Frequently Asked Questions

Expand each section to read more information on each topic.

Dry Eye /Fish Oils: There are two big things that you need to consider before deciding to take dry eye supplements.

  1. Dry eye is a chronic disease, and so you must be prepared to take fish oils for 3-6 months before you begin to evaluate their effectiveness.
  2. All fish oils are not created equal, and as with many other things in life, you get what you pay for. (We’ll elaborate more on this below)

To cut straight to the point, research indicates that for the best results, you should take omega-3’s in the triglyceride form, making sure to take at least 2,000 mgs a day, with around 1,500mg of that omega 3 being of the EPA form. This is why we recommend specific products like PRN Dry Eye Omega, Viva Naturals Omega-3, or HydroEye, instead of making a general recommendation to start taking fish oils. PRN Dry Eye Omega is pretty universally accepted as the gold standard when it comes to dry eye supplementation, but is decently expensive when compared to the other two options. For that reason many of our patients choose Viva Naturals Omega-3. Finally, if for some reason you are unable to take either of the first two choices, the third option would be HydroEye, which many patients have also found great success with. To be clear, store brand fish oil is better than taking no fish oil, but if you are looking for results, they are no where near the best option.

*Be sure to consult your doctor when considering initiation of a fish oil supplementation program, as it may be contraindicated based on other systemic issues or other medications you may be taking.

Glaucoma: First and foremost, it should be made clear that both of these supplements are not meant to replace current treatments, but are meant to be used as possible additions to those treatments for added benefit.

Mirtogenol – A combination supplement that contains both bilberry extract and French maritime pine bark extract. This supplement has been shown to be as effective at lowering eye pressure as prostaglandin eye drops, and furthermore it has been shown to be effective when used in conjunction with a prostaglandin drop. It also has been shown to be quite safe, without no serious complications resulting from taking this supplement having been reported. The main disadvantage of Mirtogenol is that it takes up to 6 months to have its full effect, which is one reason why it is not one of the first treatments for glaucoma.

At our office, we reserve Mirtogenol for patients that have had issues with other drops, or are already taking the maximum amount of drops, but are still having problems with progression of their glaucoma.

Another option that can be helpful is Ginkgo biloba, though through a completely different method. Instead of working to lower the eye pressure, Ginkgo biloba works to protect the nerves themselves. That being said, it has been observed to show improvements in the visual fields of patients with vision loss from glaucoma, even though the eye pressure remains unaffected.

Before initiating Ginkgo biloba it is important to consult with your doctor since it can have blood thinning effects. For this reason, it is generally not recommended to take Ginkgo biloba if you are already taking blood thinners. Other, more mild, side effects that have been reported include nausea/diarrhea and mild irritability.

Diabetic Retinopathy: Pycnogenol is a French maritime pine bark extract that has been shown to help strengthen the small capillaries that are affected by diabetes, and because of this, it is a supplement may be recommended if you are found to have  signs of diabetic retinopathy. The best way to stop the development of diebetic eye disease is through controlling your blood sugar, and so this supplement does not in any way replace your current medications.

Macular Degeneration: Macular degeneration can be a truly devastating disease. When progressing from dry macular degeneration to wet macular degeneration, significant vision loss can happen quickly. Without treatment, only approximately 10% of people that develop macular degeneration are unfortunate enough to have it progress to the wet stage and taking specific vitamins can help to decrease the risk of progression to the advanced stage by approximately 25%. These formulations of vitamins are generally all based on the AREDS (Age Related Eye Disease Study) formula and so many times you will see AREDS 2 written on the outside of the bottle. Macuhealth has gone one step further and financed their own research to develop a vitamin that has added components and added benefits. If you are looking to take the best possible vitamin, that would be the one I would recommend, but if the price is an issue, we recommend at least taking the AREDS formula or a comparable product.

Other things that can to help prevent progression include a healthy diet with lots of green leafy vegetables, Omega 3 supplements, exercise, controlling blood pressure, and not smoking (smoking yields a 7x greater risk).

Cautionary note 1: If you are or have been a consistent smoker in the past, you should avoid the original AREDS formulation with Beta Carotene, as this has been shown to increase the risk of cancer. This component has been removed in the AREDS II formulation, so using the new formulation should not be an issue.

Cautionary note 2: If you are allergic to soy or peanuts, there is a possibility of an allergic reaction to PreserVision AREDS II supplements, though the amounts are so small that this is unlikely.

General and Eye Vitamins: Taking a daily multivitamin is a generally a great idea. The vast majority of us are unable to obtain the proper nutrients through our diet alone. The hardest thing with starting a multivitamin is figuring out which one to take. Speaking generally, you are better off taking any daily multi off the shelf compared to taking nothing, but if you are looking for a higher quality vitamin, you would ideally take a whole food vitamin. The FDA allows for both synthesized and food based vitamins to be sold in order to make vitamins less expensive and accessible to everyone, but it probably isn’t a surprise that a synthesized vitamin is not absorbed as well as its more expensive food based counterpart.

Taking a daily eye vitamin is something many people do out of fear of developing different eye conditions such as macular degeneration, cataracts, or glaucoma. Ex: Ocuvite, Icaps, Macuhealth. Though the research is not always there to support the claims of disease progression, there is nothing wrong with taking them. Generally, these vitamins have high concentrations of vitamins and antioxidants that most people would struggle to get through diet alone. In theory, these vitamins and antioxidants should be quite useful for the retina since it is very metabolically active, so if this is something you are willing to add to your daily regimen, we would encourage you to do so!

Blue light exposure is an issue that has really only become a topic of discussion around 2012. This is partly because of the increasing use of digital devices (and therefore increased exposure) as well as the growing body of evidence demonstrating that this light can be harmful to both our eyes and the visual system in general. This is a difficult topic to discuss given that the jury is still out with regards to how much is too much, but here are a few of the facts that have lead eye care providers to be more apt to discuss blue light protection with you:

  1. Health: We all know that UV light is high energy and can be damaging to our eyes, but blue light is right next to UV on the energy scale and has been shown to have the ability to be damaging to ocular structures including the retina.
  2. Sleep: Blue light has been shown to alter sleep patterns, which is why companies like Apple have integrated technologies like ‘night-shift’ to decrease the amount of blue light emitted from devices in the evening.
  3. Eye Strain: With the widespread use of computers and other hand-held digital devices, we are consistently exposing our eyes to this high energy light. High energy light, such as blue light, is bent differently and scatters more easily than other light on the visible spectrum, which can make it difficult for the eyes to bring things into focus. It has been shown that blocking blue light can both increase the clarity and comfort of people who spend a significant amount of time on digital devices.

The dangers of blue light was initially being examined because people were spending more time on the computer, but now there are much bigger issues on the horizon. This is because blue light exposure is a viewing distance game.

Here is a thought experiment to try and drive this idea home:
Lets assume that the amount of blue light emitted from the TV is a safe amount and start from there.

The computer sits about 5 times closer than the TV, which means we are getting 25 times more exposure from the computer compared to the TV. Lets take this one step further…

If the average person uses their phone or tablet at about half the distance of their computer, that means that they are getting 4 times more exposure from that devices compared to the computer, or 100 times that of a television. Lets go even further and look at the use of Virtual Reality devices like Samsung Gear, Google Cardboard, and the Oculus Rift….

These devices place a screen within a few inches from the front of your eye, so lets conservatively say that this is four times closer than a normal working distance for a phone or tablet. The exposure for these devices would then be 16 time worse than using a phone/tablet, or 64 times worse than a computer, or an astounding 1,600 times worse than viewing a television (our assumed amount of blue light that is safe).

Excellent question, and one with a quite simple answer.

Without dilation we cannot fully examine the back of the eye (your retina). In order to examine your retina, we have to focus light through your pupil. Without dilating, we are essentially trying to examine the retina through a keyhole, which obviously limits what we can see. Once we dilate, it is more like examining the retina through a window, which allows us to examine the outer edges of your retina to ensure that everything is healthy. Given that the retina is the only place in the body that we can see live nerves and blood vessels without making an incision, a dilated exam gives us a very unique view on the way certain systemic conditions may be effecting your eyes and your body.

How often you should be dilated really depends on your individual health and family history. That being said, our office policy is to dilate new patients in the first year that we see them so that we can establish baseline data and to make sure that there is nothing in the peripheral retina that we need to be monitoring. After that, we recommend dilations every three years for our patients without any systemic or ocular health issues or concerns.

This can be broken down into 2 main reasons: Blinking and Blue Light

  1. Blinking – Blinking itself actually has two separate effects; it coats the exposed eye with tears and pumps out the oily component of our tears that helps keep our tears from evaporating. The problem is that we actually blink around 65% less when we are viewing backlit devices like computers, phones, and tablets. So not only are we not spreading our tears as often as we should be when we are on our computer, the tears that we do spread tend to evaporate more quickly, so the problem is compounded. When our eyes are dry at the end of the day, it generally feels so much better to close our eyes, which makes us feel even more tired.
  2. Blue Light – I won’t address the health issues here since they are covered in a different FAQ page(hyperlink), but it does create some visual issues too. Blue light is the highest energy light on the visible spectrum and is focused differently and scatters more easily than other visible light. This is the reason that the sky is blue, but it is also the reason that it is more difficult for our eyes to bring things into focus on the computer. While subtle, this focusing difficulty builds on itself, causing significant strain by the end of the day.

There are a few things that we commonly recommend to help alleviate those issues. With regards to blinking, we recommend the 20/20/20 rule: every 20 minutes, take a visual break by looking somewhere more than 20 feet away and consciously blink for 20 seconds. For blue light, the main thing that we recommend is a blue blocking coating on your lenses, or if you wear contact lenses or do not wear glasses at the computer, you can purchase blue-blocking screen covers to help ease your eye strain.

Pink eye is a generic term that people use to describe an inflammation of the conjunctiva (the white part of your eye). The medical term for this is conjunctivitis, which affects about 3 million people in the US each year.

When irritated, the body increases blood supply to the conjunctiva in order to help fight whatever is causing the irritation, which is what makes the eye look more red. Bacterial infections, viral infections, allergies, and dry eye are all common causes of pink eye. Treatment for pink eye varies greatly depending on the cause and so if your eye is irritated, it is well worth the trip to the office to make sure that you are not contagious and that you receive the correct treatment.

Simple answer: Presbyopia. The term presbyopia roughly translates to ‘old sight’, and is a normal age expected change that happens to everyone eventually. As we age, we generally get less flexible, and the same can be said of the lens in our eye. Focusing up close requires the lens in our eye to change shape, but as we age and our lens becomes less and less flexible, which makes it increasingly more difficult to read. This is the point where most people switch into either a progressive or bifocal style lens to be able to continue to see well at distance and at near without having to switch between two different pairs of glasses.

Other options to help correct for presbyopia include multifocal or monovision contact lenses and surgical options such as monovision LASIK, intraocular lens implants, and corneal inlays (Raindrop or Kamra).

More recently, there have been a few different eye drops that have started FDA trials with the goal of helping regain functional near vision. The drops work in a few different ways, but the preliminary results look promising. Unfortunately it likely will not be until around 2025 that the first of these drops hits the market.

A cataract is clouding of the lens in the eye. This is generally seen as a normal age-related change that gradually progresses over time, though there are a few reasons that cataracts may develop prematurely, including thing like excessive UV exposure, diabetes, and smoking. Generally, faint signs of cataracts are observable as early as age 40, but they tend to not cause any visual problems until around age 60.

The first signs that people tend to notice with regards to cataracts are that lights at night spread more than they used to and/or that they generally struggle with vision in low-light situations. Given that the cataract is clouding the lens inside of the eye, it eventually progresses to a point where you are unable to read smaller print even with the most optimal prescription placed in front of the eye.

For the vast majority of people, cataracts are managed with observation until a point in time where surgical intervention becomes necessary. This point can vary from person to person, but there are two things we watch for with regards to recommending cataract surgery:

  1. If you are unable to read the 20/40 line (the line the DMV asks you to read to renew your license) on the eye chart with an updated prescription, we recommend you at least go for a surgical consultation to fully understand the different options that are available to you.
  2. If you are finding difficulty with activities of daily living (i.e. find yourself avoiding driving at night because of glare), or if your vision has begun to limit you doing the things that you enjoy doing, we may recommend surgical intervention.

The silver lining here is that cataract surgery has become much more streamlined and reliable. The vast majority of people experience a significant improvement in vision after the surgery, even without glasses. Most individuals will still need glasses to help with fine visual tasks, but generally vision is at least improved to where glasses are not required to meet DMV driving standards.

More information about cataracts and cataract surgery can be found on the National Institute of Health website here: https://nei.nih.gov/health/cataract/cataract_facts

Clearing the Confusion: This is a question that we receive commonly so here are the differences.

  • Vision Insurance covers annual wellness visits where typically the only complaint is blur and that blur is fixed by either glasses or contacts. These visits are similar to seeing your primary care doctor for your physical exam, and generally do not allow for us to provide medical services such as special testing, prescription eye drops, or other in office treatments. The nice thing about vision plans is that they generally have no deductible, and instead have set copays for exam and glasses/contacts.
  • Medical Insurance requires visits to be complaint driven. This means that these exams serve the purpose of addressing a specific problem (ie: dry eyes, ocular discomfort, or blur/glare associated with cataracts), but they can also serve the purpose of a comprehensive eye exam for patients with certain conditions or medications that require annual eye exams such as diabetes or plaquenil (a medication often used for rheumatoid arthritis). Unlike with vision plans, medical insurance costs can be hard to predict because they depend on your individual coverage as well as whether or not you have met your personal or family deductible. Because medical insurances are only concerned about taking care of your eye health, they do not cover checking your glasses prescription (refraction) or provide any assistance towards purchasing glasses or contacts.Dealing with the bureaucracy of different insurance companies can be frustrating and often requires you to return for multiple visits in order for the insurance to cover testing that could have all been done in one visit otherwise. We know this is an inconvenience and share in your frustration as it causes extra work for our staff as well. Just know that we are always on your side and feel free to give us a call with any questions that may come about.