Many people like to rub their eyes. They get sore, feel a little itchy, and a good rub makes them feel a lot better. Many of my patients like to rub their eyes in the morning just as a part of waking up. What almost everyone (except your eye doctor) doesn’t know is how bad it is to rub your eyes. And the harder and longer you rub them, the worse it is for your eyes.

What can rubbing the eyes do that is harmful? Well, how about retinal detachment, which can cause a serious loss of vision, requiring a surgery to maintain vision. Less serious is a vitreous detachment, which can result in annoying floaters and also lead to the more serious retinal detachment. Extreme rubbing in sensitive individual can also lead t the development of keratoconus, which is a corneal condition that can significantly impact vision.

It is okay to rub the eyelids, and the skin around the eyes – it is the eyeball itself that should not be rubbed. Rubbing increases the pressure inside the eyeball, which can lead to damage to the delicate structures inside the eye.

So if you want to rub, find something else to relieve that desire. Try a cool towel or simply squeeze your eyes close. But do not – do not – rub your eyes with your knuckles or your fingers!

onjunctivitis is one of the most common and easily treatable ocular conditions affecting both adults and children. To ensure complete clearing of the condition, it is important to differentiate between allergic conjunctivitis, vernal keratoconjunctivtis (VKC) and other diseases that may have similar symptoms.

Allergic conjunctivitis, VKC and diseases, such as uveitis and chalazia, require different treatment modalities for effective clearing. Proper treatment begins with a diagnosis made during a comprehensive eye examination. In both allergic conjunctivitis and VKC, most treatments aim to reduce symptoms, but in the case of VKC, antibiotics might be necessary to treat corneal ulcers, and cycloplegia might also be required to treat an iritis caused by the corneal ulcers. VKC can be identified during an eye examination by several hallmarks, including the presence of large conjunctival papillae on the back of the superior tarsus and areas of superficial punctate keratitis. Severe cases may also present with well-demarcated corneal shield ulcers. Chalazia and uveitis, on the other hand, are characterized by a build up of immune cells and are often effectively cleared with topical steroids.

The most common symptoms of allergic conjunctivitis are itching and redness. Eyelids may also be swollen and red, and in most cases patients will report a history of allergies. Allergic conjunctivitis typically produces a watery discharge and does not involve the cornea. If a patient presents with a thick, rope-like discharge with severe itching and corneal involvement, VKC is most likely the culprit.

Patients experiencing allergic conjunctivitis may find some relief with the following treatments:

• cold compresses;
• artificial tears and other eye drops, which lubricate the ocular surface and flush away the allergens; and
• topical decongestants that cause vasoconstriction, which may also prevent the release of chemical mediators, reducing hyperemia and other symptoms.

Any eye condition that causes persistent irritation can result in more-serious complications if not treated quickly and effectively. Because allergic conjunctivitis is common, but other conditions may mimic its symptoms, a thorough eye examination is essential for a proper diagnosis.

Vision disorders are the fourth most common disability in the United States and comprise the most widespread handicapping condition in childhood. Early detection of vision problems, such as amblyopia, strabismus, and significant refractive error, ensures effective treatment and arrest the further development of many of these conditions. Yet

• <15 % of preschool children undergo a comprehensive eye examination and

• <22% receive any type of vision screening.

The American Academy of Pediatrics, the American Association of Certified Orthoptists, the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus have issued a joint policy statement recommending that every child undergo a comprehensive vision examination before entering school, preferably between the ages of 3 and 3/12 years.

The National Eye Institute, part of the National Institutes of Health, created the Vision in Preschoolers (VIP), a multicenter clinical study designed to determine the efficacy and accuracy of preschool vision testing for amblyopia, strabismus, significant refractive error, and/or reduced visual acuity. During the first 2 study phases, approximately 4000 children received comprehensive eye examinations to test for these conditions.

The results of phases 1 and 2 indicated that >99% of children enrolled in the study were able to be successfully tested. Moreover, when the tests were used by highly skilled personnel, such as ophthalmologists trained to work with young children, approximately 66% of children within ≥1 targeted disorders were identified, as well as 90% of those children with the most serious conditions. Phase 3 is still ongoing.

Baby boomers who want to rid themselves of their contact lenses should consider laser in-situ kertomileusis (LASIK) surgery as a viable option. Although LASIK traditionally has been considered less effective in individuals >40 years of age, a study shows new techniques offer better outcomes for middle aged and older patients.

In this retrospective consecutive cases series, Ghanem et al from Harvard Medical School, Massachusetts, studied outcomes in 710 eyes of 424 patients aged 40-69 years who underwent LASIK between 1999 and 2005.

The study group had refractive spherical errors ranging from -10.5 diopters (D) to +6 D and cylinder of up to 2.50 D.  Patients were divided by age into 3 groups: 40-49 years, 50-59 years and 60-69 years.  All LASIK procedures were performed by the same surgeon.  Outcomes were analyzed for nearsightedness with or without astigmatism (511 eyes) and farsightedness with or without astigmatism (199 eyes).  Outcomes were based on postoperative follow-up visits of at least 6 months.

The study indicated postoperative safety, efficacy and predictability were comparable among all age groups.  At the final follow-up, 80-100% of eyes in all groups had 20/30 or better uncorrected visual acuity and 81-90% were within ±1 D. In all 3 groups, 91-100% of patients achieved 20/40 or better visual acuity following LASIK.

Many LASIK patients in the study opted for monovision, a strategy that offers distinct advantages in addressing presbyopia, a condition often present in an older population.  In monovision, one eye is corrected for distance vision, while the other eye is corrected for near vision, often eliminating the need for reading glasses.  Researchers indicated that monovision can effectively compensate for the loss of accommodation that often occurs in older patients.  The study concluded that despite challenges unique in the 40- to 69-year age group, LASIK correction for nearsightedness and farsightedness has reasonable safety, efficacy and predictability.

Ghanem RC, de la Cruz J, Tobaigy FM, et al. LASIK in the presbyopic age group: safety, efficacy, and predictability in 40- to 69-year-old patients. Ophthalmology 2007; 114:1303-1310.

Thanks to continued advances in refractive surgery tools and techniques, glasses and contact lenses are fast becoming obsolete for many patients with astigmatism. Patients with undetected astigmatism often experience headaches, fatigue, eyestrain and
blurred vision at all distances. Because astigmatism may not be recognized as the cause of these symptoms, this condition may go undiagnosed and continue to affect sufferers. Astigmatism can also
be present in children, affecting their ability to see well in school and while playing sports.

Characterized by an irregular curvature of the cornea, astigmatism can be detected by regular eye examinations and successfully treated using procedures such as laser in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), laser thermokeratoplasy (LTK) and astigmatic keratotomy (AK; Table 1). An ophthalmologist can determine which type of procedure will work best for each patient.

Worldwide, >17 million people have undergone laser refractive surgery, and refractive surgery is one of the most commonly performed operations in the United States. The newest laser-assisted procedures are approved by the U.S. Food and Drug Administration to treat up to 6 diopters (D) of astigmatism correction, which includes roughly 98% of all astigmatism patients. Advances in laser technology continue to improve treatment outcomes.

Guttman reported on a recent study by Barraquer, a private practitioner in Colombia, of 364 astigmatic myopic patients treated with a new generation “flying spot” excimer laser. Barraquer reported postoperative best-corrected visual acuity of 20/20 or better in 99% of treated eyes at 3 months. Astigmatic correction was achieved to within ±0.50 D in 92% of eyes.

Regular eye examinations can detect the presence of astigmatism and treat it in its early stages. Because children may also have astigmatism, it is important that eye examinations be scheduled at regular intervals to detect any astigmatism early on.

Guttman C. Laser yields safe, predictable correction for astigmatism. Ophthalmology Times, Advanstar Communications, January 1, 2008;36.

Doctors say there is too much staring and not enough blinking among Americans, and it is resulting in an annoying condition called “computer vision syndrome.” This syndrome is not one defined disorder, but a collection of symptoms that are affecting people young and old who work, study, and play in front of a screen. Industry officials believe it’s more widespread than repetitive motion injuries, such as carpal-tunnel syndrome.

42 percent of respondents in a recent nationwide survey say they use a computer or hand-held device for three or more hours a day.  Most people fail to blink or take enough breaks, their lights are too bright and their computer screens are positioned incorrectly, with the result that about three-quarters of the computer users report eye problems.

The solutions are simple, but not always easy to implement: 1) Take a “vision break” for a few seconds every ten minutes: close your eyes or stare at some distant object out the window or across the room to relax your focusing muscles. 2) Remember to blink enough. We should blink every five seconds in order to keep our eyes properly healthy and moist. When we are concentrating on a screen, we on average blink only once every ten seconds, which can cause the eyes to become dry and fatigued, also blurring the vision. 3) Be aware of the angle of your computer screen and your distance to the screen. Sitting closer to the screen causes more eye fatigue.

Andrew Caster MD – Caster Eye Center:  Excellence in Laser Vision Correction of Nearsightedness · Farsightedness · Astigmatism

A note from Dr. Caster:

Lasik laser vision correction is one of the great medical advances of our time. Although you may have lived most of your lifetime with poor vision, you can now have this painless five-minute treatment and literally walk out without glasses or contact lenses. There is really no other medical procedure which combines such a profound improvement with lack of pain and very rapid recovery. I had my own nearsightedness and astigmatism corrected with Lasik in 1996, and I have enjoyed wonderful vision ever since.

I have been an ophthalmologist for almost twenty five years, but for the past twelve years I have dedicated my practice exclusively to Lasik laser vision correction. This specialization is one of the keys to our great results. When you apply all of your talent and energies in one focused area, you learn how to do it very, very well.

No one has technology that surpasses us. We have three different lasers to choose from, including our favorite, the WaveLight Allegretto. We perform all variations of laser vision correction, including Lasik, IntraLase, PRK, and Lasek. All treatments at the Caster Eye Center use Custom wavefront technology.

Laser vision correction is not right for everyone. We will only perform your treatment if we are confident that we can obtain excellent results. We advise 30% of our patients not to have laser vision correction, because they are not ideal candidates. If a different procedure is more appropriate for you, we will refer you to a top specialist in that particular technique.

One of the most important aspects of medicine is the caring approach of the doctor. A doctor who really cares will spend time talking to the patient. The truly caring doctor will use only the best equipment, will be extremely meticulous in all aspects of measurement and treatment, and will insist on having only superbly trained staff. When you speak with us, when you visit our office, and when you have your treatment, you will see the experience and the caring attitude. And you will appreciate the difference each day thereafter as you enjoy your new vision.

I look forward to meeting you.

Sincerely,
Andrew I. Caster, MD, FACS