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Scleral Lenses for Dry Eye :)

Hi! I can’t begin to convey my excitement for scleral lenses and all their various applications through text – but I’m going to try. They are incredible. And for the patients that need them – certainly life changing. There are numerous reasons why a patient may seek a scleral contact lens fit but here, briefly, I’m going to talk about their use for dry eye.

 

For many reasons, patients with dry eye (or as I like to refer to it as …ocular inflammation!) struggle greatly with wearing a traditional soft contact lens. Problems include intolerance, poor vision, lens awareness, redness, and even infection. That’s where the benefits of scleral lenses can step in and solve some of these issues while still correcting vision and in come cases, providing therapeutic relief.

 

Just to sing some of their praises – scleral lenses don’t actually touch the cornea – they vault over it. And in that vault space is fluid. And in that fluid, we can sometimes put a cocktail of healthy, regenerating components that will create a sort of “bath of moisture” that the cornea sits in while the lens is on. This both provides immediate relief (ahhhhh) and long-term healing of the corneal tissue (yay!).

 

I have a patient that has a long history of severe dry that I had fit in sclerals just recently and just saw her for a follow up and she was so so happy – remarking that this is the first time in 7 years that she’s able to function without the constant pain of dry eye. She admitted there were days she could not get out of bed due to the toll that her ocular inflammation was taking on her and now – she’s happy and joyful and able to do everything she wants and needs to do. I have hundreds of stories like this and I just hope that anyone that thinks this could be an option for them to please come in for a consultation and talk to me about it. Sclerals are truly life changing.

 

More later on these incredible lenses and their other applications.

 

With love,

Dr. Telega

Dry Eye….aka Inflammation

Hi! So, many of you know that I take a special interest in dry eye. Since day one in my career – over 15 years ago (gasp!) – I have always thought that “dry eye” was a severely undertreated condition and a lot of people were suffering, glued to their artificial tears or Restasis, without much relief. Over the years, I’ve been passionate about new research, treatments, and results for all of my dry eye patients. I’m so so happy with how far we have come with a more targeted approach to the individual instead of the “one size fits all” approach of previous years. Each and every single case of dry eye is different, and layered, and therefore the treatment must be different and layered for every patient.

 

I have curated a combination of treatments and therapies available at my office to get more to the root of the cause of the inflammation and I’m so proud to be able to offer more than artificial tears for a problem well beyond. I say all the time that artificial tears can be “like putting a packet of Kool-Aid in the ocean”. It’s just sometimes not enough. There’s a time and place for ATs, but it might not be enough to gain a therapeutic endpoint alone.

 

I also think “dry eye” is a terrible name for this chronic condition. It’s inflammation. And a disruption of “homeostasis” …or how things should work. And this then triggers a cascade of bad shit….burning, tearing, discomfort, pain…and really, aging. No one wants to walk around with red, saggy eyes after years of untreated inflammation. This has become such a passion of mine and with the right treatment – relief and healing can be obtained.

 

I want to talk a lot more about dry eye but I thought I’d at least start here to just set the stage for what’s to come. Call the office and ask for a Dry Eye Evaluation – or if you aren’t sure you have dry eye or, like me, do not like the term – ask for an Eye Inflammation Evaluation.

 

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With Love,

Dr. Telega

Happy Spring!

This time of year, I am always finding myself talking to patients nonstop about allergies. Things are blooming here in the city at a rapid pace since it’s been so warm (and sunny!) and that really does create a lot of issues for allergy sufferers. Itchy, watery, puffy eyes are the biggest symptoms, but more subtle ones can exist too like mild tearing, mild foreign body sensation, difficulty wearing contact lenses. And if you also have dry eye, then all those symptoms will be exacerbated as well.

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Here is my best advice to combat those symptoms:

  1. Get ahead of the problem! Don’t wait until things are miserable to seek help because then the symptoms are much harder to control. And why be miserable?!
  2. Reduce contact lens wear if possible – those sticky little pieces of plastic can trap allergens and leave them on the ocular surface much longer…inciting a bigger response.
  3. Artificial tears can help to wash allergens off the surface of the eye – so don’t be afraid to use those.
  4. There are now some great over the counter allergy options – and I’m talking drops here – they work better for the ocular symptoms than oral allergy medications.
  5. If you still are experiencing symptoms, then get in to see your eye doctor for more aggressive therapy, no need to suffer!!!

 

Happy Spring!!

 

With love,

Dr. Telega

Hydration!

HYDRATION!!!

 

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I find myself talking about good hydration in the exam room more often these days – especially during wintertime in Pittsburgh with the heat in our homes on (hopefully not for much longer!), our work lives including the computer, dry offices, and especially if you work in a hospital (driest place ever!), and these masks!! Those of us who wear a mask all day are finding it less convenient to drink water as much as we should (am I alone here?) and therefore we are getting in way less water than we might have a year ago.

 

Seriously though, dehydration can certainly exacerbate dry eyes and I’m constantly reminding my patients to DRINK MORE WATER!! Our tear film is much more deficient when we aren’t probably hydrated. I always say – if your skin is dry and your lips are chapped then chances are your eyes are dry too.

 

On that topic – don’t forget that caffeine, alcohol, and salty foods can also deplete us and will contribute to our dehydration. By no means, though, should you give any of that up (all our faves!) but definitely have them in moderation and absolutely supplement with more water if you are taking in any of these in your diet.

 

Another benefit will be plump and glowing skin! And who doesn’t love that.

 

With love,

Dr. Telega

Dry Eye and Scleral Lens Information Center

Hello! And welcome to the new Dry Eye and Scleral Lens Information Center. Blog ….sounds too much like social media and if you know me and Shadyside Eye Associates (SEA) …we struggle with social media. But I do want to help get information out to you all to help guide, remind, and educate you on dry eye, scleral lenses, ocular health, technology, and anything else that might be useful knowledge that I can pass along! Feel free to ask questions – DM on Instagram. Or message on Facebook are probably the easiest way.

A little background on SEA and myself, Dr. Telega – I started SEA in 2013 with a strong interest in dry eye (more on that later) and specialty contact lens fittings. These two concepts go hand in hand and I felt they really were underserved in the Pittsburgh area. Dry eye is more of an umbrella term, like “pink eye”, it doesn’t really mean much anymore. Dry eye is multifactorial and oftentimes related to both internal and external causes. And, in my opinion, “dry eye” really downplays how severe, painful, and life altering it can be. But, I still use the term anyway….trust me though, I get it. Ocular inflammation is more appropriate but still not specific enough.

So, I’m hoping to leave some information here from time to time to help anyone suffering to learn about new treatment options, and new science but without being too formal and science-y. Also try to follow us on Instagram and facebook for images and helpful times as well.

 

With love,

Dr. Telega

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Summer in the City!!

Summer in the City!!

 

Finally, blue skies and baseball and music festivals and days at the park…. I have been waiting for this forever! Or since last year. And if you are a current patient of mine, you know that everyone who leaves my office gets the warning – wear UV protection!! Why? Well, because UV light can cause our eyes to age more quickly, just like it does to our skin. And just like skin damage, UV damage to our eyes is cumulative over time. That means that the younger you start wearing sunglasses – the better.

What kind of damage can UV cause? Good question. UV light can cause each different part of our eyes to age in different ways…. Let me explain:

The Retina: UV damage to the macula has long been known to trigger a disease called Age Related Macular Degeneration (ARMD). This disease can destroy central vision and there is no cure. Because it is “age related” I stress to my patients to do the things that helps to prevent aging – UV protection, eat well/good nutrition, and don’t smoke! Prevention is key to avoiding this disease.

The Lens: your natural lens of the eye is a major player in your refractive error and therefore plays a big role in how well you see. Over time, the natural lens of the eye yellows and does not let light pass through it quite as easily to get to the retina and this reduces visual acuity. Color, detail, and contrast are also reduced. What I am describing is the formation of a cataract. UV light, smoking, medications, and poor health help to accelerate this process, so again, another great reason to wear your sunglasses.

The conjunctiva: UV can cause an ugly discoloration and thickening of the exposed part of the conjunctiva, called a pinguecula. The sun is mainly responsible for these and, although they do not cause a change in vision, cosmetically, they are pretty unappealing. They can also exacerbate dry eye symptoms and cause inflammation.

The Lids: WRINKLES! Enough said. Wear your sunglasses. Big ones.

 

Hopefully I’ve convinced you about the importance of UV protection and I’ll leave you with this thought that I tell all my patients; “you can’t put sunscreen on your eyeballs, so wear sunglasses!”

(ps – Shadyside Eye Associates carries all kinds of sunwear from amazing lenses (#Costa #Persol #Rayban) to high fashion (#Prada #Tiffany #ToryBurch) to just plain awesome (#articleone #modo #Eco)!!)

Is it Dry Eye or is it Allergies?

Is it Allergies or Dry Eye?

Well, of course, the answer may be it’s both! I get a lot of patients this time of year with dry eye symptoms – the dryness, scratchiness, burning, stinging, tired eyes, discomfort, variable vision – and the questions is… is this dry eye or is it allergies? And sometimes that answer is both!

Allergic conjunctivitis can come in many different forms, and we can get into that in another blog post, but loosely defined it’s the release of histamine caused by an allergen (this time of year, think pollen but can be anything… dust mites, cats, dogs, whatever). This causes itching, swelling, tearing, mucous production, red and swollen eyes.

Generally, the treatment for ocular allergies is going to be an antihistamines, or my favorite, a combination of an antihistamine and a mast cell stabilizer. What a mast cell stabilizer? Good question, a mast cell stabilizer actually prevents the release of histamine into the conjunctiva thereby stopping the process from happening. Once histamine is released, that’s when we need an antihistamine. So, having a drop that works both ways is way better than just one or the other in my opinion.

So, what does this have to do with dry eye? Well, dry eye and ocular allergies both create inflammation to the surface of the eye and surrounding tissue. And when you have both, the problem can definitely get more severe and intolerable… basically, one makes the other worse and the problems feed of each other … making you more miserable! For example, if you have a low volume of tears, well then you can’t wash allergens out of the eyes quite as easily and they can stay on the surface of the eye longer inciting a greater response! More itching, more tearing, more scratchiness! Many times aggressive treatment is warranted if you have both to bring the inflammation down to prevent damage to the ocular surface and you will feel much better too!! It is always better to treat these issues than to suffer with them. Call the office if you need help!

Contact Lenses Over 40?? YES!

If you are over the age of 40 (ish) and wear (or want to wear) contact lenses – then you’ve probably realized that reading and computer can be more difficult (this phenomenon is called “Presbyopia”). The good news is that there are some really excellent solutions available! They include monovision contact lenses, multifocal contact lenses, gas permeable bifocal contact lenses, glasses for certain tasks, and combinations of these choices. I’ll go over monovision and multifocal contact lenses here to get started….

 

Monovision – is where one eye is corrected for distance (your dominant eye) and one eye is corrected for near. Mono works on the premise that your dominant eye is doing most of the work for distance anyway and we just kind of “exploit” that idea by helping your non-dominant eye to work a little better for reading. I find that this solution works best for people who already have a really dominant eye (one you use more than the other, kind of like someone who is very strongly right or left hand dominant) and for people who have astigmatism and want to stay in a soft contact lens. Of course, there are always drawbacks. For one, this type of contact lens fit may reduce your depth perception. Also, it can make very small print difficult. Both of this issues can be solved with part-time eyeglasses.

 

Multifocal Soft Lenses – these contact lenses use a technology where the contact lens itself has both distance and near power built INTO the lens so each eye is receiving distance and near correction at the same time. And there are many different types of these lenses and each lens manufacturer uses a little different configuration and are always coming up with new and better technology. This type of contact lens can sometimes involve some trial and error when being fit so, as a potential candidate, it is important to have patience as the brain sometimes needs a few days to adjust and adapt to the “new vision.” But in the end, it can be really amazing. These lenses are great for people who have to work at different focal points throughout the day (like distance, reading, and the computer). There are, however, some instances when glasses overtop might be necessary (like for really small print). Some cons can include a longer fitting time (while we find which one works best for you) and ghosting. Ghosting is where you might see some halos or shadowing around images in certain lighting situations. This can get better but initially it may be a problem.

 

Both types of lenses can be done in monthly, 2-week, or my favorite – dailies! Don’t forget that, as we get older, our eyes and ocular surface may become drier and therefore we would need to treat that dryness or inflammation before proceeding with a fit for the best success. If you are interested in learning more about theses lenses, and other options, please call the office, I’d love to talk more about the choices that might be right for you!

Dry Eye Treatment – Individualized

Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.

Signs and Symptoms of Dry Eye

Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.

Some people with dry eyes also experience a “foreign body sensation” – the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye’s tears.

What Causes Dry Eyes?

In dry eye syndrome, the tear glands that moisturize the eye don’t produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs:

  • As a part of the natural aging process, especially among women over age 40.
  • As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson’s medications and birth control pills.
  • Because you live in a dry, dusty or windy climate with low humidity.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you’re staring at a computer screen all day.

Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren’s Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).

Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty – a popular cosmetic surgery to eliminate droopy eyelids.

Treatment for Dry Eye

Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye – including dryness, scratchiness and burning – can usually be successfully managed.

Your eyecare practitioner may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief.

Another option for dry eye treatment involves a tiny insert filled with a lubricating ingredient. The insert is placed just inside the lower eyelid, where it continuously releases lubrication throughout the day.

If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.

Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.

To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.

For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.

If your dry eye is caused by meibomian gland dysfunction (MGD), your doctor may recommend warm compresses and suggest an in-office procedure to clear the blocked glands and restore normal function.

Doctors sometimes also recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also offer some relief.

If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.

If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.

Curious about Cataracts?

A Little Bit About Cataracts

 

Curious about cataracts?  Most people are… especially since we will all develop cataracts to some extent in our lifetimes – provided we live long enough.  Cataracts are a natural part of aging. That’s right… it happens to everyone, just like getting grey hair.  And the way I explain this to my patients is that – just like any age related change – it all depends on the individual as to how fast and how aggressive the cataract process is.  Several factors can cause the natural lens of the eye to age more quickly and I will go over those factors, but first, what are cataracts?

Cataracts affect the natural lens of the eyes and come in several different forms.  The lens is a major refracting (focusing) element of the eye.  As light enters the eye it must pass through the cornea, then through the pupil, and then through the lens to get to the retina….and it’s this lens that can get yellow over time and impede this process of getting images to the retina.  For example, typically, when the lens is young and healthy…light and color zip through the lens to get the retina and you see clearly (provided you have your refractive error corrected). Then, as time marches by, the lens gets cloudy and yellowed and thickened and now light and color can’t zip back to the retina as easily and we start to see blur, glare, haloes, loss of color and contrast, changes to refractive status, etc.  Fortunately though, this process is usually very slow and we don’t notice the changes until they are pretty far along.

 

What are the factors that can increase cataract formation?

Factors that cause these changes to be more aggressive or to develop more rapidly include trauma (this can really cause cataracts to form quickly!), intraocular surgeries, genetics (if your parents or grandparents developed cataracts at an earlier age, you might too…), health, UV exposure, medications (for example, steroids are a big one) among other factors but these are the big ones.

 

What happens if cataracts start to affect your vision?

If your vision is worsening due to cataracts, then it might be time to have them removed.  When this happens, the cataract surgeon removed the old cloudy lens and replaces it with an implant that functions to allow light to move through the eye again to get to the retina clearly.  There are many types of implants available now and they can actually result in a lesser dependence on glasses after surgery.  Very cool stuff.   

 

How can I prevent cataracts?

The best way to prevent cataract formation is to wear good sunglasses when you are outside!   UV light causes the eyes to age more quickly and this can result in a speeding up of the cataract process.  As always, health and nutrition are important factors to keeping the entire eye healthy and functioning properly.  And don’t forget to have your eyes examined yearly by your eye doctor!!