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Patient FAQ’s

question 20signWe want to make sure that you receive all of the information that you need to make educated decisions about your eye health. Our optometrists are always available to answer your questions. Please feel free to send us your eye care questions to rbarnstein@hotmail.com

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Q: Is Corneal Refractive Therapy a good option for me?

Dr. Barnstein: Corneal Refractive Therapy is a treatment for the progression of myopia. Dr. Richard Barnstein is trained and certified to fit Paragon CRT (an FDA requirement).

With no age restrictions, Paragon CRT represents a unique opportunity for adolescents & adults to experience the freedom from daytime contacts and glasses with this great alternative to traditional vision correction. Paragon CRT is a specially designed contact lens that gently and temporarily reshapes the cornea at night.

“I’m really excited to offer this modality of treatment for the progression of myopia. This give our patients options in addition to the many choices we offer patients at Professional Vision.” – Dr. Richard Barnstein.

Paragon CRT temporarily corrects nearsightedness (myopia) with or without moderate astigmatism. Paragon CRT has been proven both safe and effective for patients of all ages when worn during sleeping hours, earning this therapy the first and only FDA approval for overnight use. The result is no more torn lenses, no more broken frames and no more discomfort from daily wear contact lens-induced dry eyes.

Whether the patient plays sports, spends time in a dusty or windy environment, or is simply applying make-up, with Corneal Refractive Therapy nothing gets in the way of their vision. Since there is no permanent change to the eye, the patient has the ultimate control and flexibility in their vision correction.

For more information, contact our office at 410-252-7414.

 

Q: Can I wear contact lenses if I need bifocals and my eye are dry?

Dr. Barnstein: My short answer is “Yes”, and “It depends.”

The great news is that there are more options than ever on the possibilities to see without glasses, with multifocal contact lens for patients. Our doctors at Professional Vision Timonium & Carney have been able to help our patients, more than ever, to wear contact lenses if they need bifocals, and also have eye dryness. There are some fantastic daily disposable multifocal contacts that many of our patients are having tremendous success with.Here are some factors to consider:

1. How much do you want to wear contact lenses, or would like to see and do things without having to wear glasses? It’s not so much “how much you want to wear contacts, as much as “how much do you want to see without having to use glasses for certain tasks?” For 1st time wearers, I’ve found this desire to be the number one factor in wearing contacts.

2. How much/how often would you like to wear them/not have to wear glasses to see something? Some of my patients wear contacts all day, while others may wear them for more specific endeavors, like for evenings, weekends, and hobbies.

3. It depends on your eye health history/Any history of eye conditions that may make it difficult to wear contact lenses. Certain health conditions can be associated with more dry eye conditions that may hinder the use of contact lenses. This doesn’t necessarily mean that someone in this situation cannot wear contacts.

4. It can depend on the type of vision you have.There tends to be more choices than ever for someone to be able to wear contact lenses, but some types of vision have more limitations in choices.

 

Q: Why Do We Need Glasses?

Dr. Barnstein: During the basic vision test, which is just one component of a complete eye exam, the optometrist examines each eye for refractive errors. These cause blurred vision and can usually be corrected by wearing prescription eyeglasses or other treatments.

 

Q: What’s That Yellowish Bump on the White Part of My Eye?

Dr. Barnstein: It’s pinguecula, (pin-GWEK-yoo-lah) which has to be one of the more unusual anatomy terms of the human body.(Great suggestion for the national spelling bee!)
A pinguecula is a yellowish formation and tissue change on the white part of the eye, from long term sun exposure. Pingueculae generally do not hurt at all, and are typically harmless. Most people complain about the piguecula’s change in color, and growth, and do not like how they appear cosmetically. Sometimes the growth/bump can become annoying when blinking.
By far the #1 method to prevent the progression of a pinguecula is to wear excellent UV protection sunglasses when outdoors. If a pinguecula ever becomes aggravated or sore, sometimes an anti-inflammatory drop can be prescribed. Artificial tears can provide relief if they become dry or irritated. Be sure to schedule an eye health examination with your eye doctor to have the proper diagnosis and possible treatment.
Q: What can I do to prevent eye fatigue?
Dr. Barnstein: Eye health issues can all lead to difficulty with near related visual tasks. Here are 5 Simple Tips for Eye Strain Good posture:
Whether you’re lying or sitting as you perform near tasks, having good posture can dramatically help with eye strain. If not, then you may be reading where one eye is farther away from the reading material than the other eye. If the head is angled away from the material, one eye’s view of the near task can often be completely blocked by the nose. Sit up straight, and face the reading material where both eyes (assuming you have the ability to use both eyes to read and see) appear equidistant from the reading material.
Children are often the biggest culprits of poor posture when performing near tasks. Incline on the reading material if it’s on a table or flat surface: If a page is lying on a flat surface when you read it, the top part of the page is typically farther from the eye than the bottom part of the page. Then when you read across, line by line, from top to bottom, the distance between the reading material and your eyes is constantly changing. This causes the eyes to work harder. By putting the reading material on an incline, it makes the top and bottom of the reading material more equidistant, thus making the eyes work less than when the material is on a flat surface.
Good lighting and contrast on your book/near task: With Ipads, computers, and smart phones, we can usually have decent contrast. If the material is a book, or paper, it’s very important to have plenty of direct lighting on the reading material. This sounds simple, but too many people take this for granted, and then wonder why they get eye fatigue after reading for short periods of time.
Move your smartphone/ computer/ book/ ect… a little bit farther away from your eyes: This can be especially effective for those approaching 40 and beyond! (I fall in that category. Yikes!) This doesn’t mean that you have to hold the near task as far from you as possible. Just be sure that it’s not too close to your face, and if you do get eye strain, try moving the near task a few inches farther from your eyes than you normally do.
Children often may lie on the floor or on their beds, and read or use hand held devices where it’s waaaaaay too close to their faces. (I have to remind my kids often to move their hand held devices farther from their faces as they’re, “in the zone”, playing on the devices.)
If you have more than one simultaneous near task, try to make the multiple near tasks more equidistant: Many of my patients work on more than one monitor, or have a computer and also near-work beneath the monitor.
If they have eye strain, I’ll often recommend (after they have their eyes examined, and updated their glasses/contacts if necessary) that they try to make the monitors and multiple near tasks more equidistant, to reduce eye strain. Be sure that you and your family members have annual eye health examinations.
These tips do not replace either having an annual eye health examination, or visiting your eye doctor if you have any visual or eye health problems.

Q: I just started wearing disposable contacts. Do you have any best practices for a new user?

 

Q: What are these spots I sometimes see in my vision?

Dr. Barnstein: Fortunately, most of the time, these spots, which can be known as “vitreous floaters”, are harmless. If you have “spots in your vision” and haven’t had an eye examination since you first noticed the floaters, I suggest you visit an eye doctor. If flashes of light also accompany the floaters, then it’s even more important to schedule an appointment with an eye doctor immediately. Sometimes the floaters can be caused by shifts in the jelly like substance in the eye called the vitreous. A small percentage of the time, floaters can be caused by an area of aggravation in the retina, that can lead to a tear, hole, or even retinal detachment. If someone has migraines, sometimes they can also have accompanying “eye migraines” or “ophthalmic migraines,” where they may notice spots or sparkles in their vision. For people with spots and even flashes after 40-50 years of age, they can sometimes have what’s called a “posterior vitreous detachment.” This is where the vitreous (jelly like substance) shrinks in size, where it pulls away from the front and back of the eye, causing a shakeup. In most cases, a posterior vitreous detachment is harmless, but it’s still important to have it checked by an eye doctor to make sure there’s nothing wrong with the retina. If you are diagnosed with vitreous floaters that turn out to be the harmless type, there is usually not a lot you can do to treat them. Over time, the brain will adapt to the spots in your vision, where they will hopefully become less noticeable. When you visit an eye doctor and they diagnosis you with floaters that are not harming your retina, you should still have the floaters monitored at least annually.

Q: Whether it’s the computer, surfing the net on your smart phone, texting, or desk work, eventually most of us around 40 start to notice some forms of eye strain at near. Presbyopia is when the ability of your eyes to focus at near start to gradually decrease. WHAT CAN BE DONE ABOUT IT?

Dr. Barnstein: 1. Single Vision Reading/Computer Glasses: This is a simple solution, where it’s still important to visit your eye doctor to get the most accurate prescription. Over the counter readers can seem to help, but they do not correct any astigmatism (oval shape of the eye which causes distortion), and most people have different prescriptions in each eye. To minimize strain at near, be sure to visit your eye doctor to obtain the most accurate near prescription.

2. Progressive lenses (no line bifocals): This gives people the ability to see at both distance and near, without having 2 pairs of glasses, or having to take reading glasses off to see at distance. It’s important to note that not all progressive lenses are the same. Many discount retail opticals sell progressives at a low price, but the optics can be lower in quality. At Professional Vision, we fit a premium progressive with high quality optics, which can give a wider reading area, less distortion, and a smoother transition from distance to near.

3. Contact Lenses (Multifocal Options): The doctors at Professional Vision specialize in “difficult to fit” contact lenses. Personally, I wear a one day disposable multifocal contact lens in one eye, and a one day astigmatism contact lens in the other eye. Sound complicated? It works great for me! There are some fantastic contact lenses out there today to help with those approaching 40 that suffer from eyestrain at near.

 

Q: What can you do to help relieve dry eye?

Dr. Barnstein: We treat and manage dry eye syndrome in a multitude of ways, from punctal plugs, to prescription drops like Restasis or steroids, to treatment of the eyelids which can be a major factor with dry eye. Many sufferers from dry eye may not realize that this is a medical condition, where the services by your eye doctor can be covered through your medical insurance. Here are some easy ways to treat dry eye on your own, in conjunction with being managed and followed by your eye doctor.

Artificial Tears: There are often many different choices, and different combinations but we suggest for starters, just trying “lubricant eye drops.” Some people use these many times a day, while others use the drops as needed.
Omega 3 fatty acids have been found to have anti-inflammatory effects on our bodies. Dry eye has an inflammatory component to it, where omega 3 fatty acids have been found to aid in dry eye relief.
Warm compresses can loosen up the clogged meibomian glands in the eyelids. These oil glands aid in lubricating the cornea.
Stop smoking: Smoke can alter and irritate the tear film.
Humidifier: Many of my dry eye patients notice more irritation when the heat’s cranking in the winter. Try using a humidifier in the room where you spend the most time.
Drink plenty of water: Hydration has numerous positive effects on the body, including one more piece to the puzzle in helping to relieve dry eye.
Q. What can you do to prevent eyestrain when using your smartphone?

 

Q: What are some simple tips for nutrition and the eyes?

Dr. Barnstein: 1. Have Your Annual Eye Health Examination: Most people have heard the term, “preventative care.” When it comes to the eyes and nutrition, many eye diseases can be not only diagnosed in an eye health examination, but also identified by the doctor before the eye condition becomes a problem. If it’s been more than a year since your last eye health examination, be sure to schedule an appointment with your eye doctor.

2. Have a Physical: This goes back to preventative care and also discussing family histories with your primary care doctor. For instance, if a doctor diagnoses diabetes during a physical, they can discuss the importance of an annual eye health examination, and also go over a nutritional management plan.

3. Eat a Diet High in Antioxidants (fruits and vegetables).(Check w/ your Doctor on this.): Many studies show that eating a diet high in antioxidants, can have preventative effects on eye conditions. People should also consult with their primary care doctor, or a nutritionist. For instance, while fruits contain a lot of antioxidant benefits, they also have a lot of sugar. So a diabetic person needs to speak with their primary care doctor/endocrinologist/nutritionist about this to determine what’s best for them.

4. Omega 3 Essential Fatty Acids: Numerous studies have shown that omega 3 essential fatty acids can have preventative effects on eye conditions like macular degeneration, dry eye syndrome, and diabetic retinopathy. Omega 3 Essential Fatty acids have also been known to aid in the vision development of children. The best omega 3 fatty acids are generally those derived from fatty fish. Check with your primary care doctor/nutritionist to determine what dosage is best for you

5. Consider Taking a Multivitamin for Starters: When it comes to taking multivitamins and other vitamins/antioxidants that can help with the eyes, I recommend consulting with your primary care doctor about dosage, etc.

 

Q: What are the best ways to wear contact lenses if I have a history of allergies and allergic conjunctivitis?

Dr. Barnstein: The Baltimore area in recent years has had some pollen levels off the charts! Symptoms of allergic conjunctivitis can include itching, watery eyes, and a white stringy discharge. One of the more bothersome complications for contact lens wear patients with allergies is Giant Papillary Conjunctivitis which causes bumps underneath the upper lid. When the upper lid blinks over that contact lens thousands of times a day, these bumps from GPC rub against the contact, causing discomfort, irritation, and even a stickiness, where the bumps under the lids can drag the contact lens out of place. There are some great peroxide based solutions like Clearcare that clean the surface of the lens to maximize comfort and minimize protein and pollen related buildup. For eye allergy sufferers, I usually explain that the healthiest way to wear contact lenses is with a daily disposable or one day contact lens. Each day that a contact lens wearer puts in a one day contact lens, it’s a clean, crisp, sterile contact lens, which means the contact lens surface has minimal time to build up protein, and other allergy related issues that stick on the lens,. If you have had trouble wearing contacts comfortably, feel free to contact me to explore your options.

 

Q: What is dry eye syndrome? Can I still wear contact lenses?

Dr. Barnstein: I’ve had dry eye syndrome for many years now, and it’s no fun! Especially if you want to wear contact lenses! The good news is that in most cases, there is a way for many people with dry eyes to be able to wear contact lenses. Dry eyes is a lack of functioning of the “good tears” or oily lubricating tears in our eyes. Patients will often ask me, “if my eyes are dry, why do they water so much?” What I’ll explain is that, just like if you got poked in the eye, or a bug flew in your eye, where it starts to water, the same applies to dry eyes. The watering is a reflex response to your eyes saying, “my eyes feel sore!” There’s a lack of lubricating tears. This confuses many patients, because of the simplicity of the term, “dry eyes.” But make no mistake about it. Dry eyes is a real medical condition that affects millions of Americans each year. We treat dry eyes in a multitude of ways including punctal plugs,steroid drops, Restasis, and many more. If you suffer from dry eyes, there may still be ways that you can wear contact lenses. I’m living proof of that. I suffer from dry eyes, and seasonal allergies, where I fall into the “difficult to fit contact lens” category. Personally, I’ve had the most success with daily disposable (one day) contact lenses, when it comes to working with dry eyes. Sometimes, patients with dry eyes may have to modify their contact lens wearing schedule, where they may need to limit wearing their contact lenses to evenings, weekends, social wear, and exercise.

 

Q: My kids passed the school screening. Do they still need an eye exam?

Dr. Barnstein: My patients with children will often ask this question. While school screenings serve a great purpose to pick up potential vision problems with kids, they’re not a substitute for a comprehensive eye health examination. I have many pediatric patients who passed school screenings with undiagnosed visual conditions. I also have many pediatric patients who fail their school screenings, and still wind up having perfect vision at their eye health examination. Most parents that I see have vision plans, where their children are covered under their insurance for routine eye examinations. If you have any questions about your insurance, feel free to contact our staff. They can look up and verify whether your child is eligible for an eye examination. Vision screenings can easily miss eye conditions such as astigmatism, amblyopia,hyperopia, and strabismus. These screenings usually do not check the health of the eyes for any conditions with the retina, cornea, lens, and iris. The doctors at Professional Vision examine children every day. If you’ve been waiting on making sure that your child has excellent vision, and healthy eyes, please give us a call! Have a great day!

 

Q: What is an Eye Twitch? How Can I Get Rid of it? (Myokymia)

Dr. Barnstein: Most people I know at one time or another have had that annoying eyelid twitch. If you haven’t, it’s when a part of your eyelid pulsates over and over, seemingly coming out of nowhere. For the person that has it, the eyelid pulsation appears like it’s so pronounced that anyone can notice it when they see you. It can last from a few minutes, up to hours, and even days and weeks. What can you do about it? A lid twitch (myokymia) is a spastic, muscle contraction inside of the lid, often related to stress, fatigue, eye strain, caffeine, dry eyes, allergies, and alcohol. I used to get them sometimes while in optometry school before big tests. I often joke with patients that what they need is a nice vacation! Whatever it is that you usually do to try and relieve stress may alleviate the symptoms some. I would exercise to help with stress back in the school days when I did get lid twitches. Most of the time eyelid twitches are harmless. Sometimes an eyelid twitch with both lids can be associated with blepharospasm and hemifacial spasms, which can be more serious and should be examined by an eye doctor. If you have any questions, feel free to contact me. Have a great day!

 

Q. Why do my eyes feel irritated when I wear contacts?

Dr. Barnstein: There can be countless reasons why someone’s eyes may be irritated with contact lens wear. I’ll list 5 of some of the most common reasons that I’ll come across. The most important thing with irritated eyes and contact lens wear, is to visit your eye doctor, so they can diagnosis the issue, and try to help you feel more comfortable with wearing contact lenses.

1. Dry Eye Components: Dry Eye affects more than 20 million people in the U.S., according to one Allergan study. (Count me as one of them!) Symptoms can include a burning sensation, excessive tearing, and redness. Some contact lenses can work better than others for dry eye patients.

2. Allergies/GPC components: Many people suffer from different degrees of allergies associated with contact lens wear. Giant Papillary Conjunctivitis (GPC) is where bumps develop under the lid, where the constant blinking motion over the contact lens can irritate the eyes. There are many effective strategies for contact lens wear and allergies. Daily disposable contact lenses can have tremendous benefits for contact lens wearers with seasonal allergies.

3. Lid involvement/ Meibomian Gland Dysfunction/ Blepharitis : Our lids have a complex system that properly lubricates the eye. When one component of it gets out of whack, it can dramatically affect the comfort of contact lens wear. There can also be different types of buildup on eyelashes, that can then fall into the eyes and irritate the surface.

4. Chronic Abuse of Contact Lenses/Overwear: Many of us have heard contact lens wearers say something like, “I wear my contacts until they start to bother me.” I’ll sometimes use the analogy of comparing that strategy to changing the oil after the car breaks down. 5. Fit/Type of Contact Lens: Whether it’s dated technology/an old school lens, or a lens that’s too loose or tight, there are many aspects of contact lens wear that can be affected by the fit and type of lens used. A person’s history is important in determining what contact lens may work best for them. Do they have allergies, dry eye, or certain systemic conditions?