We all know the importance of an annual physical to ensure our health. But what about our eyes? Sure, you think of this as necessary only if you wear glasses or contacts, or perhaps have problems with your vision. Think again, because a comprehensive eye exam is just as important to your health as an annual physical, or an annual dental exam.
Why? You may not even know you have a vision problem. That’s right. Many eye and vision issues show no obvious signs or symptoms. Everything seems fine but that simply may not be true. Even if your vision is 20/20, if you want to be as healthy as possible, there is no better place to start than by making 2020 THE YEAR OF YOUR EYE EXAM!
Scheduling a 2020 comprehensive eye exam is the simplest step you can take to preserve your eye health. Through a comprehensive eye exam, early signs of more than 270 different diseases can be identified – such as diabetes, high blood pressure, multiple sclerosis and some kinds of cancers – before they produce symptoms. An early diagnosis and treatment plan can help ensure that your eyes remain healthy, even to the point of preventing vision loss, if such problems persist. That’s why it’s important to make proper eye care part of your ongoing health care routine.
Don’t confuse a comprehensive eye exam with a vision screening. You may remember this from your (or your children's) first days in school or the simple eye test that you take at your primary care doctor’s office. Such a simple vision screening cannot asses your overall eye and vision health. A comprehensive eye exam goes much deeper. Your health history will be reviewed, including your overall health, eye or vision symptoms, medications, and potential work-related or environmental issues that may affect your vision. The exam also will include any past issues that you and your family may have or have had with vision and health conditions. Several tests are then conducted based on your specific situation and your optometrist’s professional judgment. All of your test results will be evaluated to determine if you have any visual and health problems. If you do, as your optometrists, we will discuss these problems and recommend treatment options, including the need for additional testing or consultation with other health care providers.
Give yourself peace of mind and show you care for your eyes and vision as part of your overall health routine by scheduling a #2020EyeExam for you and your family today!
Concerned about the waste created by your contact lenses?
Bring your blister packs, top foil and used contacts to our practice. At Uptown EyeCare, we collaborate with TerraCycle and Baush+Lomb OneByOne Recycling Program to recycle everything for you at no cost!
Also In This Issue ...
2) OUR NEW MANAGEMENT SOFTWARE Uptown EyeCare is excited to spend more time providing top notch personalized customer service by automating more tasks. see SOLUTIONREACH below...
3) LASHING OUT - DANGEROUS BEAUTY TRENDS The quest for longer, thicker and darker eyelashes and eyes that appear larger, does not come without risk. see LASH BEAUTY OVER FUNCTION below...
4) CHOOSE TO BE LIMITLESS, CHOOSE CRT! Learn how Paragon CRT (Corneal Refractive Therapy) helped our own employee see her life without limits! Read Morgan’s own story educating you what to expect and experience when you start wearing CRT lenses. see CRT LENSES below...
At the beginning of 2019, our practice implemented an automatic appointment reminder and recall system called Solutionreach! We have been pleased with its simplicity, usefulness and improved patient engagement for the past year so far, allowing us to spend more one-on-one quality time with each customer.
This management system allows all of our patients to be informed about their upcoming appointments via texting and/or email reminders. We ask that you confirm electronically that you are coming to your scheduled appointment, so we can keep the time reserved just for you. We also use electronic reminders to remind you when you are due for your annual routine eye exam. If you have a medical recall with us, one of our friendly staff members will contact you personally to schedule the necessary tests or follow up appointments with Dr. Friberg.
Patient are now able to TEXT USand /or REQUEST APPOINTMENTS ONLINEas well. We will be able to text you right back and help you with your immediate scheduling, or administrative needs. Remember, sharing certain medical information via text may not be secure, so we may have to send you a HIPAA-compliant waiver if you prefer this method of communication. Sensitive medical information is best sent via your SECURE PORTAL ACCESS.
If you would like, you will be able to leave us your feedback after each appointment either via our Internal Survey, or you will receive an invitation to review us on Google or Facebook.
Hopefully you will enjoy our new electronic software and stay engaged with us. If you have any questions, concerns, or would wish to change your personalized settings as to how and when you would like to receive your reminders, we are happy to customize it for you according to your personal or family needs.
The eyes are one of the biggest markers of facial attractiveness, and everyone has taken notice. The beauty industry is more than happy to aid consumers in enhancing their eyes. Salon and at-home eyelash augmentation procedures are projected to continue expanding and growing in popularity in the market, and false eyelashes alone are expected to bring in almost two billion dollars by the end of 2024.
The quest for longer, thicker and darker eyelashes and eyes that appear larger, however, does not come without risk. This is a risk many patients don’t mind taking, as they are often unwilling to give up their beauty regimen. Even knowing the risks might not be enough for patients to discontinue eye-enhancing procedures. According to a 2012 study, 97.5 percent of women who had eyelash extensions reported at least one complication after their treatment. As your care providers, our job is to advise you on safe practices when it comes to lash beauty, and help you to prevent negative sequelae associated with these beauty trends.
False Eyelashes
These are categorized as strip lashes, individual flare lashes and single individual lashes, and are made from real hair or synthetic material. These lashes are applied at the lid margin above the existing lashes with glue, which often contains harsh ingredients with allergenic properties, including formaldehyde and latex. False lashes are associated with allergic contact dermatitis, blepharoconjunctivitis and abrasions secondary to application, removal and lash-fall.
A newer false eyelash alternative created to avoid glues is the magnetic false eyelash. These lashes can be applied in two ways—either small magnets sandwich a patient’s real lashes between a set of upper and lower false lashes or the magnetic false lashes attach above the lash line to a thick line of metallic-based eyeliner. Risks include application abrasion, lash-fall due to the weight of the magnets and metal allergies in the case of the eyeliner version.
If patients choose to use false eyelashes, we recommend that they use glues that do not contain formaldehyde, choose lashes of a natural length—1/3 the eye width to facilitate the best ocular health by maintaining proper aerodynamic flow and avoiding funneling air and debris into the ocular surface—and use partial strips instead of ones that extend the full lash line to avoid using more material than necessary. Patients should take breaks in false lash wear or reserve them for special occasions. Placing a small amount of glue or metallic eyeliner on the inside of the wrist for a “patch test” could alert patients to potential allergies before contact dermatitis occurs on their eyelid.
Lash and lid procedures were created to enhance and rarely replace make-up. Mascara is often used in conjunction with false eyelashes to help “blend” them with the real ones. The addition of ocular cosmetics further increases the risk of irritation, allergic reaction and infection. Eye cosmetics themselves can contain allergenic and toxic additives.
Eyelash Extensions
This approach differs from false eyelashes in their application. Extensions are applied by gluing a single hair or synthetic lash to an existing anatomic eyelash. This is a long process and takes a trained esthetician between one and three hours to apply 50 to 200 lash extensions individually with forceps. The glues involved with application contain the same allergenic ingredients as false lashes, sometimes in even stronger concentrations. Post-application ocular irritation is common.
Most professional estheticians recommend re-doing or “filling” extensions every two to four weeks to replace lashes that have fallen as part of the natural life cycle of an eyelash—four to 11 months depending on ocular health—and achieve the best look. In order to “fill” extensions, old extensions must first be removed. Removal is often achieved by using ocular-irritating glue solvents combined with fragrances. Even in the best-case scenario, some of the remover will make its way to the ocular surface, as it would with traditional eye makeup remover. A closed eye is not an air- or water-tight seal. Hygiene may become an issue, as these lashes are meant to be worn for weeks at a time. Extensions have the same potential complications as false eyelashes, with added infective risks of chalazia/hordeola and blepharitis.
Safer practices for eyelash extensions include using glues that do not contain formaldehyde and removers that are oil-based. Patients need to practice lid hygiene and understand that extensions are not like jeans that you don’t wash in an effort to protect the look. Over-the-counter (OTC) hypochlorous acid is a cleaning option that will not dissolve the glues. More natural lash lengths are also preferable.
Eyelash Perming
Sometimes known as a “lash-lift,” lash perming is a trend that may be a bit harder to detect, as there are no false lash materials involved. The only way to know if a patient has undergone a lash-lift is via their case history. The goal with a lash-lift is for the natural eyelashes to curl up and outward. During this procedure, the eyelashes are wrapped around a metallic or plastic rod that either is coated in adhesive or comes with an adhesive for the patient/esthetician to paint on the rod. Some kits use plastic “clips” to keep the lashes in place. Then, perming and neutralizer solutions containing highly ocular toxic active ingredients—hydrogen peroxide and thioglycolic acid—and other irritating additives are applied. The entire process takes 10 to 15 minutes.
Patients should avoid lash lifting due to the potential risks. However, if a patient is adamant about attempting a lash-lift, only a highly trained professional esthetician should perform this procedure to mitigate the amount of perming and neutralizing solutions on the ocular surface. The main risk involved in lash lifting is toxic keratoconjunctivitis, and allergic reactions to perming solutions and adhesives are known to occur. Patients should see their eye doctor immediately if significant irritation ensues.
Eyelash Tinting
In this cosmetic procedure, permanent dyes are applied to darken the eyelashes. Similar to lash perming, the lashes are wrapped around a sticky plastic or metal rod and permanent dye is applied and allowed to set. Ocular toxic and allergenic ingredients commonly found in lash tinting products include hydrogen peroxide, dyes and fragrances. The main risk associated with the procedure is an allergic reaction. Again, these allergens will persist for the natural life cycle of an eyelash. Stripping the dye out comes with the risk of permanent damage to the follicle. Like lash lifting, lash tinting should be avoided, but if a patient is adamant about proceeding, only a highly trained esthetician who is willing to “patch test” prior to the tint should perform the procedure. Lash tinting is often combined with lash lifting, so the risks are twofold, and extra caution should be taken.
While eyelash extensions, perming and tinting are all highly recommended to be done by a licensed esthetician, all the products necessary for patients to self-administer are available online and don’t require a medical or esthetician license. With these lash procedures costing hundreds of dollars, the number of home attempts is high, as is the risk for mistakes.
Eyelash Serums
When Latisse (bimatoprost 0.03%, Allergan) was first approved by the FDA in 2008, it changed the pharmaceutical and cosmetic industries. The crucial side effect of darker and thicker eyelashes when this prostaglandin analog was used for glaucoma did not go unnoticed. Daily application along the lash line targets the anagen phase of the eyelash growth cycle, causing longer, thicker and more melanin deposition in the eyelash. This prostaglandin analog may also increase the number of eyelashes in the follicle, cause skin and iris pigmentation, conjunctival hyperemia, pruritus (itching) and lash-loss and lower intraocular pressure.
OTC eyelash serums have risen in popularity in the beauty industry to compete with Latisse. These OTC options can contain synthetic prostaglandins with identical side effects to the pharmaceutical option. Unlike pharma companies, cosmetic companies are not required to list these potential side effects in their packaging. Synthetic prostaglandins can be difficult to spot unless you are familiar with their common names. The key is to look for “prost” as an indicator of a potential synthetic prostaglandin ingredient. Some OTC lash serums that do not contain synthetic prostaglandins include polypeptide and lipopeptide formulations of amino acids that support eyelash growth. Even the lipopeptide and polypeptide versions do not necessarily come without risk and may contain other irritating ingredients, so it is important to read the ingredient list.
The healthiest practice for using eyelash serums is to advise patients to choose options that do not include prostaglandins. Any patient using a prostaglandin lash serum should be followed regularly to monitor ocular health. Patients with chronic ocular inflammatory conditions, including dry eye disease, should avoid prostaglandin lash serums.
Tattooed Eyeliner
Often referred to as “permanent makeup,” this is a misnomer, as tattooed eyeliner does not last forever. Most tattoos require touch-ups over time as the ink fades. Black eyeliner fades to a bluish tinge, making it easy to detect, and the ink does not always stay contained in the target location, leading to pigment spreading. The ink used in tattooing is not regulated or necessarily consistent between professional tattoo artists. Black, white and colored inks contain metallic ingredients, which can be allergy-inducing. In addition, tattooing can cause bruising, swelling, infections, scarring, granuloma formation, photo-toxicity and lamellar keratitis.
A study examining the association between tattoos and meibomian gland dysfunction (MGD) found that tattooed patients demonstrated reduced tear break-up time, loss of meibomian gland architecture and increased corneal staining. The impact of the concussive damage and chemical toxicity is also theorized to be contributory to MGD. Permanent makeup on the eyelid should be avoided, as this is not a procedure that can be reversed.
Conclusion
To keep your eyes safe, lash enhancements should be performed by an experienced and licensed esthetician in a sanitary setting, with chemicals that are safe for your skin. You should steer clear of cheaply made products or self-applications. The procedure does come with risks, namely: trauma to or infection of the eyelid or cornea, allergic reaction to the glue, and permanent or temporary loss of eyelashes. Remember that eyelash extensions, adhesives and solutions used during these procedures are not all currently regulated by the FDA, so you should first test them on your wrists before applying to your eyelashes.
The most important fact to consider is that lengthened lashes create a “funneling effect” of foreign particles toward the eye. This prevents the lashes from performing their protective function and therefore increase your risk of irritation, infection, inflammation and ocular surface disease. Thus the importance of routine cleansing regimen should be emphasized in order to mitigate this increased risk. Traditional methods for eyelid hygiene and prevention of meibomian gland dysfunction, blepharitis, demodex and sty formation are appropriate: mild tear-free soap and water and Ocusoft wipes/cleansing foam. Regardless of the cleansing technique, the goal is to prevent buildup of debris and bacteria, which now have a larger surface area on which to accumulate.
Maintaining the health of the eyelid margin will prevent some of the chronic problems associated with lash modifications. If patient aren’t mindful of the steps they are taking to modify their eye appearance, they may end of doing more harm then good.
After 13 years of not being able to find the right soft contact lens for me, I realized I was running out of options. I had tried numerous contact lens brands and it didn’t matter if it was a monthly, bi-weekly or daily lens; my eyes always felt dry, tired and I could feel the lenses throughout the day. They never felt comfortable. Not wanting to become a full-time eyeglasses wearer and knowing I was not a good candidate for LASIK, I decided to give CRT lenses a try.
So, what is CRT? CRT (Corneal Refractive Therapy) is a form of orthokeratology that utilizes a unique rigid gas permeable contact lens designed to temporarily correct myopia (nearsightedness) by reshaping your cornea while you sleep. When worn overnight, CRT lenses gently correct the curvature of the cornea resulting in a flatter corneal shape that focuses light correctly onto the retina. CRT lenses are designed to allow the patient to see through them so if you awaken in the middle of the night, or put them on before bed, you are still able to see out of them and function with them. When removed in the morning, distant objects will come back into focus and patients can see clearly without the use of eyeglasses or daytime contacts.
Usually optimal vision can be achieved after 10-14 days of new wear, though some patients may be able to see clearly during the first few days. There may be initial awareness and adaptation in getting used to wearing the contact lens, but the therapy itself should not be painful. It is important that overnight CRT lens wear is continued on a prescribed schedule. Failure to do so can affect daily activities, since there will be visual fluctuations and changes in the intended correction. Lenses with time can become scratched or covered with protein/lipid build-up, therefore, it is recommended that the CRT lenses be replaced once a year for optimal eye health. And it is imperative that you see your eye care provider on a yearly basis!
The initial process involved my eyecare provider (Dr. Friberg) measuring the shape of my cornea with a Topography machine and determining which lenses would work best for me and my prescription. The initial fitting was not very comfortable. It was not painful, but my eyes would tear up excessively since they were not accustomed to this new feeling. The lenses felt heavy and with each blink I could feel the lens move and rub against my upper eyelid. My vision was checked with them on and Dr. Friberg checked to make sure they were fitting and sitting correctly.
I was educated on how to insert and remove the lenses before I went home. Insertion was easy due to my experience from wearing soft contact lenses. It is important that the placement of the lens is in the correct location. Soft contact lenses are more pliable and easier to move inside the eye so if the lens didn’t feel right, I would simply move the lens around with my index finger. With CRT lenses, its hard to move the lens around and adjust it, since the lenses are thicker and heavier. There’s a lot of discomfort when you try moving the lens, so if it’s not in the correct spot, it’s best to remove and re-insert. Removing the lenses took much more practice for me. I was given a small plunger-tool to help remove the lenses and after a few tries it did become easier. I was shown how to clean and store my lenses and was sent home with instructions to wear my CRT lenses overnight and continue to wear them in the morning to my first follow up appointment the next morning.
The first night wearing my CRT lenses things went smoothly. My eyes teared up a bit after inserting the lenses, but I had no issues sleeping with them. The following morning, I continued with my daily routine but kept the lenses in my eyes per the instructions I was given. Getting ready with the lenses was troublesome since I was not used to wearing them while awake. Dr. Friberg checked how the lenses were fitting and then I removed them. She took more measurements and checked my vision without any correction. I was shocked to see how clear the world was just after one night! I could read the 20/20 line easily without the aid of my glasses or soft contact lenses! I was warned that my vision would likely fluctuate the first few days and that I might need to rely on soft contact lenses of a different prescription power than my habitual lenses as the day progressed, but I decided to make do without any soft contacts and test my “new” and improved vision. I was able to get good vision for a good part of my day. By early afternoon things were fuzzy, but still manageable.
With each passing day my eyes would tear up less and less. The “heavy” feeling I was experiencing when I would wear the lenses was becoming less bothersome. My eyes had gotten used to how the lenses felt so by the 3rd and 4th day I was acclimated to them and felt comfortable with having them in my eyes. I also noticed my vision was fluctuating less and I was able to get clear vision until the evening hours. I had a one week follow up appointment at the end of the my work day to test to see how my vision was doing and I was able to see the 20/20 line pretty good. It was a little fuzzy, but I could make out the letters correctly. By the one week mark I felt like a pro with putting my lenses and taking them out. On some occasions I did have the situation where the lens didn’t feel like it was placed in the right spot.
Removing the lens, cleaning it and reinserting lens always fixed the problem. I continued having quick follow ups with Dr. Friberg to ensure the lenses were working how they were designed to. The visits have become less frequent but they still occur.
12 months later I am still wearing my CRT lenses and they have given me so much freedom! I no longer have to worry about things like over-wearing my soft contact lenses or falling asleep in them since it’s okay to sleep with my CRT lenses. I get really good vision for long days now. I will admit that I have accidentally forgotten to put my lenses in a time or two before bed and have been surprised to see that my vision is still good for a period of time and then it gets blurry which is why it is imperative you wear them nightly. I no longer have to resort to wearing my eyeglasses during allergy season (my soft contact lenses made my eyes feel itchy and dry).
I have more freedom with outdoor activities where my eyeglasses would get in the way. Overall, this has been a positive and limitless experience for me, and I wish knew about this option sooner. I literally put my lenses on, go to sleep and when I wake up, I remove them and can see!
By Morgan Uribe, Uptown EyeCare’s optometric assistant
Now considered a major health concern, myopia (nearsightedness) has increased by 66% in the United States since 1971. By 2050, the WHO (World Health Organization) predicts that 50% of the world will be myopic. Onset can begin as early as age 6, and early detection with annual eye exams is the key to prevention and reduction of potentially serious complications later in life.
The exciting benefit for children is that CRT lenses have shown a 50-60% reduction of myopia progression! How do these lenses do that? By creating a phenomena called “peripheral hyperopic defocus”, where the retina receives a clear zone of vision surrounded by a ring of defocused vision from the CRT design, and it is this defocused area what slows or stops the signal to elongate the eye, thereby reducing myopia progression.
Today’s frame styles are available in many different materials, from many different sources. Material and production are key in the overall quality of a frame, which makes this an elemental reason to consider high quality materials when selecting a frame. With the availability of cheap frames and cheap lenses online, glasses are developing a reputation as a disposable item these days. But, as in all things “you get what you pay for”.
There are significant differences in frame materials. The following is a brief summary of frame materials, their advantages and disadvantages:
Cellulose acetate used in eyewear is handmade plastic material, and mainly produced in Italy. It is derived from cotton. Cellulose acetate is formed into small rectangular, colorful pieces. The pieces can be arranged in a variety of ways to make a unique color palette and layout. Frame manufacturers who use this high-end plastic material are capable of achieving color saturation that is more intense than plastics used in an injection molded frame. Once the frames are hand designed and carved, they are tumble finished to bring out the material’s shine. They are then finished off by hand polishing. Cellulose acetate can last many years before showing signs of aging or brittling, but can be susceptible to excessive heat. (Featured Etnia Barcelona above)
Injection molded plastic framesare made from petroleum, and generally sourced from China. The materials come in pellet form. A machine melts the pellets and injects them into a mold of the specific shape. After that, a spray application is used to apply color and they are tumbled for shine. Injection mold frames are generally less expensive and considered to be lower quality. They are more susceptible to becoming brittle and scratched with wear, and tend to contain hidden defects from the injection process.
Ultemis a semi-transparent high strength plastic material that can withstand high temperatures and remain undamaged. It is very light in weight and flexible, making it a great material for glasses frames for active people and children. (Featured: 141 Eyewear below)
Stainless steel is an alloy made mainly of iron, with a mix of nickel, manganese, and chromium. Stainless steel can produce a thin and sturdy frame with strong corrosion resistance. Qualities of stainless-steel frames include light weight, low toxicity, and strength. Most stainless-steel frames are nickel-free, which makes them hypoallergenic. (Featured: Mykita below)
Titanium is extremely lightweight and will not rust, making it a very popular material for eyeglass frames. Titanium’s strength allows it to be made thin. It is known for its beneficial qualities of strength, lightness, and flexibility. Eyeglass frames that are 100 percent titanium are hypo-allergenic, making this material a good choice for individuals with allergies to other eyeglass materials. Many designer frame brands, such as Bevel, use titanium in some part of their collections.
Aluminum is very lightweight, low in density, but difficult to weld, which limits its adaptability to different designs. Hinges, nose pads and end pieces must be usually fastened with rivets or screws, increasing the change of frame breakage. Aluminum is also very stiff, which limits its versatility. Those who used to wear Kilsgaard frames from us may remember that we always needed to adjust your frames very carefully with special tools, and the adjustments were unfortunately always pretty limited.
Trilastonis a new state-of-the-art nickel-free memory alloy that enables a twisted or bent frame to return to its original shape, therefore holding its adjustments longer. In our collection, EasyTwist Eyewear is an ideal brand for kids of all ages who want low-fuss, durable frames.
Wood, bone and buffalo horn are usually hand-made and one-of-a-kind pieces. Wood and bone, although stiffer (and therefore very hard to adjust), and much more expensive than other frame materials, are appealing because of its beauty. Buffalo horn frames have an elegant look, but are usually also challenging to adjust and can crack easily.
In conclusion, the longevity, durability, and overall performance of your eyeglasses is dependent upon the quality of the products they are composed of. Choosing a frame made of high-quality materials is making an investment not only in your vision, but in yourself. Your glasses are a part of how people view you, assess you, and remember you. Keep your quality at face value!
By Lori Nasshahn, Uptown EyeCare’s optician, sourced from “Frame Materials” by Amy Endo, AOA.
Today’s progressive lenses provide clients with a “personalized” lens based on measurements of their selected frame, or “customized” based on lifestyle questionnaires. In this article, learn how Shamir Intelligence Progressive lenses use big data on demographic analytics and artificial intelligence to produce a first in its kind continuous progressive lens design concept.
For the past 29 years, I’ve worked with and dispensed many different brands and types of progressive lenses, and I have really been enjoying the new Intelligence lenses by Shamir. Being a “middle presbyope”, I’ve found that the distance vision in these lenses is very wide and comfortable, and the transition between distance and near vision is remarkably smooth. I’ve become a huge fan of this lens, and I have had great success in dispensing them to my patients!
The technological advances Shamir has made in the lens design are unique and unprecedented. They have actually researched how patients use their progressives relative to their age group, and found that not all progressive wearers wear their lenses in the same way.
Traditional progressive designs tend to offer consistent zones for distance, intermediate and near, no matter what the add power is (see chart below). The research that Shamir has done shows that as a person ages their visual needs change. For example, younger and middle presbyopes need a solution for digital reading (cell phones and tablets), and tend to move back and forth between distance and near more frequently. By contrast, older presbyopes move back and forth from distance and near less frequently, needing a more balanced solution. By deducing one’s “visual age” via the add power, and combining that with extra custom measurements, we are now able to make a progressive lens that is very honed in to each individual’s visual needs.
Because of this new technology, each lens is unique according to the patient’s “visual age”. This makes the progressive design much easier to adapt to for new wearers, and vision is much more natural and smoother for current progressive wearers. We as eyecare practitioners are now so much less limited as to how we can solve the visual needs of all of our presbyopic patients!
