ask me about eyes

[slim]

[ QUOTE ]
Slim,

I have never owned a pair of sunglasses. Is this really bad for my eyes or will I be ok?

[/ QUOTE ]

Depends how much you are outdoors. If you work outdoors everyday, it's strongly recommeneded you get a pair that has UV protection, but if not you're fine.

PS. It might be bad for your bankroll though to not have a pair. [img]/images/graemlins/cool.gif[/img]

[CourtesyFlush]

Slim,

I used Visine workplace every day for about 5 years (I know) and now that I have stopped my eyes are red and feel sore/unfortable every day. This has been going on for about 3 years.

I went to an opthalmologist and she determined that I had ocular rosacea, but her treatment has not helped much if at all. I am wondering if the effects of using Visine for that long makes my eyelids look as I have rosacea when it's not the case (I don't have rosacea anywhere else on my face or any allergies).

Anyway, any thoughts or ideas on where I should go from here?

[Ryanski]

Hi Slim:

I got glasses about 10 years ago, and am currently 19. 2 years ago, December 2004, I went to the optometrist, and received a L -2.5, R -2.75 prescription. I just went about one week ago to the same optometrist(2 years later!), and received a prescription of L -2.0, R -2.25.

The only thing I've done in the last two years differently than in years previous is I never weak glasses for close work(I'm on the computer a lot, etc.), and I wear weaker lenses(currently L -1.5, R -1.75) for any distance stuff.

I really have no idea if this has helped improve my vision....I feel like there has not been any change at all in my visual acuity, but I felt the same basically when I had to get glasses for the first time, in that I felt my vision hadn't gotten worse when it had, so it's hard to tell..

Do you think wearing weaker lenses has helped improve my visual acuity at all? If not, then what possibly did? Is there any way that, say, if I go to the optometrist two years from now, my prescription could again lower by 0.5 diopters in each eye? If not, why?
Is there a chance that my vision did not actually improve at all, but the optometrist made a small mistake either in our appointment two years ago or one week ago, and my vision has remained the same? If so, how likely or unlikely is this?

Hope you can help me with some of these, thanks Slim.

[slim]

[ QUOTE ]
Slim,

I used Visine workplace every day for about 5 years (I know) and now that I have stopped my eyes are red and feel sore/unfortable every day. This has been going on for about 3 years.

I went to an opthalmologist and she determined that I had ocular rosacea, but her treatment has not helped much if at all. I am wondering if the effects of using Visine for that long makes my eyelids look as I have rosacea when it's not the case (I don't have rosacea anywhere else on my face or any allergies).

Anyway, any thoughts or ideas on where I should go from here?

[/ QUOTE ]

There are many kinds of Visine drops. If the one you were using does not contain vasoconstrictors (if it doesn't say "gets the red out") then the redness and dryness is probably not from the drops.

Since it's been a long time since you used Visine, the redness and dryness is not from it. Rosacea can have ocular manifestations before the dermatological signs appear so even though your skin is OK now it doesn;t mean you can't have OR. Also, OR can have remissions and flare ups. How long have you tried the treatment regimen from your MD and what is the regimen? WEre you prescribed antibiotic pills?

[slim]

[ QUOTE ]
Hi Slim:

I got glasses about 10 years ago, and am currently 19. 2 years ago, December 2004, I went to the optometrist, and received a L -2.5, R -2.75 prescription. I just went about one week ago to the same optometrist(2 years later!), and received a prescription of L -2.0, R -2.25.

The only thing I've done in the last two years differently than in years previous is I never weak glasses for close work(I'm on the computer a lot, etc.), and I wear weaker lenses(currently L -1.5, R -1.75) for any distance stuff.

I really have no idea if this has helped improve my vision....I feel like there has not been any change at all in my visual acuity, but I felt the same basically when I had to get glasses for the first time, in that I felt my vision hadn't gotten worse when it had, so it's hard to tell..

Do you think wearing weaker lenses has helped improve my visual acuity at all? If not, then what possibly did? Is there any way that, say, if I go to the optometrist two years from now, my prescription could again lower by 0.5 diopters in each eye? If not, why?
Is there a chance that my vision did not actually improve at all, but the optometrist made a small mistake either in our appointment two years ago or one week ago, and my vision has remained the same? If so, how likely or unlikely is this?

Hope you can help me with some of these, thanks Slim.

[/ QUOTE ]

The most likely scenario is that your optometrist over prescribed 2 years ago. Young people like yourself have a very active focussing ability which means when you are behind that machine where he flips the lenses and asks you "which is better 1 or 2" you are likely to choose the lens that makes the letters bolder but not necesaarily sharper. This is a very common error but don't worry because wearing the wrong glasses for 2 years does not harm the eyes.

[7ontheline]

[ QUOTE ]
7thonline,

I would like to ask you a couple of glaucoma questions if I may.

1) If a patient has no cupping, can they have glaucoma. i.e if a patient has has pressures of 28mmHG but no cupping at all, is there a point in doing fields? Why or why not?
2) Are you currently using dynamic tonometry? IF so, what is now considered abnormal IOP's considereing that the old standards were flawed?

[/ QUOTE ]

You are definitely correct in that treating glaucoma is often as much feel as science. That said, I'm not referring to different choices of medications as mismanagement. I'm talking about waiting far too long to refer for laser/surgery. I personally believe it's because ODs do not perform surgery or get as much exposure to it so they wait too long. As for your questions:

1) Can they have glaucoma? Yes, but it depends. What is the corneal thickness? How big is the cup? No cupping might mean 0.1, or 0.3. Could be a big difference. How large is the nerve itself? A small nerve is much more suspicious even without significant cupping. What is the IOP? One reading of 28 and mostly lower, or consistently that high? Visual fields are important because they will pick up early damage likely before you can see it on exam. I would almost definitely get at least a baseline set, and probably a couple of more over time. You could consider getting a blue/yellow field too - they can be more sensitive.

2) I do not currently have dynamic tonometry, but I see its benefits. However, it is just another tool to help determine what your course of treatment should be. Focusing on a "normal" vs. "abnormal" IOP is a mistake IMO, and often one that doctors who don't treat glaucoma well make. Every patient's ideal IOP is different - determining it depends on progression, visual fields, maximum IOP, etc. Don't forget when you consider the old "wrong" standard Goldmann IOP that all current literature is still based on it. Trying to apply dynamic tonometry to current recommendations may or may not be useful.

[7ontheline]

Slim,

Regardless of this OD/MD debate, I do have to say that I tend to associate posters with their avatars so all I can think of when I see your posts is a flamboyantly gay, annoyingly loud pansy with funny hair.

[slim]

[ QUOTE ]
[ QUOTE ]
7thonline,

I would like to ask you a couple of glaucoma questions if I may.

1) If a patient has no cupping, can they have glaucoma. i.e if a patient has has pressures of 28mmHG but no cupping at all, is there a point in doing fields? Why or why not?
2) Are you currently using dynamic tonometry? IF so, what is now considered abnormal IOP's considereing that the old standards were flawed?

[/ QUOTE ]

You are definitely correct in that treating glaucoma is often as much feel as science. That said, I'm not referring to different choices of medications as mismanagement. I'm talking about waiting far too long to refer for laser/surgery. I personally believe it's because ODs do not perform surgery or get as much exposure to it so they wait too long. As for your questions:

1) Can they have glaucoma? Yes, but it depends. What is the corneal thickness? How big is the cup? No cupping might mean 0.1, or 0.3. Could be a big difference. How large is the nerve itself? A small nerve is much more suspicious even without significant cupping. What is the IOP? One reading of 28 and mostly lower, or consistently that high? Visual fields are important because they will pick up early damage likely before you can see it on exam. I would almost definitely get at least a baseline set, and probably a couple of more over time. You could consider getting a blue/yellow field too - they can be more sensitive.

2) I do not currently have dynamic tonometry, but I see its benefits. However, it is just another tool to help determine what your course of treatment should be. Focusing on a "normal" vs. "abnormal" IOP is a mistake IMO, and often one that doctors who don't treat glaucoma well make. Every patient's ideal IOP is different - determining it depends on progression, visual fields, maximum IOP, etc. Don't forget when you consider the old "wrong" standard Goldmann IOP that all current literature is still based on it. Trying to apply dynamic tonometry to current recommendations may or may not be useful.

[/ QUOTE ]

Thanks for the reply. I guess to clarify, what I mean is, if a patient has NO cupping (0.1), and had pressures of 28 or even 30, can they have field loss? Let's assume you have a patient you've seen for 10 years and each year he comes in his pressures creep up 1-2mmHG from 18 to 30 over a 10 year span but his ONH looks exactly the same (which is easy to tell bc there is NO cupping). Is it possible for him to have field loss from POAG?

[slim]

[ QUOTE ]
Slim,

Regardless of this OD/MD debate, I do have to say that I tend to associate posters with their avatars so all I can think of when I see your posts is a flamboyantly gay, annoyingly loud pansy with funny hair.

[/ QUOTE ]

Beleive it or not, I did not put that avatar there. I have had no avatar for about 4 years bc I don't know how to upload an image. SO a few months ago I asked 2p2 how to create an avatar and was given general directions. I spent a few minutes trying but couldn't do it and then a few days later , this gay avatar showed up. I didn't choose it but I figured it was better than no avatar so I didn't bother trying to figure out how to get rid of it.

[7ontheline]

[ QUOTE ]

Thanks for the reply. I guess to clarify, what I mean is, if a patient has NO cupping (0.1), and had pressures of 28 or even 30, can they have field loss? Let's assume you have a patient you've seen for 10 years and each year he comes in his pressures creep up 1-2mmHG from 18 to 30 over a 10 year span but his ONH looks exactly the same (which is easy to tell bc there is NO cupping). Is it possible for him to have field loss from POAG?

[/ QUOTE ]

In this case it is pretty unlikely that he will have field loss. However, I would still get a baseline set of VFs because he certainly seems like he may be headed towards glaucoma. Better to have at least one documented normal field in a patient like this who you are certainly going to monitor. Optic nerve drusen are a possibility also if his nerve appears crowded with no cup whatsoever. I would absolutely have a corneal thickness measurement as well. If it comes back at 600 I feel a lot better. If it is 500 I may even start treatment because the results of the OHTS study give this guy a high probability of advancing to glaucoma (don't remember exact numbers, but I think around 20%) - although if his cup is so small and his fields are normal I might wait. It would depend on what the patient wanted also.