After 19 years in practice, Ophthalmologist Charles D. Finley, M.D. is retiring from medical practice. Dr. Finley served his entire medical career at Columbia Eye Clinic and has been proud to work in partnership with some of the most respected physicians in the field of Ophthalmology as well as highly skilled clinical staff. The fifteen physicians and more than 100 staff of Columbia Eye Clinic congratulate him on his retirement.
Nearly everyone, even those who have never had vision problems before, begin to experience blurry near vision around age 40. Each eye contains a lens, much like a camera lens, positioned right behind the pupil, that is elastic and attached to muscles so that its shape can be controlled. When one is young the changing shape of the lens allows one to focus from distance to near and back. As one ages the lens gradually loses elasticity and cannot continue to focus adequately on near objects. This process, called presbyopia, is natural and most adults struggle to find the best way to “work around” this problem.
If presbyopia is your only vision deficit, reading glasses are probably all you need.
If you have other vision problems, there are many corrective options available. Bifocals have a prescription for distance in the top and near vision in the bottom. Trifocals have areas for distance, mid-range and near vision. Progressive lenses work like bifocals and trifocals but the prescription changes gradually from the top to bottom.
If you prefer to wear contact lenses, one option is monovision, wearing a near vision lens in one eye and a distance vision lens in the other eye. It does take some adjustment to train your brain to see using monovision and some people find they are unable to accurately judge speed and distance. A multifocal contact lens with rings or zones set at different powers is another option. Your eyes will select the right focus for near, intermediate and distance vision, however some people find their vision is less sharp than with a monofocal lens. You may find that a contact lens to correct distance vision plus reading glasses for close-up work is the best option.
Currently, there is no perfect surgical option for completely reversing presbyopia, though researchers continue to explore refractive procedures and even medications.
Candidates for cataract surgery can opt for monovision or multifocal lens replacements much like the corrective contact lens options described above.
Presbyopia progresses over time, so regular eye exams are important to keep you seeing your best.
Good vision and overall eye health are vital to learning and academic success. Children’s eyes change rapidly as they grow, making regular vision screenings an important step in detecting and correcting eye problems early.
In addition to screenings for infants, the American Academy of Ophthalmology recommends further vision screening for children when they are:Pre-School age, between age 3 and 3 ½ years old
Experiencing a possible vision problem
For school-age children, a vision screening, which is less comprehensive than a dilated eye examination by an ophthalmologist, can be performed by a pediatrician, family physician, nurse or trained technician during regular checkups. If the screening detects a problem, the child may need to see an ophthalmologist — an eye physician and surgeon.
Parents should share information about their family eye health history with the person performing the screening when possible. Examples of common eye conditions include refractive errors (nearsightedness, farsightedness, astigmatism) crossed eye, known as strabismus, and lazy eye, known as amblyopia. If crossed eye and lazy eye are not treated in childhood, they can sometimes cause permanent vision loss in one or both eyes.
Symptoms that could indicate an eye or vision problem in a child include complaints of eyestrain, headaches and squinting when reading or performing other common activities. Other symptoms to look for include a white or grayish-white coloring in the pupil, one eye that turns in or out, or eyes that do not track in sync together.
If your child plays racket sports, hockey, baseball or basketball, consider having them wear goggles or other certified protective eyewear. Eye injuries while playing sports can cause serious damage, whether by getting smacked with an elbow during basketball or hit with a hockey stick.
Visit the American Academy of Ophthalmology’s website to learn more about common childhood eye conditions.
Eye drops can be essential in healing your eyes after surgery or infection and preserving your sight if you have chronic eye disease. To get the greatest benefit from eye drops, you must use them properly.
Each time you miss your eye when putting in expensive prescription eye drops, you are throwing money down the drain. Also, if the drops are dripping out of your eye they are not providing the sight preserving medicinal benefit intended.
If you are having difficulty administering your eye drops, you can practice with over-the-counter preservative-free artificial tears for mild dry eyes. Using a preservative-free formula eliminates the risk of you being allergic to preservatives found in many artificial tears.
If you have been prescribed more than one type of medicated eye drop, wait at least five minutes to put the additional drop in the same eye. This will allow the first medication to be fully absorbed and help prevent both medications from dripping out of the eye. If your physician has recommended both a prescription eye drop and over-the-counter lubricating eye drop on the same eye, administer the prescription drop first.
STEP BY STEP INSTRUCTIONS
- Wash your hands with soap and water. Dry your hands with a clean towel.
- Check to see if your eyes have crusting or drainage. If they do, close your eyes and gently wash or wipe the outside of your eyelids with a clean wet cotton ball.
- If you are wearing contact lenses, remove them. The only exception is if you are using eye drops that are specifically formulated to remoisten your contacts or if your doctor advised you to administer drops with your contacts in.
- Shake the eye drops container gently. Be sure to use only the eye drops prescribed for you. Always check the container to be sure that it is the right drug, right number of drops, and the correct schedule (when you should put in your drops).
- Remove the cap of the eye drop bottle. Place the dropper cap on its side and rest it on a clean tissue. Do not touch the dropper tip with your hand or any object to avoid contaminating the drops in the bottle with bacteria and other organisms.
- Either lie down or tilt your head back and look up at the ceiling. Concentrate on a point on the ceiling, keeping your eye wide open.
- Place one or two fingers on your face about an inch below your eye; gently pull down to create a pocket between your lower eyelid and your eyeball.
- Use your other hand to hold the eye drop bottle, pointing the tip downward. Resting your hand on your forehead may help steady it.
- Hold the bottle close to your eye (about an inch away). Be careful not to let the dropper touch your eye or eyelashes to avoid contaminating the drops in the bottle with bacteria and other organisms.
- Squeeze the bottle lightly to allow the drop to fall into the pocket inside your lower lid.
- Remove your hands from your face, gently close your eyes and tilt your head down for a few seconds. Try not to squeeze or blink your eyes after putting in drops. This can force some of the drop out of your eye before it has had a chance to be absorbed.
- To keep as much of the drop on your eye as possible, press lightly on the inner corner of your eyelid, next to your nose. A small duct that drains tears away from your eye and into your nose is located here. By pressing at this point, you close the opening of this drainage duct, allowing the eye drop to remain on the surface of your eye longer. This technique also minimizes the funny taste you may get in your mouth after applying certain eye drops.
- Use a clean tissue to absorb and wipe away any drops that spill out of your eye and onto your eyelids and face.
- If you are using eye drops on both eyes, repeat this procedure for the second eye. Use a clean, separate tissue to blot excess drops from each eye.
- Replace the cap of the bottle and screw it on securely. Never wipe the dropper tip with anything, to avoid contaminating the drops.
Botox is most commonly thought of as the “magic” wrinkle remover that was once the secret weapon of only celebrities and the rich and famous. Botox is the most popular cosmetic medical treatment in the US among men and women looking for economical and non-surgical facial rejuvenation. However, long before Botox was the cosmetic treatment for which it is best known, Botox was used, and still is, for a variety of medical indications.
Botox is one of several pharmaceutical products manufactured from an exotoxin which is produced by the Clostridium botulinum bacteria. This is the same bacteria that cause botulism, a sometimes- fatal disease contracted from eating improperly canned fruits and vegetables, or occasionally from exposure of wounds to contaminated soil, etc. There is also a variant form of botulism contracted by infants who ingest, not the toxin, but the clostridium spores, from eating honey.
Trivia: Though rare, when a canned food is found to harbor the Clostridium bacteria, what is the most common canned culprit?
Answer: Traditionally, the answer has been peppers, but according to the CDC, over the last 5 years the sources of food borne botulism have included carrots, beets, soups, and fish, including improperly prepared seal flipper.
One of the devastating symptoms of botulism is paralysis or muscle weakness. Scientists studying botulism found that they could extract, isolate, and purify some of the exotoxin and make it into a concoction, that when injected into or near a muscle, would cause temporary weakness. In fact, botulinum toxin was studied as a potential biological weapon in WWII.
The first clinical use of botulinum toxin for medicinal purposes occurred in the 1960s and ‘70s when ophthalmologist Dr. Alan B. Scott began injecting small amounts into the eye muscles to try to correct various forms of “crossed eyes” (medically referred to as strabismus). He eventually won FDA approval in 1978 for his purified version of botulinum toxin, which he named Oculinum. Ten years later, Allergan, the pharmaceutical giant, bought the rights to Scott’s product, changed its name to Botox, and the rest, so they say, is history.
Today botulinum toxin is marketed under several brands including Botox, Dysport and Xeomin (made from type A toxin), Myobloc (made from type B toxin). There is no actual bacteria in Botox. During production the toxin is extracted, purified, and dose-standardized so that it can be injected in small reproducible unit for the desired effects. Currently approved indications include blepharospasm (involuntary closing of the eyelids), various movement disorders and muscle-contraction disorders, excessive sweating, overactive bladder, migraine, and the list keeps growing.
Botox is injected beneath the skin into or near a muscle using a syringe and a small needle. Botox blocks signals from the nerves to the muscles. The injected muscle can no longer contract, which in the case of cosmetic use, causes the wrinkles to relax and soften. These effects can be harnessed by our physicians to improve frown lines between the brows, crow’s feet at the outer corners of the eyes, horizontal lines in the forehead and eyebrow height and shape. The injections are only mildly uncomfortable and take only a few seconds. Improvements in facial appearance typically last three to four months. This means that treatments usually need to be repeated periodically.
Side effects of the injections include pain and bruising or swelling at the injection site which are usually minor. Other side effects can result in overproduction or underproduction of the desired effects or in the unwanted weakening of nearby muscles. Naturally, the side effects, if any, also wear off in several months, as the effects of Botox, both the wanted and unwanted, are typically not permanent.
Next time you’re at a party and you see someone who looks just a little younger than they used to, while you’re complimenting them on their youthful appearance, remember that Botox was used for many movement disorders long before its cosmetic use became popular. Also, maybe consider skipping the seal flipper if it’s being served…