wound.  A scratched eye can be excruciating, so a bandage contact lens can be a godsend!

In a previous post we discussed how contact lenses are in the preliminary stages of adding electrical circuitry which can be used to measure the internal pressure of the eye 24 hours of the day.

Now it seems that accurate eye medicine delivery can be achieved using contact lenses.Does this mean that eye drops could be a thing of the past?  See the video below for an introduction to eye medicine delivery through a novel contact lens design.

The Byrne Lab in the USA has developed polymers that can be moulded into contact lenses.  These contact lenses can be impregnated with therapeutic medication, whether it be for bacterial infection, reducing eye pressure in glaucoma or to reduce inflammation. 

Potentially this could be a tremendous step forward for eye disease management. 

Eye drops have significant disadvantages:

• The patient or their carer has to remember to put the eye drops in the eye/s. Compliance is a huge issue with up to 50% of patients not compliant with any form of disease treatment.  Eye treatment is no different.
• In eye drop form, the drug needs to be in relatively high concentration as the contact time with the treated eye is short.  This is because most of the drop will quickly either spill out of the eye or will be drained away through the nose into the gut.
• Most eye drops need to instilled multiple times per day, in fact in some severe bacterial infections eye drops are required every 15 minutes, around the clock.  Realistically this needs to be done in a hospital environment so is very expensive.

Delivering eye medication through contact lenses has a number of significant advantages:

• Once the medicated contact lens is put in the eye by the treating optometrist or ophthalmologist, the patient does not have to do anything else, so compliance will be no longer an issue.
• Treatment will be more effective, as a calculated dose will consistently be delivered for what ever time frame is required.

Possible pitfalls with this treatment will be:

• Often treatment requires two or more eye drops.  Normally with eye drops, one medication is used followed by the second one 5 minutes later so that they will not dilute each other. Mixing two medications in the matrix of a contact lens will have all sorts of unexpected chemical reactions.
• We suspect multiple medication contact lenses will take significantly longer to get to clinical trials if they make it at all. 

Future eye medicine delivery techniques:

Even though eye drops are a reasonable way to treat most eye issues there certainly is a need for superior methods.  The contact lens delivery method is one such enhancement but this will have strong competition from Nanoparticle technology.  Nanoparticles are microscopic entities that have very specific chemical properties that allow the nanoparticle with the medicine piggybacked on it to more efficiently enter the eye.

Time will tell which technology takes over from the traditional eye drop approach.

Contact Lenses in Australia, are only used by 8% of the population that need vision correction. One might logically conclude that this is because most people choose to have laser vision correction. Well you might be surprised to hear that less than 2% choose laser as a vision correction option – the overwhelming reason not  to proceed is the fear of something going wrong. It is obvious from these statistics that at least 90% of the population that requires visual correction is choosing spectacles.

Another amazing statistic is that of all the people starting contact lenses this year, about 50% will have dropped out by next year (some sooner and some later).

Most people that wear contact lenses just go with the flow and do not realize that there are many things they are doing wrong or could do better. By being oblivious to these issues many are doomed to failure.

Fortunately, you can be different! Over the course of the next few Contact Lens posts, Dr Jim Kokkinakis will go through some vital points to minimize the chance of you becoming a statistic of contact lens failure.

Possibly the single most important point is not cleaning or disposing of contact lenses and storage cases properly.  Often the patient and the practitioner contribute to either a misunderstanding or just plain laziness.  Most of the time it is probably a bit of both.

It might sound like common sense that being hygienic with your contact lenses is critical to minimise problems but... many studies have demonstrated that more than 60% of people do not clean or dispose of their contact lenses properly!

At The Eye Practice we specialise in all types of contact lenses from the most simple to the most complex.  Half of our day involves managing contact lens complications.  These are referred in by other optometrists, GP's and even ophthalmologists. Now many of our new patients are finding us off the internet.

Not being hygienic with your contact lenses can cause all sorts of complications from minor to sight threatening.

     

         Contact Lenses related conjunctivitis                                    Contact Lens related corneal ulcer - this is an emergency 

The above photos represent eye conditions that need treatment.  They sometimes can feel similar, although the second photo can sometimes cause a lot of pain.  The first photo requires a prophylactic antibiotic with a steroid, whereas the second photo needs hospitalization with round the clock treatment to save the eye.  Both of these conditions are much more likely to occur if contact lenses are not cleaned properly and are not disposed of properly and on time.

Another very common condition which can cause contact lens failure but is not eyesight threatening is called Giant Papillary Conjunctivitis.

      

                                 Mild GPC                                                                                             Severe GPC     

Giant Papillary Conjunctivitis (GPC) can be observed by flipping the top eye lid upside down.  This should be done on most contact lens related eye tests - especially for patients wearing soft contact lenses and especially if they are using the new generation silicon hydrogels and not using daily disposable contact lenses.

Giant Papillary Conjunctivitis can occur because of an ill fitting contact lens, or a contact lens that is dirty.  The contact lens causes a frictional irritation under the top eye lid and gradually the GPC reaction occurs.  Typically patients will complain of lenses moving excessively in their eyes and a feeling of grittiness.  If this issue is not attended to, eventually the patient will become intolerant to the contact lenses and become one of the failure statistics that we have talked about before.

We cannot stress enough how important complying with contact lens cleaning and disposal instructions is to long term successful contact lens wear.  RESPECT YOUR CONTACT LENSES and they will respect your eyes!

If you are having any issues with your contact lenses come in and see us.  There is a good chance you are doing something wrong that we can advise about and make contact lens wear the liberating experience it should be. Call us on 9290 1899 or MAKE AN APPOINTMENT ONLINE NOW.

 

Glaucoma historically was diagnosed by a measuring a pressure inside the eye of over 21mm of mercury.  To put this in context we are all familiar with blood pressure.  Normal readings for blood pressure as the heart beats is 120mm of mercury while when the heart relaxes drops the blood pressure when normal to 80mm of mercury. Hence when a blood pressure is documented it looks something like: 120/80.

When measuring the eye pressure even though it is documented as a single number, there is in fact a normal fluctuation of 4mm of mercury.  It is too difficult to measure this exactly in a clinical setting so it is just averaged.  Just like blood pressure varies quite significantly during the course of the day, the eye pressure in certain individuals can also vary dramatically.

Relying on just one measurement for a glaucoma assessment can be very misleading, as in certain cases of glaucoma the pressure can be normal at certain hours of the day yet be dramatically abnormal at other hours.

A recent patient of Dr Jim Kokkinakis had been diagnosed with glaucoma in China.  In China he was hospitalised over night and was awakened very hour to have his pressure measured.  The results are summarised as follows:

8.00am : 24mmHg; 10.00am : 18mmHg; 2.00pm : 17mmHg; 2.00am : 32mmHg; etc

It can be seen that the pressure varied from 17mmHg to 32mmHg during the course of 24 hours.  Certainly the pressure measurement of 32mmHg is indicative of glaucoma but here is something to ponder?  Were these pressure readings accurate?

Hospitalising glaucoma suspects for 24 hour pressure measurements are not done in Australia, as it is felt to be a waste of resources.  Dr Jim Kokkinakis definitely agrees with this but...

Wouldn't it be great if there was some simple way of measuring eye pressure around the clock?  After all it is known that eye pressure is just a risk factor for glaucoma and no definite number means you will have glaucoma damage to the eye.  What is certain that as the pressure increases more and more people will develop glaucoma.  Even though no definite pressure is definitive of glaucoma, once progressive glaucomatous damage is seen, the only real treatment we have is to reduce the pressure normally by at least 30%.

It seems that a high tech contact lens has been developed that incorporates a microchip and wireless transmission of the eye pressure.  The patient therefore can be fitted with the contact lens and allowed to go home, go about normal daily activities, go to sleep and then return to the treating practitioners office where a complete download of all pressure measurements can be documented on the patients eye health record.

Apparently this device called "The TriggerFish" is currently being used in some countries of Europe and in Japan.  What begs the question though is how accurate is it - I guess time will tell with ongoing studies.  What is certain though is that as the technology to measure eye pressure throughout the day becomes easily accessible our management of glaucoma will just get better and better.

For more information on "The TriggerFish" CLICK HERE for an interesting news article.

If we go back to Dr Kokkinakis' patient who had his eye pressure measured at 2.00am in the morning woken up each hour, one must question the accuracy of a test with a tired patient, trying to sit still hour after hour - we have our reservations.

Keratoconus in the last 40 years or so has been principally managed with rigid contact lenses.  The category of rigid contact lenses is very vague, as within this, there are half a dozen possibilities that can work very well - So which is the best visual option when correcting blurry vision caused by Keratoconus?

Possibly what the average patient with Keratoconus does not realise is that in a country the size of Australia, there are probably around 10 contact lens specialists that have adequate experience in fitting all keratoconus contact lens designs.

What is normal to find, is the average optometrist will not have any contact lens templates designed specifically for keratoconus.  This is because at most they might run into one keratoconus patient per year, therefore investing in contact lens designs and high tech equipment for keratoconus is a waste of time and money. 

To try and fit a patient with keratoconus, the average optometrist will either refer the patient to a specialist (usually the best option) or borrow a trial set from one of the contact lens laboratories and take on the challenge.

At The Eye Practice one of our specialisations is fitting contact lenses to eyes that cannot wear glasses due to irregular corneal topography.  The conditions include:

• Keratoconus
• Failed Laser Eye Surgery
• Corneal Grafts
• Failed Radial Keratotomy (this was the old Russian technique)
• Pellucid Marginal Degeneration
• Traumatised Eyes
• Other conditions that cause irregular corneal topography.

 Every person that has any of these eye conditions tends to be unique, therefore having all options available in template format is critical to success.

At The Eye Practice, Dr Jim Kokkinakis has over the years traveled around the world to not only extend his knowledge in Keratoconus and all other irregular corneal conditions, but to also source as many different contact lens templates to try and maximise successful outcomes for patients. These people would otherwise not be able to visually function.

Often patients and other practitioners ask: "What are the BEST contact lenses for these irregular corneal conditions?"

The honest answer is - it depends!  The trick seems to be to try and follow a process that will begin with the simplest contact lens options first followed by more complex ones if the simpler ones fail. 

The following is a series of lens fittings that occurred for a complicated keratoconus patient:

1. Left Eye: 9.0mm diameter rigid gas permeable keratoconus design - even after adjustment lens was unsuccessful due to being unstable and uncomfortable.
2. Changed to a larger diameter 10.2mm rigid gas permeable keratoconus design - one change was required to loosen the lens and success was achieved for the left eye with 6/7.5 vision. Patient could wear the lens all day with minimal discomfort.
3. After 6 months patient returned and wanted a lens that she could play high level soccer in. We fitted her with a Synergeyes ClearKone. This lens is much more stable, but tended to dry out in air conditioned environments for this particular patient. She therefore wears the ClearKone for sport and the rigid gas permeable for work and other activity. She was delighted with this outcome.

1. Right Eye: Required a corneal transplant as previous lens fitted by inexperienced practitioner had caused scarring and therefore reasonable vision was impossible.
2. The right eye was followed over the rehabilitation process, which took over 12 months for the sutures to be removed. During this period glasses could not be prescribed as the surface of the cornea was too irregular for reasonable vision. Luckily she was doing very well with the left eye.
3. Sutures were finally removed and a contact lens had to be fitted over the corneal transplant to achieve reasonable vision.
4. Corneal topography and observation revealed that the junction between the host cornea and the graft cornea had a deep ridge. Fitting with a smaller rigid lens was impossible.
5. The eye was therefore fitted with a 15mm miniscleral design, which could achieve great vision of 6/6 or 20/20 but was still rubbing on the ridge.
6. The miniscleral was changed to a 18.5mm scleral imported from the US and after one adjustment to tighten the lens we finally had a great result.

This is not a common case but without having the ability to use over 30 different lens designs, fitting this patient successfully wold have been impossible.  The following points are worth mentioning:

• A successful outcome can be very inconvenient and expensive on both the patient and the practitioner.
• Occasionally many options need to be worked through to achieve what is perceived as a successful result. This really only can be achieved by a specialist contact lens practitioner, who has available a plethora of different lens designs.
• What price can you put on getting your vision and life back?