When Allergies Come ‘March’-ing In

By Stephen Cohen, O.D.

Although allergies can occur year-round, we are now entering the prime season…beautiful weather that reminds us why we live here, but a huge challenge trying to fend off the plethora of allergens floating around. Up to 30 percent of Americans have some form of allergy, and itchy, watery eyes ranks No. 1 as the most annoying symptom (ahead of runny nose, sneezing and scratchy throat). Most people are left to feel that they “just have to learn to live with it.” Fortunately, that is not the case.

The hallmark ocular allergy symptom is itchiness. Other ocular symptoms can include redness, tearing, increased mucous production, foreign body sensation, grittiness and scratchiness. During the height of allergy symptoms, people may also complain about blurry vision, and many contact lens wearers cannot tolerate having their lenses in their eyes.

Most people will “self-medicate” with OTC allergy products, which may not be effective and can even cause adverse reactions. Unlike “pink eye” (Bacterial Conjunctivitis), an antibiotic is ineffective in treating allergies, and since the signs of allergic conjunctivitis often look similar, many health care providers often try an antibiotic first. Newer prescription allergy medications provide both antihistaminic relief of symptoms, and also control the underlying cause of allergy symptoms, often providing some relief within even one or two doses. For severe symptoms, a steroid drop may be added for short term use. Cool compresses and certain lubricating drops can also provide some relief of symptoms. Lastly, there are oral non-sedating prescription antihistamines, which have been effective in decreasing ocular allergy symptoms along with the typical nose, sinus and throat symptoms. It is important to note, however, that with the use of antihistamines, we experience an increase in dry eye symptoms. This can be a particular challenge to contact lens wearers.

If you are an allergy sufferer, you know how debilitating it can be. For those who do, it’s a shame to have to look forward to the “dog days of summer,” when allergens tend to decrease, in order to find relief. Allergies cannot be cured, but they can be controlled. Your eye doctor can help you come up with a plan that will control and often prevent ocular allergy symptoms. What do you have to lose, except your itchy, watery, mucousy, blurry, scratchy, gritty eye symptoms? And that’s “nothing to sneeze at.”

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Blue Light: The Visible Danger

By Stephen Cohen, O.D.

Over the past decade, our lives have been transformed due to smartphones, tablets and other handheld devices. These devices are backlit by LED light. Also, legislation has been implemented that require that incandescent light bulbs be replaced by more energy efficient LED bulbs. Unfortunately, this change in technology has come with a price tag: these devices emit high levels of “blue light.”

Think about the colors of the rainbow. On the spectrum, blue light is right next to ultraviolet radiation (UV). We know that UV (which we cannot see) can be damaging to our skin and to our eyes. Its neighbor, blue light, has been found to cause numerous problems in higher and extended doses. Although the sun is the major source of all wavelengths of light, including blue light, we have experienced a tremendous increase in blue light exposure in other settings, such as in our office, on our laptop and even in our beds when we tend to use our smartphones and tablets before going to sleep.

Here are some of the challenges we now face. Blue light suppresses melatonin, which helps us fall asleep. Using a smartphone in bed for a short time in anticipation of sleep actually wakes us up. Apple has come up with an adjustment to turn down the blue light at night in an attempt to counteract this problem for its iPhone users. Blue light also causes significant eyestrain. This can affect visual comfort, moods and behavior, whether for adults in an office, or, more significantly, for children in a classroom.

There is growing evidence that long-term exposure to blue light (which has been found to penetrate deeper into our eyes) may contribute to Macular Degeneration later in life. Protecting your eyes now will not only help to improve your quality of life today, it can help in the future as well. There are now coatings that can be applied to lens surfaces that block UV, glare and blue light. This can enhance clarity (since the “blue” end of the visible spectrum tends to be more distorting), reduce strain and protect your eyes. Special filters on computer/tablet screens can reduce blue light exposure. Using the adjustment settings on your smartphone can also reduce exposure to higher levels of blue light.

We are familiar with the term unintended consequences, where some advance provides benefits but can also cause unanticipated challenges. Such is the case with lighting changes that were made for environmental benefits. So, while we help to protect our environment, let’s protect our eye health and visual comfort as well.


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The Magnificent Seven

By Stephen Cohen, O.D.

Most people cherish their vision more than any other sense. However, like many things in life, we often become most motivated to preserve our vision only when we find ourselves at risk to lose our vision. With deference to the proverbial “an ounce of prevention,” here are seven things you can easily do to help protect your eyes.

  1. UV or Not UV: Ultraviolet radiation can cause both short and long-term damage to our eyes. A simple triad of a hat with a brim, sunglasses, and for those who wear contact lenses, a UV-blocking lens (e.g., Acuvue), can help protect the highly sensitive external and internal ocular structures. Recent research has shown that in addition to UV, “blue light” can be cause long-term damage to our eyes (macular degeneration). Blue light is emitted more heavily by newer fluorescent lighting, hand-held devices, computers, etc. There are now lens coatings that will block UV, glare, and blue light.
  2. Have a Heart: Increasing your heart rate (e.g., three workouts per week) has been shown to reduce eye pressure and can reduce the risk of developing “glaucoma,” also known as the “silent thief of sight.”
  3. Eat Your Greens: Dark, leafy vegetables (e.g., spinach, kale, collard greens) contain carotenoids that may help reduce the risk of cataracts and macular degeneration.
  4. Don’t Rust: Oxidation causes rust on metal surfaces, and in our bodies, causes cellular damage that can lead to cataracts and macular degeneration. Berries, oranges and foods high in anti-oxidants can help reduce the damage that can come from environmental factors like UV and pollutants. There are also some very good supplements (e.g., lutein) that will help to protect your eyes.
  5. Have You Seen a Rabbit Wearing Glasses?: Carrots and butternut squash contain beta-carotene, which can help keep eyes healthy.
  6. Time For a ‘Flintstone’ Vitamin: A National Eye Institute study verified that supplements with antioxidants — beta-carotene, copper and zinc — slowed the progression of macular degeneration. Other studies show that B6, B12, and Folic Acid can slow the onset of cataracts.
  7. Gone Fishin’: Omega-3 Fatty Acids (e.g., cold water fish such as halibut, salmon and tuna) can help treat dry eyes, prevent cataracts and protect the retina. For a fish oil supplement, look for one that is in the triglyceride form, which provides higher bioavailability (absorption). [NOTE: Most fish-oil is in an ethyl ester form. Feel free to contact me for recommendations if you have trouble finding one in a triglyceride form.]

We have two eyes that are designed to last a lifetime. Take some simple steps now. Your eyes will thank you later!

Photo credit: Foter.com

Baby Eyes

By Stephen Cohen, O.D.

There are few things as wonderful as looking into the clear eyes of a baby, and seeing warm recognition in response. While it is easy to see a child’s development in other areas (e.g., walking, talking), we really don’t “see” a child’s eyes develop. Over time, we just recognize that they can respond to visual stimuli, see further and reach for things accurately. Similarly, it is also difficult to notice when vision problems begin. Some changes are very subtle and undetectable to a parent, relative or caregiver.

For example, one study found that a child who had vision testing before the age of two and a half was 17 times less likely to develop a previously undetected “lazy eye” by age eight. Other studies have shown that one in 10 children will have undiagnosed vision problems. About 80 percent of what is learned is through the visual system, so assessing the visual system early increases the chances of school success later.

The American Optometric Association created “InfantSee,” a no-cost public health program designed to address the eye care needs for infants nationwide. I have been a provider for the program since its inception and have had the absolute delight of examining these precious treasures. It has truly become one of the highlights of my practice. Some of the original InfantSee patients I saw continue to come in and are now heading toward becoming teenagers!

To learn more about the program as well as about vision development, you can go to InfantSee through the “links” page on my website, www.doctormyeyes.net. InfantSee services are free for children up to one year of age. The national website is www.infantsee.org. The website also includes a description of vision development during that first year, and activities to help stimulate proper development.

The InfantSee eye evaluation is quick, non-invasive (your baby can sit on your lap during testing), and utilizes testing that might not be available to pediatricians and family doctors. It can detect potential problems that can lead to vision and learning issues later in life, and give parents peace of mind that their infant’s vision is developing normally. One of the major conditions that the testing can identify is early signs of amblyopia, or a “lazy eye.” Undetected, this could lead to permanent vision loss in that eye.

Vision is considered our most precious sense. Let’s make sure all children get off to the best possible start for a lifetime of wonderful vision.

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The Eyes Have It!


– By Stephen Cohen, O.D.

Happy New Year! Hopefully, included in your resolutions is taking care of your most precious sense: your vision. We were not designed for the current demands on our eyes. If we were, we’d have one eyeball in the middle of our foreheads! For a little diversion, here are some (hopefully) interesting facts about eyes and vision.

Our eyes are composed of more than two million working parts, processing 36,000 bits of information every hour (who did they find to count that?). The eyes can distinguish 200 separate colors (which could make for an impressive Crayola Crayon set!). Our eyes contribute to 85 percent of our total knowledge, and utilize 65 percent of all pathways to our brain. Our two eyes working together is what provides us with depth perception (3-D vision).

In nature, while a worm has no eyes at all, an ant has two eyes that are actually made up of many smaller eyes. An ostrich eye is two inches across, but weighs more than its brain. The giant squid, at 18 inches across (the size of a beach ball), has the largest eyes. In addition to vision, a frog’s eyes help to push food down its throat (really!). The human front of the eye has three layers, but a cow’s has eight layers to protect it from injury while grazing along the ground. Dogs cannot distinguish between reds and greens (I wonder how they told us that). An owl can see a mouse moving more than 150 feet away with light equivalent to a candle (poor mouse). On the other hand, an elephant can see about 100 yards, the size of a football field (but once they see something, they “never forget it”…sorry…couldn’t resist).

Babies cry, but don’t produce tears until up to three months after birth. It can also take several months before a baby’s permanent eye color is established. Of all the muscles in our body, the eye muscles are the most active. We blink (which re-coats our eyes with new tears) about 12 times per minute, and an average blink lasts about one-tenth of a second. Conversely, when we work on a computer, our blink rate can decrease by up to 60 percent. Each of our eyelashes has a “life span” of about five months. Up to 80 percent of the ultraviolet radiation (which can contribute to cataracts and other eye disorders) we are exposed to in our lifetime occurs by 18 years of age. And, last but not least, Elton John is purported to have over 4,000 pairs of glasses (I wonder if he gets a volume discount?).

Aren’t you glad you asked?

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Vision And Driving


– By Stephen Cohen, O.D.

If you have a child of driving age, you get to experience the pleasure…as well as the anxiety…of having a child out on the road behind the wheel. Sixteen to 19 year olds are the highest risk driving group, particularly during the first driving year. These “vision and driving” facts and tips could help to reduce the risk factors for all drivers, but especially for new drivers.

Vision good enough for TV or the classroom isn’t necessarily good enough for the road. Even a mild prescription can sometimes make a difference. Peripheral awareness is seeing things off to the side while still paying attention to the road directly ahead. All drivers should periodically scan the road left and right to maintain awareness and reduce visual fatigue. Depth and color perception, and focusing and eye coordination skills, all impact driving. During an eye exam, these skills are tested and quantified. Even mild vision problems can impact driving judgment, especially at night. Glare (e.g., oncoming headlights), can cause temporary but dramatic decreases in vision, but there are glasses lens coatings that can dramatically reduce glare. Drivers can also gaze slightly down and to the right side of the road to reduce the oncoming glare affect. Sunglasses, especially those with “polarized” lenses, reduce daytime brightness and glare. This is particularly important this time of the year, when daylight hours are the longest. Not all sunglasses are created equal. Better quality sunglasses typically have sharper optics, allowing for clearer vision. As obvious as it may sound, drivers should remember to not use their sunglasses at night.

Air conditioning vents pointed directly in the driver’s face can dry out the surface of the eyes, causing temporary blur. Also, when we are concentrated on driving, our blink rate (which creates new tears) will decrease, causing drying and resultant blur. So keep blinking!

Particularly if you share a car, remember to adjust the rear and side-view mirrors to reduce “blind spots,” keep windshields clean, fasten seat belts (half of auto fatalities were not using theirs), and have young drivers commit to not use cell phones or text messaging while driving (about 25 percent of all accidents).

Driving can be a wonderful privilege. By recognizing that our eyes are the first-line defense, we can better anticipate and react to potential obstacles and hazards. Especially for new drivers, these tips may increase road safety, so that we can all likely sleep better at night!

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3-D Or Not 3-D


– By Stephen Cohen, O.D.

Technology changes so fast that what was new last year, can be passé today. While these mind-boggling advances occur at breakneck speeds, we can’t always anticipate the unintended consequences that come with the advances. Many of us face the challenges that arise from computer use, such as neck/backaches, dry eyes and carpal tunnel. The recent explosion in 3-D technology is showing signs of being a similar example.

It is summer blockbuster time for the movies. Many movies are now being released in 3-D as well as 2-D technology. What many don’t realize, though, is that our ability to appreciate the 3-D effect is contingent upon the eye’s ability to see the two images with equal clarity and positioning in order to merge them into one three-dimensional image.

A recent peer-reviewed study published in Optometry and Vision Science showed that for about 20 percent of study participants, 3-D images (movies, home TV, video games) can lead to blurred or double vision, dizziness, disorientation, motion sickness and nausea. Interestingly, younger study participants were more symptomatic than older study participants.

Here are some tips. If your child complains while watching a 3-D movie or while using a 3-D device, schedule an eye exam to see if there is an issue with how their eyes are working as a team. Such a problem can not only affect movie-going, but can create problems with reading and with sports. When you go to a 3-D movie, studies suggest that sitting in the center and/or closer to the screen can increase symptom, while sitting at an angle to the screen may help to decrease symptoms.

For the future, there is hope. Technology in 3-D filming, projecting, and movie 3-D glasses are being developed to address this mismatch between how our eyes focus and how they work together as a team. This issue that appears to be the primary cause of these symptoms.

Until then, pay attention to your symptoms. If it’s an issue for you, try going “old school” for now and see the movie in 2-D – a good movie is a good movie in either form. Doing so can help relieve you of 3-D induced headaches, both in the wallet as well as above the shoulders.

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Am I Blue?


– By Stephen Cohen, O.D.

When we see a rainbow, it is the composite of colors of visible “white light” radiation.  On one end is “blue” light, which comes right after Ultraviolet Radiation (UV).  The potential damaging effects of UV are well known.  It can contribute to skin damage (aging, cancer) and contributes to cataract development in the eyes.  It has now been shown that the blue end of the visible spectrum of light can penetrate deeper into our eyes and may contribute to conditions such as macular degeneration.  The macula is the sensitive part of the retina that gives us our central, sharp vision.

Blue light comes from the sun, but is also emitted by overhead lighting, hand held devices, smart phones, and computers. Blue light also stimulates the pituitary gland.  This is part of the process that tells us it’s time to wake up in the morning.  It is, therefore, interesting that when people pick up their iPad or iPhone when they have trouble sleeping, they are actually further stimulating their “wake-up” system.

There are several things that can be done to protect our eyes from UV and blue light.  Most sunglasses include UV protection, but might not carry over into the blue end of the visible spectrum.  However, there are coatings (virtually clear) that can be added to any glasses that blocks UV and blue light, as well as reducing glare that can cause strain.  There are also supplements that can help to protect the backs of our eyes.  Many of you may have heard of “Lutein,” which is a retinal metabolite that protects the back of our eyes.  There are now products that have this plus two other important supplements that help to maintain the thickness of the sensitive part of our retinae, which, in turn, helps to block UV and blue light.  The right type of Omega-3’s could also protect the back of the eyes.

There are modifiable risk factors for macular degeneration (e.g., smoking, high BMI, fatty diets, sun/blue light exposure, thinning of the macula) and non-modifiable risks (e.g., age, female greater than male, light colored eyes or skin, family history, inherited inflammatory disease).  A low-fat diet with plenty of green, leafy vegetables, as well as supplements and lifestyle modifications can help to prevent this debilitating disease.  Your eyes will thank you for it!

UV Or Not UV? That Is The Question


– By Stephen Cohen, O.D.

It’s “that” time of year. As we move from the season that reminds us why we live here, to the one that makes us question our sanity for living here, we tend to pay extra attention to protecting our skin from the potential ravages of Ultra-Violet Radiation (UVR). We consider things like “SPF” and UV “indices.” What we don’t often consider is the full affect the sun has on our eyes, particularly for our children, since up to 80 percent of lifetime UVR exposure occurs by age 18. Surveys show that whereas almost nine out of 10 people understand that UVR can be damaging to our skin, nine out of 10 do not realize the potential damage that repeated UVR exposure can have on our eyes. Unfortunately, like skin damage, the effect of UVR to our eyes is cumulative, and may not show up for decades. For example, up to one-third of all cataracts are as a result of long-term UV exposure. There are also unsightly benign growths on the white part of our eyes that result directly from UVR exposure, as well as cancerous growths, and potential retinal damage (e.g., macular degeneration).

UV coatings in glasses and contact lenses are virtually clear. The degree of tinting (lens darkness) merely determines how much the visible light might be reduced. Recent research has shown that, beyond just UVR, the “blue” end of the visible radiation spectrum can penetrate deeper into our eyes. This blue light that is emitted in notable amounts by newer overhead lighting, as well as computers and hand-held devices, may contribute to the development of macular degeneration. Newer glasses coatings are now available, which will block UVR and blue light. For sunglasses, although even cheaper lenses can have adequate UV protection, they may distort vision as a result of inferior optics of the lenses. Sunglasses should have three qualifications: ample coverage to protect the eyelids (one of the major locations for the development of melanoma) as well as the sides of the eyes, good optics and adequate levels of UV-blocking. On another note, most contact lenses offer about 10 percent UVR protection, however, there are now contact lenses that provide protection equivalent to sunglasses.

Optimal UVR protection involves a hat with a brim, sunglasses and where appropriate, contact lenses with UVR protection. This summer, while you’re looking for those few inches of shade, or applying layers of sunscreen, give your most precious sense some consideration as well. In the long run, your eyes will thank you for it.

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Drying Out After The New Year



“Go on that diet.” “Exercise more.” “Spend more time with my family.” “Save more money.” The start of the New Year gives us a clean slate to work with. While you’re “editing” your 2016 list of resolutions, let me add a few small things you can do on a regular basis that will enhance your most precious sense, your vision.

Our eyes are coated by a very complex protective layer of tears. Each time we blink, we recoat our eyes with new tears that help to maintain the quality of our vision. When this layer of tears is disrupted, we can experience symptoms such as irritation, burning, stinging, heaviness, fatigue, blur, itchiness and foreign body sensation. An airplane is known to be a very dry environment. Humidity in flight can be as low as four percent. In our desert, that may not sound that extreme to us. In addition to our dry environment, other factors can affect our tears and our eyes. Wind, air conditioning and fans will greatly increase evaporation of our tears. Working on a computer or reading will typically decrease the rate at which you blink, leading to dryness. Certain skin disorders and diseases will affect our tears, as will many medications (e.g. antihistamines, tranquilizers, diuretics). Smoke, dust, and excessive eye makeup can also irritate our eyes.

With that background, here is a list of dry eye resolutions:

  • Don’t wait until your eyes hurt to use artificial tears. Keep your eyes lubricated throughout the day. It is akin to preventing a fire rather than trying to put one out.
  • Carry the right type of eyedrop with you. Not all drops are the same, and some that claim to treat dryness (those with vasoconstrictors to “get the red out,” and others with certain preservatives) may actually increase dry eye symptoms.
  • DRINK WATER! Although carrying bottled water has become common, most of us do not consume enough of it. A new daily standard is to consume one ounce of water for every two pounds of body weight (e.g., a 150 lb. individual should consume 75 ounces of water daily).
  • If you wear contact lenses, make sure you are using the right contact lens solution, and not just “whatever is on sale.” Some newer solutions will actually help to keep your contacts hydrated during the day. Also, if you travel, consider wearing your glasses on the airplane.
  • Increase consumption of Omega-3’s (e.g, cold water fish, fish oil supplements). These fatty acids are not naturally produced by our bodies, and studies are showing that these help to decrease dry eyes, and are also good for our heart, joints and brain.
  • When you work on a computer, take frequent breaks. A new mantra is “20-20-20.” Take a 20 second break every 20 minutes and look at something 20 feet away (or close your eyes and envision you are looking off to the horizon). This is like taking breaks between sets of weight lifting.
  • GET YOUR EYES EXAMINED. If you experience even occasional symptoms associated with dry eyes, there are tests to determine the exact cause and specific treatments that can help.

If you have questions about specific product recommendations, feel free to email me at stephen.cohen@doctormyeyes.net. In the meantime, these simple steps can help to make 2016 even brighter, clearer, and more comfortable than last year. Now give me 50 and then get back on that treadmill!

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